Running Biomechanics and Clinical Features Among Adolescent Athletes With Lower Leg Chronic Exertional Compartment Syndrome.

OBJECTIVE: To compare clinical measures between patients with chronic exertional compartment syndrome (CECS) and healthy controls and evaluate running biomechanics, physical measurements, and exertional intracompartmental (ICP) changes in adolescent athletes with lower leg CECS. DESIGN: Cross-sectional case-control study. SETTING: Large tertiary care hospital and affiliated injury prevention center. PARTICIPANTS: Forty-nine adolescents with CECS (39 F, 10 M; age: 16.9 ± 0.8 years; body mass index (BMI): 23.1 ± 2.9 kg/m 2 ; symptom duration: 8 ± 12 months) were compared with 49 healthy controls (39 F, 10 M; age: 6.9 ± 0.8 years; BMI: 20.4 ± 3.7 kg/m 2 ). INTERVENTIONS: All participants underwent gait analyses on a force plate treadmill and clinical lower extremity strength and range of motion testing. Patients with chronic exertional compartment syndrome underwent Stryker monitor ICP testing. MAIN OUTCOME MEASURES: Symptoms, menstrual history, and ICP pressures of the patients with CECS using descriptive statistics. Mann-Whitney U and χ 2 analyses were used to compare CECS with healthy patients for demographics, clinical measures, and gait biomechanics continuous and categorical outcomes, respectively. For patients with CECS, multiple linear regressions analyses were used to assess associations between gait biomechanics, lower extremity strength and range of motion, and with ICP measures. RESULTS: The CECS group demonstrated higher mass-normalized peak ground reaction force measures (xBW) compared with controls (0.21 ± 0.05 xBW ( P < 0.001) and were more likely to have impact peak at initial contact ( P = 0.04). Menstrual dysfunction was independently associated with higher postexertion ICP (ß = 14.6; P = 0.02). CONCLUSIONS: The CECS group demonstrated increased total force magnitude and vertical impact transient peaks. In women with CECS, menstrual dysfunction was independently associated with increased postexertion ICP. These biomechanical and physiological attributes may play a role in the development of CECS.

Telehealth Potential in Pediatric Orthopaedics and Sports Medicine Care is Comparable to In-Person Care But Disparities Remain.

BACKGROUND: Understanding the challenges and potential of telehealth visits (THVs) in a large population can inform future practice and policy discussion for pediatric orthopaedic and sports medicine (OSM) care. We comprehensively assess telehealth challenges and potential in a large pediatric OSM population based on access, visit completion, patient satisfaction, and technological challenges. METHODS: Demographics, address, insurance, visit information, patient feedback, experience with video visits, and technical challenges of all 2019 to 2020 visits at our hospital were assessed (3,278,006 visits). We evaluated the differences in rate of telehealth utilization, rate of patient adherence, disparities in care access and patient satisfaction, and technological issues. RESULTS: Compared with in-person prepandemic visits, THVs had lower ratios of non-White patients (by 5.8%; P <0.001), Hispanic patients (by 2.8%; P <0.001) and patients with public insurance (by 1.8%; P <0.001), and a higher mean distance between the patient's residence and clinic (by 18.8 miles; P <0.001). There were minimal differences in median household income (average $2297 less in THV; P <0.001) and social vulnerability index (average 0.01 points lower in THV; P <0.001) between groups. THVs had comparable patient satisfaction to in-person visits. Non-White patients, Hispanics, and those with public insurance had lower ratings for both in-person visits and THVs and had more technical difficulties during their THV. CONCLUSIONS: Telehealth is a viable method of care for a range of pediatric OSM conditions, providing a similar quality of care as in-person visits with a greater geographic reach. However, in its current format, reduced disparities were not observed in pediatric OSM THVs. LEVEL OF EVIDENCE: Level III.

Protocol and validity testing of femoroacetabular posterior translation with dynamic hip ultrasonography.

