bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Patellofemoral Joint Morphology During Skeletal Growth and Maturation are not Sex-Dependent
Authors: Pruneski James A. , Hosseinzadeh Shayan , Emami Seyed A. , Sanborn Ryan , Barnett Samuel , Kiapour Ata M. 
Published: May 2022

Background: Patellofemoral disorders account for approximately 25% of patients seen in sports medicine clinics. A variety of anatomic risk factors have been identified in the pathogenesis of patellofemoral instability. While studies have analyzed these factors in adults, or compared them between healthy controls and patients with patellar injuries, little is known about how these anatomic markers change during skeletal growth and development. Hypothesis/Purpose: (A) The anatomic risk factors associated with patellar instability and dislocation change significantly during skeletal maturation. (B) These age-related changes during maturation will differ between male and female patients. Methods: After institutional review board approval, magnetic resonance imaging data from 239 unique knees (patient age 7-18; 55% female), without previous or current injury, were randomly selected and used to measure patellar height, lateral patellar tilt angle, trochlear width, trochlear depth, trochlear sulcus angle, and tibial tubercle trochlear groove distance. Linear regression was used to test the associations between age and anatomic measurement indices. Subsequently, patients were divided into four age groups: pre-pubertal school-aged children (7-10 years old), early adolescents (11-14 years old), and late adolescents (15-18 years old). Additionally, two-way analysis of variance with the Holm-Sidak post hoc test was used to compare anatomic morphologies between male and female patients in each age group. Results: Patellar height (Caton-Deschamps index), lateral patellar tilt angle and trochlear sulcus angle all decreased significantly with age (P<0.001). Trochlear width, depth, and tibial tubercule trochlear groove distance all increased significantly with age (P<0.001). Except for trochlear width in late adolescence (P<0.001) where males had wider trochlea (medial and lateral) compared to matched females, the age-related anatomic changes were similar between males and females (P>0.1). Conclusion: The findings partially support our hypothesis, as we observed significant age-related changes in all quantified anatomical indices, which was not different (except trochlear width in late adolescence) between males and females. The lack of significant differences in key morphological features of the patellofemoral joint that are linked to patellar dislocation between females and males is consistent with a similar prevalence of this injury between the two. However, the findings suggest that there are significant differences in the trochlear width between females and males at later stages of growth and maturation. The current observations suggest that these anatomic risk factors undergo significant changes during skeletal growth, providing us with a window of opportunity to use prophylactic interventions to prevent or minimize the development of high-risk morphology. [Figure: see text][Figure: see text]
Surgical Management of Patellofemoral Instability in Adolescents with High Grade Trochlear Dysplasia
Authors: Wilson Benjamin R. , Nunally Kianna D. , Cook Danielle L. , Hussain Zaamin B. , Zheng Evan T. , Yen Yi-Meng , Kramer Dennis E. , Micheli Lyle J. , Kocher Mininder S. , Heyworth Benton E. 
