bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can the Posterior Cruciate Ligament (Pcl) Predict Anterior Cruciate Ligament (Acl) Size For Planning During Acl Reconstruction?
Authors: Strada Nicholas A. , Vutescu Emil Stefan , Mojarrad Mohammadali , Harrington Ryan , Orman Sebastian , Evangelista Peter , Cruz Aristides I. 
Published: May 2022

Background: Pediatric Anterior Cruciate Ligament reconstruction (ACLR) has increased over the past several years. Estimating the native ACL size on pre-op imaging would ideally inform graft size during surgery and make it possible to individualize ACL graft size to each patient. Hypothesis/Purpose: To establish a correlation between the ACL and PCL size in normal pediatric knees, with the goal of informing appropriate graft size for ACL reconstruction. Methods: MRIs of 540 patients ages 8-18 years were assessed. Measurements included: ACL and PCL length, thickness and width (Figure 1). ACL footprint thickness and width at the tibial insertion was also measured. Inter-rater reliability was assessed with a random set of 25 patients. Pearson correlation coefficients were used to assess the correlation between ACL and PCL measurements. Linear regression models were used to test whether the relationship between ACL and PCL measurement differed by sex or age. Results: Demographic data for 540 patients are shown in Table 1. Inter-rater reliability was high for all measurements except PCL thickness at midsubstance. ACL length was most strongly correlated with PCL length (r=0.57, p<0.0001). ACL origin thickness was most strongly correlated with PCL mid-thickness (r=0.26, p<0.0001). ACL origin width was most strongly correlated with PCL insertion width (r=0.49, p<0.0001). ACL insertion thickness was most strongly correlated with PCL insertion thickness (r=0.27, p<0.0001). ACL insertion width was most strongly correlated with PCL mid-width (r=0.39, p<0.0001). Sample equations for estimating ACL size from each sex and age category are as follows: ACL Origin Thickness = 3.21 + 0.26PCL Origin Thickness (R2=0.07; 8-12yo males), ACL Origin Width = 1.35 + 0.15PCL Insert Width (R2=0.23; 8-12yo females), ACL Insert Thickness = 7.02 + 0.22PCL Mid Thickness – 0.17PCL Insert Width, (R2=0.10; 13-18yo males), ACL Insert Width = 2.31 – 0.09PCL Length + 0.39PCL Mid Thickness + 0.27PCL Mid Width + 0.25PCL Insert Width (R2=0.31; 13-18yo females). Conclusions: Correlations exist between ACL and PCL measurements with some moderated by sex and/or age. This study is the first step in potentially informing normal ACL size in pediatric patients based on an intact PCL on MRI. [Table: see text][Figure: see text]
ACL Graft Growth in Pediatric Patients After ACL Reconstruction
Authors: Mendez Hanna E , Hovater Whitney L , Schuster Julia , Howell David R , Mayer Stephanie W , Albright Jay C 
Published: May 2022

Background: The native anterior cruciate ligament (ACL) changes in diameter and cross-sectional area throughout growth and up until age 18. The size and morphology of the native ACL continues to change throughout skeletal maturation. While ACL autografts have been shown to increase in size following ACL reconstruction in adults, there have been no similar studies to evaluate the change in ACL autografts in skeletally immature patients. Purpose: The primary aim of this study was to measure changes in ACL graft diameter in pediatric patients based on subsequent magnetic resonance imaging (MRI) after ACL reconstruction surgery. The second aim was to determine if there is evidence of ACL autograft growth after ACL reconstruction in skeletally immature patients. Methods: This was a retrospective review of 21 skeletally immature patients (mean age 14 years, range 12-16 years, 76% female) who underwent ACL reconstruction from January 2009 to July 2020 and had a subsequent MRI following surgery. We excluded patients who were treated with an allograft or underwent subsequent MRI for ACL re-injury. We measured the mid-substance ACL cross-sectional area and the post-operative graft diameter on subjects’ subsequent MRI. The recorded intra-operative graft diameter was compared to the post-operative graft diameter to determine the change