bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age-Related Changes on Mri Of Posterior Cruciate Ligament Morphology in A Skeletally Immature Population
Authors: Flaugh Rachel A. , Feroe Aliya G. , Shahein Amir A. , Mathew Stephen T. , Miller Patricia E. , Kocher Mininder S. 
Published: May 2022

Background: Magnetic resonance imaging (MRI) analysis of the developmental morphology of the anterior cruciate ligament (ACL) in pediatric and adult patients has led to the identification of anatomical risk factors for injury and optimization of surgical reconstruction. Similar work regarding pediatric posterior cruciate ligament (PCL) morphology is limited despite increasing incidence of PCL injury and rising favorability of surgical reconstruction. Purpose: The aim of this study was to describe age-dependent changes in ligamentous and osseous anatomy of the pediatric PCL by comparison of MRI measurements across pre-adolescent and adolescent age groups. Methods: Sixty patients with a knee MRI and wrist radiographs who were seen from 2008 to 2018 at a single tertiary care center were randomly selected from a departmental database and categorized into skeletal age groups (ages 7-9 years, 10-12 years, and 13-15 years) with 20 patients in each group (Table 1). Skeletal age was determined from wrist radiographs and patients with a PCL injury or prior knee surgery were excluded. Twelve dimensions of the PCL substance or its osseous attachment sites were measured on MRI by two independent reviewers. Pairwise comparisons were conducted between the youngest and intermediate, as well as the intermediate and oldest skeletal age groups. Results: There was statistically significant growth across skeletal age groups in femoral physis width (p<0.001), tibial physis width (p<0.001), and medial femoral condyle (MFC) width (p<0.001) and height (p<0.001). Growth in femoral PCL height (p=0.02), femoral PCL footprint to femoral physis height (p=0.004), tibial PCL insertion width (p<0.001), tibial PCL footprint to tibial physis height (p<0.001), and tibial epiphysis height (p=0.003) and width (p<0.001) was only statistically significant between the youngest and intermediate groups. Only MFC height (p=0.03) and width (p=0.001), femoral PCL height (p=0.05), and tibial physis width (p=0.02) were significantly larger in the oldest compared to the intermediate group. Intrasubstance PCL width did not demonstrate significant age-related change (Table 2). Intrarater reliability for all measurements was excellent; interrater reliability was variable. Conclusions: Morphological changes of the pediatric PCL and associated osseous anatomy vary by skeletal age throughout childhood and adolescence. These changes were most pronounced in preadolescents with open physes (ages 7-12 years) compared to adolescents with closing physes (ages 13-15 years), who demonstrated slowed or plateaued growth in most dimensions. These skeletal age-dependent transformations of the PCL and surrounding osseous anatomy may guide surgical planning and inform injury risk prediction and prevention in this active population. [Table: see text][Table: see text]
Factors Influencing Operative Management of Adolescent Proximal Humerus Fractures
Authors: Chan Jason , Para Ashok , Hernandez Vanessa , Nagel Sarah , Crawford Lindsay , McCormick Sekinat , Edobor-Osula Folorunsho 
Published: May 2022

Background: Controversy exists in the treatment of adolescent proximal humerus fractures as patients reach skeletal maturity. No universally agreed upon treatment algorithm currently exists for this population. Purpose: The purpose of this study is to determine risk factors that may pre-dispose a patient to have surgical treatment over non-operative treatment. Methods: This is an IRB approved multi-center retrospective cohort study of adolescent proximal humerus fractures treated by three pediatric orthopaedic surgeons at three academic hospitals. Adolescent was defined at ages 12-17. Variables analyzed include age, weight, mechanism of injury, treatment, associated injury, Neer-Horowitz (NH)grade, neck-shaft angle of the AP, axillary lateral and scapular Y view. Two-sample T-test was used to analyze continuous variables and categorical variables were analyzed using Chi-square test. Results: A total of 76 patients met inclusion criteria. 38.2% of patients received operative management. 28/76 (37%) fractures were classified as NH1, 22/76 (29%) as NH2, 12/76 (16%) as NH3 and 14/76(18%) as NH4. 4% of NH1, 17% of NH2, 100% of NH3, and 100% of NH4 fractures were treated operatively (p<0.001). When these fractures were simplified into <1/3 (NH1,2) or >1/3 displaced (NH3,4), the latter group had operative intervention more often (83% vs 4%) with risk ratio (RR) of 9.23 (P<0.001). Patients who were treated operatively were older (14.1yrs) than those who were managed non-operatively (13.3yrs) (p=0.01). Of the patients in the operative group, those who were treated with ORIF were older (15.2yrs) than those who were treated via percutaneous methods (13.8yrs) (p=0.01). Adolescents who were pedestrian struck were more likely to undergo operative management than other mechanisms RR=2.2 (p<0.01). Those who were polytraumatized more likely to undergo operative management than those with isolated injuries RR= 1.9 (p=0.02). Patient gender, BMI, weight, initial neck/shaft angulation and race were not found to be predictive of operative intervention. Conclusion: At the time of injury, factors that predispose an adolescent patient with a proximal humerus fracture to operative intervention are increased age, greater fracture displacement, pedestrian struck mechanism and being polytraumatized. These findings suggest that higher energy mechanisms of injury are predictive factors for operative intervention in adolescent proximal humerus fractures.
