bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Early Range of Motion Versus Immobilization Following Acute First-Time Lateral Patellar Instability Episode: Randomized Control Trial
Authors: Purcell Nicholas , McKay Scott , Saloom Adam , Mitchell Katy 
Published: May 2022

Background: The acute management of lateral patellar dislocations (LPD) typically consists of placing the patient in a knee immobilizer for 2 to 6 weeks, but it is not clear on how long these patients should be immobilized, if at all. Hypothesis/Purpose: The purpose of this study is to compare outcomes for patients following a rehabilitation protocol that is initiated with or without a short period of immobilization after sustaining a LPD. Methods: An IRB-approved prospective study was performed at a children’s hospital which included patients <18 years of age (mean = 14.22) diagnosed with LPD (<10 days). A total of 18 (14 females, 4 males) patients diagnosed with LPD were consented and enrolled in the study (Early ROM group = 11, Immobilization group = 7). Inclusion criteria for the study was history of knee instability, effusion or history of effusion, and (+) apprehension. Subjects were followed for 4 weeks and the following outcomes were assessed: knee ROM, isokinetic strength, Kujala, Pedi-IKDC, and Y balance scores. Split-plot (2x2) ANOVAs were conducted for each of the dependent variables with an alpha level set at .05 for the global tests and independent t-tests were run at baseline and 4 weeks. Results: There were no significant differences between groups at baseline. Knee flexion ROM showed a significant main effect of time (p≤.0005) and group (p=.012). Pedi-IKDC showed a significant main effect of time (p≤.0005) and group (p=.026). When comparing groups at 4 weeks, the early ROM group had significantly better scores in both the Kujala (means for both groups: 76.78 and 52.67), p=.049)), and the Pedi-IKDC (means for both groups: 68.85 and 40.88), p=.025)). There were no significant differences in isokinetic strength measures between the groups except for affected side knee flexion at 60 degrees/sec (p=.039) with the early ROM demonstrating higher strength. In addition, the affected side composite Y-balance scores were significantly better for the early ROM group (as compared to the immobilization group) at p=.031. Conclusion: Patients that underwent early ROM following LPD scored significantly better across patient derived outcome measures and functional outcomes at 4 weeks following the initial physical therapy evaluation when compared to a group that underwent a 2 week period of immobilization. Future studies should analyze longer term comparisons between groups to determine if this short term difference leads to long term differences or improved re-injury rates.
Are Different Aged Youth Skiers and Snowboarders Experiencing Different Injury Patterns?
Authors: Chesler Kyle C. , Howell David R. , Pierpoint Lauren A. , Comstock R. Dawn , Khodeae Morteza , Provance Aaron J. 
Published: May 2022

Background: Skiing and snowboarding have grown significantly in the past decades with millions of participants worldwide. With popularity increasing, specifically amongst youth athletes, so has the number of injuries and fatalities associated with these sports. In this study, we investigate age as a potential determinant for injury patterns for the growing population of youth skiers and snowboarders. Hypothesis/Purpose: The purpose of our study was to investigate the factors associated with different anatomical injury locations among youth skiers and snowboarders. We hypothesized that youth skiers would exhibit predominately lower body injuries, while snowboarders would predominately exhibit upper body injuries. We also expected higher rates of head injuries for the younger snowsports participants given their larger head to body ratios and decreased cervical muscular strength. Methods: This retrospective study was conducted from data acquired from the Winter Park Resort during the 2012/13–2016/17 ski seasons. The population includes youth (3-17 years old) participants injured at Winter Park Resort while skiing or snowboarding. Patients were sorted by sport and then into age bins 0-6, 7-14, and 15-17 years of age. The study population was described for gender breakdown, run difficulties, equipment usage, skill level, injury location, mechanism, anatomical location, and diagnosis. Logistic regression analysis was used to examine the association between age, sport, and other predictors of injury with different anatomical locations. Results: The study population is described in Table 1. Skiers were more likely than snowboarders to sustain a head injury (odds ratio=1.6, 95% CI=1.2, 2.2), while snowboarders were more likely to sustain upper extremity injuries (odds ratio=5.9, 95% CI=4.6, 7.6). Skiers age 0-6 suffered more head/neck/face injuries (24.2% compared to 14.46 and 14.86% respectively in age bins 7-14 and 15-17). Skiers age 0-6 suffered more fractures (48.2% compared to 28.4% and 23.8% for ages 7-14 and 15-17, where strains/sprains were leading diagnoses). Conclusion: Age was associated with injury patterns in youth skiers, as we observed more fractures, head/neck/face injuries and collision-related trauma in skiers age 0-6. Like previous studies, skiing was associated with lower extremity injuries and snowboarding was associated with upper extremity injuries. Taken together, these data support age as a determinant of injury patterns among youth skiers and snowboarders. [Table: see text][Figure: see text]
Quantifying the Impact of the Covid-19 Pandemic on Youth Sports-Related Injuries
Authors: Oganezova Karina , Houlihan Nathan , Maguire Kathleen J. , Lawrence J. Todd , Ganley Theodore J. , Williams Brendan A. 
