bluuebunny/crossref_metadata_2025_split huggingface dataset:
Isolated Lateral Release is Inferior to Medial Patellofemoral Ligament Reconstruction for Surgical Management of Patella Instability in Pediatric Patients
Authors: Varshneya Kunal , Money Adam , Curtis Daniel , Ray Taylor , Shea Kevin , Abrams Geoffrey D. , Safran Marc , Sherman Seth L. 
Published: May 2022

Background: The optimal treatment for chronic patella instability remains controversial. Medial patellofemoral ligament reconstruction (MPFLR) has emerged as the “gold standard” for soft tissue stabilization. However, isolated lateral release (ILR) is still commonly performed to treat chronic patella instability despite growing evidence against this approach. Hypothesis/Purpose: Our purpose is to evaluate long-term revision rates and short-term post-operative complications in pediatric patients undergoing either MPFLR or ILR for recurrent patellar instability. The hypothesis is that MPFLR is a superior treatment option with reduced long term revision rates and comparable short-term complications. Methods: The MarketScan database was queried from 2007-2015 to identify patients who underwent MPFLR or ILR as their primary surgical treatment of their chronic patellar instability. Patients were excluded if they had incomplete records up to 5 years or if they underwent concomitant osteotomy or cartilage restoration during their index stabilization procedure. Baseline demographic data and patient co-morbidities were documented. Two and five year revision surgical stabilization rate and post-operative complications were reported. Results were analyzed statistically. Results: This study identified 471 patients (mean age 15.6 years, female 56.9%) who underwent MPFLR and 528 patients (mean age 15.5 years, female 70.5%) who underwent ILR for chronic patellar instability. Patients were stratified into two mutually exclusive groups: 1) MPFLR only or 2) ILR only. Patients who underwent MPFLR experienced higher rates of overall complications within 90 days of surgery (8.7% vs 4.9%, p = 0.0171). MPFLR had a higher rate of early wound complications (0.8% vs. 0%, p <.033) There was no difference in revision stabilization rate between MPFLR and ILR at 2 year follow-up. However, at 5 years of follow-up, 8.9% of patients who underwent ILR underwent revision surgery compared to 3.0% of patients who underwent MPFLR as their index surgery (p < 0.0001). Conclusions: Isolated lateral release is an inferior treatment option for surgical stabilization of chronic patella instability as compared to medial patellofemoral ligament reconstruction in pediatric patients. Despite slightly higher rate of short term complications in the MPFLR group and similar revision rates at 2 years, MPFLR has significantly decreased risk of revision stabilization at 5 year follow-up. [Table: see text][Table: see text]
Comparison of a Novel MRI Technique that Produces Equivalent Bone Contrast with 2D-CT for the Assessment of Glenoid Bone Loss
Authors: Alizai Hamza , Chen Diana , Chang Joseph , Ellis Henry B. , Wilson Phillip L. 
