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  • 1
    Online Resource
    Online Resource
    Strength Deficits at 3 and 6 Months Can Predict Timing of Return to Sport after ACL Reconstruction in Adolescent Athletes
    American Academy of Pediatrics (AAP) ; 2016
    In:  Pediatrics Vol. 137, No. Supplement 3 ( 2016-02), p. 560A-560A
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 137, No. Supplement 3 ( 2016-02), p. 560A-560A
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.137.Supplement_3.560A
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2016
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  • 2
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    Male and Female Adolescent Athletes' Readiness to Return to Sport After Anterior Cruciate Ligament Injury and Reconstruction
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Clinical Journal of Sport Medicine Vol. 31, No. 4 ( 2021-07), p. 383-387
    Details
    In: Clinical Journal of Sport Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 31, No. 4 ( 2021-07), p. 383-387
    Abstract: The purpose of this study was to examine whether readiness to return to sport (RTS) differed between adolescent male and female athletes after anterior cruciate ligament reconstruction (ACLR). Design: Longitudinal, prospective cohort. Setting: Outpatient office associated with tertiary-care hospital. Patients: A total of 93 adolescent athletes, 17 years of age and younger, who underwent ACLR surgery with a hamstring autograft were included. Independent Variables: Male and female athletes. Main Outcome Measures: Anterior cruciate ligament–return to sport after injury (ACL-RSI) completed at 3 time points: (1) preoperatively (Pre-op), (2) approximately 3 months into rehabilitation (Post-op 1), and (3) during RTS phases of recovery (Post-op 2). Results: There was a significant main effect for both sex ( P 〈 0.010) and time ( P 〈 0.0001) with male athletes having higher ACL-RSI scores than female athletes at all 3 time points; however, there was no significant time by sex interaction. All ACL-RSI scores increased significantly across time, regardless of sex. There were no statistically significant differences between ACL-RSI scores at all 3 time points between individuals who did and did not receive physician clearance. Conclusions: This study provides a longitudinal depiction of adolescent athletes' readiness to RTS after ACL injury throughout recovery. Both male and female athletes demonstrated diminished ACL-RSI scores before undergoing surgery, with increasing scores at both postoperative time points for both sexes. Overall, female athletes reported lower readiness to RTS at all 3 time points compared with male athletes.
    Type of Medium: Online Resource
    ISSN: 1050-642X
    URL: Article
    DOI: 10.1097/JSM.0000000000000751
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2045233-0
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  • 3
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    Clinical Outcome Measures and Return-to-Sport Timing in Adolescent Athletes After Anterior Cruciate Ligament Reconstruction
    Journal of Athletic Training/NATA ; 2018
    In:  Journal of Athletic Training Vol. 53, No. 5 ( 2018-05-01), p. 442-451
    Details
    In: Journal of Athletic Training, Journal of Athletic Training/NATA, Vol. 53, No. 5 ( 2018-05-01), p. 442-451
    Abstract: Multiple factors are likely associated with an adolescent athlete's ability to return to play after anterior cruciate ligament (ACL) reconstruction (ACLR). Objective:  To investigate the relationship between self-reported and functional outcome measures on return-to-play timing in an adolescent population, in athletes who returned and those who did not return to sport, and to identify a cutoff value for isometric quadriceps strength that could serve as a clinical target for maximizing the odds of returning to play after ACLR. Design:  Cross-sectional study. Setting:  Outpatient clinic. Patients or Other Participants:  Adolescent athletes who underwent ACLR and completed clinical measures at their 3- and 6-month follow-up appointments were included. Main Outcome Measure(s):  Clinical measures included functional outcomes of isometric and isokinetic strength tests and the Anterior Cruciate Ligament Return to Sport After Injury scale and the pediatric version of the International Knee Documentation Committee subjective form. Physician clearance dates for return to play were obtained from patient records. Results:  Higher strength measures were associated with better scores on the Anterior Cruciate Ligament Return to Sport After Injury and the pediatric version of the International Knee Documentation Committee instruments at each follow-up. Differences were found in isometric extension strength (P = .001) and isokinetic extension strength at 180°/s (P = .03) and 300°/s (P = .002) between patients who returned to sports and those who did not. A 6-month isometric extension deficit (mean Limb Symmetry Index = 85.48 ± 23.15) displayed high accuracy (area under the curve = 0.82, 95% confidence interval = 0.68, 0.95) for identifying patients who returned to play after ACLR. Conclusions:  Higher strength measures at both 3 and 6 months after ACLR were associated with greater self-reported knee function and greater readiness to return to functional activities at 6 months and ultimately earlier return to sport in adolescent athletes. These results provide evidence that self-reported outcome scores should be used as an additional screening tool in conjunction with quadriceps strength testing to help provide realistic recovery timeframes for adolescent patients.
