bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Anterolateral Ligament Reconstruction and Lateral Extra-Articular Tenodesis in Children and Adolescents
Authors: Patel Neeraj M. , McKay Scott D. , Pandya Nirav K. , Ganley Theodore J. 
Published: May 2022

Background: Graft failure remains a challenging complication after anterior cruciate ligament reconstruction (ACLR) in children and adolescents. Anterolateral ligament reconstruction (ALLR) and lateral extra-articular tenodesis (LET) show promise in lowering the risk of ACL graft failure, but there is little data on surgeon practices and preferences in the pediatric population. An improved understanding can help determine the feasibility of future research, identify questions of interest, and ultimately design clinical studies. Hypothesis/Purpose: The purpose of this study is to quantify surgeon practices regarding ALLR and LET in children and adolescents. Methods: An electronic survey was administered to surgeons in the Pediatric Research in Sports Medicine (PRiSM) society. Surgeon and practice demographic information was collected. The survey then asked several questions about indications, preferences, and techniques for ALLR or LET in the context of primary and revision pediatric ACLR. Chi-square and Fisher exact tests were used to evaluate factors that impact surgical preferences. Results: A total of 63 surgeons completed the survey, of which 62% performed ≥50 pediatric ACLR annually. In the setting of primary ACLR, 35/63 (56%) sometimes perform ALLR or LET. The frequency increased to 50/63 (79%) with revision ACLR. The most common indications for ALLR/LET in the primary setting were high-grade pivot shift, knee hyperextension, generalized laxity, and type of sports participation. Surgeons whose practice was >75% sports medicine were more likely to perform ALLR/LET with both primary and revision ACLR (p=0.005 and <0.001, respectively). Those that completed a sports medicine fellowship were more likely to perform these procedures than those with only pediatric orthopaedic training in both primary (68% vs. 36%, p=0.01) and revision scenarios (92% vs. 60%, p=0.002). Of the 28 respondents that do not perform ALLR/LET with primary ACLR, 75% cited insufficient evidence as the reason. However, 95% of surgeons that do perform these procedures expressed interest in studying them prospectively and 86% were willing to randomize patients. Conclusion: In this study of pediatric sports surgeons, 56% sometimes perform ALLR or LET with primary ACLR and 79% with revision ACLR. Surgeons with sports medicine fellowship training or a mostly sports practice were more likely to perform these procedures. Insufficient evidence was the most common reason given by those that do not perform ALLR or LET. However, there was substantial willingness to prospectively study and even randomize pediatric patients to assess the impact of ALLR/LET in this population.
Anterior Cruciate Ligament Injuries Change Muscle Co-Activation Strategies in Adolescent Females During Landing
Authors: Bel Michael Del , Romanchuk Nicholas J. , Benoit Daniel , Carsen Sasha 
Published: May 2022

Background: Anterior cruciate ligament (ACL) injuries in adolescents continue to rise. Given that muscles are the only modifiable contributors to knee joint control, there has been a focus on their management in rehabilitation research. After an ACL injury, increased co-activation of the thigh muscles is considered a hallmark characteristic in stabilising the knee joint among adults with ACL injuries. However, increasing co-activation to improve joint stiffness should not be the rehabilitation goal after an ACL injury since a prolonged increase in co-activation about the joint alters knee joint loads and is associated with the onset and progression of knee osteoarthritis in adults. Purpose: Co-activation information currently does not exist among adolescents, therefore this study set out to address this gap. Methods: Twelve female patients with ACL-deficiency (ACLd) and 12 matched controls (CON) performed countermovement jumps while having the following muscle activations recorded for both limbs: rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), semitendinosus (ST), lateral (LG) and medial gastrocnemii (MG), and gluteus medius (GM). During the landing phase of the task, co-activation indices were calculated for the lateral thigh muscles (VL and ST), medial thigh muscles (VM and BF), and the total thigh muscles (VL&VM and BF&ST). Independent-sample t-tests ( p=.05) evaluated mean group differences for each of the three co-activation indices. Results: A significant difference was found in medial co-activation ( p=.019), while a trend towards significance ( p=.071) was found in total thigh co-activation, with ACLd females having higher co-activations indices in both compared to matched controls (Figure 1). No differences were observed between groups in their demographics or lateral co-activation indices. Conclusion: Failure to appropriately adapt one’s neuromuscular control strategies may explain why some individuals continue to have knee instability and difficulty returning to their pre-ACL injury activity levels after rehabilitation. This is evidenced by our findings among this cohort of females with ACL injuries who displayed higher co-activations, specifically in the medial thigh musculature. Moreover, our findings highlight the need to target individual muscles during rehabilitation and to avoid generalization of segment muscles (i.e. quadriceps and hamstrings) where vital information in knee joint stabilization may be missed. [Figure: see text]
Objective Infrared Eye Tracking Aids in the Identification of Concussion-Related Vision Disorders in Adolescen Ts with Persistent Post-Concussive Symptoms
Authors: Master Christina , Rogers Tyson , Podolak Olivia , Howell David , Grady Matthew F. , Scheiman Mitchell 
Published: May 2022