in graft size. Results: 76% (n=16) of subjects were treated with a quadriceps autograft. Follow-up MRIs were performed at a mean of 1.7 years (range 0.3 – 3.8 years) post-operative. Post-operative grafts increased 2.2mm (p<0.001, 95% CI = 1.8-2.7) in diameter compared to the intra-operative graft diameter (Figure 1). Conclusions: In our study population, there was a significant increase of 2.2mm in ACL graft diameter an average of 1.7 years after ACL reconstruction in skeletally immature patients. Our results are similar to previous studies demonstrating an increase in graft size post-operatively in adults. These results suggest that it may be useful for surgeons to take the likely changes in graft size into account when determining appropriate autograft size in skeletally immature patients. [Figure: see text]
A Functional Near Infrared Spectroscopy Investigation of the Physiological Underpinnings of Visual Cognitive Workload After Concussion
Authors: Master Christina , Storey Eileen , Wang Lei , Grady Matthew , McDonald Catherine , Margulies Susan , Arbogast Kristy , Ayaz Hasan 
Published: May 2022

Background: In concussion, functional near infrared spectroscopy (fNIRS) has been shown to detect differences in cortical oxygenation during neurocognitive testing, with concussed adults manifesting less task-based cortical activation compared to controls. In addition, fNIRS has identified significantly reduced interhemispheric coherence in adult concussions relative to controls. In addition, adults with greater post-concussive symptom burden demonstrate lower task-related oxygenation in the frontal and dorsolateral prefrontal cortex (DLPFC) and reduced connectivity compared to controls. Hypothesis: The goal of this study was to use fNIRS to identify any differences in visual task-related cortical activation between concussed adolescents and healthy controls while performing a the King-Devick (KD) test. Methods: We enrolled 112 adolescents, ages 12-18 years, with recent concussion and 165 healthy controls as part of a large observational prospective cohort. Participants were provided standardized instructions to read the KD cards while wearing the fNIRS sensor pad. The relative changes in the difference of oxy-and deoxy-hemoglobin concentrations over each task condition for each optode were calculated via the Modified Beer-Lambert Law using local baselines for each task condition period as its beginning. The averaged oxy-hemoglobin concentration changes for each task period were used for statistical analysis of group (e.g., concussed vs healthy) effect. Results: The concussed adolescents (n=112) and healthy controls (n=165) were demographically comparable with respect to age, sex, and race/ethnicity. The concussed group was more likely to have a history of prior concussion (p = <.0001) and migraine (p = .0001) compared to the healthy control group (Table 1). The concussed adolescents were assessed with fNIRS while performing a visual task a median of 10 days after injury (IQR 4-16). The concussed group had significantly lower oxygenation changes that are the difference between oxygenated and deoxygenated hemoglobin as an indicator of task-evoked response, on left lateral prefrontal area (p<.005, FDR q<.005). As expected, there was also a main effect for task condition (cards) at right lateral prefrontal cortex (p<.001, FDR q<.005). Conclusions: fNIRS is able to distinguish concussed adolescents from healthy controls while performing a visual-cognitive task, the K-D test. Injured adolescents with concussion demonstrated a compensatory pattern of cortical activation, suggesting localized brain dysfunction, recruiting from both hemispheres, distinguishing it from the pattern of cortical activation in healthy controls. fNIRS, as a modality, is not only able to differentiate concussion from healthy controls, but also captures the compensatory mechanisms of cortical activation that underlie visual cognitive function after injury.
Effects of a Medial Unloader Brace on Gait Mechanics in Patients with Osteochondritis Dissecans
Authors: Loewen Alex , Ulman Sophia , Erdman Ashley , Cooper Savannah , Tulchin-Francis Kirsten , Wilson Philip , Ellis Henry B. 