OBJECTIVE: To describe femoroacetabular posterior translation (FAPT) using dynamic hip ultrasonography (DHUS), and to determine the inter- and intra-rater reliability of hip ultrasound measurements of FAPT. MATERIALS AND METHODS: The study design was a feasibility study of 13 healthy young adults (26 hips) using test-retest analysis. The data was collected prospectively over a 2-week time period. Three DHUS measurements (posterior neutral (PN), flexion, adduction, and internal rotation (PFADIR), and stand and load (PStand) were measured by four independent raters (2 senior who divided the cohort, 1 intermediate, 1 junior) at two time points for bilateral hips of each participant. Reliability was assessed by calculating the intraclass correlation coefficient (ICC) along with 95% confidence intervals (CIs) for each rater and across all raters. RESULTS: A total of 468 US scans were completed. The mean age of the cohort was 25.7 years (SD 5.1 years) and 54% were female. The inter-rater reliability was excellent for PFADIR (ICC 0.85 95% CI 0.76-0.91), good for PN (ICC 0.69 95% CI 0.5-0.81), and good for PStand (ICC 0.72 95% CI 0.55-0.83). The intra-rater reliability for all raters was good for PFADIR (ICC 0.60 95% CI 0.44-0.73), fair for PN (ICC 0.42 95% CI 0.21-0.59), and fair for PStand (ICC 0.42 95% CI 0.22-0.59). CONCLUSION: This is the first study to present a protocol using dynamic ultrasonography to measure FAPT. DHUS measure for FAPT was shown to be reliable across raters with varying levels of ultrasound experience.

The Effects of Injury Type on Health-Related Quality of Life in Youth Athletes: A Cross-Sectional Analysis.

OBJECTIVE: The relationship between health-related quality of life (HRQoL) and injury type has not been analyzed for young athletes. We hypothesized that there would be no difference in HRQoL between injured athletes, injured nonathletes, and normative data for healthy youth (NDHY) or among athletes with acute, overuse, or concussion injuries. DESIGN: Cross-sectional clinical cohort. SETTING: Primary care sports medicine clinics at 3 academic institutions. PARTICIPANTS: Patients aged 8 to 18 years presenting with injury. INDEPENDENT VARIABLES: Injury type and athletic participation. MAIN OUTCOME MEASURES: Health-related quality of life measured 1 month after injury through the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric-25 v2.0 assessed pain interference, peer relationships, depression, fatigue, anxiety, and mobility. One-way analysis of variance was performed with P values of <0.05 considered significant. Concussion Learning Assessment and School Survey (CLASS) evaluated academic performance. RESULTS: Three hundred fifty-seven patients (36% male), with average age of 14.2 years, completed HRQoL and CLASS surveys following injury. There were 196 overuse injuries (55%), 119 acute injuries (33%), and 42 concussions (12%). Ninety-four percent were athletes. Six percent were nonathletes; 90.5% of concussed patients reported grades worsening. Concussed athletes reported more fatigue (P = 0.008) compared with other injury types but no worse than NDHY. Athletes with overuse injuries had lower mobility (P = 0.005) than other injury types and NDHY. Patients with lower HRQoL were female, older age, or required surgery. No other domains had significant differences by injury type nor did HRQoL differ between the athletes, nonathletes, and NDHY. CONCLUSIONS: With the exception of injuries requiring surgery, HRQoL of injured young athletes was similar to NDHY in most domains.

Clinical assessment, treatment, and referral trends for adolescent runners seeking care at an injured runners' clinic.

PURPOSE: Over a 10-year time frame, this study aimed to evaluate diagnosis, treatment, and referral trends for adolescent runners seeking care for running-related injuries (RRIs) at a clinic that specializes in running medicine. METHODS: This study was a retrospective chart review of 392 adolescent runners (2,326 encounters) who sought care for RRIs between the years 2011 and 2021. Descriptive statistics were used to summarize clinical assessments, referrals, assistive devices, and medications prescribed or administered overall and by injury type. Chi-square analyses were used to compare proportions of services rendered across the 10-year time frame. RESULTS: Patients most frequently received manual evaluations or special tests during clinic visits. Most visits resulted in at least one referral (91%), primarily for physical therapy or gait-training. Assistive devices and medications/supplements were offered at only 18% of patient visits. The majority of assessments (X2 = 69.7, p = 0.002), treatments (X2: 23.6-43.8, p: <  0.001-0.003), and referrals (X2 = 132, p <  0.001) were for shin injuries. Larger proportions of nutrition assessments (X2 = 40.7, p <  0.001), interventions (X2 = 26.8, p = 0.003), and referrals (X2 = 27.5, p = 0.002) were performed in or after the year 2015. CONCLUSION: Clinic visits for shin injuries required the most clinical resources per episode of care. There were observed shifts in clinical assessment and treatment approaches to include more expanded nutritional and physiologic considerations.

