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BACKGROUND: Radiographic measurements of limb alignment in skeletally immature patients with anterior cruciate ligament (ACL) tears are frequently used for surgical decision-making, preoperative planning, and postoperative monitoring of skeletal growth. However, the interrater and intrarater reliability of these radiographic characteristics in this patient population is not well documented. HYPOTHESIS: Excellent reliability across 4 raters will be demonstrated for all digital measures of length, coronal plane joint orientation angles, mechanical axis, and tibial slope in skeletally immature patients with ACL tears. STUDY DESIGN: Cohort study (diagnosis). METHODS: Three fellowship-trained orthopaedic surgeons and 1 medical student performed 2 rounds of radiographic measurements on digital imaging (lateral knee radiographs and long-leg radiographs) of skeletally immature patients with ACL tears. Intrarater and interrater reliability for continuous radiographic measurements was assessed with intraclass correlation coefficients (ICCs) across 4 raters with 95% CIs for affected and unaffected side measurements. Interrater reliability analysis used an ICC (2, 4) structure and intrarater reliability analysis used an ICC (2, 1) structure. A weighted kappa coefficient was calculated for ordinal variables along with 95% CIs for both interrater and intrarater reliability. Agreement statistic interpretations are based on scales described by Fleiss, and Cicchetti and Sparrow: <0.40, poor; 0.40 to 0.59, fair; 0.60 to 0.74, good; and >0.74, excellent. RESULTS: Radiographs from a convenience sample of 43 patients were included. Intrarater reliability was excellent for nearly all measurements and raters. Interrater reliability was also excellent for nearly all reads for all measurements. CONCLUSION: Radiographic reliability of long-leg radiographs and lateral knee x-rays in skeletally immature children with ACL tears is excellent across nearly all measures and raters and can be obtained and interpreted as reliable and reproducible means to measure limb length and alignment. LEVEL OF EVIDENCE: Level III.
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Lesões do Ligamento Cruzado Anterior , Criança , Humanos , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos de Coortes , Reprodutibilidade dos Testes , Extremidades , Bolsas de EstudoRESUMO
BACKGROUND: Historically, total meniscectomy was recommended as the treatment for a symptomatic discoid meniscus. Improved meniscal repair techniques and inferior long-term outcomes associated with meniscectomy have resulted in a trend toward meniscal preservation, with saucerization and repair of meniscocapsular tears. Reoperation rates after treatment of torn discoid menisci vary, with some series reporting high rates of reinjury and reoperation. The purpose of this study is to describe the intermediate-term outcomes of pediatric patients treated with saucerization and meniscocapsular repair of discoid lateral menisci with peripheral rim instability. METHODS: A single-institution retrospective review was performed of consecutive patients less than 18 years of age treated with saucerization and repair for a meniscocapsular tear of a discoid lateral meniscus from 2013 to 2017. All patients had a minimum 24-month follow-up. A chart review was performed to describe tear location and repair type. The primary outcomes were revision meniscus surgery and Pedi-International Knee Documentation Committee and Tegner activity scores obtained at the final follow-up. RESULTS: In total, 32 knees in 30 patients, including 15 males and 15 females with a mean age of 12 years (range, 5 to 17 y), were included. Tear patterns included anterior meniscocapsular (14 knees), posterior meniscocapsular (16 knees), and both anterior and posterior meniscocapsular (2 knees). Arthroscopic saucerization and meniscocapsular repair were performed in all knees. Repair types were outside-in (10 knees), inside-out (8 knees), all-inside (8 knees), and hybrid (6 knees). The mean follow-up was 54 months (range, 30 to 86 mo). Three knees (9%) underwent revision meniscus surgery, including 2 all-inside repairs and 1 partial meniscectomy. At the final follow-up, mean International Knee Documentation Committee score was 96 (range, 82 to 100). A total of 89% of patients reported returning to the same or higher level of activity following surgery. CONCLUSIONS: Saucerization of discoid lateral menisci with repair of meniscocapsular tears is associated with low rates of revision surgery and good intermediate-term outcomes. LEVEL OF EVIDENCE: Level IV.
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Artroscopia , Meniscos Tibiais , Complicações Pós-Operatórias , Artroscopia/efeitos adversos , Artroscopia/métodos , Criança , Feminino , Humanos , Artropatias/congênito , Artropatias/fisiopatologia , Artropatias/cirurgia , Articulação do Joelho/anormalidades , Articulação do Joelho/cirurgia , Masculino , Meniscos Tibiais/anormalidades , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Revision anterior cruciate ligament (ACL) reconstruction in pediatric patients has not been well studied. The purpose of this study was to assess the demographics, technique, and results of ACL revision surgery in children and adolescents. METHODS: This was a retrospective case series with outcomes assessment of patients 18 years old and younger who underwent revision ACL surgery over a 16-year period at a single institution. Medical records were reviewed for demographics, clinical and operative data, and patients were contacted for outcomes at a minimum of 1 year after revision surgery. RESULTS: Ninety revision ACL reconstructions were performed by 7 surgeons in 88 patients (44 male, 44 female). Average patient age at the time of revision was 16.6 years (SD, 1.7), and 28.8% of patients were skeletally immature. Time to failure after primary ACL reconstruction was 1.28 years (SD, 1.1) and revision surgery was performed 1.56 years (SD, 1) after the index procedure. Revision graft type included allograft (61.1%), patellar tendon (21.1%), hamstring (16.7%), and iliotibial band (1.1%). There was a 20% graft reinjury rate. Subsequent surgical procedures after revision were required in 25.5% of knees. Twenty percent of revision reconstructions had contralateral ACL injuries, and this percentage was higher (33%) among those who went on to injure their revision graft. Median outcome scores collected from 44 patients (50%) at a mean of 5.1 years following surgery (SD, 3.4) were: Pedi-IKDC 79.9, Lysholm 84.5, and Tegner 9.0. Sixty-nine percent of patients reported returning to sports, however, only 55.2% of these reported being able to return to the same level of play. CONCLUSIONS: Revision ACL reconstruction in pediatric patients was associated with suboptimal patient-reported outcomes, high complication rates, relatively high graft retear rates, high risk of contralateral ACL injury, and compromised return to sports rates. LEVEL OF EVIDENCE: Level IV.