    Type of Medium: Online Resource
    ISSN: 1062-6050
    URL: Article
    DOI: 10.4085/1062-6050-302-16
    Language: English
    Publisher: Journal of Athletic Training/NATA
    Publication Date: 2018
    detail.hit.zdb_id: 2070051-9
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  • 4
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    PATIENT REPORTED OUTCOME SCORES DIFFER IN ADOLESCENTS WHO DISCONTINUE ATHLETIC PARTICIPATION FOLLOWING CONCUSSION
    SAGE Publications ; 2019
    In:  Orthopaedic Journal of Sports Medicine Vol. 7, No. 3_suppl ( 2019-03-01), p. 2325967119S0011-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 7, No. 3_suppl ( 2019-03-01), p. 2325967119S0011-
    Abstract: Clinical knowledge of concussion injuries and subsequent recovery has grown significantly in recent years. However, an area that has not been well investigated is a patient’s psychological readiness to return to their sport following their concussion and the potential impact the injury may have on their athletic participation. A recent preliminary study on the Concussion Return to Sport After Injury questionnaire showed the outcome to be valid and reliable. Further investigations to determine clinical relevance are warranted to specifically understand the ability of the outcome to correctly identify athletes who are fearful or lack confidence to return back to their main sport. Therefore, the purpose of this study was to investigate if C-RSI scores were different in adolescent athletes who made the decision to discontinue participating in their main sport against those who were remaining in their main sport following a concussion. Methods: As part of clinical care, all concussion patients seen at an outpatient adolescent sports medicine concussion clinic complete a series of patient reported outcomes, which includes the Concussion Return to Sport After Injury Questionnaire (C-RSI), at their initial evaluation and release visit. The C-RSI is a 12-question patient reported outcome designed to measure readiness to return to sport after an injury. Patients who decided not to return to their main sports following their concussion were identified from a prospectively collected database, based on a “no” response to the question “are you planning on returning back to your main sport” (Group 1). A group of gender, age, previous concussion history, main sport and outcome time point (initial visit or final visit) matched patients who answered “yes” to this same question were collected as a control group (Group 2). Description statistics were computer for all patient demographics and C-RSI scores. Student T-tests were completed to determine if differences existed between groups for patient demographics and C-RSI scores. Results: A total of 126 patients were included in this study, with 28 females and 35 males in each group. There were no differences between groups for age (Group 1 - 14.9±2.4 years, Group 2 - 14.9±2.1 years; p=0.938), previous concussion history (Group 1 – 33 patients, Group 2 – 31 patients; p=0.596), or length of recovery (Group 1 – 86±68 days, Group 2 – 69±53 days; p=0.142). Group 1 had an average C-RSI score of 56.2±20.4 at initial evaluation (n=33) and 73.9±20.8 at final visit (n=30), compared to Group 2’s average C-RSI score of 68.1±22.7 (n=33) and 83.1±12.9 (n=30). Group 1 had statistically lower C-RSI scores compared to Group 2 at both initial visit (p=0.011) and final visit (p=0.044). Two thirds of the patients in Group 1 cited fear of getting another concussion (38.1%), family encouraged discontinuation of main sport (33.3%), physician encouraged discontinuation of main sport (8.0%) as the reasons for not continuing. Conclusion: Concussions are challenging injuries that can result in a significant psychological response in patients. Patient reported outcomes have been shown to be beneficial in providing clarifying information regarding how the patient perceives their recovery and overall health. The results from this study demonstrate that C-RSI scores were statistically lower in adolescent patients who decided to discontinue their main sport following a concussion. The use of the C-RSI in clinical practice may help identify patients who are at risk of not returning back to their main sport due to internal and external psychological factors such as fear or lack of confidence. Further investigation is warranted to understand the length of time adolescent patients remain away from their main sport and if they choose to pursue a secondary sport.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967119S00114
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 5
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    Do Age and Weightbearing Radiographs Affect Lateral Joint Space and Fibular Height Measurements in Patients With Discoid Lateral Meniscus?
