bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantifying the Relationship Between the Medial Patellofemoral Complex and Patellar Borders: A Pediatric Cadaveric Study
Authors: Baskar Danika , Stavinoha Tyler , Rohde Matthew , Tompkins Marc , Ganley Theodore J. , Ellis Henry B. , Wilson Philip L. , Green Daniel W. , Segovia Nicole , Shea Kevin G. 
Published: May 2022

Background: The medial patellofemoral complex (MPFC) is comprised of the medial quadriceps tendon-femoral ligament (MQTFL) superiorly and the medial patellofemoral ligament (MPFL) inferiorly. The anatomy of the pediatric MPFL has been well-described, however, the MPFC in skeletally immature patients and its relationship to the quadriceps tendon and superior patellar border has yet to be described. Purpose: To evaluate the relationship between the MPFC attachment and quadriceps tendon and patella in skeletally immature patients. Methods: 16 pediatric knees were dissected to analyze the MPFC insertion on the quadriceps tendon. Dissection was performed using a lateral parapatellar arthrotomy followed by eversion of the extensor mechanism to evaluate the MPFC fibers from its undersurface. The patellar articular length (PL), patellar width, and quadriceps tendon attachment (QTA) of the MPFC above the superior pole of the patella were measured using the ImageJ program. Additionally, the ratio of quadriceps tendon attachment to patellar length was calculated as a percent (QTA/PL%). Two sample t-tests were used to identify significant differences. Results: The average age of the specimens included in this study was 9.6 years. Specimens were divided into two cohorts: a younger cohort (4-8 years), and an older cohort (9-12 years). The QTA above the patella averaged 10.6 mm in the younger cohort and 13.4 mm in the older cohort with no significant difference between the two groups (Figure 1). There was no significant difference in average QTA/PL% which was found to be 47.8% and 48% for the younger and older cohorts respectively (Figure 1). PL was significantly longer in the older cohort (Figure 1). As shown in Figure 2, the insertion of the proximal MPFC into the quadriceps tendon can be variable across specimens. Conclusion: This study clarifies the anatomy of the pediatric MPFC in exceptionally rare pediatric specimens. The MQTFL relationship to the quadriceps tendon is important to guide surgical reconstructions of the medial stabilizers of the patellofemoral joint. Primary and recurrent patella instability remains a significant problem in those under 20 years. A better understanding of the MPFC (both the MQTFL and MPFL components) will support anatomic reconstructions to stabilize the joint. [Figure: see text][Figure: see text]
Quantifying Knee Strength Deficits and Muscular Contribution to Torque Generation in ACL-Injured Adolescents Using A Simple Musculoskeletal Model
Authors: Flaxman Teresa E. , Romanchuk Nicholas , Shourijeh Mohammad S. , Carsen Sasha , Bel Michael Del , Benoit Daniel L. 
Published: May 2022

Background: Surface electromyography (sEMG) is commonly used to elucidate the effect of anterior cruciate ligament (ACL) injury on neuromuscular function. To facilitate comparisons, sEMG is normalized to a known value, such as peak activation during a maximum voluntary isometric contraction (MVIC). However, voluntary muscle inhibition after an injury compromises one’s ability to achieve a true MVIC value. Musculoskeletal modeling can be used to quantify this strength deficit by comparing a theoretical MVIC torque to the actual MVIC torque. Purpose: This study sought to evaluate voluntary knee extensor and flexor strength deficits and individual muscle contribution to peak torque generation in ACL injured (ACLi) and uninjured (CON) adolescent populations using a simplified subject-specific modeling framework. Methods: Thirty-nine ACLi (25 females) and 39 CON (25 females) adolescents (12-17years) completed knee extension and flexion MVICs on an isokinetic dynamometer. Peak experimental torque (TE) was identified. A subject-specific modeling framework used normalized sEMG of the quadriceps, hamstrings, and gastrocnemius muscles to determine theoretically ideal torque (TI) for each exercise, assuming agonist muscles were fully activated. Strength deficit ratios (TE/TI) and individual muscle contribution to TE were computed. Group mean differences were compared using independent t-tests. Results: ACLi demonstrated significantly lower extension (2.53±0.94 vs 3.07±0.57Nm/kg, p<0.001) and flexion (1.14±0.50 vs 