Background: The visio-vestibular examination (VVE) of smooth pursuit, saccades, vestibulo-oculomotor reflex, near point of convergence (NPC), accommodative amplitude (AA), and complex tandem gait, has enhanced the physical examination of concussed individuals. The EyeBOX is a FDA-approved device for the diagnosis of concussion. Hypothesis: The goal of this investigation was to determine the diagnostic accuracy for concussion-related vision disorders of infrared eye-tracking via the EyeBOX. Methods: A cross-sectional study of 112 adolescents ages 11-18 years of age experiencing persistent post-concussion symptoms 4-12 weeks after concussion was conducted. All subjects had a clinical visio-vestibular examination (VVE) with a sports medicine physician, and a formal, comprehensive vision examination conducted by a pediatric developmental optometrist. A binocular eye tracking assessment was performed using the EyeBOX. Binocular pupil gaze positions are captured to ensure quality data acquisition and binocular movements in the X and Y axes are recorded at 500 Hz. Dynamic time series eye tracking data is acquired with 89 different metrics from eye movement in different planes recorded for each eye at 500 Hz captured over 220 seconds. From the time series data, a summary score, between 0 and 20, the BOX score, is generated. Logistic regression was used to estimate the association between each clinical VVE parameter and concussion-related vision diagnosis. Univariate and multivariate analyses were performed to determine the predictive ability of all VVE parameters to predict a concussion-related vision diagnosis. The area under the receiver-operator (ROC) curve was estimated by treating the linear predictor from the logistic regression as a continuous diagnostic parameter. A p-value is reported for the Wald test of whether a logistic regression coefficient differs from zero. Results: The clinical VVE variables had an AUC = 0.64 for tandem gait errors (p=0.06), 0.64 for monocular AA (p=0.01 for each), and 0.66 for NPC (p<0.01). A multivariable model including all nine VVE variables had predictive ability to identify concussion-related vision disorders in adolescents with persistent post-concussion symptoms with an AUC = 0.73. The BOX score alone had an AUC = 0.67 (p<0.01). Conclusions: The addition of the BOX score, a composite measure of objectively acquired eye tracking data, to the multivariable model with all nine dichotomous VVE variables added significant additional diagnostic ability (p<0.01), yielding an AUC = 0.81. The combination of a clinical visio-vestibular examination and objective infrared eye tracking has relevant diagnostic value, facilitating identification and treatment of concussion-related vision disorders.
Effect of Menstrual Dysfunction in Adolescent Concussion Patients on Length of Time to Recovery and Symptom Burden
Authors: Barsky Brandon W , Fischer Anastasia N. , Young Julie A. 
Published: May 2022