Published: May 2022

Background: The COVID-19 pandemic has had a tremendous impact on youth sports participation for children and adolescents in the United States. Prior work demonstrated that pandemic-related closures led to a significant reduction in pediatric sports-related injury in the first half of 2020. However, these trends have yet to be evaluated on a national level and during the latter half of the year when organized youth sports began to re-emerge. Purpose: To estimate monthly and annual trends in youth sports-related injury over the last 5 years using a national injury database in order to measure the impact of the COVID-19 pandemic on overall and sport-specific rates of injury. Methods: We retrospectively reviewed data from the National Electronic Injury Surveillance System (NEISS) database identifying children and adolescents (0-18yo) presenting to US emergency departments with sport participation product codes (Table 1). Cases associated with >1 product code were excluded. The monthly and annual frequency of sports-related injuries was estimated. Quasi-experimental interrupted time series analysis was performed using the period of March-December 2020 as a binary variable. Differences in total and sport-specific injury estimates were calculated with pre-and post-trend analysis of the interrupted time series. Results: Our study criteria identified 152,560 youth sports-related injury cases corresponding to a national estimate of 4,582,892 injuries from 2016-2020 (95% CI=4,420,534-4,745,250). The mean yearly estimate from 2016-2019 was 1,041,944 injuries [890,047-1,193,841]. An estimated 415,115 injuries [357,779-480,594] occurred in 2020. Seasonal peaks in September and May were identified. There was a statistically significant decrease in national youth sports-related injuries that coincided with the nationwide COVID-19 shutdown in March 2020 (56,945 [33,143-80,747] fewer monthly injuries (P < 0.0001)). From March-December 2020, an estimated 457,221 [388,450-525,992] fewer sports-related injuries occurred than would have been expected based on prior trends. Sport-specific analyses (Table 1) demonstrated the greatest reduction of estimated injuries from March-December 2020 occurred in basketball (137,772 fewer injuries [130,192-145,246]), football (123,345 fewer injuries [86,883-159,807]), and soccer (70,383 fewer injuries [65,849-74,919]). Estimates of injuries associated with wrestling, ice hockey, and cheerleading had the greatest proportional reduction during the March-December time period (99%, 93%, and 79% respectively.) Conclusion: There was a significant reduction in youth sports-related injuries in 2020 coinciding with the nationwide COVID-19 shutdowns in March 2020 and persisting throughout the remainder of the year. Reduced injury burden was most notable for contact sports including basketball, football, and soccer. [Table: see text][Figure: see text]
Surgical Management of Distal Clavicle Fractures in Skeletally Immature Athletes
Authors: Jasty Naveen , Waters Peter M. , Bae Donald S. , Heyworth Benton E. 