Sport specialisation and performance-enhancing substance use by young athletes.

Objectives: To investigate the association of reported legal performance enhancing substance (PES) use and consideration of banned PES use among sport-specialised and non-sport-specialised young athletes. Methods and design: Cross-sectional study of 1049 young athletes enrolled in an injury prevention programme from 2013 to 2020. We used logistic regression modelling to determine the independent association between sports specialisation. We reported (1) legal PES use and (2) consideration of banned PES use after adjusting for the effects of gender, age, having a relative as a coach, unrestricted internet access, use of a weight training regimen, and weeknight hours of sleep. Results: The final cohort consisted of 946 athletes with a mean age of 14. 56% were female, and 80% were sport-specialised athletes. 14% reported legal PES use, and 3% reported consideration of banned PES use. No difference was found between sport-specialised athletes who reported legal PES use (OR=1.4; 95% CI 0.81 to 2.43; p=0.23) or consideration of banned PES use (OR=3.2; 95% CI 0.78 to 14.92; p=0.1) compared with non-sport-specialised athletes. Reported legal PES use was more common among athletes who were male, older, used weight training, and slept less. Reported consideration of banned PES use was more common among male and older athletes. Conclusions: PES use is not independently associated with sport specialisation in young athletes. Athlete sex, age, training, and sleep patterns are important factors for young athletes to consider in PES use.

Adolescent and young adult hip and knee strength profiles relate to running gait biomechanics.

OBJECTIVES: Compare and assess relationships between strength and running biomechanics among healthy adolescents and young adult males and females. DESIGN: Retrospective cohort. SETTING: Clinic. PARTICIPANTS: 802 healthy participants (570 F, 232 M; 16.6 ± 2.3 years). MAIN OUTCOME MEASURES: Mass-normalized knee flexor and extensor strength, hip adductor and abductor strength, hamstrings-to-quadriceps (H:Q), and abductor-to-adductor (Abd:Add) ratios were obtained using hand-held dynamometry. Mass-normalized peak vertical ground reaction force (vGRF), %stance, cadence, and stride length were obtained using an instrumented treadmill. Multivariate analyses of variance were used to compare strength and biomechanics across ages and sexes. Linear regressions were used to assess the relationships between strength and biomechanics, accounting for speed, age, and sex. Independent t-tests were used to compare strength between strength ratio profiles. RESULTS: Strength and running biomechanics significantly differed between sexes (p-range: <0.001-0.05) and age groups (p-range: <0.001-0.02). Strength and strength ratios were significantly associated with increased cadence (p-range:0.001-0.04) and stride lengths (p-range:0.004-0.03), and decreased vGRF (p < 0.001). Lower H:Q ratios had significantly lower strength measures (p < 0.001). Higher Abd:Add ratios had significantly increased abductor strength (p < 0.001). CONCLUSIONS: Strength and running biomechanics differed by sexes and ages. Hip and knee strength and strength ratios were related to select spatiotemporal and kinetic biomechanical features.

Outpatient Runners Clinic Visit Trends and Injury Characteristics Among 392 Child and Adolescent Patients: A 10-year Chart Review.