Background: Concussions are one of the most common sport-related-injuries seen in the adolescent population. It is well known that female athletes are at higher risk for concussion, but factors that influence this risk, including hormonal influences, are not entirely known. There is no literature to date that explores the relationship between menstrual dysfunction (MD) and outcome measures of concussion. Hypothesis/Purpose: Our primary purpose is to determine if MD predicts prolonged recovery from concussion and our secondary purpose is to determine if MD predicts a higher initial symptom burden. Methods: Patients who presented to a pediatric sports medicine concussion clinic for an initial visit, were ≤18 years-old, and were at least 2 years post-menarchal were included in the study. Those who reported taking any hormonal medications, were pregnant, or who suffered symptoms greater than 180 days were excluded. Subjects who were >15 years old at menarche, experienced <10 menstrual periods per year or >35 days between cycles were categorized as having MD. Two linear regressions were analyzed to determine differences in initial symptom score and time to recovery between those with and without MD while controlling for age, history of headaches, and history of prior concussions. Results: A total of 801 participants were included in the study (697 controls and 108 MD patients). There was no statistically significant difference in time to recovery between the groups (p=0.12). However, MD patients took 5 days longer to recover than controls (51.23 vs. 46.42 days). There was no statistical difference in initial symptom score between the MD and control groups (p=0.67, 56.04 for controls and 58.47 for MD). Conclusion: No statistically significant differences were found in time to recovery after concussion or in initial symptom burden between subjects with MD and controls. Additional study is warranted to further characterize these relationships.
The Association Between the Female Athlete Triad and Mental Health in High School Athletes
Authors: Wolfenden Emily , Olson Emily Miller , Mehta Shayna , Sainani Kristin , Roche Megan , Jochen Karis , Hastings Katherine , Kraus Emily 
Published: May 2022

Background: The Female Athlete Triad (Triad) is the interrelationship of low energy availability, reproductive irregularities, and low bone mineral density. It is theorized that mental health illness can both contribute to and result from low energy availability. Limited data exists that describes the relationship between the Female Athlete Triad and mental health symptoms. Hypothesis/Purpose: The purpose of this study was to investigate the relationship between the Triad and mental health illness, specifically depression and anxiety symptoms, in high school athletes. Methods: This was a cross-sectional survey study of high school athletes distributed via social media with responses accepted from 12/30/20 – 2/15/21. Data was collected including age, sex, training history, menstrual history, history of bone stress injuries, and eating behaviors. The Female Athlete Triad Coalition Consensus Statement Cumulative Risk Assessment Tool was used to score athletes (range: 0-10 points) and to classify them as low-, moderate-, or high-risk for Female Athlete Triad. Mental health was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress Depression and Anxiety short form questionnaires. Mental health scores were scored as none, mild, moderate, or severe self-reported depressive or anxious symptoms. Ordinal logistic regressions were performed. Results: There were 78 self-reported female high school participants (mean age = 16). Depression symptoms were reported in 74% of participants (19% mild, 40% moderate, 15% severe). Anxiety symptoms were reported in 64% of participants (18% mild, 26% moderate, 21% severe). Triad risk assessment responses categorized participants as 45% low risk, 41% moderate risk, and 14% high risk of developing the Triad. Depression symptoms were significantly associated with increasing Triad risk assessment score: Odds Ratio (per 1 point Triad risk score) = 1.245 (1.004 – 1.544) ( p = .0462). Anxiety symptoms were also significantly associated with increasing Triad risk assessment score: Odds Ratio (per 1 point Triad risk score) = 1.264 (1.020 – 1.567) ( p = .0319). Conclusion: Anxiety and depression symptoms were both significantly associated with increasing Triad risk scores in this preliminary cross-sectional study. Notably, this study is limited by sampling bias. Further research is needed to explore the relationship between mental health illness and the Female Athlete Triad.
Treatment of Borderline Acetabular Dysplasia in the Adolescent Patient: Outcomes of Periacetabular Osteotomy
Authors: Parilla Frank , Clohisy John C. , Nepple Jeffrey J. 
Published: May 2022

Introduction: The treatment of borderline acetabular dysplasia [defined as lateral center edge angle (LCEA) 18-25°] is controversial as there is limited evidence regarding the optimal surgical treatment [hip arthroscopy versus periacetabular osteotomy (PAO)]. The decision-making is particularly challenging in the adolescent patient where a durable outcome is particularly important. Purpose: To define early clinical outcomes, complications and rates of reoperation in adolescent patients undergoing PAO for the treatment of borderline acetabular dysplasia. Methods: A prospective single surgeon hip preservation database was retrospectively reviewed for adolescent patients treated with PAO for symptomatic instability in the setting of borderline acetabular dysplasia. A total of 56 hips were identified from 2010 to 2019 and followed for an average of 3.5 ±1.9 years (range, 1-7). Modified Harris hip scores (mHHS) were analyzed relative to minimal clinically important difference (MCID 8) and patient acceptable symptoms state (PASS>74). Complications and reoperations were recorded. Results: The 56 included hips (age 16.3 ±1.4 years; 89% female) had a mean preoperative LCEA of 20.9° ±.2.0° (37%, 18-20°; 63% 20-25°). Concurrent hip arthroscopy for symptomatic labral pathology was performed in 28% of cases. Major improvement in mHHS (27 ±17) from baseline to final follow-up (59 vs. 86, p<0.001) corresponded to a high observed rate of achieving MCID or PASS (91%). Two patients (3.6%) underwent subsequent arthroscopy. There were no other non-hardware removal reoperations. There were no outcome differences between those treated with and without concurrent arthroscopy (p>0.5). Conclusion: PAO surgery provides excellent pain relief and improved function in adolescent patients with symptomatic, borderline acetabular dysplasia. The observed reoperation rate (3.6%) is low for this patient population. The PAO remains our preferred treatment for borderline dysplasia with clinical signs and symptoms of hip instability.
Magnetic Resonance Image (Mri) Measurements of Lateral Discoid Meniscus (Ldm) in Pediatric Patients Match Adult Lateral Discoid Meniscus Definitions
Authors: Beck Jennifer , Wood Anna , Bennet Abbie , Jackson Nicholas 
Published: May 2022