Published: May 2022

Background: High-grade trochlear dysplasia (HGTD) has previously been identified as a risk factor for failure of surgical management of patellofemoral instability (PFI). However, limited data exists on the influence of the type of surgical procedure performed on postoperative outcomes in these patients. Hypothesis/Purpose: The purpose of this study was to identify the rates of failure of primary PFI surgery in patients with HGTD compared to those without HGTD and to assess the effect of the type of surgery on recurrent instability and return to OR. Methods: A retrospective review was performed on patients aged ≤19 years who underwent primary surgery for PFI at a single tertiary care center between 2008 and 2017. Patients underwent procedures including medial retinacular plication/reefing/advancement (MRP), graft-based medial patellofemoral ligament reconstruction (MPFLR), tibial tubercle osteotomy with or without MRP (TTO), or combined MPFLR + TTO. Exclusion criteria were BMI >30kg/m2, surgery for fixation of chondral fractures >1cm, and diagnosis of a syndromic disorder. Trochlear dysplasia was evaluated based on pre-operative MRI according to the Dejour classification system. Those with Dejour grade B or higher were designated as having HGTD. Comparisons were made between HGTD patients and non-HGTD patients, with logistic regression utilized to determine if surgery type was associated with recurrent PFI and revision PFI surgery. Results: 303 patients (mean age 15.1 years, 71% female) underwent primary surgical stabilization for PFI with median follow up time of 3.0 years. Approximately half (149/303, 49%) of the cohort had HGTD. Demographics were comparable between HGTD and non-HGTD patients (Table 1). HGTD and non-HGTD cohorts showed similar rates of post-operative instability, revision PFI surgery, and non-PFI secondary surgery. HGTD patients (Table 2) who underwent MPFLR had a 63% decrease in the odds of post-operative PFI compared to those who underwent MRP (OR=0.37; p=0.03). HGTD patients who underwent TTO had an 80% decrease in the odds of post-operative PFI compared to patients undergoing MRP (OR=0.20; p=0.002). Conclusion: Adolescents with PFI and HGTD have similar results after surgical stabilization to those patients without HGTD. Within the HGTD cohort, however, the type of surgery performed significantly influenced outcome. Patients with HGTD that underwent MRP had significantly more recurrent PFI and revision PFI surgery than patients that underwent other procedures, suggesting a limited role for this procedure in this sub-population of PFI patients. [Table: see text][Table: see text]
The Effects of Blood Flow Restriction Training on Strength and Function During Early Rehabilitation After Anterior Cruciate Ligament Reconstruction in Adolescents
Authors: Giampetruzzi Nicholas , Fredericks Arthur , Roman Dylan , Prue Jennifer , Lolic Adel , Pace Lee , Crepeau Allison , Weaver Adam 
Published: May 2022

Background: Blood flow restriction training (BFRT) has gained popularity due to reported benefits in reducing muscle atrophy and mitigating strength deficits following anterior cruciate ligament reconstruction (ACLR). While there are a number studies that have reported on the use of BFRT in the adult population, there is limited information about the use of BFRT in the adolescent population and its effect on muscle strength and function. Hypothesis/purpose: The purpose of this study was to determine the effect of adding BFRT to traditional rehabilitation in the adolescent population after ACLR. This study’s primary aim was to investigate the impact BFRT has on isometric strength testing and patient reported function at 3 months post-operatively. Methods: A prospective intervention group was compared to an age matched retrospective control group as part of an ongoing clinical trial. This included patients between 12 and 18 years of age, who underwent primary ACLR at Connecticut Children’s from January 2020 to present. In addition to a standardized rehabilitation protocol these patients utilized a personalized tourniquet system for BFRT with limb occlusion pressure of 80%. A standardized BFRT protocol was followed over initial 12 weeks, completing 3 BFRT exercises per session. Load progression was based on the patient’s perceived level of exertion. A three month strength assessment was completed by patients in both groups. The test included isometric knee extension and flexion strength at 60° of knee flexion. Peak torque was normalized to body weight and used to calculate limb symmetry index (LSI). IKDC scores were recorded. Two-sample t tests were used to determine differences between the BFRT and control groups. Results: The BFRT group consisted of 11 patients (6 females; 14.9 ± 1.8 years old). The control group consisted of 47 patients (24 females; 15.2 ± 0.6 years old). Age, height, and weight were not significantly different between groups (Table 1). Significant differences were seen between the BFRT and control groups for peak knee extensor torque when normalized to body weight in both the surgical (1.8 ± 0.4 vs 1.4 ± 0.6 Nm/kg, p=0.02) and nonsurgical limbs (2.7 ± 0.6 vs 2.1 ± 0.5 Nm/kg, p=0.03) (Table 2). No significant differences were seen between groups for knee extensor or flexor LSI or IKDC scores (Table 2). Conclusions: In adolescents, BFRT may impact bilateral knee extensor force production during early post-operative ACLR rehabilitation. Continued investigation is needed to further evaluate the impact of BFRT in this population. [Table: see text][Table: see text]
Rotator Cuff Injury in the Pediatric Population: A Retrospective Review of Patient Characteristics and Treatment at a Single Treatment Center
Authors: Harwood Kathleen , Oganezova Karina , Orellana Kevin J. , Ashe Katherine , Williams Brendan A. , Horneff J. Gabe 
Published: May 2022