OBJECTIVE: To evaluate clinic visits and running-related injury (RRI) characteristics among child and adolescent runners seeking care at an outpatient clinic over a 10-year time frame. DESIGN: Retrospective chart review. SETTING: Outpatient hospital-affiliated Injured Runners Clinic. PATIENTS: Children and adolescent runners (6-17 years) with RRIs. INDEPENDENT VARIABLES: We examined electronic medical records (EMRs) among child and adolescent patients in the hospital database from 2011 to 2021 to obtain RRI characteristics and key demographic factors. MAIN OUTCOME MEASURES: We assessed volume and frequency of patient visits to the clinic by RRI characteristics. Chi square analyses were used to compare the proportion of clinic visits over time and injury trends by body region and diagnosis. RESULTS: There were 392 patients (sex: 277 F; mean age: 16.1 ± 1.3 years) and an average of 5 clinic visits per diagnosis (5 ± 4 visits; min: 1 visit, max: 31 visits). Number of visits generally increased over time up to 2016 but declined most drastically during the years of the pandemic (2020-2021; χ 2 = 644, P < 0 .001). Of the 654 new injury diagnoses, 77.68% were attributed to repetitive stress. Bone stress injuries to the tibia were the most common RRI (χ 2 = 1940, P < 0 .001; N = 132; 20.2% of all injuries) and constituted most of the clinic visits (χ 2 = 9271, P < 0 .001; N = 591; 25.4% of all visits). CONCLUSION: We identified that adolescents with overuse injuries, particularly bone stress injuries to the tibia, constituted most of the visits to the outpatient healthcare setting. Clinicians should emphasize injury prevention efforts in clinical practice to reduce RRI burden.

Adolescent exercise-related lower leg pain musculotendinous characteristics.

BACKGROUND: Exercise-related lower leg pain (ERLLP) is one of the most common injuries among adolescent runners; however, there is limited information available on lower extremity musculotendinous characteristics in relationship to injury. Ultrasound imaging has previously been used to evaluate musculotendinous structures among adults with chronic lower limb injuries. Similar measurement approaches may be adopted to assess young runners with ERLLP. OBJECTIVE: To compare ultrasound-derived lower extremity musculotendinous thickness, echogenicity, and muscle fiber pennation angles between adolescent runners with and without ERLLP. DESIGN: Cross-sectional design. SETTING: Hospital-affiliated sports injury prevention center. PARTICIPANTS: Twenty-eight adolescent runners with (N = 14) and without ERLLP (N = 14). INTERVENTIONS: Runners' patellar and Achilles tendons, and tibialis anterior, medial gastrocnemius, abductor hallicus, and flexor digitorum brevis muscles were assessed with ultrasound imaging using standardized procedures. MAIN OUTCOME MEASURES: Separate repeated measures multivariate analyses of covariance (covariate: gender) were used to compare groups and limbs for mass-normalized musculotendinous thickness, musculotendinous echogenicity, and extrinsic ankle muscle fiber pennation angles. RESULTS: The adolescent ERLLP group had reduced average muscle size for all structures except the tibialis anterior compared to the uninjured group (mean difference [MD] range: -0.12-0.49 mm/kg; p range: .002-.05), and reduced average medial gastrocnemius pennation angles on their case limb compared to their contralateral limb and the uninjured group (MD range: -3.7-6.4°; p < .001). The ERLLP group additionally had reduced average patellar and Achilles tendon size (MD range: -0.14--0.15 mm/kg; p range: .02-.03), and lower Achilles tendon echogenicity compared to uninjured counterparts (MD: -18; p = .02). CONCLUSIONS: Adolescent runners with ERLLP exhibited morphological musculotendinous changes that may occur either as a result of or as a contributing factor to pain and persistent dysfunction. The findings highlight key targets for rehabilitation for young, injured runners, particularly intrinsic foot muscle strengthening.

Assessment of Physical Tests in 6-11 Years Old Children: Findings from the Play Lifestyle and Activity in Youth (PLAY) Study.

The purpose was to evaluate selected physical tests in children and to compare the outcomes by sex. A cross-sectional study design was used to evaluate children 6-11 years who completed five physical tests: hand grip, vertical jump, sit and reach, Y-balance, and obstacle course (time and score). The outcome measures including test results were descriptively examined and compared by sex. The study participants consisted of 133 children (62 males and 71 females, with a median age of 7.8 years). Girls showed superior sit and reach performance (p = 0.002) compared with boys. Boys demonstrated better Y-balance scores (p = 0.007) and faster obstacle time (p = 0.042) than girls. Sex comparison within three age groups (6-<8 years, 8-<10 years, and 10-<12 years) showed that girls performed better on the sit and reach compared with boys in the in 6-<8 years (p = 0.009). Boys demonstrated higher Y-balance scores (p = 0.017) and faster obstacle time (p = 0.007) compared with girls in the 8-<10-year age group. These data will serve to guide future efforts to evaluate normative measures of physical literacy and guide targeted training interventions to promote sustained physical activity in children with deficits relative to their age and sex norms.