Published: May 2022

Background: Advanced imaging in patients with shoulder instability can be variable. MRI offers visualization of soft tissue injuries including capsulolabral injuries, however may not be ideal to assess osseous injuries. CT examination may often be desired as the accepted standard for assessment of glenoid and humeral bone loss, the extent of which can dictate surgical management in the adolescent age group in which bone loss is common. Hypothesis/Purpose: Our hypothesis, MRI bone sequence/method (FRACTURE: FFE Resembling A CT Using Restricted Echo-spacing) can provide measurements comparable to standard CT for glenoid bone loss. The objective of this study was to validate this technique in a cadaveric glenoid bone loss model using 2D-CT as the reference standard. Methods: Glenoid fractures of varying sizes were arthroscopically created in 10 cadaveric shoulders. 2D-CT and MRI FRACTURE on 3T Philips Ingenia; Philips Healthcare, Best, Netherlands) were performed on all 10 shoulders. FRACTURE is a 3D-gradient echo pulse sequence with restricted echo-spacing combined with an automated post-processing is a technical innovation which provides superior cortical and trabecular bone contrast on MRI. The CT and MRI were presented in a blinded fashion to 2 experienced musculoskeletal radiologists for independent measurement of the glenoid fracture length, width, as well as % glenoid bone loss using the best-fit circle method. Paired t-tests were performed to compare the measurements obtained on CT with those obtained on the MR FRACTURE images. Intraclass correlation coefficient was used to measure interobserver reliability. Results: There was no statistically significant difference between CT and MRI in terms of the measured glenoid fracture length(P-value=0.54) or fracture width(P-value=0.86). The mean length measured on CT was 23.40 mm ± 6.87 and on MRI was 22.96 mm ± 7.38. The mean width on CT measured 7.96 mm ± 3.51 and on MRI measured 7.89 mm ± 3.18. There was also no statistically significant difference between CT and MRI in terms of measured glenoid bone loss (P-value=0.65). Intraclass correlation coefficients for interobserver reliability ranged from 0.95 to 0.99 for measurements performed on CT and MRI. Conclusion: Measurements of glenoid fracture and associated % bone loss on CT were comparable with measurements obtained using the MR FRACTURE technique. Inter-observer reproducibility for these measurements was excellent. MRI FRACTURE technique may obviate preoperative CT in patients with anterior shoulder instability.
Recovery from Medial Patellofemoral Ligament Reconstruction with and Without Tibial Tubercle Osteotomy: An Assessment by Promis
Authors: Block Andrew M. , Ganapathy Aravinda , Nepple Jeffrey J. 
Published: May 2022

Introduction: Patellar instability is a common problem in the active pediatric and adolescent population. Medial patellofemoral ligament (MPFL) reconstruction with or without associated tibial tubercle osteotomy (TTO) are the most commonly utilized surgical treatment. Patient-Reported Outcomes Measurements Information System (PROMIS) has been shown to be a valid and reliable means to assess patient-reported outcomes in the pediatric orthopedic population. Currently, little is known about the relative recovery of isolated MPFL reconstruction compared to MPFL reconstruction with combined TTO. Purpose: To assess the outcomes of patients undergoing an isolated MPFL Reconstruction or MPFL with TTO utilizing PROMIS during post-operative recovery period. Methods: Patients undergoing patellofemoral surgery were prospectively given PROMIS assessments at each clinical visit. Inclusion criteria included a diagnosis of patellar instability, no prior MPFL procedures, <18 years old and follow up of at least 6 months. Additionally, subjects must have had a pre-operative evaluation and at least 3 FU visits within 6 months. Pediatric PROMIS domains assessed were Pain Interference and Mobility. Time points for PROMIS were labeled as pre-operative, 1 week, 1 month, 3 months, 6 months, and 1 year. Time points were then compared utilizing a mixed-linear regression model. Significance was set at p < 0.05. Ceiling or Floor Effects were present when ≥15% of study cohort had reached the maximum or minimum possible score. Results: A total of 58 patients were identified, 40 patients that underwent isolated MPFL and 18 patients that underwent MPFL + TTO. Both groups were relatively similar in terms of mean age (14.4 v. 15.3) and sex (62.5% v. 77.8% female). Changes in Mobility and Pain Interference were seen compared to baseline in both groups. For both Mobility and Pain interference, postoperative PROMIS changes were similar between isolated MPFL and MPFL + TTO groups (no significant differences at any timepoint) (Figure 1 and 2). Conclusions: MPFL reconstruction with or without TTO demonstrate improvements in PROMIS Mobility and Pain Interference after surgical treatment. The postoperative recovery of isolated MPFL reconstruction or MPFL reconstruction with TTO were very similar at all timepoints for PROMIS Mobility and Pain Interference. [Figure: see text][Figure: see text]
Pediatric Low-Grade ACL Sprains: Trends in Characteristics, Management, and Outcomes
Authors: Smith Caitlyn , Worrall Hannah , Ellis Henry B. , Wilson Philip L. , Jones Jacob C. 