Published: May 2022

Background: Non-operative treatment for osteochondritis dissecans (OCD) of the knee traditionally includes casting, bracing, and activity restrictions. An unloader brace is an option that may result in improved compliance due to the ability of the patient to continue daily activities while maintaining brace wear, and it may have biomechanical advantages for lesion healing. However, the biomechanical efficacy of a medial unloader brace has not been confirmed in a pediatric population. Hypothesis/Purpose: To determine whether the use of a medial unloader brace alters gait mechanics in patients with medial femoral condyle OCD. We hypothesized that while knee alignment in the coronal plane will remain unaltered, the valgus moment will decrease due to the applied tension of the adjusted unloader brace. Methods: Fifteen medial femoral condylar OCD patients (14 male, 12.7±2.6 years, 156.9±14.8 cm, and 52.0±16.2 kg) were tested utilizing a medial Ossur Unloader One knee brace. All patients performed over-ground walking at a self-selected speed under three brace conditions: no brace (NB), unadjusted (U), and adjusted (A; prescribed tension applied). Pelvis and lower extremity kinematic and kinetic data were computed in the sagittal, coronal, and transverse planes during single-limb stance phase (SLS). Wilcoxon signed-rank tests were performed to identify statistical differences between brace conditions ( α=0.05), and clinical significance was only determined when statistically significant joint angle and moment differences were greater than 3° and 0.1Nm/kg, respectively. Results: Between braced conditions, mean knee valgus was not statistically significant, however, peak internal knee valgus moment consistently decreased with each brace condition (NB-A: 0.06 Nm/kg, p=0.017). Similarly, hip abduction moment at the second peak of SLS decreased while wearing the brace (NB-U: p=0.061, NB-A: 0.07 Nm/kg, p=0.009). Conclusion: Peak knee valgus moment was decreased during walking with an adjusted medial unloader brace. These results highlight potential biomechanical advantages of a medial unloader brace for medial femoral condylar OCD. Future work will measure compliance of brace wear and compare additional brace designs. [Table: see text][Figure: see text]
Musculoskeletal Ultrasound of the Patellar Tendon in Adolescent Athletes
Authors: Boucher Laura C. , DeLuca Meridith K. , Newman Makalya , Tatarski Rachel , Young Julie , Duerson Drew , Napolitano Jonathan 
Published: May 2022

Background: Patellar tendinopathy is a common chronic condition caused by mechanical loading that leads to patellar tendon (PT) degeneration, with an estimated incidence of 13% across all sports in adolescents. Musculoskeletal ultrasound (MSK-US) evaluation is becoming more common in the diagnostic process, but normative data are extremely rare for the adolescent population. These normative data are needed to aid in proper interpretation of the MSK-US image. Purpose: The purpose of this study was to determine standard reference values for thickness, width, and cross-sectional area (CSA) of the PT using MSK-US in asymptomatic adolescent athletes. Methods: IRB approval, parental consent, and athlete assent were obtained prior to data collection. Bilateral PT were scanned using a portable US unit with a 12-4MHz linear array transducer. Long axis images were captured at the apex and 1cm distal to the patella, 1 cm proximal to the insertion and at the PT insertion (Figure 1a & 1b). Short axis images were captured 1 cm proximal and distal to the attachments. PT thickness, width, and CSA were measured using ImageJ by a single evaluator. Additional exploratory analyses were also conducted. Results: Seventy-one adolescent athletes (27 males, 44 females) between 11-18 years old (13.8 ±1.8 years) volunteered. Mean values for PT thickness, width, and CSA are found in Table 1. Significant differences in PT thickness and CSA between sex were identified at each measurement location (P<.05), with males ranging 4.0-9.9 mm thicker than females. PT width was not significantly different proximally or distally. The left proximal PT was significantly wider than right (P<.0001), but no other side differences were found. Lastly, significant weak positive correlations were present in distal tendon CSA with height (left PT: r(52)=.348, P=.014, right PT: r(49)=.369, P=.007) and weight (left PT: r(50 )=.290, P=.041). There was no correlation with age. Conclusion: These data represent one of the largest healthy cohorts of adolescent athletes from which normative data have been collected. This preliminary analysis reveals some interesting trends, such as the thickness of the PT is greatest at the insertion and origin, while thinner at mid-tendon, with the insertion the thicker of the two. Age was not correlated with PT size, but distal PT CSA was larger with taller and heavier individuals. These data will contribute to the paucity of adolescent PT MSK-US data, which should aid clinicians in interpretation, diagnostic accuracy, and management of active adolescent patients with patellar tendinopathy. [Figure: see text][Table: see text]
The Outcomes of Conservative Versus Surgical Treatment of Pelvic and Hip Avulsion Fractures: A Systematic Review and Meta-Analysis
Authors: Block Andrew M. , Oladeji Afolayan K. , Carsen Sasha , Crepeau Allison , Ellis Henry B. , Nepple Jeffrey J. 