Changes in training patterns and confidence to return to sport in United States collegiate athletes during the COVID-19 pandemic.

OBJECTIVE: To describe the training patterns, return to sport (RTS) confidence, and perceived fitness during the COVID-19 pandemic summer 2020 and to compare training patterns and RTS readiness during COVID-19 versus during the 2019 summer in a cohort of Division III collegiate athletes. METHODS: An electronic survey of varsity athletes ≥18 years at three United States Division III colleges querying athlete demographics, Modified Athletic Identity Scale (mAIMS), changes in training regimen summer 2020 vs. 2019, RTS confidence, and perceived physical fitness. RESULTS: One hundred and ninety-two surveys were completed (19% response). Total reported summer 2020 training decreased by 4 hours/week, with increased aerobic (56% vs. 53%, p = 0.03) and decreased sport-specific training (48% vs 70%, p < 0.001). Median RTS confidence score for formal training and competition was 3 ('neither more or less confident') in men's versus 2 ('less confident') in women's athletes. Median fitness self-assessment for men's athletes was 3 ('neither more nor less physically fit') compared to previous season versus median score of 2 ('less physically fit) among women's athletes (p = 0.004). For each mAIMS unit, training increased by 11 minutes/week (95% CI: 2-19 minutes; p = 0.01) and sport-specific training increased by 1.3% (95% CI: 0.5-2.2%; p = 0.003), controlling for age, sport, grade, and school. mAIMS was not associated with confidence or fitness rating. CONCLUSION: Collegiate athletes decreased overall training hours, particularly sport-specific training time during the COVID-19 summer compared to the prior summer. Athletic identity was related to overall and sport-specific training hours but not confidence to RTS or fitness.

Moderate and High Sport Specialization Level in Ice Hockey Athletes Is Associated With Symptomatic Cam Deformity.

BACKGROUND: There is a known association between ice hockey and cam deformity in growing athletes. Similarly, the association between sport specialization and overuse injury in youth athletes has been well established. Limited research exists examining the relationship between cam deformity and sport specialization. HYPOTHESIS/PURPOSE: Our hypothesis was that there would be a positive association with cam deformity and sport specialization category. STUDY DESIGN: Retrospective chart review and cross-sectional questionnaire study. LEVEL OF EVIDENCE: Level 4. METHODS: Study participants included athletes aged 15 to 25 years with symptomatic femoroacetabular impingement (FAI) and considered ice hockey as their primary sport. All participants had completed Dunn lateral radiographs or hip magnetic resonance imaging as part of their clinical evaluation. All participants completed a survey regarding sport specialization level. Multivariable linear regression analysis controlling for sex was used to analyze the association between degree of sport specialization, age of sport specialization, position played, and level played. Comparisons in radiographic parameters across ice hockey groups were conducted using Student t tests and chi-square tests. RESULTS: Sixty-six ice hockey participants made up the cohort. The majority reported high sport specialization (41/66, 62%). The mean age of sport specialization was 10.7 years (SD 3.5). Participants with moderate specialization had 25 times the odds of a cam deformity (odds ratio [OR] 25.2; 95% CI 1.5-410.7; P = 0.02) and those with high specialization had 9 times the odds of cam deformity (OR 9.3; 95% CI 1.2-74.2; P = 0.04) compared with those with a low degree of specialization, controlling for patient sex. No association was detected between the age of specialization and the likelihood of cam deformity when controlling for patient sex. CONCLUSION: Level of sport specialization was associated with a cam deformity in this cohort of youth ice hockey athletes. CLINICAL RELEVANCE: This study suggests that an association exists.