Published: May 2022

Background: Anterior cruciate ligament (ACL) injuries are among the most common knee injuries in pediatric athletes. While much of the literature focuses on partial or complete tear of the ligament, there is little information on low-grade ACL sprains in either the adult or pediatric literature. Purpose: This study seeks to provide an analysis of grade 1 pediatric ACL sprains investigating injury characteristics, and report trends in management and outcomes. Methods: A retrospective review of patients, aged 8-19 years, presenting to a sports medicine clinic with a knee injury between January 2014-February 2021 was performed. Electronic medical records were queried for a diagnosis of low-grade ACL sprain based on radiology (MRI) reports that identified the injury. Charts were reviewed to collect data on demographics, sport history, injury details, clinical exam, return to play (RTP), and MRI findings. Descriptive statistics and comparisons within gender, age, and RTP were analyzed. Results: 67 patients were diagnosed with a grade 1 ACL sprain based upon clinical assessment and MRI findings and treated for such. Average age at injury was 14.51±2.46 years (56.72% male), with a mean RTP of 8.77±6.67 weeks from date of diagnosis and 12.57± 8.04 weeks from date of injury. Most frequent activities when injured were soccer (23.88%), football (16.42%), and basketball (14.93%).0 patients underwent ACL surgical treatment; 2 patients underwent surgery for concomitant injuries (both meniscus tears). 55 patients (82.09%) sustained one or more concomitant injuries: bone contusion (50.91%), non-ACL ligamentous injury (30.91%), meniscus injury (25.45%), soft tissue/muscular injury (12.73%), other (31.48%). 23 patients (37.7%) had non-negative Lachman on clinical exam. Successful conservative interventions included therapy (95.45%), bracing (87.88%), and activity restrictions (86.15%). Females were more likely to be injured in their primary sport than males (82.14% vs. 59.46%, p=0.05). Analysis of bone contusion location vs. RTP clearance date was performed. Patients who took longer to RTP (16+ vs <16 weeks) were more likely to also have a lateral femoral condylar (LFC) contusion (75% vs. 16.67%, p=0.05). Conclusion: Given limited literature on the topic, this review provides presentation characteristics and initial RTP correlates for pediatric low-grade ACL sprains. While longer term follow-up is needed as we continue to learn about the injury, the success rate of conservative treatment indicates that therapy, bracing, and activity restrictions may be considered over surgical management for low-grade ACL sprains.
Non-Private Health Insurance Plans and Delayed Access to a Specialty Pediatric Concussion Clinic
Authors: Ellis Christine S. , Caze Todd J. , Burkhart Scott O. , Abt John P. 
Published: May 2022

Background: Delayed access to specialty concussion clinic results in a 5.5 times greater risk of protracted recovery and higher costs to the healthcare system. Previous research highlighting health equity disparities has shown that being female, of minoritized status, or having non-private health insurance doubles the risk of delayed access to specialty concussion clinic. Purpose: The purpose of this project was to better characterize those with non-private insurance receiving care at a specialty concussion clinic and examine factors potentially contributing to delayed access to specialty care. Methods: Medical records of 231 patients with non-private insurance were reviewed. Patients were divided into two categories (Equivocal, Unequivocal) based on handbook language requiring PCP referral. Equivocal were insurance plans with ambiguous language requiring PCP referral. Unequivocal were insurance plans with a specific statement requiring a referral. Access to clinic was defined as early (0-7 days) or delayed (8-20 days). Descriptive stats were run to determine the number of males/females, providers previously seen, and if previously seen in the Emergency Room (ER). A one-way analysis of variance (ANOVA) was run along with Tukey post hoc to determine if there were any significant differences between number of previous providers seen and previous ER visit in the average number of days to specialty care. Results: Most patients, 97% (n=224) were in the equivocal category. The equivocal category was mostly male (n=145, 64.7%) and of minoritized status (n=177, 79%) with over 35% (n=80) being delayed to clinic (M=6.8 days, SD=4.7). The majority of those in the equivocal category (n=157, 67.9%) saw at least one previous provider, 53% being evaluated first in an ER (n=119). Those with a previous provider visit took longer to seek specialty care (F(2,230) = 3.54, p = 0.03). Those seeing two previous providers (M=9.4 days) on average took more days to get to initial specialty care compared to seeing one previous provider (M=6.8 days) or going straight to clinic (M=6.2 days). Conclusion: Patients with a non-private health insurance plan experience delayed access to specialty concussion care. Those with equivocal insurance plan language were delayed to clinic, seen by multiple providers, and first evaluated in the Emergency Room. Non-private insurance is often financially subsidized, yet the equivocal language in these policies could be a detriment contributing to overall increases in health care costs and quality of care for those who have sustained a concussion.