1.37±0.31Nm/kg, p<0.001) peak TE compared to CON (FIG 1.A). Significant between group differences in sEMG of antagonist muscles were observed. Both groups demonstrated similar TI values (FIG 1.B-upper). Significantly lower trends in strength ratios (TE/TI) were maintained between groups (FIG 1.B-lower). However, percent between group differences were minimized from 17.8% to 6.3% for knee extension, and 16.7% to 10.0% for knee flexion, when TE is expressed relative to TI. Significantly lower medical gastrocnemius contribution to flexion TE was also observed in the ACLi (24.7±0.08%) compared to CON (30.9±10.1%, p=0.037). Conclusion: Significant between group differences in peak extensor or flexor torques were observed. Our model confirmed a strength deficit in ACLi compared to CON, however, between group differences were less prominent when described relative to TI. This may be attributed to between group differences in antagonist contributions (i.e. co-contraction) during MVIC exercise. Simplified modeling frameworks that can incorporate muscle activations as well as torque generation may be more appropriate for evaluating functional outcomes of ACLi populations in a clinical setting. [Figure: see text]
The Association Between Physical Competence and Psychological Response Among Young Athletes Following ACL Reconstruction
Authors: Zwolski Christin M. , Paterno Mark V. , Thomas Staci , Hand Brittany , Goodway Jackie , Quatman-Yates Catherine , Schmitt Laura C. 
Published: May 2022

Background: The traditional index of return to sport (RTS) readiness following anterior cruciate ligament reconstruction (ACLR) is the achievement of physical competence criteria. Emerging research indicates that psychological response and self-perceptions of physical competence may be critical for successful RTS among young athletes. Hypothesis/Purpose: The purpose of this study was to test the hypothesis that young athletes with higher actual and perceived physical competence will demonstrate a more positive psychological response at time of RTS after ACLR. Methods: Thirty-eight athletes (median age=16.9 years [IQR: 16.1, 18.8]) following primary ACLR completed testing within 8 weeks of medical clearance to RTS. All participants completed isokinetic knee extension strength (180°/s) and single-limb crossover hop for distance, in addition to the Knee injury and Osteoarthritis Outcome Score (KOOS), Self-Perception Profile Athletic Competence, and ACL Return to Sport after Injury (ACL-RSI) questionnaires. Criteria for the achievement of actual (APC) and perceived physical competence (PPC) were operationally defined based on established age- and activity-relevant cutoff scores (Table 1). Psychological response was assessed with ACL-RSI overall score, in addition to each ACL-RSI subscale score (Emotions, Confidence, Risk Appraisal). Multiple linear regression analyses were used to determine differences in ACL-RSI scores based on achievement of APC and PPC, while adjusting for age and sex. Results: Of the 38 participants, 9 (23.7%) were able to meet all criteria for High APC, while 29 (76.3%) participants were categorized as Low APC. Twenty-one (55.3%) of the 38 participants were categorized as Very Good PPC, and 17 (44.7%) were categorized as Somewhat Good PPC. The regression model for overall ACL-RSI score was significant ( F (4,33) = 5.224, p=0.002, adj. R2 = 0.313), with age explaining 26.4% of the total variance (p=0.001). In evaluating the ACL-RSI subscales, the regression model for the ACL-RSI Emotions score was significant ( F(4,33) = 7.760, p<0.001, adj. R2 = 0.422), with age, sex, and PPC explaining 33.9% (p<0.001), 7.0% (p=0.04), and 7.7% (p=0.03) of the total variance, respectively. Lastly, the regression model for ACL-RSI Risk Appraisal score ( F(4,33) = 3.416, p=0.019, adj. R2 = 0.207) was significant, with age and PPC explaining 10.5% (p=0.034) and 12.9% (p=0.02) of the total variance, respectively (Table 2). Conclusion: In partial accordance with our hypothesis, higher PPC, but not APC, was significantly associated with a more positive psychological response among young athletes after ACLR. Interventions to improve self-perceptions of competence may optimize psychological readiness to RTS. [Table: see text][Table: see text]
Older Age and Surgical Delay May Affect Medial Meniscus Repairability During Anterior Cruciate Ligament Reconstruction in Adolescents and Young Adults
Authors: Saper Michael , Mand Simran , Sorey Woody , Kweon Chris , Gee Albert , Schmale Gregory A. , Bompadre Viviana , Hagen Mia S. 
