bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pupillary Light Reflex Metrics Differ in Adolescents with Acute Concussion VS. Persistent Post-Concussion Symptoms
Authors: Master Christina L. , Podolak Olivia E. , Ciuffreda Kenneth J. , Joshi Nabin R. , McDonald Catherine C. , Margulies Susan S. , Grady Matthew F. , Arbogast Kristy B. 
Published: May 2022

Background: A potential objective measure that may assist in identifying vision disorders after concussion is the pupillary light reflex (PLR), which is under autonomic control and contributes to normal convergence and accommodative function which is altered after concussion. This study sought to compare pupillometry measures in adolescents with concussion initially presenting for care in the early acute time frame (≤ 2 weeks post-concussion) to those presenting in the later acute time frame (4 ± 1 weeks). Hypothesis: To determine whether PLR metrics are similar or different between athletes with concussion presenting earlier (≤ 2 weeks post-concussion) for care vs. those presenting later for care (4 ± 1 weeks). Methods: Athletes, ages 12-18 years, with a diagnosis of sport-related concussion (n = 110) were recruited. 89 concussed subjects had their PLR assessment performed at an early acute time point ≤ 2 weeks after concussion, while 21 concussed subjects had their first assessment at a later acute time point (4 week±1 week). Pupillary dynamics were measured in response to a brief, step-input, white light stimulus (154 ms duration; 180 micro watts power) via a Neuroptics PLR-3000 hand-held, infrared, automated, monocular pupillometer (Neuroptics, Irvine, CA). The means of the PLR metrics were compared between groups with one-way Student’s t test. Bonferroni correction was applied. Results: The baseline pupil diameter (mean ± SD) was significantly larger (p<0.05) for the subjects seen later 4 ± 1 week (5.09 mm ± 0.63) as compared to the cohort of subjects who presented earlier within 2 weeks after injury (4.72 ± 0.79mm). Average constriction velocity ACV for the later-presenting cohort (3.35±0.45 mm/s) was significantly faster compared to the early-presenting cohort (3.04±0.59 mm/s). Similarly, maximum constriction velocity for the groups were significantly different (early 4.82±0.90 versus late 5.31±0.70 mm/s), even after Bonferroni correction (p<0.05), with alpha of 0.025. All the other pupillometric parameters were not different from each other. Conclusion: When comparing adolescents with concussion presenting early in the acute phase ≤ 2 weeks after concussion to those presenting later in the acute timeframe to care 4±1 weeks, those presenting later demonstrate enhancement of certain PLR metrics, namely larger baseline pupil diameter and faster average constriction velocity (ACV) and maximum constriction velocity (MCV). Differences in these PLR metrics in those presenting later in the acute timeframe may represent findings in those who are more likely to have persisting post-concussion symptoms, potentially shedding light on pathophysiological underpinnings of lingering symptoms.
Plain Radiographs Have Limited Utility in the Evaluation of Discoid Lateral Meniscus
Authors: Schlesinger Reid P. , Rangwani Sean M. , Patel Neeraj M. 