Achilles Tendon Tears in Adolescents and Young Adults
Authors: Kramer Dennis E. , Beck Jennifer J. , Sanborn Ryan M. , Miller Patricia E. , Yen Yi-Meng , Park Howard Y. , Heyworth Benton E. 
Published: May 2022

Background: Achilles tendon tears are rare in adolescents and young adults, and management of these injuries remains controversial. Hypothesis/Purpose: To describe long-term limitations and physical activity levels following full or partial Achilles tears in adolescents and young adults, and report rates of surgical management, complications, re-tears, and time to return to sports (RTS). Methods: We conducted a descriptive study of young patients (8-22 years old) who were treated for a partial or full Achilles tear at two pediatric hospitals between 2004-2018. Demographic, imaging, and treatment data were retrospectively collected. Patient reported outcomes were obtained including the Achilles Tendon Total Rupture Score (ATRS), Foot and Ankle Outcomes Score (FAOS), Tegner Activity Scale (TAS), and separate questions about reinjury and return to sport. Results: Of the 41 eligible patients with Achilles injuries, 25 (61%; mean age 18.9 years; 40% male) had a minimum one year of follow-up data and were further analyzed. Twenty-three patients (92%) underwent surgical repair. Twenty patients (80%) returned questionnaires at a median 6.3 years (IQR, 3.4 to 9.7 years), while the other 5 patients were followed for a median of 1.8 years (IQR, 1.1 to 2.5 years). Twenty-two (88%) injuries were full tears, 53% (10/19) with reported location occurring mid-tendon. Median ATRS score was 96 (IQR, 82-100) and median TAS score was 6 (4-8). Median FAOS scores were excellent for symptoms (91), pain (100), ADL (100), and sports (98), and were good for QOL (88). The 6-month RTS probability was 47% (95% CI, 19-66%) and at 12 months was 95% (65-99%). The median time to RTS for partial tears was 5.6 months vs. 6.6 months for full tears (p=0.05). One surgical patient (4%) had a retear which required revision repair while 2 others needed additional surgery (1 - arthroscopy for ankle impingement, 1 - surgery for haglund’s deformity). In addition to the 3 surgical patients requiring re-operation, 8 patients experienced other complications (11/25 total complications, 44%), which included minor wound/scar complications (4), scar formation necessitating hydrodissection (1), Achilles tendonitis (2), and persistent pain following conservative treatment leading to surgical repair (1). Females were more likely to experience a complication (9/15, 60%) compared to males (2/10, 20%), but this difference was not statistically significant (p=0.10). Conclusion: Adolescents and young adults surgically treated for an Achilles injury reported satisfactory long-term outcomes.
