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  • 1
    Online Resource
    Online Resource
    Use of a Modified All-Epiphyseal Technique for Anterior Cruciate Ligament Reconstruction in the Skeletally Immature Patient
    SAGE Publications ; 2018
    In:  Orthopaedic Journal of Sports Medicine Vol. 6, No. 7 ( 2018-07), p. 232596711878176-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 6, No. 7 ( 2018-07), p. 232596711878176-
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967118781769
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 2
    Online Resource
    Online Resource
    Progressive elbow abnormalities are common on MRI in asymptomatic Little League baseball players
    SAGE Publications ; 2020
    In:  The American Journal of Sports Medicine Vol. 48, No. 2 ( 2020-02), p. 466-472
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 48, No. 2 ( 2020-02), p. 466-472
    Abstract: Prior studies have revealed magnetic resonance imaging (MRI) evidence of elbow pathology in single-season evaluation of competitive youth baseball players. The natural history of these findings and risk factors for progression have not been reported. Purpose: To characterize the natural history of bilateral elbow MRI findings in a 3-year longitudinal study and to correlate abnormalities with prior MRI findings, throwing history, playing status, and physical examination. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective study of Little League players aged 12 to 15 years was performed. All players had preseason and postseason bilateral elbow MRI performed 3 years before this study. Players underwent repeat bilateral elbow MRI, physical examination, and detailed assessment of throwing history, playing status, and arm pain. Imaging was read by a blinded musculoskeletal radiologist and compared with prior MR images to assess for progression or resolution of previously identified pathology. Results: All 26 players who participated in the previous single-season study returned for a 3-year assessment. At the completion of the study, 15 players (58%) had dominant arm MRI pathology. Eighty percent (12/15 players) of MRI findings were new or progressive lesions. Players with postseason MRI pathology at the beginning of the study were more likely to have MRI pathology at the 3-year follow-up than players with previously normal postseason MRI ( P 〈 .05), although 6 of the 14 players (43%) with previously normal MRI developed new pathology. Year-round play was a significant predictor of tenderness to elbow palpation ( P = .027) and positive MRI findings at 3 years ( P = .047). At the 3-year follow-up, 7 players (27%) reported having throwing elbow pain and 3 had required casting. Additionally, differences were noted in the dominant arm’s internal and external rotation in those that continued to play baseball ( P 〈 .05). Conclusion: Dominant elbow MRI abnormalities are common in competitive Little League Baseball players. Year-round play imparts significant risk for progression of MRI pathology and physical examination abnormalities.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    URL: Article
    DOI: 10.1177/0363546519888647
    DOI: 10.21203/rs.2.23779/v1
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 3
    Online Resource
    Online Resource
    Recurrence of Patellar Instability in Adolescents Undergoing Surgery for Osteochondral Defects Without Concomitant Ligament Reconstruction
    SAGE Publications ; 2019
    In:  The American Journal of Sports Medicine Vol. 47, No. 1 ( 2019-01), p. 66-70
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 47, No. 1 ( 2019-01), p. 66-70
    Abstract: First-time patellar dislocation with an associated chondral or osteochondral loose body is typically treated operatively to address the loose fragment. The incidence of recurrent instability in this patient population if the medial patellofemoral ligament (MPFL) is not reconstructed is unknown. Purpose: To determine the recurrent instability rate in patients undergoing surgery for patellar instability with chondral or osteochondral loose bodies, as well as to identify and stratify risk factors for recurrent instability. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective analysis of adolescent patients treated operatively for acute patellar dislocation with associated chondral or osteochondral loose bodies between 2010 and 2016 at a single pediatric level I trauma center with minimum 2-year follow-up. Potential demographic, injury-related, radiographic, and surgical risk factors were recorded. The primary outcome variable was recurrent subluxation and/or dislocation. Secondary outcome variables included need for additional procedures, Kujala score, Single Assessment Numerical Evaluation (SANE) score, and patient satisfaction. Results: Forty-one patients were included. In total, 61% experienced recurrent instability at a mean follow-up of 4.1 years and 39% required subsequent MPFL reconstruction. Tibial tubercle-trochlear groove (TT-TG) distance greater than 15 mm was a risk factor for recurrent instability ( P = .03). Patients with TT-TG distance greater than 15 mm and greater than 20 mm had recurrent instability rates of 75% and 86%, respectively. MPFL repair did not reduce the rate of recurrent instability ( P = .87). Recurrent instability was associated with significantly worse mean Kujala (93.9 vs 83.0; P = .01), SANE (88.9 vs 73.1; P = .01), and patient satisfaction scores (9.4 vs 7.3; P = .002). Conclusion: If the MPFL is not reconstructed during index loose body treatment, children have a 61% recurrent instability rate. Patients with TT-TG distance greater than 15 mm, and particularly greater than 20 mm, are at highest risk for recurrent instability.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546518808486