Published: May 2022

Background: Debate persists regarding which radiographic measurements are important when investigating a possible discoid lateral meniscus and the utility of x-rays in the diagnostic workup. Hypothesis/Purpose: The purpose of this study was to identify differences in various measurements between healthy knees and those with a discoid meniscus while controlling for other patient characteristics. Methods: Radiographs of patients with a confirmed discoid lateral meniscus were matched by age and sex to those with a healthy knee (verified by magnetic resonance imaging). The following parameters were associated with discoid meniscus in previous studies and were measured on x-ray for each subject: lateral joint space height (both in the central and medial portion of the compartment; LJSH-C and LJSH-M, respectively), medial joint space height, fibular head height (FHH), lateral tibial spine height, femoral inter-epicondylar distance, lateral tibial plateau obliquity, and chordal distance of the femoral condyle (medial and lateral). Ratios were calculated between LJSH-C/M and medial joint space height. Univariate analysis was followed by multivariate regression to adjust for confounders. Results: The study included 57 patients with a discoid meniscus and 55 controls with a mean age of 11.0±3.5 years (50% female). The median LJSH-C for subjects with a discoid meniscus was 7.3 mm [interquartile range (IQR) 2.1] compared to 5.8 mm (IQR 2.2) in normal knees (p<0.001). A similar difference was found for LJSH-M [6.9 mm (IQR 2.9) vs. 5.4 mm (IQR 2.4), p=0.002]. Mean FHH was lower for discoid menisci than controls (12.5±4.0 mm vs. 14.9±5.9 mm, p=0.01). No other radiographic measurements were significantly different between cases and controls. When adjusting for covariates in regression analysis, the presence of a discoid meniscus was predictive of a higher LJSH-C and LJSH-M and lower FHH. Of note, age and sex were also significantly predictive in these models. Patients with a discoid meniscus had 3.5 times higher odds of LJSH-C ≥7 mm [95% confidence interval (CI) 1.5-8.3, p=0.005), 3.3 times higher odds of LJSH-M ≥6 mm (95% CI 1.4-7.9, p=0.006), and 3.1 times higher odds of FHH <16 mm (95% CI 1.2-7.8, p=0.02). Conclusion: After controlling for other factors, LJSH-C, LJSCH-M, and FHH on plain radiographs were associated with a discoid lateral meniscus. However, many previously reported measurements were not predictive. While these parameters may aid diagnostic decision making when there is suspicion for a discoid meniscus, age and sex must also be considered. Advanced imaging may be required to confirm the diagnosis.
Altered Joint Powers During Running After Tibial Bone Stress Injury
Authors: Lyons Samuel M. , Morgan Jeffery J. , Chan Salinda K. , Kraus Emily A. 
Published: May 2022

Background: Tibial bone stress injuries (tib-BSI) are common in adolescent runners. Previous research has examined running mechanics as possible risk factors for tib-BSI’s and implications have been observed for both kinematic and kinetic measures. Combining these measures to examine power absorption and production of the lower extremity can provide context on mechanical differences in individuals with a history of tib-BSI. Hypothesis/Purpose: The purpose of this study was to examine total limb power and percent joint contribution in healthy adolescent runners compared to peers with a history of tib-BSI. It was hypothesized that runners with a history of tib-BSI would have a greater contribution of power production and absorption at the ankle, and less at the hip and knee joints, with no difference in total power. Methods: Twenty-six runners were divided into groups: history of tib-BSI (n=14; male=10, female=4; age=16±2) and healthy controls (n=12; male=5, female=7; age=18±7). Data were collected using 3D motion capture with embedded force plates during overground running at self-selected pace. Total limb power and percent joint contribution were calculated from joint work. Positive and negative joint work was summed from the integrations of the joint power-time curve in each plane. Joint work was divided by step-time to obtain total joint power. Joint powers for the hip, knee, and ankle were summed to determine total limb power and percentage of limb power was calculated for each joint. Variables were grouped by control limb (CON), uninvolved limb (UNI), and involved limb (BSI). Both limbs in the healthy controls were averaged to generate the CON group. A one-way ANOVA was used to compare the variables of limb and joint power. Results: There were no significant differences between BSI and UNI limbs for any variables measured. The CON group exhibited significantly greater hip negative power compared to the BSI group (p=0.047), and significantly less ankle negative power compared to the BSI (p=0.001) and UNI groups (p=0.002). Despite a significant difference in total positive power between groups (p=0.04), there were no differences in joint positive power. Variables are presented in Table 1. Conclusion: This study is preliminary evidence that adolescent runners with a history of tib-BSI can present with adaptations in running mechanics that are not limited to the injured leg. Negative power may be more sensitive to change with the ankle increasing its contribution, comparatively. Clinicians and researchers should be aware of this adaptation after injury as it may influence treatment.