Published: May 2022

Background: Avulsion fractures of the pelvis and hip are common injuries in adolescent patients. Avulsion sites include the rectus femoris at the anterior inferior iliac spine (AIIS), the sartorius at the anterior superior iliac spine (ASIS), the hamstrings at the ischial tuberosity, abdominal muscles on the iliac crest (IC), iliopsoas at the lesser trochanter (LT). Although these fractures are commonly treated conservatively, there is no consensus on the preferred treatment modality (conservative vs. surgical fixation) or thresholds for surgical treatment. The published literature is generally limited to small retrospective series, with in some cases conflicting results. Purpose: To summarize the available evidence on outcomes of pelvic and hip avulsion fractures in the pediatric and adolescent population using a systematic review of the literature. Study design: Systematic review. Methods: A systematic review of the literature was performed per PRISMA guidelines. Inclusion criteria included mean patient age of ≤18.0 years, ≥5 patients, avulsions treated with 3 months of injury, and publication in the English language. Patient characteristics, type of activity performed when injured, treatment modality, complications, and outcomes (rates of persistent symptoms, return to sport, subsequent surgery), were recorded by specific fracture type. Results: A total of 1034 patients with acute avulsion fractures from 23 studies were included. Of these, the outcomes were reported in 799 patients, including 693 (86.7%) who underwent conservative treatment and 106 (13.3%) who underwent surgical intervention. All types of acute avulsion fractures had good results with conservative treatment. Ischial tuberosity avulsions had the highest rate of persistent symptoms (25.4%) but only 10.2% underwent subsequent surgery. AIIS avulsions also had a high rate of persistent symptoms (19.3%) but very few underwent subsequent surgery (1.3%). Faster return to sport was noted in conservatively treated patients in ASIS and AIIS avulsions (both p<0.05). While good results have been reported with surgical treatment, conservative treatment of ASIS, AIIS, ischial tuberosity, IC, and LT avulsions appears to be nearly uniformly successful with low rates of persistent symptoms or subsequent surgery. Conclusions: Both conservative treatment and surgical treatment of pelvic avulsion injuries appear to be effective for the majority of patients. Ischial tuberosity and AIIS avulsions have the highest rates of persistent symptoms at 25% and 19%, respectively. Further prospective research into all fracture types is needed to better define indications for surgery in a subgroup of patients. [Figure: see text]
Sports and Physical Activity Attenuate the Emotional Toll of the Covid-19 Pandemic
Authors: Walker Gregory A. , Seehusen Corrine N. , Armento Aubrey , Provance Aaron J. , Howell David R. 