Sinding-Larsen-Johansson Disease: Analysis of the Associated Factors in the Largest Cohort to Date
Authors: McCormick Kyle L. , Tedesco Liana J. , Bixby Elise C. , Swindell Hasani W. , Popkin Charles A. , Redler Lauren H. 
Published: May 2022

Background: Sinding-Larsen-Johansson Disease (SLJ) is an overuse disorder seen in skeletally immature adolescents, on the same spectrum as Osgood-Schlatter disease (OSD). SLJ is caused by weakness at the tibial tubercle apophysis, leading to stress at the patellar apophysis. Like other overuse disorders, the mechanism behind this is thought to be quadriceps tightness. However, there is a paucity in research done on SLJ, with the vast majority of research being case reports. To our knowledge, we are able to present the largest cohort to date of 40 knees in 29 patients. Hypothesis/Purpose: Our aim was to utilize this large cohort to look at the demographics, clinical presentation and radiographic evidence of the disease, and begin to evaluate trends in SLJ. Methods: A case control study was conducted utilizing pediatric patients from our institution seen between 2013 and 2019 diagnosed with SLJ. The following variables were collected: demographics, clinical presentation, sporting activities, radiological evidence of effusion and fragmentation, and posterior tibial slope. Results: A total of 40 knees in 29 patients were analyzed. 38% (11/29) of patients presented with bilateral disease. The mean age of presentation was 12.1 ± 1.4 years. 62% of patients were male, with an average BMI of 19.7 ± 2.9. 41% presented with concomitant overuse injuries, predominantly OSD (31%) and Sever’s Disease (7%). All of the patients played sports; basketball and soccer were the most common (27.6% each). While some patients presented with symptoms that forced them to modify their activity level (35%), the vast majority (65%) had symptoms considered “mild,” with no changes to daily activities. Most patients (96%) had stable ligamentous exams. 100% of x-rays showed evidence of an effusion. The average posterior tibial slope was 8.2 ± 2.1°, with an average fragmentation of 0.8. We found no correlation between posterior tibial slope and severity of symptoms (p = 0.75) or between posterior tibial slope and fragmentation of the tibial apophysis (p = 0.70). Conclusion: Most patients with SLJ present with unilateral disease. Additionally, close to half of patients presented concomitantly with other overuse disorders. These patients are consistently athletes, but the disease predominantly did not cause a change in daily activities. We also found that patellar effusion was universally present in our cohort. More work needs to be done to determine factors associated with SLJ, but we believe this is the strongest and largest analysis to date of the patients presenting with this disease.
Elective Sports Surgery Leads to Postoperative Weight Changes in Pediatric Patients
Authors: Huang Sharon G. , Ellis Henry B. , Worrall Hannah , Ramo Brandon A. , Wilson Philip L. 