Background: As youth participation in contact and overhead sports has increased in recent decades, so has the occurrence of traumatic and overuse injuries of the shoulder. Rotator cuff injury (RCI) is an infrequent shoulder pathology in pediatric patients and its description in the literature has been scarce leading to management derived largely from adult-based evidence. Greater understanding of RCI characteristics and treatment outcomes in children and adolescents would improve our understanding of this pathology and help to guide clinical decision-making. Purpose: To identify pediatric patients with MRI-confirmed RCI treated at a single center in order to summarize injury characteristics, treatment and outcomes. Methods: A retrospective review of pediatric patients (<18yo) diagnosed with and treated for a RCI between 1/1/2011 and 1/31/2021. Patient demographics, injury mechanism and type, treatment, and outcomes were collected. Descriptive statistics were performed. Bivariate testing was also used to compare operatively and nonoperatively treated cohorts. Results: Fifty-two pediatric patients treated for a rotator cuff avulsion, partial tear, or complete tear were identified. Table 1.1 details injury characteristics, treatment modalities, and patient outcomes overall and each treatment cohort. Mean age was 14.9yo (10-17) and 67% of patients were male. Injuries were most commonly related to participation in the throwing sports (baseball, football, and softball). Operative management was employed in 23% of patients while 77% were managed nonoperatively. Treatment cohorts differed based on tear type with all complete tears being managed operatively (p<0.01). Associated shoulder pathology was common, with the most frequent finding being anterior shoulder instability pathology. One operative patient experienced a retear. Return to play was longer for operatively managed patients (7.1 vs. 4.5 months, p<0.01). Conclusion: The present study expands the limited data available regarding RCIs in pediatric patients. Most injuries are associated sports and typically involve the supraspinatus tendon. RCIs are not restricted to skeletally mature patients and are frequently associated with other shoulder pathology. RCIs were associated with good outcomes and low rates of reinjury in patients managed both non-operative and operatively. RCI should be considered in throwing athletes with shoulder pain, even in skeletally immature patients. The optimal treatment strategy for each tear type remains uncertain, but outcomes appear favorable for patients overall. [Table: see text]
Variability Exists in Pain Management Practices for Pediatric ACL Reconstruction
Authors: Wagner K. John , Beck Jennifer J. , Carsen Sasha , Crepeau Allison E. , Cruz Aristides I. , Ellis Henry B. , Mayer Stephanie W. , Niu Emily , Pennock Andrew T. , Stinson Zachary S. , VandenBerg Curtis , Ellington Matthew D. 
Published: May 2022

Background: Effective pain management for anterior cruciate ligament (ACL) reconstruction may improve both patient satisfaction and function. However, there is limited data supporting clear guidelines regarding pain management for ACL reconstruction in the pediatric population. Hypothesis/Purpose: The purpose of this study is to survey current pain management practices for ACL reconstruction among pediatric orthopaedic surgeons. Methods: A cross-sectional survey study was conducted in which orthopaedic surgeons were asked about their pain management practices for pediatric ACL reconstruction. The voluntary survey was sent to members of the Pediatric Orthopaedic Society of North America (POSNA). Inclusion criteria were performs ACL repair or reconstruction on patients under age eighteen and willing to participate in the survey. Responses were anonymous and consisted of demographics, training, current practice, and pain management strategies. Survey data were assessed using descriptive statistics, Pearson’s chi-squared test and Fisher’s exact test for categorical variables, and two-sample t-test for continuous variables. Results: There were 77 responses, of which 64 fit the inclusion criteria. The average age of respondents was 48.9 years, 84.4% were male, and 31.3% practiced in the southern region of the US (Table 1). 39.1% of respondents utilized preemptive analgesia, 90.6% utilized perioperative blocks, 82.8% routinely advocated for scheduled non-narcotic medications post-operatively, and 93.8% recommended cryotherapy post-operatively (Table 2). Respondents that reported not using a peri-operative block and not advocating for scheduled non-narcotic pain management post-operatively were older on average than those that did (57.6 vs. 47.7 years, p=0.04; 56.7 vs. 47.0 years, p<0.01; respectively). Acetaminophen was the most commonly used pre-operative medication (31.3%), the most common perioperative block was an adductor canal block (73.4%), and the most typically prescribed post-operative analgesic medication was ibuprofen (60.9%). Most respondents reported prescribing 10-20 opioid pills (46.9%), 20.3% prescribed >20 opioid pills, and 10.9% did not prescribe opioid pain medication at all. In total, 89.1% of respondents reported prescribing opioid pain medication post-operatively, however, only 59.4% reported counseling patients on appropriate disposal of extra pills. Prior training or experience was more frequently reported than published research as a primary factor influencing pain management protocols. Conclusion: Significant variability exists in pain management practices in pediatric ACL reconstruction. There is a need for more evidence-based practice guidelines regarding pain management. [Table: see text][Table: see text]
The Effect of A Home Exercise Program on Visio-Vestibular Function in Concussed Pediatric Patients
Authors: Roby Patricia R. , Storey Eileen P. , Master Christina L. , Arbogast Kristy B. 