Remodeling of Adolescent Displaced Clavicle Fractures: A Facts Study
Authors: Pennock Andrew T. , Bae Donald S. , Boutelle Kelly , Busch Michael T. , Carroll Alyssa , Edmonds Eric W. , Ellis Henry B. , Hergott Katelyn , Kocher Mininder S. , Li Ying , Nepple Jeffrey J. , Pandya Nirav K. , Perkins Crystal , Sabatini Coleen S. , Spence David D. , Willimon Samuel C. , Wilson Philip L. ,   FACTS Study Group (Function after Adolescent Clavicle Trauma and Surgery [FACTS], prospective, multicenter cohort study), Heyworth Benton E 
Published: May 2022

Background: The phenomenon of bony remodeling of healed displaced clavicle midshaft fractures in adolescents remains poorly understood. Hypothesis/Purpose: The purpose of the current study was to evaluate and quantify clavicle remodeling in a large population of adolescents with completely displaced fractures treated non-operatively to understand the factors that may influence this process. Methods: Patients were identified from the database(s) of a multi-center study group investigating the functional outcomes of adolescent clavicle fractures. Patients between the ages of 10 and 19 years with completely displaced mid-diaphyseal clavicle fractures that were treated non-operatively who had further imaging of the affected clavicle at a minimum of 9 months from initial injury were included. Radiographic measurements were performed on the injury and final follow-up films. Fracture remodeling was subjectively classified as ‘complete/near-complete’, ‘moderate’, or ‘minimal’ (Figure 1) and subsequently analyzed quantitively and qualitatively to determine factors associated with deformity correction. Results: Eighty-one patients (mean age of 14.4±2.2 years) were analyzed at a mean radiographic follow-up of 34.8±24.3 months. Fracture shortening, superior displacement, and angulation significantly improved during the follow-up period by 60%, 57%, and 38% respectively. Fracture remodeling was found to be associated with patient age and follow-up time, with younger patients and those with longer follow-up undergoing more remodeling. All patients <14 years and 83% of patients ≥14 years-old at time of injury with a minimum follow-up of four years underwent complete/near-complete remodeling. Conclusion: Significant clavicle remodeling occurs in adolescent patients with displaced fractures, including older adolescents and particularly when followed for longer time intervals. This finding may help explain why symptomatic malunions are so infrequently observed in adolescent patients, even in severely displaced fractures. [Figure: see text]
Sport-Specific Amcamp: New Modular Tools For Measuring Adolescent Self-Confidence in Sport-Specific Movement
Authors: May Keith H. , Espinoza William C. , Guccione Andrew A. 
Published: May 2022

Background: Despite increasing interest throughout sports rehabilitation in psychological factors that affect outcome such as the impact of self-efficacy on readiness to return to play, few clinical tools are available to assess a patient’s self-confidence in performing sports-specific movement patterns in the pediatric/adolescent population prior to return to sport. Hypothesis/Purpose: The purpose of this study was to develop and validate sports-specific modules to supplement a general measure of movement self-efficacy, the Adolescent Measure of Confidence and Movement Performance (AMCaMP) and provide clinicians with reliable and valid tools to assess adolescent self-confidence in performing sports-specific movements. Methods: After preliminary testing for readability and ease of administration, we administered one of 12 sport-specific modules pertinent to the individual’s sport (baseball, softball, basketball, football, gymnastics, cheerleading, soccer, ballet, swimming, lacrosse, tennis, and cross country), to a total of 14,744 patients, 11-18 years of age, who were drawn from 12 pediatric sports physical therapy facilities in a single health care system. Respondents completed the assigned sport-specific self-report questionnaire both at their initial visits and upon conclusion of their episodes of care. Results were analyzed using classical test theory measures including but not limited to factor analysis suitability, exploratory factor analysis, and confirmatory factor analysis. Results: Based on sample sizes, Bartlett’s Test of Sphericity, and Kaiser-Myer-Olkin measures, nine of the 12 candidate modules (baseball, softball, basketball, football, gymnastics, cheerleading, soccer, ballet, and swimming) were deemed suitable for factor analysis. The sample for each module was then divided into a test sample and a validation sample to avoid model overfitting and to check for generalizability. Exploratory factor analysis revealed an underlying structure ranging from one to three factors depending upon the particular module. Subsequent confirmatory factor analyses fully supported the hypothesized factor structures for each module except swimming. Additional analyses to determine coefficient alpha (range=0.8-0.976), Standard Error of Measurement (range=1.12-2.33), and Minimum Detectable Change (range=3.1-6.47) confirmed the reliability of each of these modules. Conclusion: The AMCAMP sport-specific modules are reliable and valid self-report tools to capture self-confidence in performing essential movements specific to a sport and supplement the AMCAMP’s evaluation of self-efficacy in performing the general movements of everyday life. The results of this study support the use of the AMCAMP sport-specific modules as a reliable and valid self-report instruments as part of the overall clinical evaluation of psychological readiness to return to sport.