Published: May 2022

Background: Patients who undergo orthopaedic surgeries often have activity restrictions during postoperative recovery. It is unknown whether these extended periods of reduced activity lead to postoperative weight changes in pediatric patients. Purpose: The purpose of this study was to evaluate changes in body mass index (BMI) percentile in children and adolescents following primary sports surgeries. Methods: After institutional review board (IRB) approval was obtained, institutional records for utilized current procedural terminology (CPT) codes were used to identify patients who underwent elective sports surgery at a single pediatric orthopaedic institution between October 2016 and December 2018. Non-primary surgeries and patients without preoperative BMI measurements were excluded. Demographic characteristics, height, weight, and BMI at every follow-up visit within 30 months of surgery were collected. To account for expected growth with age, BMI percentiles were calculated. Statistical analysis of changes in BMI percentile at follow-up intervals of 3-7 months, 9-18 months, and 24-30 months after surgery was performed. Analyses were also performed based on preoperative BMI category (underweight, normal-weight, overweight, or obese, per Centers for Disease Control definitions) and upper- or lower-extremity surgery. Results: A total of 468 patients (50.4% female, average age 14.5 years) were available for study. Seven patients (1.5%) were underweight at the time of surgery, 262 normal-weight (56%), 87 overweight (18.6%), and 112 obese (23.9%). Sixty-nine surgeries were performed on the upper extremity, while 399 were on the lower extremity. While on average patients demonstrated a tendency to increase BMI percentile at each follow-up interval, these values did not reach significance. However, analysis by preoperative BMI category revealed that at 24-30 months after surgery, normal-weight patients had increased BMI percentile by 6.74 points ( p = .041) compared to baseline, while overweight patients had decreased BMI percentile by 17.65 points ( p = .020) (Table 1). By final follow-up, 32 of 262 initially normal-weight patients had increased their weight category to overweight or obese, while 40 patients who were initially overweight or obese had favorable decreases in weight category. Conclusion: Children and adolescents undergoing primary sports surgeries may experience postoperative changes in BMI percentile. Normal-weight patients tend to increase weight, while overweight patients may decrease weight over 2.5 years after surgery. [Table: see text]
Establishing A Crosstalk Between Pediatric and Adult Promis Domains in Sports Medicine
Authors: Block Andrew M. , Minaie Arya , Merklein Meghan , Nepple Jeffrey 
Published: May 2022

Introduction: Patient-Reported Outcomes Measurements Information System (PROMIS) has been shown to be a valid and reliable means to assess patient-reported outcomes in athletes participating in orthopedic research and clinical care. PROMIS domains are separately validated in both pediatric (<18 years) and the adult (>18 years) populations. However, the utilization of PROMIS in the adolescent athlete is complicated by the inability to convert between pediatric and adult PROMIS domains. Purpose: This study sought to establish conversion factors to transition between pediatric and adult values of the commonly tested PROMIS domains. Methods: This study consisted of 100 participants, aged 14-21 years old, who presented to orthopedic outpatient clinics with lower extremity complaints in various stages from initial presentation to postoperative recovery (excluding any within three months of surgery). All participants completed both adult and pediatric versions of the following PROMIS domains: Adult/Pediatric Mobility, Adult/Pediatric Pain Interference (PI), and Adult Physical Function (PF). Linear regression was utilized to determine a conversion factor between the two age groups within each domain by the mean difference. To evaluate the clinical significance of this difference, a 5-point threshold (representing minimally clinically important difference) between the two scores was set and 1-sided t-tests were performed. Results: Overall, 50 pediatric patients (mean age of 15.6 ± 1.1) and 50 young adult patients (18.9 ± 1.0) were included. Each group had roughly the same ratio of males to females (18:32 v. 17:33 for the pediatric and adult groups, respectively). Adult and Pediatric domains were all strongly correlated (range of r=0.85-0.87). In both groups, subjects scored higher on Adult domains than Pediatric domains (mean difference ranging from 4.2-6.3 points), all of which were significantly different (p<0.05 for all domains). When assessed for clinical significance, only Mobility and Pain Interference performance in the pediatric group were found to be significantly different (mean difference of 5.8 and 5.4, respectively). To convert between the scores for both populations, the following were calculated: Adult Mobility to Pediatric Mobility -4.2, Adult Physical Function to Pediatric Mobility -6.3, and Adult Pain Interference to Pediatric Pain Interference -4.3. Conclusion: This study demonstrated that while Adult and Pediatric domains are highly correlated, over half of patients demonstrated clinically significant differences between scores. This study established correction factors to allow conversion between Pediatric and Adult PROMIS domains with high correlation.