Published: May 2022

Background: In the setting of meniscus pathology, earlier treatment of meniscus tears may increase the likelihood of repair in young patients. Moreover, delayed anterior cruciate ligament reconstruction (ACLR) has been associated with an increased risk of meniscus injury. There is, however, limited data on the relationship between surgical delay and meniscus repairability in the setting of an ACLR in young patients. Purpose: The purpose of this study was to examine meniscus tear patterns and the likelihood of repair at the time of ACLR in young athletes, and specifically, to determine whether age and time from injury to surgery are correlated with tear patterns or meniscus repairability. Methods: Records were retrospectively reviewed on patients aged 13-25 years who underwent primary ACLR from January 2017 through December 2017. Patients with multi-ligament knee injuries were excluded. Demographic data were collected including age, sex, BMI, race/ethnicity, insurance status, primary sport, mechanism of injury, and time from injury to surgery. Operative reports were reviewed to document meniscus tear type/pattern and all concomitant pathology/procedures. Univariate and logistic regression analyses were used to determine factors associated with meniscus repair. Results: 89 eligible patients underwent ACLR during the study period. 59 (51% females) with mean age 19.3 ± 3.4 years had concomitant meniscus pathology and were included for analysis. The mean time to surgery was 5.2 ± 7.4 months. Combined medial and lateral meniscus tears accounted for 37% of tears, followed by lateral (32%) and medial (31%) tears. For tear type, medial and lateral tears were most commonly vertical (57.5%) and complex (34%), respectively. Surgical repair was performed in 67.5% of medial tears but only 34% of lateral tears. Univariate analyses demonstrated a statistically significant correlation between medial meniscus repair and time to surgery ( p=0.01) and age ( p=0.01), with repair less likely with a surgical delay >3 months and age >18 years. However, time to surgery was not significant after adjusting for age. There was a statistically significant difference in age between those with a surgical delay > 3 months (20.6 ± 3.4 vs.18.3 ± 3.0; p=0.01). Age and time to surgery did not affect the location or type of meniscus tear. There was no correlation between other demographic or surgical variables and time to surgery. Conclusion: In the setting of concomitant ACL and medial meniscus injury, age >18 years and surgical delay >3 months may decrease the likelihood of medial meniscus repair in young athletes.
Understanding the Progression of Function and Psychological Readiness of Pre-Adolescent Athletes Following Anterior Cruciate Ligament Reconstruction
Authors: Greenberg Elliot M. , Dyke Julie , Link Meredith , Todd Lawrence J. , Ganley Theodore 
Published: May 2022

Background: Patient reported outcome measures (PROM) allow for a comprehensive assessment of physical and emotional factors not accounted for by functional performance testing after anterior cruciate ligament reconstruction (ACLR). The ACL-RSI gauges an athlete’s psychological readiness to return to sport and recent evidence suggest this measure may help identify individuals at risk of secondary injury. Our current knowledge of how physical function and psychological preparedness change during recovery after ACLR in youth athletes it limited. Understanding the change and interplay between these factors will help optimize rehabilitation and improve patient care. Purpose: The purpose of this study was to evaluate changes in psychological readiness (ACL-RSI), knee related function (Pedi-IKDC) and generalized activity (Pedi-FABS) throughout the course of rehabilitation in a group of pre-adolescents after ACLR. Methods: A prospective observational cohort study of pre-adolescent athletes who underwent ACLR within a single institution. All subjects had surgery between 12/2017-12/2020 and followed institutional specific protocol emphasizing clinical rehabilitation for a duration of 7-9 months. Subjects completed a series of PROM (ACL-RSI, Pedi-IKDC and Pedi-FABS) quarterly for the initial 12 months following ACLR. Friedman’s test for repeated measures and Wilcoxon Matched Pairs Signed Ranks Test with a Bonferonni correction (p <= 0.017) was used to determine if differences existed amongst each measure over time. Results: A total of 28 subjects were included in this analysis (21 male; mean age 12.43 ± 1.40 yrs). Pedi-FABS and Pedi-IKDC both demonstrated significant changes from 3 months (Pedi-FABS 2.63 ± 3.95, Pedi-IKDC 70.84 ± 11.36) to 6 months (Pedi-FABS 9.9 ± 8.55, Pedi-IKDC 87.05 ± 8.03) and from 6 to 9 months (Pedi-FABS 16.57 ± 6.88, Pedi-IKDC 94.40 ± 5.24) (p <= 0.017)(Figure 1 & 2). ACL-RSI approached significance for 3 months (57.81 ± 24.73) to 6 months (70.36 ± 19.77) (p = 0.019) and was definitively significant for changes between 6 to 9 months (85.83 ± 11.02) (p = 0.003) (Figure 3). No significant change was observed between 9-12 months post-operatively for any of these measures. Conclusion: In preadolescent athletes, steady improvements in generalized activity and knee function occur during the first 9 months following ACLR. Psychological readiness to return to sport trended upwards, but didn’t reach statistical significance until later in recovery. Beyond 9 months, physical function and psychological preparedness remain largely unchanged. These data support a prolonged recovery period is required to maximize self-reported function and psychological readiness after ACLR in preadolescent athletes. [Figure: see text][Figure: see text][Figure: see text]
A Modified Lemaire Lateral Extra-Articular Tenodesis in High Risk Adolescents Undergoing Anterior Cruciate Ligament Reconstruction: Two-Year Clinical Outcomes
Authors: Cordasco Frank A. , Perea Sofia Hidalgo , Brusalis Christopher , Green Daniel W. 