Covid-19 Restrictions and the Effects of Physical Activity on Mental Health in Midwestern Adolescent Adaptive Athletes
Authors: Choe Joshua , Azerf Saji , Lang Pamela 
Published: May 2022

Background: The COVID-19 pandemic and related lockdowns in 2020 negatively impacted high school students, with increased depression and anxiety especially in athletes who participated in team sports. For adolescents with disabilities, physical activity provides physical and mental health benefits; however, the impact of COVID-19 related adaptive sports cancellations have not been thoroughly investigated. Hypothesis: Adaptive athletes with lower activity levels during a period of COVID-19 related restrictions will have worse scores of depression, anxiety, and quality of life. Methods: Institutional Review Board (IRB) exemption was granted. Adaptive athletes ages 12-21 were identified through Midwestern adaptive athletic associations. Athletes completed a survey between June 2020 and January 2021 including Patient Health Questionairre-9 Item (PHQ-9) for depression, General Anxiety Disorder-7 Item (GAD-7) anxiety, Pediatric Functional Activity Brief Scale (PFABS) for activity level, and Pediatric Quality of Life Inventory 4.0 (PedsQL) for quality of life. PFABS and PedsQL were modified as appropriate to adaptive athletes. Univariate analysis was performed using chi-square tests to assess the association between activity and mental health. Student T-tests were used for multivariate analysis to assess the role of sex, grade in school, and individual vs team sport participation on quality of life. Results: Twenty-four respondents completed the survey in its entirety, with majority from Wisconsin, Minnesota, and Illinois. Demographics are shown in Table 1. There was no significant association between physical activity levels and GAD-7 (R2=-0.040), PHQ-9 (R2=-0.020) or PedsQL (R2=-0.043). Activity levels of adaptive sports athletes did not differ by gender, sport type or school grade (Table 1). Discussion: Unlike previous work in able-bodied adolescents, we found no correlation between physical activity and scores related to depression and anxiety among adolescent adaptive sports athletes during COVID-19. Additionally, there were no difference in activity levels nor mental health scores by gender, sport type nor school grade, a proxy for age. While, the sample size in this study was a fraction of those used in previous work, adaptive athletes are a small proportion of adolescent athletes. Adaptive athletes, who face greater challenges in society on a daily basis, may have had lower quality of life measures at baseline or more sophisticated coping mechanisms already in place providing fortitude in mental health in the face of the pandemic. Conclusion: In a small cohort of adaptive athletes in the Midwest region of the USA, sport related cancellations had no association with mental health scores from June 2020 to January 2021. [Table: see text]
Return to Play Rates of Young Athletes After Patellofemoral Instability Treatment
Authors: Brenner Madison , Cooper Savannah , Johnson Benjamin L. , Wyatt Charles W. , Wilson Philip L. , Ellis Henry B. 