Attitudes and Behaviors of Physical Activity in Children with Cerebral Palsy: Findings from PLAY Questionnaire.

To investigate the domains of physical activity in children with cerebral palsy (CP) and to compare these findings to typically developed (TD) children. Methods: A cross-sectional study design. Responses of the four domains in Play Lifestyle and Activity in Youth (PLAY) questionnaire were descriptively analyzed and compared between children with CP (GMFCS I-II) and TD children. Results: Fifty-three children with CP (N = 53, 36 males and 17 females, age of 8.4 ± 1.7 years) and 58 TD children (N = 58, 34 males and 24 females, age of 7.6 ± 1.4 years) participated in this study. In analyses of daily behavior, reported participation in weekly (adaptive) physical education (PE) and sports were more frequent in children with CP (0.6 ± 0.5 days per week) compared to TD children (0.4 ± 0.6 days per week, p = 0.040). Outside play time including free play, organized (adaptive) sports and recess were higher in children with CP (2.7 ± 0.8 days per week) than TD children (2.4 ± 0.7 days per week, p = 0.022). About motivation/attitudes, a higher proportion of TD children feel sad if they are not able to play sports during the day (74.1%) compared to children with CP (48.7%, p < 0.001). Conclusion: Physical activity level was comparable between children with CP and age-matched TD children, while TD children showed higher scores in knowledge and understanding, motivation/attitudes, and physical competence.

Attitudes and behaviors of physical activity in children: Findings from the Play, Lifestyle & Activity in Youth (PLAY) Questionnaire.

BACKGROUND: The identified domains of child physical literacy include knowledge/understanding, behavior, motivation/confidence, and physical competency. Understanding physical literacy is critical to moving forward intervention efforts surrounding physical inactivity. OBJECTIVES: To investigate physical literacy domains by presenting responses to the Play, Lifestyle & Activity in Youth (PLAY) questionnaire and analyze the relationship between comparable questions in the child and parent sections. DESIGN: Cross-sectional questionnaire study. SETTING: Suburban youth program, United States. MAIN OUTCOME MEASURE: Parent and child responses to the PLAY questionnaire. RESULTS: Questionnaire data were collected for 106 children 6-11 years old and 91 parents. Children (93.3%, 83/91) reported enjoyment in physical education, despite 70% participation in physical education 0-1 day/week. 66.6% (26/91) of children preferred active to passive play and played outside most days/week (5.0 median). Similarly, a high proportion of children (93.3%, 83/91) reported feeling that they physically performed similar to or higher than their peers and took ownership to improve motor competency versus taking a more passive approach. Most children (96.7%, 87/91) reported feeling happy when they were able to play sports/run around, enjoyed gym class (93.3%, 83/91), and reported feeling sad if they cannot play sports/run around during the day (75.6%, 68/91). Parents and children reported rules around screen time and bed time, and reinforced these rules often. Child and parent responses were associated for comparable questions about bedtime and screen-time/media rules, moderate-to-vigorous physical activity per day, sport camp preference, and play equipment use (Fisher's p = .051 screen time, p < .001 other questions). CONCLUSIONS: PLAY questionnaire internal validity showed agreement between comparable parent and child responses and an association for select comparable questions.

Association of Social Media Use on Sleep Quality and Performance Among Collegiate Athletes.

OBJECTIVE: (1) To examine the effect of social media (SM) use on sleep quality and (2) to determine the effect of SM on competition performance among college athletes. DESIGN: Cross-sectional study. SETTING: Two local Division III colleges, MA, USA. PARTICIPANTS: National Collegiate Athletic Association Division III swim and track and field athletes. INTERVENTION: Data were collected onsite through an SM use form, the lifestyle survey, and the Patient-Reported Outcomes Measurement Information System Sleep Disturbance Questionnaire. Participants were divided into 3 groups based on their SM volume: (1) less active SM users (≤2 h/d), (2) moderately active SM users (>2-≤5 h/d), and (3) active SM users (>5 h/d) for analysis. MAIN OUTCOME MEASURES: Sleep quality and sport performance data collected through publicly available competition results. The independent variable, SM volume (hours of SM use per day over 7 days), was collected using the iPhone screen time function. RESULTS: The cohort consisted of 40 male track and field athletes and 47 female track and field (37, 79%) and swimming (10, 21%) athletes. Mean SM use was 4.6 ± 3.4 h/d. The sleep quality of active SM users was worse than less active SM users ( P = 0.033). There was an independent association between increased Facebook time and poor performance after adjusting confounders (adjusted odds ratio: 0.990, 95% confidence interval: 0.981-0.999, P = 0.049). CONCLUSIONS: High SM use has a negative impact on sleep quality and may hinder competition performance among college athletes. These findings may have implications for developing SM use guidelines for college athletes to improve their sleep quality and performance.