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 4
    Online Resource
    Online Resource
    Improving Lower Extremity Casting Quality by Providing an Experienced Assistant in Pediatric Tibia Fractures Managed by Trainees
    SAGE Publications ; 2022
    In:  HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery Vol. 18, No. 1 ( 2022-02), p. 122-129
    Details
    In: HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery, SAGE Publications, Vol. 18, No. 1 ( 2022-02), p. 122-129
    Abstract: Background: The value of employing an orthopedic technician or advanced practice provider (OT/APP) to assist trainees during on-call hours has not been assessed. As the third most common pediatric long bone fracture, most tibial fractures can be managed with closed reduction and casting. Purpose: We sought to determine whether clinical outcomes could be positively affected for traumatic childhood tibia fractures by using an experienced OT/APP to aid orthopedic surgery residents with closed reduction and casting. Methods: We performed a retrospective chart review of tibial shaft fractures that occurred between 2010 and January 2017. Fractures undergoing manipulation and closed reduction by orthopedic surgery residents (post-graduate year 2 to 4) in the emergency department were included and differentiated into 2 cohorts: (1) residents who performed the procedure alone and (2) residents who were assisted by an OT/APP. Comparisons in cast quality and treatment success were made using univariate statistics followed by a multivariate Classification and Regression Tree (CART) analysis. Results: Of the 73 patients who met our criteria, 38 received treatment by a resident alone and 35 by a resident assisted by an OT/APP. Evidence to support our hypothesis was found with the resident-alone group “over” padding the casts posteriorly. Univariate analysis demonstrated that the rate of subsequent surgical intervention was more than double in the resident-alone group (31% vs 14%), yet OT/APP castings underwent more wedging at follow-up (17% vs 0%). CART analysis revealed initial fracture severity and lack of OT/APP assistance as predictors of surgical intervention with terminal nodes, in increasing order of risk of requiring surgical intervention: lower translation on sagittal and anteroposterior (AP), lower sagittal translation with greater AP translation, greater sagittal translation with OT/APP assistance, and greater sagittal translation without assistance. The initiation of a cast application-training program in 2015 decreased the need for surgical treatment in the resident-only group (pre-program 38.5% vs post-program 17%), although this was not statistically significant. Conclusion: When residents were assisted by OT/APP with initial tibia closed reduction and casting, subsequent loss of reduction was more likely to be managed with cast wedging; when this assistance was not available, there was a higher rate of fractures needing surgical intervention due, in part, to poor casting technique. The reduction in the rate of surgical intervention after an internal training program was implemented suggests that trainees may improve their casting ability without added help of an experienced assistant. Future study should be performed on distal radius fractures to determine if the presented findings are valid across casting types.
    Type of Medium: Online Resource
    ISSN: 1556-3316 , 1556-3324
    URL: Article
    DOI: 10.1177/1556331621992259
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2210985-7
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  • 5
    Online Resource
    Online Resource
    Adolescent Medial Patellofemoral Ligament Reconstruction: A Comparison of the Use of Autograft Versus Allograft Hamstring
    SAGE Publications ; 2018
    In:  Orthopaedic Journal of Sports Medicine Vol. 6, No. 5 ( 2018-05-01), p. 232596711877427-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 6, No. 5 ( 2018-05-01), p. 232596711877427-
    Abstract: Recurrent patellar instability is commonly treated with medial patellofemoral ligament reconstruction (MPFLR), and the use of allograft in anterior cruciate ligament reconstructions has demonstrated inferior outcomes. Purpose: To compare the outcomes of allografts versus autografts in adolescent MPFLR for patellar instability. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review was completed on patients younger than 18 years who underwent MPFLR for recurrent instability after failed nonoperative management over an 8-year period with a minimum 2-year follow-up. Patients were divided into autograft or allograft hamstring cohorts for comparison. Primary outcome measures were return to normal activity, incidence of redislocation/subluxation, pain, stiffness, other complications, and Kujala scores. Statistical analysis using unpaired t tests was performed, with an alpha value set at P 〈 .05. Results: After criteria were applied, 59 adolescents (36 allograft, 23 autograft; 38 girls, 21 boys) with a mean ± SD age of 15.2 ± 1.7 years and a mean follow-up of 4.1 ± 1.9 years (allograft, 3.3 ± 1.1 years; autograft, 5.7 ± 2.1 years; P ≤ .001) were included. Seven patients had concurrent osteotomies (3 allograft, 4 autograft), 11 patients had concurrent loose body removals (5 allograft, 6 autograft), and 9 patients had concurrent lateral release (7 allograft, 2 autograft). Between groups, no significant difference was found in change between preoperative and most recent follow-up (mean, 1.2 ± 2.1) or rate of return to sports (mean, 73.3%). In total, 9 surgeries failed (3 allograft, 6 autograft). For the surviving grafts, a statistical difference in mean Kujala scores at final follow-up was noted (allograft, 92.7; autograft, 97.4; P = .02). Conclusion: We identified no significant differences in return to activity, pain score changes, and incidences of failure between patients undergoing MPFLR with allograft versus autograft. Although teenagers with surviving autograft MPFLR reported statistically higher Kujala scores, the mean score difference of 5 points was not clinically significant. It appears that using allograft tendon instead of autograft tissue for MPFLR in this teenage population does not adversely affect long-term outcomes.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967118774272
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 6
    Online Resource
    Online Resource
    Chemical biology
    Elsevier BV ; 2000
    In:  Current Opinion in Chemical Biology Vol. 4, No. 3 ( 2000-6), p. 243-251
    Details
    In: Current Opinion in Chemical Biology, Elsevier BV, Vol. 4, No. 3 ( 2000-6), p. 243-251
    Type of Medium: Online Resource
    ISSN: 1367-5931
    URL: Article
    DOI: 10.1016/S1367-5931(00)00083-1
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2000
    detail.hit.zdb_id: 2019216-2
    SSG: 12
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  • 7
    Online Resource
    Online Resource
    Intra-articular Physeal Fractures of the Distal Femur: A Frequently Missed Diagnosis in Adolescent Athletes
    SAGE Publications ; 2017
    In:  Orthopaedic Journal of Sports Medicine Vol. 5, No. 10 ( 2017-10-01), p. 232596711773156-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 5, No. 10 ( 2017-10-01), p. 232596711773156-
    Abstract: Intra-articular physeal fractures of the distal femur are an uncommon injury pattern, with only a few small case series reported in the literature. Purpose: To pool patients from 3 high-volume pediatric centers to better understand this injury pattern, to determine outcomes of surgical treatment, and to assess risk factors for complications. Study Design: Case series; Level of evidence, 4. Methods: A multicenter retrospective review of all patients presenting with an intra-articular physeal fracture between 2006 and 2016 was performed. Patient demographic and injury data, surgical data, and postoperative outcomes were documented. Radiographs were evaluated for fracture classification (Salter-Harris), location, and displacement. Differences between patients with and without complications were compared by use of analysis of variance or chi-square tests. Results: A total of 49 patients, with a mean age of 13.5 years (range, 7-17 years), met the inclusion criteria. The majority of fractures were Salter-Harris type III fractures (84%) involving the medial femoral condyle (88%). Football was responsible for 50% of the injuries. The initial diagnosis was missed in 39% of cases, and advanced imaging showed greater mean displacement (6 mm) compared with radiographs (3 mm). All patients underwent surgery and returned to sport with “good to excellent” results after 2 years. Complications were more common in patients with wide-open growth plates, patients with fractures involving the lateral femoral condyle, and patients who were casted ( P 〈 .05). Conclusion: Clinicians evaluating skeletally immature athletes (particularly football players) with acute knee injuries should maintain a high index of suspicion for an intra-articular physeal fracture. These fractures are frequently missed, and advanced imaging may be required to establish the diagnosis. Leg-length discrepancies and angular deformities are not uncommon, and patients should be monitored closely. Surgical outcomes are good when fractures are identified, with high rates of return to sport.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967117731567
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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  • 8
    Online Resource
    Online Resource
    Chemical biology
    Elsevier BV ; 2000
    In:  Current Opinion in Chemical Biology Vol. 4, No. 4 ( 2000-8), p. 357-366
    Details
    In: Current Opinion in Chemical Biology, Elsevier BV, Vol. 4, No. 4 ( 2000-8), p. 357-366
    Type of Medium: Online Resource
    ISSN: 1367-5931
    URL: Article
    DOI: 10.1016/S1367-5931(00)00115-0
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2000
    detail.hit.zdb_id: 2019216-2
    SSG: 12
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  • 9
    Online Resource
    Online Resource
    The Curse of the All-Star Team: A Single-Season Prospective Shoulder MRI Study of Little League Baseball Players
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Pediatric Orthopaedics Vol. 40, No. 1 ( 2020-01), p. e19-e24