    SAGE Publications ; 2018
    In:  Orthopaedic Journal of Sports Medicine Vol. 6, No. 3 ( 2018-03-01), p. 232596711876053-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 6, No. 3 ( 2018-03-01), p. 232596711876053-
    Abstract: Several radiographic parameters have been associated with a discoid lateral meniscus. However, limited information is available regarding the radiographic findings of a discoid meniscus in the pediatric population. Purpose: To determine the effect of age and weightbearing (WB) on radiographic parameters associated with discoid lateral menisci in pediatric patients. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Radiographs of pediatric patients with arthroscopically confirmed lateral discoid menisci were compared with age-, side-, and sex-matched individuals with confirmed normal menisci. Radiographic parameters of lateral joint space width (LJSW) and fibular head height (FHH) were measured by 3 physicians. Results: Significant differences were found between the discoid and control groups when LJSW ( P = .002) and FHH ( P 〈 .001) were compared. Interrater reliability was good for LJSW (intraclass correlation coefficient [ICC], 0.635) and excellent for FHH (ICC, 0.759). WB radiographs were noted to have better interrater reliability compared with non-WB radiographs for LJSW (ICC, 0.729 vs 0.514, respectively) but had reduced interrater reliability for FHH (ICC, 0.625 vs 0.868, respectively). Subgroup analysis with age stratification indicated that FHH was significantly decreased (indicative of a high fibular head) in the discoid group for all age groups ( P 〈 .001 for 〈 10 years and 10-14 years; P = .030 for 〉 14 years); however, LJSW was significantly different only in patients older than 14 years. Conclusion: Increased LJSW and FHH were associated with discoid lateral menisci and showed satisfactory interrater reliability. Radiographic evaluation for potential discoid meniscus in pediatric and adolescent patients may be improved by use of fibular height to indicate the presence of a discoid lateral meniscus across age groups, while lateral joint space may be more reliable for older patients.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967118760534
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
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  • 6
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    Osteochondritis Dissecans of the Knee: An Interrater Reliability Study of Magnetic Resonance Imaging Characteristics
    SAGE Publications ; 2020
    In:  The American Journal of Sports Medicine Vol. 48, No. 9 ( 2020-07), p. 2221-2229
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 48, No. 9 ( 2020-07), p. 2221-2229
    Abstract: Imaging characteristics of osteochondritis dissecans (OCD) lesions quantified by magnetic resonance imaging (MRI) are often used to inform treatment and prognosis. However, the interrater reliability of clinician-driven MRI-based assessment of OCD lesions is not well documented. Purpose: To determine the interrater reliability of several historical and novel MRI-derived characteristics of OCD of the knee in children. Study Design: Cohort study (diagnosis); Level of evidence, 3 Methods: A total of 42 OCD lesions were evaluated by 10 fellowship-trained orthopaedic surgeons using 31 different MRI characteristics, characterizing lesion size and location, condylar size, cartilage status, the interface between parent and progeny bone, and features of both the parent and the progeny bone. Interrater reliability was determined via intraclass correlation coefficients (ICCs) with 2-way random modeling, Fleiss kappa, or Krippendorff alpha as appropriate for each variable. Results: Raters were reliable when the lesion was measured in the coronal plane (ICC, 0.77). Almost perfect agreement was achieved for condylar size (ICC, 0.93), substantial agreement for physeal patency (ICC, 0.79), and moderate agreement for joint effusion (ICC, 0.56) and cartilage status (ICC, 0.50). Overall, raters showed significant variability regarding interface characteristics (ICC, 0.25), progeny (ICC range, 0.03 to 0.62), and parent bone measurements and qualities (ICC range, –0.02 to 0.65), with reliability being moderate at best for these measurements. Conclusion: This multicenter study determined the interrater reliability of MRI characteristics of OCD lesions in children. Although several measurements provided acceptable reliability, many MRI features of OCD that inform treatment decisions were unreliable. Further work will be needed to refine the unreliable characteristics and to assess the ability of those reliable characteristics to predict clinical lesion instability and prognosis.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546520930427
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2063945-4
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  • 7