Pediatric Hurdle Injuries in Track and Field: A Descriptive Epidemiologic Study
Authors: Radel LC , Jones JC , Garcia KS , Soma DB , Sugimoto D 
Published: May 2022

Background: Track & field has more combined participants compared to any other high school sport in the United States. Hurdling is a track event that is unique due to a combination of running and jumping over an apparatus. As a result, this puts athletes at risk for various musculoskeletal injuries. However, there has been a paucity of studies describing the epidemiology of pediatric hurdle injuries Purpose: To examine hurdle-related injury types, body locations, injury mechanisms, and injury settings in children and adolescents. Methods: This was a retrospective review of data that was extracted from the National Electronic Injury Surveillance System (NEISS), which represents emergency room visits. Injury data involving hurdle injuries was searched during a 10-year period (2008-2017) involving patients 18 and under. Injuries were then classified based upon injury type, body locations involved, injury mechanisms, and injury settings. Descriptive statistics were used including mean ± standard deviation and frequency (N) was expressed as percentages (%). Results: A total of 749 hurdle related injuries were found from 333 males (44.5%) and 416 females (55.5%). Their mean ages were 14.0±2.2 years. The top 3 commonly recorded injury types were traumatic fracture (N=218, 29.1%), joint sprain (N=191, 25.5%), and contusion/hematoma/bruise (N=78, 10.4%). The overall top 3 injured body locations were ankle (N=140, 18.7%), knee (N=120, 16.0%), and wrist (N=69, 9.2%). Most injury mechanisms were trips, falls, and landings involving the hurdle (N=594, 79.0%). The rest of the mechanisms included ground involvement only (N=47, 6.3%) and other equipment (N=7, 0.9%). Finally, injury settings consisted of track & field practices (N=469, 62.6%), track & field meets (N=96, 12.8%), and other settings including gym, physical education class, recess, school activities, and camps (N=49, 6.5%). Conclusion: In pediatric hurdle athletes, most injuries seen in the emergency room are due to involvement of the hurdle and most occur during track practices. Although most injuries occur in the lower extremity, upper extremity injuries are also common. This information could be helpful in playing a role in targeted event-specific injury prevention initiatives.
Regulation and Selective Utilization of Peripheral Nerve Blocks Decrease Residual Neurological Symptoms After Pediatric Knee Surgery
Authors: Xu Amy L. , Lee R. Jay 
Published: May 2022

Background: Peripheral nerve blocks (PNBs) are an essential tool for reducing postoperative pain, but they have recently been associated with a higher incidence of complications than previously thought. Hypothesis/Purpose: We compared 1) incidence of PNB-related postoperative neurological symptoms and 2) patient selection, operative practices, and anesthetic practices regarding PNBs for pediatric patients who underwent knee surgery before and after changes in administration of PNBs at our institution. Methods: We compared data from pediatric patients who underwent knee surgery with PNBs at our institution during 2 periods: 2014–2016 (Cohort 1; 100 patients) and 2017–2019 (Cohort 2; 104 patients). Cohort 1 was described in a previous study, and Cohort 2 consisted of consecutive patients treated by 1 orthopaedic surgeon after recognition of the higher rate of complications and limiting use of PNBs to an anesthesia service at our institution. We compared cohorts using Student t-tests and chi-squared tests. P < 0.05 was considered significant. Results: The incidence of PNB-related neurological complications was significantly lower in Cohort 2 (0.96%; n = 1) than in Cohort 1 (6%; n = 6) (p = 0.045). The 1 patient in Cohort 2 had numbness proximal to the knee, which resolved by 9.5 weeks postoperatively. Of the 6 patients in Cohort 1, 5 also had numbness proximal to the knee, and 1 had shooting pains down the leg upon palpation of the femoral block site. Three of these patients had unresolved symptoms at final follow-up. There was a greater proportion of female patients in Cohort 2 (57%) than in Cohort 1 (36%) (p = 0.01), with no significant differences in age or BMI. The Cohort 2 surgeries also had significantly longer average operating times and a higher proportion using tourniquets (p<0.01). More fellows (67% vs. 55%) and fewer residents (6.9% vs. 16%) performed PNBs in Cohort 2 than in Cohort 1 (p = 0.01). The most common anatomical site for PNBs was the femoral nerve (51%; n = 85) in Cohort 1 and the saphenous nerve (51%; n = 90) in Cohort 2 (p < 0.01). Conclusions: The incidence of PNB-related complications after pediatric knee surgery was significantly lower after our institution implemented changes in the regulation of PNB use. This reduction may be explained by a shift toward more experienced providers administering PNBs and preference for distal anatomic sites, which may suggest actionable items for other institutions aiming to lower their PNB complication rate. [Table: see text][Table: see text]