Published: May 2022

Background: Following non-operative or operative treatment, many young patients with patellofemoral instability (PFI) desire to return to sport. The rate of return to play in young athletes following PFI treatment is not well known. Hypothesis/Purpose: To examine the return to play rates of skeletally immature and mature patients after either non-operative or operative treatment for PFI. Methods: Patients from a pediatric sports medicine clinic diagnosed with PFI prospectively followed over a 4+ year time frame were evaluated. Patients who had documented physical exam follow-up with a recorded date of return to play (RTP) were included in the study. Demographics, skeletal maturity, type of treatment, and physical exam details were included in the analysis. Results: Within this cohort of 62 knees, 35 of the 54 knees that played a primary sport (63.4%; mean age=14.87±2.02) ultimately returned to activity. 28 were skeletally immature (45.2%) and 34 were mature (54.8%). 5 knees received non-operative treatment (8.06%), and 57 received operative treatment (91.94%), including medial patellofemoral reconstruction, tibial tubercle osteotomy, and lateral release, among other procedures. 75.81% of patients were female, and 24.19% were male. The average time from PFI treatment to return to play was 236.48 days (±108.95). This time did not significantly differ between males and females, nor skeletally immature or mature knees (p=0.485; p=0.629). No physical exam points, such range of motion, J-sign, or patellar apprehension, were significant. Residual signs and symptoms were infrequent, but not absent at RTP: 11.1% positive apprehension, 8.5% mild J-sign, and 5.2% continued pain or instability in one or more locations on their knee at RTP. Significantly fewer skeletally mature patients returned to their primary sport after treatment (95.5% immature vs 40% mature, p<0.0001) not necessarily related to their knee or treatment. 32.76% of knees included had bilateral instability, which could increase average RTP if these athletes were not receiving simultaneous treatment. Conclusion: Over half of young athletes treated at a sports medicine clinic returned to play following PFI treatment.
Objective Diagnosis of Multidirectional Instability in Adolescent Patients Based on Glenohumeral Joint Capsule Dimensions on MR Analysis
Authors: Yoder Mason , Veerkamp Matthew , McDonald Colin , Parikh Shital N. 
Published: May 2022

Background: Multidirectional Instability (MDI) of shoulder in adolescents is a clinical diagnosis and there are no defined objective criteria to validate the diagnosis. Most patients with MDI have no identifiable labral or capsular tear pattern on MR imaging. Purpose: To identify objective criteria for MDI diagnosis in adolescent patients based on glenohumeral capsular dimensions on MR imaging. Methods: In a comparative retrospective study, the clinical records and MR arthrogram of adolescent patients treated for shoulder instability at our center between 2008 and 2019 were reviewed. Twenty-four patients treated for MDI were age-matched to 25 patients treated for Bankart tears. The width and depth of the rotator interval and multiple linear dimensions of the glenohumeral capsule were measured on sagittal-oblique MR arthrography sequences, after controlling for glenoid size. These dimensions were compared between the 2 groups using Student’s t-test. Power analysis showed a sample size of 16 in each group to be sufficient to detect 5 mm difference in average capsular dimension of 20 mm (power 0.8). Results: 24 patients (28 shoulders) 20 females, 4 males were in the MDI group; average age at time of surgery was 15.2 years (range, 8-20 yrs). The Bankart group consisted of 25 patients (27 shoulders), 9 females, 16 males; average age at time of surgery was 15.4 years (range, 11-18 yrs). The rotator interval depth was significantly greater in the MDI group than the Bankart group (MDI 8.5mm; Bankart 6.1mm) (p <0.01). The inferior, posteroinferior, and posterior dimensions (posterior-inferior quadrant, 3 to 6 o’clock position for left shoulder) of the glenohumeral joint capsule were significantly greater in the MDI group (inferior 24.5mm; posteroinferior 26.4mm, posterior 22.5mm) than in the Bankart group (inferior 20.4mm, posteroinferior 21.9mm, posterior 19.3mm) (p <0.01). Rotator interval width and all other capsular dimensions showed no statistically significant difference between the 2 groups. Conclusion: The depth of the rotator interval and dimension of the glenohumeral joint capsule in the posteroinferior quadrant on MR arthrography were significantly greater in adolescent patients with MDI. This is the first study to objectively quantify capsular volume in adolescent patients with MDI. This information needs to be further validated in prospective fashion and compared to normal capsular dimensions to calculate cut-off values for MDI diagnosis on MR analysis. [Figure: see text][Table: see text]