Outcomes of Isolated Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability in Ehlers-Danlos Syndrome
Authors: Nemunaitis James , Parikh Shital N 
Published: May 2022

Background: Ehlers-Danlos syndrome (EDS) -hypermobility type is characterized by generalized hyperlaxity which is considered to be a risk factor for patellar instability. Surgery is discouraged in this subset of patients due to high rates of failure. The outcomes following isolated Medial Patellofemoral Ligament Reconstruction (MPFLR) for patellar instability in EDS population has not been reported. Purpose: To analyze re-dislocation rates and patient-reported outcomes of isolated MPFLR for recurrent patellar instability in adolescents with EDS. The second purpose of the study was to compare allograft vs autograft for MPFL reconstruction in this specific population. Methods: Between 2010 and 2016, 21 knees in 16 consecutive patients underwent isolated MPFLR reconstruction for recurrent patellar instability. The diagnosis of EDS-hypermobility type, was confirmed by genetics for all patients, with Beighton score as the chief determinants. All patients underwent isolated MPFL reconstruction with hamstring tendon graft. Recurrent dislocation rate and patient-reported outcomes, including Pedi-IKDC, Kujala Score, HSS Pedi-FABS, Banff Instability Instrument 2.0, and KOOS Knee Survey were collected at minimum 2 year follow-up. Results: The mean age of the cohort was 15.4 years (range 13-18 years). All patients were females. 16 knees had atraumatic mechanism of patellar dislocation. 2 patients had an osteochondral fracture. 5 patients underwent bilateral MPFLR. 9 patients had prior surgeries on their knee; 6 were failed patellar stabilization procedures but only 1 was failed MPFLR. 14 knees had hamstring autograft and 7 had hamstring allograft. At minimum 2 years follow-up, 3 of 21 knees (14.2%) had recurrent dislocation. There were no other complications. The mean pedi IKDC, Kujala, Pedi-FABS, and BANFF scores were 66.62 (95% CI 8.52), 73.5 (95% CI 8.68), 6.73 (95% CI 2.86) and 57.15 (95% CI 10.24) respectively. The overall mean KOOS pain subscale was 73.85 (95% CI 9.95) and KOOS symptoms subscale score was 48.54 (95% CI 5.56). There were no significant differences in outcome scores and re-dislocation rates between autograft and allograft (p>0.5). There was no significant correlation between functional score and Beighton score. Conclusion: EDS-related patellar instability are primarily atraumatic in origin without an osteochondral fracture. Patients had significant improvements in function following isolated MPFLR at minimum 2 years follow-up. However, these functional improvements were less than historical controls. Re-dislocation rate of 14% is higher than normal population. EDS and joint hypermobility is not a contraindication to MPFLR but caution is recommended in managing patient expectations.