Background: Commonly cited lateral discoid meniscus (LDM) imaging definitions are based upon adult MRI measurements: >70% tibial plateau coverage on the sagittal, >20% tibial plateau coverage on the coronal and >3 bowtie signs. This pathology more commonly presents in pediatric populations and it is unknown if these measurements apply to a pediatric population. Therefore, it is important to understand the Magnetic Resonance Image (MRI) measurements of LDM in a pediatric population. Hypothesis/Purpose: The purpose of this study is to define LDM measurements on MRI in a pediatric population. Authors hypothesize there is a wide variation in LDM characteristics on MRI. Methods: 100 MRIs on LDM patients who are skeletally immature were evaluated and 91 included in this study. Demographics were recorded. Two study authors independently reviewed MRIs measuring meniscal height and width on sagittal and coronal images, tear presence, number of “bowties” on sagittal images, as well as tibial sagittal and coronal width. One study author repeated measurements a minimum of 4 weeks after initial review. Figure 1 describes each measurement. Statistical analysis was performed using fisher’s exact test for differences, as well as multinomial, linear and logistic regression models with clustered robust standard errors. Results: Average age at MRI was 12.3 ± 3.4 years, 51% male, 56% left knees. Table 1 reports gender comparison of MRI measurements. Table 2 reports gender comparison of bowtie sign and ratios of meniscal width to tibial width on coronal and sagittal images. Tears were reported in 72 MRIs (80%). Genders of patients with tears were not statistically different (Female: N=33; 73%, Male: N=39; 87%, p=0.16). Sagittal anterior (p=0.005) meniscal width, anterior to posterior meniscal width (p<0.001), and # of bowtie signs (p=0.043) were significantly associated with tear presence. Conclusion: MRI characteristics can aide in accuracy of LDM diagnosis. Pediatric patients with diagnosed discoid meniscus had >3 bowtie signs, >70% tibial plateau coverage on the sagittal, and >20% tibial plateau coverage on the coronal consistent with adult reported definitions of discoid meniscus. [Figure: see text][Table: see text][Table: see text][Table: see text]
Differences in Lower Extremity Kinematics Based On Drop Vertical Jump Task Variations
Authors: Loewen Alex M. , Erdman Ashley , Tulchin-Francis Kirsten , Ulman Sophia ,   PRiSM Motion Analysis Research Interest Group
Published: May 2022