Published: May 2022

Background: Distal clavicle fractures account for a significant proportion of clavicle fractures in the pediatric and adolescent age groups, but clinical decision making to date has largely been informed by adult studies. However, surgical treatment in this younger population may have unique technical and clinical considerations, due to distinct fracture patterns, increased healing potential and periosteal thickness. Hypothesis/Purpose: The objective of this study was to characterize distal clavicle fractures in a cohort of pediatric and adolescent athletes who underwent operative treatment at a single, tertiary-care pediatric center, including surgical techniques used and resultant clinical outcomes. Methods: A retrospective review was performed of all operatively-treated clavicle fractures extending to the coracoclavicular ligaments or lateral, between 2005-2020. Patients >19 years-old or those with pathological fractures were excluded. Radiographic characteristics, surgical fixation construct, time to radiographic healing, return to sports, and complications were analyzed. Results: Fifty-two patients were identified, with mean age 13.8 ± 2.2 years. The majority of fractures were classified as Nenopoulus type IIB (transverse, displaced; 42.3%) or type IIIB (oblique, displaced; 26.9%), with type IIA (transverse, minor displacement; 3.8%), IV (comminuted; 11.6%) , and V (AC dislocation; 15.4%) patterns also observed. Primary direction of displacement was posterior in 90% of cases and superior in 10%. Plate fixation was performed in 53.8% of surgeries, with locking plate (26.9%) and hook plate (17.3%) most frequent. Suture-based fixation was performed in 32.7% of cases (Figure 1). Rate of removal of implants was 66% after plate fixation, the majority of which (72.2%) were planned at the time of primary fixation. Patient age was comparable in suture and plate cohorts (12.9 vs. 13.5, p = 0.19). Total complication rate, including unplanned removal of implants, was higher in the plate fixation group (25%) than in the suture-based fixation group (11.2%). Time to radiographic healing was not significantly different between plate and suture-based constructs (2.9 vs. 2.9 months, p = 0.96) though patients with suture-based constructs returned to sport faster (2.5 vs. 3.6 months, p = 0.014). Conclusion: The vast majority of distal clavicle fractures treated operatively in pediatric and adolescent athletes are posteriorly displaced fractures. When chosen in the appropriate patient, suture-only constructs can lead to similar healing and faster return to sports compared to plate-based constructs, with greatly reduced need for removal of hardware. These data provide a foundation for future comparative research further elucidating precise surgical indications and optimal treatment approaches. [Table: see text]
Patterns and Predictors of Opioid Use Following Surgery for Sports-Injury in Adolescents
Authors: Groenewald Cornelius B. , Schmale Gregory A. , Saper Michael G. , Palermo Tonya M. , Rabbitts Jennifer 
Published: May 2022

Background: Opioids provide effective pain relief for many adolescents following sports-injury surgery. However, a subgroup experiences poor pain relief with significant risk of developing iatrogenic problematic opioid use behaviors, such as persistent opioid use and opioid misuse (use in a way other than prescribed: e.g. longer duration, higher doses). Currently, our ability to predict this risk-benefit ratio for individual patients is limited by inadequate understanding of associated risk factors. Therefore, we aimed to 1) characterize opioid use over 14 days following surgery, 2) examine relationships between pre-operative risk factors (pain intensity, depressed mood, sleep disturbance, substance use history) and postoperative opioid use, and 3) determine rates of opioid misuse/persistent use at 2 months post-surgery. Hypothesis: We hypothesized finding 1) wide variability in opioid use over the first 14 days post-surgery, 2) higher pre-surgery pain intensity, depressed mood, sleep disturbance, and history of substance use associated with increased opioid use, and 3) 5-10% of patients reporting opioid use beyond 14 days from surgery. Methods: Prospective observational study of 50 adolescents (50% female) undergoing outpatient sports-injury (knee, shoulder, elbow) arthroscopic and limited-open surgery. Prior to surgery, participants were surveyed about pain symptoms, depressive symptoms, sleep disturbance, and a history of substance use using validated patient-reported questionnaires. All participants received opioids (oxycodone) to manage moderate-severe pain at home. Opioid use was objectively monitored using a novel medication adherence tracking device (electronic pill box). The primary outcome variable was the number of opioid doses used from the initial prescription following surgery. Generalized estimating equation (GEE) regression models examined associations between risk factor/predictor (pain, depression, sleep, substance use) and opioid use variables, controlling for time since surgery. Results: Mean age was 13 years (range 10-18 years). Mean opioid use was highly variable, ranging from 1-25 doses over the first 14 days following surgery (mean 8.5±5.8 doses). Pre-surgery pain (Beta(β)=0.39, p<0.0001), sleep disturbance (β =0.35, p=0.026), and history of substance use (β =0.22, p=0.04) predicted increased opioid use over 14 days. Surgery type and depressive symptoms were not associated with opioid use. At 2-month follow-up, 6/50 (12%) patients reported use of opioids beyond 14 days after surgery. Conclusion: Opioid use following sports-injury surgery varies widely and may be related to modifiable preoperative risk factors, suggesting an important role for screening and brief preoperative interventions. Up to 12% of patients used opioids up to 2 months following surgery, however, whether this phenomenon suggests opioid misuse versus persistent opioid use for pain remains unknown.