Physical Therapy Visit Utilization is Not Associated With Hop Test Performance After Acl Reconstruction in Pediatric and Adolescent Athletes: A Multicenter Study
Authors: Saper Michael , Butler Lauren , Giampetruzzi Nicholas , Greenberg Elliot , Link Meredith , Prati Victor , Weaver Adam 
Published: May 2022

Background: The relationship between physical therapy (PT) visit utilization and performance during single-legged hop testing after anterior cruciate ligament reconstruction (ACLR) in young patients is unclear. Purpose: To examine the effect of PT utilization on hop testing performance in pediatric and adolescent patients after ACLR. Methods: A retrospective review of patients who underwent primary ACLR between 2013 and 2019 at 5 institutions was conducted. All patients followed a structured rehabilitation protocol as directed by the treating institution and completed a return to sport (RTS) test which included single-legged hop testing. PT frequency was assessed both overall and by time period (first 6 weeks, week 7-month 3, 3-6 months, and 6-12 months). PT visits were recorded up until the time of hop testing. To account for variability, the average number of visits attended per week during the observed time was calculated for each patient. The effect of PT visit rate on the odds of passing a hop test was assessed using multivariable logistic regression controlling for time to test, age, sex, and insurance status. Passing was defined as achieving a limb symmetry index (LSI) ≥ 90% on all available tests (single hop, triple hop, crossover hop, and timed hop, if performed), as well as passing just the single hop test. The primary predictor of interest included the average rate of PT visits at the time of hop test (≥1 visit per week vs. <1 visit per week). Results: 289 patients were identified (mean age, 15.7 ± 1.9 years). The mean time from surgery to the first PT visit was 0.36 ± 0.24 months. RTS testing was performed at a mean of 8.0 ± 1.9 months. Patients averaged 0.98 ± 0.38 visits per week until the RTS test. Mean LSIs for the single hop, triple hop, crossover hop, and timed hop were 96.3 ± 8.2, 97.1 ± 6.5, 98.5 ± 7.8, and 98.2 ± 7.4, respectively. 68.9% of patients passed all performed test; 85.5% passed the single hop test. The weekly rate of PT visits had no statistically significant effect on the odds of passing all performed hop tests (OR, 0.98; 95% CI, 0.56-1.71) or the single hop test (OR, 1.05; 95% CI, 0.51-2.18). Furthermore, the distribution of PT visits did not affect hop testing performance (Table 1). Conclusion: The rate and distribution of PT visit utilization was not associated with hop testing performance in pediatric and adolescent patients after ACLR. [Table: see text]
Sport Participation and Specialization Characteristics in a Pediatric Sports Medicine Clinic
Authors: Worrall Hannah M. , Cooper Savannah , Jones Jacob C. , Miller Shane M. , Chung Jane S. 
Published: May 2022

Background: Recent trends in youth sports demonstrate athletes specializing in a single sport at younger ages in an effort to increase athletic success. Research suggests that increased training volume and early sport specialization are associated with increased injury risk, overuse injury, and athlete burnout. Although the exact threshold to avoid injuries has not been elucidated, some pediatric studies have shown increased risk of overuse injury with training more hours per week than their age in years. Hypothesis/Purpose: To determine if athletes presenting to a pediatric sports medicine clinic are participating in more hours per week than their age in years and associated factors related to sport participation. Methods: Data were prospectively collected from participants who presented to a tertiary sports medicine clinic for injury evaluation between October 2016-May 2021. Participants aged 5-<19 years who reported playing sports and had hours per week in their primary sport documented were included. Demographic and sport-related variables were reviewed. Participants were separated into two groups based on whether number of hours per week in their primary sport exceeded their age: UNDER (chronologic age and under) and OVER. Results: 10,586 total participants: 8846 (83.6%) UNDER and 1740 (16.4%) OVER. There was no difference in age (13.7±2.6 vs 13.6±2.6 years, p=0.27) between the UNDER and OVER group. There were more males (49.7 vs 38.5%, p<0.0001) and more Hispanic or Latinos (20.2 vs 16.4%, p<0.0001) in the UNDER compared to the OVER group. Soccer (23.0%) was the most common primary sport for the UNDER group while gymnastics (27.1%) was for the OVER group. More participants considered themselves single-sport athletes (68.5 vs 54.1%, p<0.0001) and reported their highest level of competition as club/select/travel (52.0 vs 38.2%, p<0.0001) in the OVER group than the UNDER group. The OVER group reported a significantly higher number of sport participation hours per week than the UNDER group (20.5±8.2 vs 6.9±3.7 hours, p<0.0001, Figure 1), an additional year (6.8±3.2 vs 5.6±3.3 years, p<0.0001), and weeks per year participating in their primary sport (41.7±13.4 vs 32.0±15.5 weeks, p<0.0001). Conclusion: About 15% of athletes seen at the sports medicine clinic reported participating in more hours per week than their age. These athletes were more likely to report being single-sport athletes and participating in club-style teams. Understanding this information may aid providers in educating families in the OVER group about potential increased risk for injury due to high weekly participation volumes and sport specialization. [Figure: see text]