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    Sleep Disturbance and Neurocognitive Function During the Recovery From a Sport-Related Concussion in Adolescents
    SAGE Publications ; 2015
    In:  The American Journal of Sports Medicine Vol. 43, No. 3 ( 2015-03), p. 633-640
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 43, No. 3 ( 2015-03), p. 633-640
    Abstract: Sleep disturbances are a hallmark sign after a sport-related concussion (SRC). Poor sleep has been shown to adversely affect baseline neurocognitive test scores, but it is not comprehensively understood how neurocognitive function is affected by disrupted sleep during recovery from a concussion. Purpose: To identify the correlation between adolescent athletes’ neurocognitive function and their self-reported sleep quantity and sleep disturbance symptoms during recovery from SRC. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Immediate Post-Concussion Assessment and Cognition Testing (ImPACT) data were retrospectively collected for 545 adolescent athletes treated for SRC at a sports medicine concussion clinic. Patients were stratified into groups based on 2 criteria: self-reported sleep duration and self-reported sleep disturbance symptoms during postinjury ImPACT testing. Sleep duration was classified as short ( 〈 7 hours), intermediate (7-9 hours), and long ( 〉 9 hours). Sleep disturbance symptoms were self-reported as part of the Post-Concussion Symptom Scale (PCSS) as either sleeping less than normal, sleeping more than normal, or having trouble falling asleep. One-way analyses of variance were conducted to examine the effects that sleep duration as well as self-reported sleep disturbance symptoms had on composite scores. A total of 1067 ImPACT tests were analyzed: test 1, 545; test 2, 380; and test 3, 142. Results: Sleeping fewer than 7 hours the night before testing correlated with higher PCSS scores ( P 〈 .001), whereas sleeping longer than 9 hours correlated with worse visual memory ( P = .01), visual motor speed ( P 〈 .001), and reaction time ( P = .04) composite scores. With regard to self-reported sleep disturbance symptoms, patients demonstrated worse composite scores during ImPACT testing when they self-reported sleeping more than normal (ImPACT test 1: verbal memory, P 〈 .001; visual motor speed, P = .05; reaction time, P = .01; ImPACT test 2: verbal memory, P 〈 .001; visual memory, P 〈 .001; visual motor speed, P 〈 .001; reaction time, P = .01). Adolescent patients recovering from SRC demonstrated higher (worse) PCSS scores ( P 〈 .001) when they sensed that their sleep had been disrupted. Conclusion: Adolescent patients who perceive that their sleep is somehow disrupted after SRC may report a greater number of concussion symptoms during their recovery. In addition, the study results suggest that sleeping more than normal may identify an individual who continues to be actively recovering from concussion, given the correlation between lower neurocognitive function and this self-reported symptom.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546514560727
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2063945-4
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  • 8
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    Descriptive Epidemiology From the Research in Osteochondritis Dissecans of the Knee (ROCK) Prospective Cohort
    SAGE Publications ; 2022
    In:  The American Journal of Sports Medicine Vol. 50, No. 1 ( 2022-01), p. 118-127
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 50, No. 1 ( 2022-01), p. 118-127
    Abstract: Osteochondritis dissecans (OCD) occurs most commonly in the knees of young individuals. This condition is known to cause pain and discomfort in the knee and can lead to disability and early knee osteoarthritis. The cause is not well understood, and treatment plans are not well delineated. The Research in Osteochondritis Dissecans of the Knee (ROCK) group established a multicenter, prospective cohort to better understand this disease. Purpose: To provide a baseline report of the ROCK multicenter prospective cohort and present a descriptive analysis of baseline data for patient characteristics, lesion characteristics, and clinical findings of the first 1000 cases enrolled into the prospective cohort. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients were recruited from centers throughout the United States. Baseline data were obtained for patient characteristics, sports participation, patient-reported measures of functional capabilities and limitations, physical examination, diagnostic imaging results, and initial treatment plan. Descriptive statistics were completed for all outcomes of interest. Results: As of November 2020, a total of 27 orthopaedic surgeons from 17 institutions had enrolled 1004 knees with OCD, representing 903 patients (68.9% males; median age, 13.1 years; range, 6.3-25.4 years), into the prospective cohort. Lesions were located on the medial femoral condyle (66.2%), lateral femoral condyle (18.1%), trochlea (9.5%), patella (6.0%), and tibial plateau (0.2%). Most cases involved multisport athletes (68.1%), with the most common primary sport being basketball for males (27.3% of cases) and soccer for females (27.6% of cases). The median Pediatric International Knee Documentation Committee (Pedi-IKCD) score was 59.9 (IQR, 45.6-73.9), and the median Pediatric Functional Activity Brief Scale (Pedi-FABS) score was 21.0 (IQR, 5.0-28.0). Initial treatments were surgical intervention (55.4%) and activity restriction (44.0%). When surgery was performed, surgeons deemed the lesion to be stable at intraoperative assessment in 48.1% of cases. Conclusion: The multicenter ROCK group has been able to enroll the largest knee OCD cohort to date. This information is being used to further understand the pathology of OCD, including its cause, associated comorbidities, and initial presentation and symptoms. The cohort having been established is now being followed longitudinally to better define and elucidate the best treatment algorithms based on these presenting signs and symptoms.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465211057103
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2063945-4
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  • 9
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    Motion analysis evaluation of adolescent athletes during dual-task walking following a concussion: A multicenter study
    Elsevier BV ; 2018
    In:  Gait & Posture Vol. 64 ( 2018-07), p. 260-265
    Details
    In: Gait & Posture, Elsevier BV, Vol. 64 ( 2018-07), p. 260-265
    Type of Medium: Online Resource
    ISSN: 0966-6362
    URL: Article
    DOI: 10.1016/j.gaitpost.2018.06.165
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 1500471-5
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  • 10
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    Patient-Reported Outcomes, Return-to-Sport Status, and Reinjury Rates After Anterior Cruciate Ligament Reconstruction in Adolescent Athletes: Minimum 2-Year Follow-up
    SAGE Publications ; 2020
    In:  Orthopaedic Journal of Sports Medicine Vol. 8, No. 11 ( 2020-11-01), p. 232596712096447-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 8, No. 11 ( 2020-11-01), p. 232596712096447-
    Abstract: Significant variation exists in the published rates of return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR). Functional outcomes and psychological response to injury have been implicated as factors that influence return to sport. Most studies focus on patients aged in the mid-20s, and less is known about this topic in adolescents. Purpose: To report midterm ACLR results for adolescent patients with regard to return to primary sport, patient-reported outcomes, and reinjury rate. Study Design: Case-control study; Level of evidence, 3. Methods: Adolescent athletes were contacted at a minimum of 2 years after ACLR. Patients completed 2 patient-reported outcome measures, the ACL--Return to Sport After Injury (ACL-RSI) and the International Knee Documentation Committee (IKDC) subjective form, and responded to questions regarding preinjury primary sport and level of competition, post-ACLR return to primary sport status, and reinjury. Results: A total of 74 patients (mean ± SD surgical age, 15.9 ± 1.5 years; follow-up age, 19.9 ± 2.0 years; response rate, 24.5%) completed the surveys at a mean of 4.0 ± 2.0 years after primary ACLR. Outcome scores averaged 90.3 ± 12.3 for IKDC and 81.6 ± 20.4 for ACL-RSI. Questionnaire responses indicated that 27.0% of patients did not return to or sustain primary sport participation after ACLR; the principal reasons were poor knee function, team/training change, and fear of another injury. Both IKDC and ACL-RSI scores were statistically lower in patients who did not successfully return to their primary sport in contrast to patients who successfully resumed their primary sport (IKDC, P = .026; ACL-RSI, P 〈 .001). IKDC and ACL-RSI scores were moderately positively correlated with one another ( r Spearman = 0.60). There were 18 patients (reinjury rate, 24.3%) who suffered another ACL injury; 8 of these injuries included ipsilateral ACL graft tear (retear rate, 10.8%). Conclusion: In our cohort, 73% of adolescent patients successfully returned to their primary preinjury sport at a minimum of 2 years after ACLR. Both knee function and psychological responses to injury were important in determining an adolescent athlete’s return to sport. The findings support the use of the IKDC and ACL-RSI at midterm follow-up, with higher scores associated with a greater likelihood of adolescent patients returning to sport after ACLR.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967120964471
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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