Grit After Acl Reconstruction: Sex Differences and Association with Knee Outcomes Among Adolescent Athletes
Authors: Armento Aubrey , Logterman Stephanie , Gagliardi Alexia , Hovater Whitney , Howell David , Albright Jay 
Published: May 2022

Background: Grit reflects perseverance for pursuing long-term goals. Recovery from ACL reconstruction requires a long and challenging rehabilitation process. While grit has previously been used to predict success in education and military settings, little is known about the association between grit and the rehabilitation process among adolescent athletes after ACL reconstruction. Purpose: The primary aim of the study was to determine differences in GRIT-S scores between male and female athletes pre-operatively to 6 months post-ACL reconstruction. The second aim of the study was to assess the relationship between pre-operative GRIT-S scores and knee outcome measures 6 months post-operatively. Methods: All participants completed the GRIT-S questionnaire, the Pediatric International Knee Documentation Committee (Pedi-IKDC) subjective knee form, and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) at a pre-operative appointment and then again approximately 6 months after ACL reconstruction. We conducted a linear mixed model analysis to assess the effects of sex and time on GRIT-S scores. We then conducted a linear regression analysis to determine if pre-operative GRIT-S scores predicted IKDC and HSS Pedi-FABS scores at 6 months post-operatively. We defined statistical significance as p < 0.05. Results: We included 83 participants (mean age 16.0 +/- 2.3 years, 70% female) from a prospective registry of pediatric athletes undergoing ACL reconstruction by one surgeon at a single institution. For the entire study population, there was no statistically significant change in GRIT-S scores from the pre-operative assessment to 6 months post-operatively. However, there was a statistically significant effect of sex (p=0.03) on GRIT-S scores from pre-operative assessment to 6 months post-operatively, with female athletes demonstrating more grit than male athletes across both assessments (Figure 1). Additionally, there was no significant association between pre-operative GRIT-S scores and Pedi-IKDC and HSS Pedi-FABS scores 6 months post-operatively for the entire group (Figure 2). Conclusion: In our study population, female athletes reported higher GRIT-S scores than male athletes across the first 6 months of rehabilitation after ACL reconstruction. Pre-operative GRIT-S scores do not appear to be significantly associated with knee outcome measures 6 months post-operatively, which could suggest that grit may not necessarily predict success in the rehabilitation process after ACL reconstruction. However, future studies will examine how grit is associated with return-to-sport outcomes to determine if grit is a useful marker in predicting successful return-to-sport after ACL reconstruction in adolescent athletes. [Figure: see text][Figure: see text]
Influence of Gender, Race/Ethnicity & Socioeconomic Factors on Meniscus Treatment with Pediatric and Adolescent Acl Reconstruction
Authors: Mercurio Angela M. , Coene Ryan P. , Cook Danielle , Feldman Lanna , Milewski Matthew D. 