    Details
    In: Journal of Pediatric Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 1 ( 2020-01), p. e19-e24
    Abstract: Throwing guidelines have been implemented in Little League baseball in an attempt to minimize injuries in young baseball players. We hypothesized that playing pitcher or catcher and increased innings played during the season would result in dominant shoulder magnetic resonance imaging (MRI) abnormalities. Methods: A prospective evaluation of Little League players aged 10 to 12 years was performed. Players recruited before the start of the season underwent bilateral preseason and dominant shoulder postseason MRI, physical examination, and questionnaires addressing their playing history and arm pain. Innings played, player position, pitch counts, and all-star team selection were recorded. Results: In total, 23 players were enrolled. The majority (19/23, 82.6%) were right-handed and 16 of 23 (69.6%) played at least 10 innings as pitcher or catcher. Sixteen were selected for the all-star team. Fourteen players (60.9%) had positive dominant shoulder MRI findings not present in their nondominant shoulder. Eight players (34.8%) had new or worsening postseason MRI findings. Thirteen players (81.3%) selected to the all-star team had abnormal MRI findings whereas only one (14.3%) player not selected as an all-star had MRI abnormalities ( P =0.005). Year-round play ( P =0.016), innings pitched ( P =0.046), innings catcher ( P =0.039), and number of pitches ( P =0.033) were associated with any postseason MRI abnormality, but not for new or worsening MRI changes. Single sport athletes and players playing for multiple teams were significantly more likely to have abnormal MRI findings ( P =0.043 and 0.040, respectively) when compared with multisport athletes playing on a single team. Conclusions: MRI abnormalities involving the dominant shoulder are common in Little League baseball players and often develop or worsen during the season. Contrary to our hypothesis, MRI abnormalities were not associated with player position and pitch counts. Instead, they were most closely associated with year round play, single sports participation, and all-star team selection. The increased demands required for all-star selection comes at a price to the young athlete as the majority of players selected for this honor had abnormal MRI findings in their throwing shoulder while few non all-stars demonstrated such pathology. Level of Evidence: Level II.
    Type of Medium: Online Resource
    ISSN: 0271-6798
    URL: Article
    DOI: 10.1097/BPO.0000000000001391
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2049057-4
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  • 10
    Online Resource
    Online Resource
    Shoulder MRI Abnormalities in Asymptomatic Little League Baseball Players
    SAGE Publications ; 2018
    In:  Orthopaedic Journal of Sports Medicine Vol. 6, No. 2 ( 2018-02-01), p. 232596711875682-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 6, No. 2 ( 2018-02-01), p. 232596711875682-
    Abstract: Youth baseball is extremely popular in the United States, but it has been associated with shoulder pain and injury. The incidence of shoulder abnormalities in this athletic population has yet to be defined. Purpose: To examine abnormalities noted on magnetic resonance imaging (MRI) in the shoulders of asymptomatic Little League baseball players and to correlate these findings with the players’ throwing history and physical examinations. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 23 Little League baseball players aged 10 to 12 years were recruited. All players underwent a comprehensive physical examination and responded to a questionnaire addressing their playing history and any arm or shoulder pain. Bilateral shoulder MRIs were performed and read in a blinded manner by 2 radiologists. Responses on the questionnaire and physical examination findings were compared between participants with and without positive MRI findings through use of chi-square test and analysis of variance. Results: The dominant arm was 8.5 times more likely to have an abnormality on MRI compared with the nondominant arm. In all, 12 players (52%) had 17 positive MRI findings in their throwing shoulder that were not present in their nondominant shoulder. These findings included edema or widening of the proximal humeral physis (n = 5), labral tear (n = 4), partial rotator thickness tear (n = 4), acromioclavicular joint abnormality (n = 2), subacromial bursitis (n = 1), and cystic change of the greater tuberosity (n = 1). Two primary risk factors were associated with an abnormal MRI: year-round play and single-sport athletes focusing solely on baseball ( P 〈 .05). Players with no risk factors, 1 risk factor, and both risk factors had a 25%, 71%, and 100% chance, respectively, of having an abnormal MRI. A majority of players (61%) had previously experienced shoulder pain, especially pitchers throwing curveballs and sliders ( P 〈 .05), but this was not associated with an abnormal MRI. Conclusion: Abnormalities seen on MRI involving the shoulder are common in Little League baseball players, especially those who are single-sport athletes playing year-round.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967118756825
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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