Published: May 2022

Background: A home exercise program (HEP) can provide an equitable and cost-effective method for therapy targeted towards visio-vestibular deficits that are common following concussion. It is unclear if pediatric patients prescribed a HEP demonstrate improved visio-vestibular function. Purpose: To explore if a HEP affects visio-vestibular function in concussed pediatric patients. Methods: This observational study included 1,041 patients (614 female(59.0%); age=14.0±2.5 years) reporting to a specialty care concussion center for an initial visit within 28 days of injury and a first follow-up visit within 60 days of injury. All patients completed a Visio-Vestibular Examination (VVE) at both time points, which consisted of 9 maneuvers: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Patients were given a HEP at initial visit which consisted of exercises, including saccades, gaze stability, convergence, and balance, and instructed to complete these exercises 1-2 times daily. At follow-up, patients were asked to report their progress with the HEP, which was categorized as 1) has not done the HEP, 2) is currently doing the HEP, or 3) has completed the HEP. Primary outcomes included HEP status at first follow-up, VVE subtests (normal/abnormal), and total VVE (abnormal=2+ abnormal subtests). Separate chi-square tests with Bonferroni corrections were used to determine if the proportion of abnormal VVE outcomes was associated with HEP status (α=0.017 a priori). Results: At initial visit, 812 (77.6%) patients presented with abnormal total VVE. The proportion of abnormal subtests at initial visit ranged from 16.0% (right monocular accommodation) to 77.4% (horizontal gaze stability). At first follow-up, the proportion of abnormal total VVE did not differ among patients reporting not doing the HEP (101(62.0%)), patients currently doing the HEP (516(69.0%)), and patients who had completed the HEP (51(69.0%)). However among VVE subtests, a lower proportion of patients who completed the HEP presented with abnormal smooth pursuit (7.5%), horizontal (3.8%) and vertical (3.8%) saccades, and complex tandem gait (0%) relative to patients who were currently doing the HEP (P≤0.003) and to patients not doing the HEP (P≤0.01). Conclusions: Our findings indicate that patients who completed the HEP presented with better aspects of visio-vestibular function (smooth pursuit, saccades, and complex tandem gait) relative to those who did not start or were currently doing the HEP. This suggests that a HEP may be effective in reducing visio-vestibular dysfunction following concussion. Additional research investigating cost-effective concussion management tools is needed to improve patient outcomes.
Spre-Pubertal Runners Demonstrate Different Temporal-Spatial Parameters Than Mid- and Post-Pubertal Runners
Authors: Garcia Micah C. , Jordan Emily A. , Vollmar Brittany , Bazett-Jones David M. 