Published: May 2022

Background: The COVID-19 pandemic resulted in the alterations or restrictions of youth sports and physical activity. These changes may have had negative ramifications on anxiety and both physical and psychological readiness to return to sport in youth athletes. Hypothesis/Purpose: Our purpose was to investigate the relationships between the physical and mental health ramifications on youth athletes during restricted sport activities that resulted from COVID-19 stay-at-home orders. Our hypothesis was that youth athletes who participated in a similar or greater volume of organized sports would have less anxiety during the COVID-19 stay-at-home orders compared with those who reported a decrease in organized sport volume. Methods: Our cross-sectional study evaluated male and female athletes who competed in club sports (e.g., non-school sponsored) at the time of questionnaire completion. All participants completed an online questionnaire between July 15, 2020 and August 10, 2020. We asked participants to report the average hours/week they spent in organized sports or physical activity unrelated to their sport prior to COVID-19 and currently. We grouped participants on whether they had a decrease or increase/no change in their reported activity level. Participants also completed the Generalized Anxiety Disorder-7 questionnaire. Results: A total of 192 participants (13.0±2.2 years of age; range= 6-18 years, 56% female) completed the study. On average, participants reported 2.3 (SD+5.2) fewer hours of sport training per week during the COVID-19 stay-at-home orders compared to prior. Over half (56%) of participants reported a decreased training volume during stay-at-home orders, and 44% reported a similar or increased training volume (Table 1). The respondents reporting decreased training volumes had significantly greater anxiety scores than those who reported similar training volumes (Figure 1). After adjusting for the potential confounders of age, sex, and body size, decreased training volumes during stay-at-home orders were significantly associated with higher anxiety levels (β coefficient = 2.02; 95% confidence interval = 0.64, 3.41; p = 0.005). Those with decreased training volumes were more likely to report feeling undertrained (72% vs 30%, p<0.001) and less physically ready to return to sport (56% vs 88%, p<0.001) compared to those with similar/increased training volumes (Table 1). Conclusion: The COVID-19 pandemic resulted in decreased training volumes and higher anxiety scores (mean difference= 1.9 GAD-7 points, 95% confidence interval= 0.6, 3.2) compared with athletes who reported similar/increased training volumes. Lastly, those in the decreased training cohort felt both under-trained and less physically ready to return to sports. [Table: see text][Figure: see text]
Technique Variation for MPFL Reconstruction in Skeletally Immature Patients: Data from the Jupiter Cohort
Authors: Heyworth Benton E. , Perea Sofia Hidalgo , Veerkamp Matthew , Parikh Shital N. , Wall Eric J. , Wilson Philip L. , Stein Beth E. Shubin ,   JUPITER Study Group, Green Daniel W. 
Published: May 2022

Background: Management approaches and surgical techniques, when applied for pediatric and adolescent patellofemoral instability (PFI), continue to lack clear clinical guidelines and indications. Medial patellofemoral ligament reconstruction (MFPLR) is among the most popular surgical options. However, variation in technique remains significant, particularly in skeletally immature sub-populations. Purpose: The purpose of this study was to examine the variation in MPFLR technique in skeletally immature patients within a cohort of 20 orthopedic surgeons with different experience levels and specialty training backgrounds. Methods: All operative records of skeletally immature patients from 2016 to 2021 were retrieved from the JUPITER cohort, a multi-center prospective study involving 13 different tertiary care academic centers. Patients who underwent a primary single-stage MPFLR were evaluated in this study. Demographic information and operative details were collected for each knee. Results: Of the 306 knees, 205 (53% female, 47% male) met inclusion criteria and comprised the final cohort (Table 1). The average age was 13.6 ± 1.8 yrs (5.1-19.0). The initial injury mechanism was of a non-contact nature in 73% and a result of contact in 17%. 47% of surgeons utilized autograft while 53% utilized allograft. Suture anchors (including small tenodesis screws) were the most popular patellar fixation technique (61%), followed by the use of tunnel under a bone bridge (37%). The majority of surgeons utilized 2 suture anchors (59%). Interference screws were the most popular femoral fixation technique (84%), followed by suture anchors (12%). The majority of surgeons used either 1 interference screw 97(%) or 1 suture anchor at the femur (96%). In addition to MPFLR, 15% of patients underwent osteochondral fracture treatment: 36% underwent loose body removal, while 61% underwent fixation. Lateral Retinacular Release was performed in 13% of cases, and lateral retinacular lengthening was performed in 2%. 10% of patients underwent concomitant hemi-epiphysiodesis for genu valgum, 3% underwent medial quadriceps tendon-femoral ligament reconstructions, and 3% underwent a Grammont realignment (patellar tendon medialization) procedure. Conclusion: Variation in different aspects of MPFLR technique is substantial among this cohort of orthopedic surgeons. Given the well-established importance of decreasing variation for healthcare cost containment and optimization of outcomes, comparative studies and sub-stratified analyses are needed to better elucidate the most favorable techniques and their components. [Table: see text]