Published: May 2022

Background: The rate of anterior cruciate ligament reconstruction (ACLR) in pediatric/adolescent populations has increased over time. However, there is less evidence to support the relative change in concomitant meniscus procedures over time. Demographics and socioeconomic (SES) factors may be implicated in the rate and usage of meniscectomy vs. meniscal repair as treatment. Hypothesis/Purpose: The purpose of this study is to assess if the rate of concomitant meniscus procedure with ACLR is increasing and what factors may be contributing to this rise. We hypothesize that age, sex, race/ethnicity, income, or insurance type may affect the rate of concomitant meniscus procedures. Methods: The Pediatric Health Information System (PHIS) Database was queried for all patients 18 years or younger who underwent ACLR with or without concomitant meniscus procedures based on CPT code from 2015-2019. Data from 39 out of 52 centers were included based on completeness of their data. Basic demographic information including age, sex, self-identified race/ethnicity, and insurance status was collected. Urban and rural designation was identified based on rural-urban commuting area (RUCA) codes. Based on the 2015 Department Health & Human Services Federal Poverty Guidelines (FPL), patients were stratified into lower (≤199% of FPL) and higher (≥200% of FPL) income brackets. Linear regression was used to model trends and multiple logistic regression modeling was used to test for associations. Results: 14,398 patients underwent ACLR during the study period with 8,337 patients (58%) having concomitant meniscal procedures with a 1.24-fold increase over five years (Figure 1). Of the 8,337 patients with concomitant meniscus treatment, 46% had a meniscectomy and 54% had a meniscus repair. There was a 0.86-fold change in meniscectomy and a 1.70-fold increase in meniscus repair during the study period (Figure 2). Males, older patients, Black race, living in an urban area, and those with non-private insurance had increased odds of undergoing a concomitant meniscus procedure (all p<0.05). Patients of Black or other race and those with non-private insurance had increased odds of having a meniscectomy vs. meniscus repair (all p≤0.01). There were no associations detected between income bracket and our outcomes. Conclusions: This study shows that in pediatric and adolescent patients undergoing ACLR, there is a rise in concomitant meniscus procedures from 2015-2019. In addition, patients of non-white race and those with non-private insurance have increased odds of undergoing meniscectomy vs. meniscus repair. This study identifies access and inequality issues in ACLR with concomitant meniscus procedures in pediatric and adolescent populations. [Figure: see text][Figure: see text]
Can a Knee Brace Prevent Acl Re-Injury: A Systematic Review
Authors: Marois Bianca , Tan Xue Wei , Pauyo Thierry , Dodin Philippe , Ballaz Laurent , Nault Marie-Lyne 
Published: May 2022

Background: Recent literature shows a rate of ACL retear after ACLR when returning to sport between 8% and 23%, depending on the population and clinical implications. The risk of a second injury is higher in patients who (1) return to cutting and pivoting sports, (2) do not meet the return to sport criteria before returning to sport, and (3) returning to pivoting sports earlier than 9 months after ACLR. A second ACL injury, either a graft rupture or contralateral ACL injury after ACLR, negatively impacts knee function, quality of life, accelerates degenerative changes in the knee and challenges an athlete’s career. Purpose: This systematic review aimed to investigate whether a knee brace when returning to sport (RTS) could prevent a second injury after anterior cruciate ligament reconstruction (ACLR). Methods: This study was registered with the PROSPERO database and followed PRISMA guidelines. A systematic search of PubMed, Ovid Medline, Ovid All EBM Reviews, Ovid Embase, EBSCO Sportdiscus and ISI Web of Science databases for meta-analysis, randomized controlled trials and prospective cohort studies published before July 2020 was undertaken. The inclusion criteria were: (1) Comparing with and without brace at RTS, (2) follow up of at least 18 months after ACLR, (3) reinjury rates included in the outcomes. Data were extracted independently by two reviewers. Quality appraisal analyses were performed for each study using the Cochrane Collaboration tools for randomized and nonrandomized trials. Results: A total of 1196 patients in 3 studies were included. One study showed a lower rate of reinjury when wearing a knee brace at RTS. One study found the knee brace to have a significant protective effect for younger patient. (p < 0.05). Conclusion: Current data cannot support that using a knee brace when RTS will decrease the rate of reinjury after ACL reconstruction. [Table: see text][Figure: see text][Table: see text][Table: see text][Table: see text][Table: see text]