Published: May 2022

Background: Temporal-spatial parameters (TSPs; e.g., cadence, step length) have been associated with running-related injuries in adult long-distance runners. However, it is unknown if TSPs are different among adolescent runners of different physical maturation stages. During sprinting, pre-pubertal runners demonstrated lower cadence and shorter step length than mid- and post-pubertal runners, but TSPs have not been investigated for adolescents of different physical maturation stages when running at submaximal speeds. Hypothesis/Purpose: The purpose of this study was to compare TSPs among adolescent long-distance runners of different physical maturation stages. It was expected that pre-pubertal runners would demonstrate a lower cadence and shorter step length than mid- and post-pubertal runners but there would be no differences in TSPs between mid- and post-pubertal runners. Methods: The study was a cross-sectional design with 93 adolescent long-distance runners (F=48, M=45). Participants were categorized into pre- (n=15, age=10.3±1.6 y), mid- (n=35, age=13.0±1.1 y), and post-pubertal (n=43, age=16.4±1.2 y) physical maturation groups. Participants underwent a three-dimensional running analysis at a comfortable self-selected speed. TSPs (cadence [steps/min], step length [m]) were compared among physical maturation groups using one-way ANCOVA (covariate=running speed) with Sidak pairwise comparisons when a main effect was found (P<.05). Results: The average running speeds for pre-, mid-, and post-pubertal runners were 3.36±0.51 m/s, 3.49±0.71 m/s, and 3.79±0.69 m/s, respectively. ANCOVA analysis showed significant differences in cadence (P<.001) and stride length (P<.001) among physical maturation groups when controlling for running speed (Table 1.1). Pre-pubertal runners had a greater cadence (178±13 steps/min) than mid- (169±12 steps/min, P=.01) and post-pubertal runners (168±11 steps/min, P<.001). Pre-pubertal runners also had a shorter step length (1.13±0.20 m) than mid- (1.24±0.20 m, P=.01) and post-pubertal runners (1.36±0.21 m, P<.001). There were no significant differences between mid- and post-pubertal runners (P>.22). Conclusion: When controlling for running speed, pre-pubertal runners demonstrated a greater cadence and shorter step length than both mid- and post-pubertal runners. Lower cadence and longer stride lengths have been associated with running-related injuries in adults. If TSPs have the same association with injury in adolescents as adults, then our study suggest mid- and post-pubertal runners may be at a higher risk of sustaining a running-related injury than pre-pubertal runners due to their lower cadence and longer step lengths. However, prospective research is necessary to better understand the importance of TSPs and running-related injuries in adolescent long-distance runners. [Table: see text]
Does Shortening Change in the First 2 Weeks Following Completely Displaced Adolescent Clavicle Fractures?
Authors: Perkins Crystal A , Nepple Jeffrey J ,   FACTS Study Group, Heyworth Benton E 
Published: May 2022

Background: Shortening of midshaft clavicle fractures has been described as a critical fracture characteristic to guide treatment in clavicle fractures. However, the degree to which shortening may actually change in the weeks following injury has not been well studied. Purpose: The purpose of this study was to evaluate the potential change in shortening of adolescent clavicle fractures in the first 2 weeks following injury. Methods: This was an IRB-approved multi-center study of prospectively collected data which was acquired as a part of a larger cohort study evaluating functional outcomes of adolescent clavicle fractures. A consecutive series of patients ages 10 – 18 years of age with completely displaced diaphyseal clavicle fractures with a baseline AP clavicle radiograph (0-6 days from date of injury) and a follow-up AP clavicle radiograph (7 – 21 days from date of injury) were included. Measurements of end-to-end clavicle shortening were performed with validated techniques. Results: 142 patients met inclusion criteria. Baseline radiographs were obtained at a mean of 1 day +/- 1.7 days following injury. Mean baseline shortening was 22.3mm +/- 0.6mm. 69% of patients had >/= 20mm of shortening. Follow-up radiographs were obtained at a mean of 13.8 days +/- 3.8 days post-injury and demonstrated a mean change in shortening of 5.4mm, compared to baseline films. 41% of patients had >5mm of change in shortening and 15% of patients had >10mm change in shortening. Using a threshold shortening of 20mm, 26% of patients had a change from baseline to follow-up from either above to below 20mm or below to above 20mm. This includes 28% of patients with 20-25mm of shortening at baseline that were less than 20mm at follow-up. Conclusion: Significant changes in fracture shortening occur in many adolescents with completely displaced clavicle fracture in the first 3 weeks. More than a quarter of patients demonstrated a drop from above to below 20mm, a commonly used threshold for surgical decision making. While there is minimal evidence to suggest that shortening influences outcomes following this fracture in adolescent sub-populations, the findings of this study support repeat radiographic assessment 2-3 weeks post-injury prior to making definitive treatment decisions.