Background: More advanced measures of movement quality may be necessary to better estimate return-to-play readiness. This emphasizes the need for a standardized motion analysis protocol to capture patients’ biomechanics during dynamic tasks, such as the drop vertical jump (DVJ). Given that the DVJ elicits a dynamic, game-like movement, it is commonly used in return-to-play functional testing and injury-risk research. However, the task procedure is not consistent across treatment and/or research centers. Hypothesis/Purpose: The purpose of this study was to determine whether variations in jump distance, verbal instructions, or target use would influence mechanics during a DVJ task. Methods: Fourteen healthy subjects (7 female, aged 22.7±3.7 years) were asked to perform six DVJ tasks from a 31cm plyo-box. Lower extremity kinematics were collected during the first landing/takeoff phase. Three tasks varied by jump distance (distance from box to center of force plates): zero distance (DROP), one-third (THIRD) and one-half (HALF) subject height. Additional verbal instructions were provided for the DROP task. Specifically, subjects were asked to first “drop off the box onto the force plates” (DROP), and then to “slightly bend their knees to ‘pop-off’ the box with both feet at the same time” (POP). Lastly, a target was positioned above the force plates for the HALF (H-TAR). Wilcoxon signed-rank tests were performed to assess differences between tasks ( α=0.05). Results: At initial contact (IC), knee flexion increased in the DROP (24.0˚±18.4˚, p=0.011) and THIRD (16.3˚±7.9, p=0.005) compared to the HALF (12.0˚±6.8˚). During the landing phase, maximum hip flexion increased in the HALF (106.0˚±27.5˚) compared to the DROP (100.6˚±25.0˚, p=0.011). Average pelvic tilt decreased in the DROP (32.1˚±4.8) compared to both the POP (37.8˚±5.7˚, p=0.009) and THIRD (34.5˚±6.2˚, p=0.008). When using a target, knee flexion increased at IC during the H-TAR (H-TAR:18.8˚±8.8˚, HALF:12.0˚±6.8˚, p=0.004). Conclusion: These findings emphasize the importance of understanding movement strategies associated with different variations of the DVJ. Specifically, a shift in landing strategy was seen as box distance increased. Therefore, the DROP may be more appropriate early in rehabilitation given that maximum hip flexion was reduced. In contrast, the HALF may be more appropriate for return-to-sport testing given that patients would exhibit improved neuromuscular motor control. These findings also highlight the need for standardized instructions and task setup. While this pilot data was collected in young adults, future work will need to focus on evaluating these task variations in a youth population. [Table: see text]
Short-term Recovery After Displaced Adolescent Clavicle Fractures: Do Differences an Exist Between Surgical and Non-Surgical Treatments?
Authors: Block Andrew M. , Ganapathy Aravinda , Nepple Jeffrey J. 
Published: May 2022

Introduction: Clavicle fractures are common in the young, active adolescent population. It is increasingly recognized that displaced clavicle fractures treated either conservatively or surgically have good outcomes at 1 year. Currently, it is not well established whether any differences in the short-term recovery (<3 months) exist. Patient-Reported Outcomes Measurements Information System (PROMIS) computer adaptive testing (CAT) has been shown to be a valid and reliable means to assess PROs. Purpose: To compare short-term recovery between surgical and non-surgical treatment of displaced clavicle fractures in adolescents utilizing PROMIS. Methods: Patients with displaced clavicle fractures were assessed prospectively utilizing PROMIS at each clinic visit. Patients completed the Pediatric PROMIS CAT domains Upper Extremity Function and Pain Interference. Inclusion criteria included patients <18 years old, treatment either surgically or conservatively, and at least two follow up time points within 2 months post-op. Time points were calculated as <10 days, 7-21 days, 6 weeks (22-52 days), and 3 month (70-110 days) post-injury. Time points were compared utilizing a mixed-linear regression model. Ceiling or Floor Effects were present when ≥15% of study cohort had reached the maximum or minimum possible score. Results: A total of 52 patients with displaced clavicle fractures were identified (26 surgically treated and 26 conservatively treated). Mean age was similar (15.4 v. 14.1, respectively). No differences in mean PROMIS scores between treatment modalities were present at baseline (p>0.05). For Pain Interference and Upper Extremity Function, significant improvement by 6 weeks was seen in both surgically and conservatively treated patients (Figure 1). For Pain Interference, significant improvement by 6 weeks was seen in both surgically (Δ=-6.8, p=0.03) and conservatively treated patients (Δ=-8.3, p=0.003). More surgically treated patients reached a floor effect for Pain Interference at 6 weeks (24%), compared to conservatively treated patients (4%). For the Upper Extremity function, significant improvement was seen by 6 weeks in both surgically (Δ=7.2, p=0.042) and conservatively (Δ=11.9, p=0.003) treated patients. For UE Function, 21% of surgically treated patients reached a ceiling effect at 6 weeks, compared to 13% for conservative treatment (p>0.05). No differences were present at 3 months post-injury. Conclusions: While both surgical and conservative treatment of adolescent displaced clavicle fractures demonstrate similar trends of PROMIS recovery, surgical treatment may allow for rapid recovery at 6 weeks compared to conservative treatment in some patients.