Hallux Sesamoid Injury Characteristics in Young Athletes Presented to the Sports Medicine Clinic.

OBJECTIVE: To investigate clinical diagnoses, sports participation, and return to sport timeline associated with hallux sesamoid injuries with sex comparisons. DESIGN: Descriptive epidemiology study. SETTING: Sports medicine clinics at a tertiary-level pediatric medical center. PATIENTS: Six hundred eighty-three young athletes (546 women and 137 men). INDEPENDENT VARIABLES: Sex (women vs men). MAIN OUTCOME MEASURES: Clinical diagnoses, participating sports, and injury timeline. RESULTS: The most common diagnosis was sesamoiditis (62.6%). The top 3 primary sports were dance (34.6%), running (13.7%), and soccer (11.7%). When stratified by sex, dance (40.1%), running (13.6%), and soccer (10.7%) were the top primary sports for women while running (19.4%), soccer (18.5%), and basketball (11.3%) were the leading diagnoses for male athletes. The mean time between injury occurrence and first clinic visit was 135.5 ± 229.3 days. The mean time between the first clinic visit and return to sport was 104.3 ± 128.2 days. Comparison by sex showed that women had a longer mean time than men (women: 111.5 ± 132.5 days, men: 67.2 ± 96.3 days, P = 0.001). The mean time from injury occurrence to return to sport was 235.2 ± 281.0 days. Women showed a longer mean timeline for return to sport compared with men (women: 245.2 ± 288.2 days, men: 179.3 ± 231.9 days, P = 0.014). CONCLUSION: Sesamoiditis was the most common diagnosis, and dance, running, and soccer were top 3 sports. The most salient finding was that women taking almost twice as long to return the sport or activity compared with men, which likely stems from delay of reporting symptom onset to clinics.

Platelet rich plasma for hallux sesamoid injuries: a case series.

OBJECTIVE: Hallux sesamoid injuries are well described and can be debilitating and chronically disabling. The role of orthobiologics such as platelet-rich plasma (PRP) in sesamoid injuries has not been reported. This study describes three cases of recalcitrant hallux sesamoid injuries in teenage athletes who returned to impact activities, pain free, following one treatment of PRP. METHODS: This is a case-series study describing three teenage athletes presenting to a tertiary level pediatric sports medicine practice with chronic hallux sesamoid injuries. RESULTS: The three patients (two female, one male) described in this case series were 13-, 16-, and 17-year-old athletes. Their primary sports were ballet, basketball, and Irish step dance, respectively. All three athletes received PRP: two received unilateral treatment (one tibial sesamoid, one fibular sesamoid) and one received treatment to bilateral tibial sesamoids. The average duration of symptoms prior to PRP was 52.5 weeks (14-128 weeks). The average time out of their primary sport was 48.7 weeks (20-78 weeks). Three of the 4 sesamoids treated with PRP were tibial sesamoids. Each site of injury was treated with one treatment of leukocyte-rich PRP. All three athletes were cleared to return to impact activities such as running and jumping at 6-9 weeks following PRP, specifically 9 weeks after the final PRP injection for the patient who underwent bilateral treatments. CONCLUSION: In the three cases provided of sesamoid injuries treated with PRP, the time to return to impact activities was less than reported for athletes not treated with PRP. Acknowledging that other management factors likely contributed to return to impact activities, this case series sets the groundwork for future research investigating the role of PRP with needle fenestration in the treatment of sesamoid injuries.