Published: May 2022

Background: The incidence of anterior cruciate ligament reconstruction (ACLR) in patients aged 19 years or younger is increasing significantly and many patients possess risk factors that predispose to ACL re-tear. Lateral extra-articular tenodesis (LET) may be performed in conjunction with ACLR to reduce the risk of ACL re-tear. Purpose: To evaluate the safety and efficacy of performing a lateral extra-articular tenodesis (LET) with a modified Lemaire technique (MLT) in conjunction with anterior cruciate ligament reconstruction (ACLR) in children and adolescents at increased risk for failed ACLR. Methods: A consecutive series of patients who underwent ACLR and LET with a minimum of 2-year follow-up data was analyzed retrospectively. ACLR techniques included all-epiphyseal (AE) and complete transphyseal (CT) and were indicated based on skeletal age. Skeletally immature patients underwent a QUAD ACLR. Patients with closed or closing growth plates underwent a BTB ALCR. Outcome measures included participants’ return to sports, concomitant or subsequent surgical procedures and multiple patient-reported outcome measures, including Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC) and HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores. Results: Sixty-seven consecutive patients (mean age 15.16 ±1.74 years, range 11-19 years, 64% female) were analyzed (Table 1). Sixty-five patients (97%) participated in organized sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. The median grade at the time of surgery was 9th grade. Eleven patients (16%) were revision ACLR procedures. Eight (12%) patients underwent AE and 59 (88%) underwent CT ACLR. Forty-six (69%) cases employed a QUAD autograft, while 21 (31%) utilized a BTB autograft. All patients underwent a LET with a MLT and 2 patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum. At two-year follow-up, median SANE score was 97, median Pedi-IKDC score was 91, and median HSS-Pedi Fabs score was 25. RTS rate was 93%. Fifteen patients had subsequent surgical procedures, including 3 hardware removal procedures for hemiepiphysiodesis, 4 contralateral ACLR, 5 meniscus surgeries, 1 lysis of adhesions, 1 hammertoe correction and 1 revision ACLR for BTB graft re-rupture. Two patients were lost to follow-up and excluded from the study. Conclusion: The findings suggest that concomitant LET and ACLR in adolescent patients with risk factors for failed ACLR is associated with favorable patient-reported outcomes, high return to sports participation, and low ACL re-rupture rate at two years follow-up. [Table: see text]
Pluralistic Ignorance in Concussion Reporting Among Student- Athletes
Authors: Berkner Paul D. , Driscoll Haley T. , Marchetti Gregory F. , Penna Joseph W. , Ali Humza , Jewell Danielle E. , Herrmann Lily 
Published: May 2022

Background: The underreporting of concussions is a persistent problem among student athletes and has the potential to lead to negative health outcomes. The reasons for underreporting are multifactorial and included cultural norms and peer pressures of which one component is pluralistic ignorance. Purpose: To evaluate the impact of pluralistic ignorance on the decisions of concussion reporting amongst Division III athletes. We propose that gender, age, and type of sport will impact the responses that individuals make within a survey that they took in a group setting. Methods: A Qualtrics® survey was created which contained an array of questions including; concussion knowledge, impulsivity, intention of self and teammate to report concussions and cultural reporting norms. The survey was administered in a group team setting and contained video vignettes depicting concussions and other injuries. The survey was administered to 295 NCAA Division III athletes representing 13 different sports: men’s baseball, basketball, ice hockey, football, and women’s field hockey, volleyball, soccer, softball, squash, and men’s and women’s Nordic skiing, lacrosse, rugby, ultimate frisbee. Results: 295 student athletes participated, 150 were women, 142 were men, 3 gender identified as other, and their ages ranged from 18 to 26. Individuals were excluded from the analysis if the individual responded inconsistently to both validator questions. Contact sport participants had higher scores on the knowledge questions and had increased agreement for teammate intention to report than their non-contact and collision counterparts (Kruskal-Wallis H = 9.61, P = .008) and had overall lower measures of impulsivity (H = 7.88, P = .019). Collision sport participants were less likely (59%) to endorse a teammate culture that was supportive of concussion reporting (C2 = 13.56, P = .036) however female athletes (72%) and non-contact participants (79%) were more likely to endorse a culture supportive of self-reporting. Overall, regardless of gender, intention to play (self and teammate) despite concussion symptoms was endorsed by 66% of athletes and was more common among collision (75%) and contact participants (70%, C2 = 12.14, P = .016). Conclusion: Despite the fact that the majority of college athletes don’t endorse pluralistic ignorance within their teams (i.e. a cultural of not reporting) two-thirds of the college athletes still indicate they would not report their concussion symptoms.
K-12 Athletic Trainers’ Current Concussion Baseline Practice Patterns
Authors: Williams Richelle M. , Hattrup Nicholas , Pardini Jamie E. , Shapiro Marla 
Published: May 2022

Background: Concussion baseline assessments are often administered during the pre-season of sports. Current recommendations suggest that baseline assessments may be useful in aiding and interpreting post-injury evaluations but are not necessary. However, it has become common practice for athletic trainers (ATs) to administer and implement baseline assessments in athletes. Hypothesis/Purpose: The purpose was to determine K-12 ATs’ current concussion baseline assessment practice patterns. Methods: A Qualtrics survey was designed and implemented to 443 ATs (193 males, 244 females, 5 prefer not to answer, n=1 missing). Most respondents had earned a master’s degree (n=288, 65.0%), and were employed full-time (n=381,86.4%). Respondents were solicited over email to complete the survey which consisted of multipart, multiple-choice, and open-ended questions. Responses are reported as frequencies and percentages. Chi-square analysis was run to determine group (years of experience) and baseline practice patterns, p<0.05. Results: Seventy-five percent of respondents (n=330) reported administering baseline concussion assessments, with 37 (8.4%) reporting they do not administer baseline assessments but plan to in the future. The top five most reported assessment tools used were ImPACT (n=245, 55.3%), SCAT 5 (n=59, 13.3%), CNS Vital signs (n=25, 5.6%), BESS (n=25, 5.6%), and VOMS (n=22, 5.0%). The majority of respondents reported standard of care (n=226, 51%), provide better care (n=202, 45.6%%), school/organization policy (n=197,44.5%), to help diagnose concussion (n=139, 31.4%), concussion education (n=117, 26.4%), and liability (n=101, 22.8%), as the top reasons for using concussion baseline assessments. No differences were found between ATs with less than 10 years of experience, 11-20 years of experience, or 21+ years of experience in having formal training on administration of baseline assessments ( p=.164), or having received formal training on interpretation of baseline assessments ( p=.104). However, differences were noted by years of experience for reviewing baseline assessments for validity 2= 8.68, p=.013, and for those who restrict testing when individuals are sleep deprived 2=10.06 p=0.039. The majority reported receiving formal training to administer (n=209, 66.8%) and to interpret (n=178, 56.9%) neurocognitive baseline assessment. The majority of respondents report feeling extremely comfortable (n=214, 69%) and extremely competent (n=205, 65.9) in administering neurocognitive assessments, and moderately comfortable (n=117, 38.2%) and moderately competent (n=137, 45.1%) in test interpretation. Conclusion: The majority of ATs reported administering baseline concussion assessments and felt comfortable and competent in the administration and interpretation of assessments in adolescent athletes. Most ATs reported standard of care and providing better care as reasons for implementing assessments.