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Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Complicações Pós-Operatórias/cirurgia , Reoperação , Adolescente , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Criança , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Volta ao Esporte/estatística & dados numéricos , Medição de RiscoRESUMO
The objective of the study was to determine whether 1) the proportion of athletes with mental health diagnoses and 2) athlete motivations for playing differ between team sports and individual sports. We conducted a cross-sectional study of child and adolescent athletes assessed at a sports injury prevention center. We compared self-reported anxiety, depression, and reasons for participating in sports between athletes in individual sports (e.g. gymnastics, running, diving) and team sports (e.g. soccer, football, hockey). In addition, we categorized motivation for participating in sports as 1) for fun, with associated benefits of participation including, motives such as making friends and being part of a team or 2) for goal-oriented reasons with associated benefits of participation including motives such as obtaining scholarship or controlling weight. At the time of this analysis, 756 athletes between the ages of 6 and 18 years had undergone a sports injury prevention evaluation. Most athletes were White (85%) and there was a slight female predominance (56%). Of the total population, 8% reported suffering from anxiety or depression. A higher proportion of individual sport athletes reported anxiety or depression than team sport athletes (13% vs. 7%, p < 0.01). Individual sport athletes were more likely than athletes in team sports to play their sports for goal-oriented reasons, as opposed to for fun (30% vs. 21%, p < 0.05). Individual sport athletes are more likely to report anxiety and depression than team sport athletes. The mental health benefits of participation in organized sports may vary between individual sport athletes and those playing team sports.
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Ansiedade/etiologia , Atletas/psicologia , Depressão/etiologia , Esportes Juvenis/psicologia , Adolescente , Criança , Comportamento Competitivo , Estudos Transversais , Feminino , Objetivos , Humanos , Masculino , Motivação , AutorrelatoRESUMO
BACKGROUND: Pediatric both-bone diaphyseal forearm fractures are commonly treated in a variety of clinical settings. Most often, closed reduction followed by immobilization leads to satisfactory results. However, in the adolescent population (10-16 years of age), forearm fractures are more challenging due to less remodeling potential. The purpose of this review was to provide an overview of the anatomy, biomechanics, and treatment options relevant to adolescent patients. METHODS: A systematic review of peer-reviewed publications and abstracts related to the treatment for pediatric both-bone diaphyseal forearm fractures in adolescents was carried out. RESULTS: Forearm fractures in the pediatric population are most common following indirect blows to the forearm. When treating these fractures using closed reduction, it is important to recognize the muscular attachments of the forearm. In roughly 70-90% of cases, closed reduction leads to adequate alignment. In all cases, return to function is the primary goal; however, exact alignment parameters remain controversial. In the adolescent population, surgical treatment has risen substantially in the last few decades. Intramedullary nailing and open reduction using plate fixation are the two most common operative techniques. Unfortunately, recent results have shown that nonunion, malunion, and overall complication rates are higher in older pediatric patients. Moreover, no consensus exists regarding one technique over another. CONCLUSIONS: Both-bone diaphyseal fractures in the adolescent population present unique challenges regarding optimal treatment, especially when considering surgical intervention. Further research is necessary to better understand indications for specific surgical treatment.
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Fixação Intramedular de Fraturas , Fraturas do Rádio/terapia , Fraturas da Ulna/terapia , Adolescente , Fenômenos Biomecânicos , Pinos Ortopédicos/efeitos adversos , Placas Ósseas/efeitos adversos , Diáfises/lesões , Antebraço/anatomia & histologia , Antebraço/fisiologia , Fixação Intramedular de Fraturas/efeitos adversos , HumanosRESUMO
Purpose: To examine age- and sex-related differences in postoperative functional outcomes at approximately 6 months after anterior cruciate ligament reconstruction (ACLR). Methods: In this study, patients who underwent primary ACLR performed a series of return-to-sport functional tests at 5 to 8 months after surgery. Functional tests included strength tests (knee extensors, knee flexors, hip abductors, and hip extensors), a balance test (Y-balance composite score), and hop tests (single, triple, crossover, and 6-m timed hop tests). Limb symmetry was calculated to compare the reconstructed limb with the uninvolved limb. A 2-way multivariate analysis of covariance was used, and effect size was calculated for data analysis. Results: A total of 176 subjects were included in this study. There were no significant interaction between age and sex on return-to-sport functional tests after ACLR. Also, no main effects of age and sex on return-to-sport functional tests were found in our data. Conclusions: Age and sex do not significantly affect functional test performance after ACLR 6 months postoperatively. Level of Evidence: Level III, retrospective review of prospective cohort study.
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BACKGROUND: There is an increasing rate of procedures being performed for concomitant injuries during anterior cruciate ligament (ACL) surgery. Few studies have examined risk factors for these associated injuries in young patients. HYPOTHESIS: There are patient-related factors predictive of concomitant knee pathology that differ between age-based cohorts. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Natural language processing was used to extract clinical variables from available notes of patients undergoing ACL surgery between 2000 and 2020 at a single institution (5174 ACL surgeries; mean age, 17 ± 4 years; 53.1% female; accuracy, >98%). Patients were stratified to pediatric (5-13 years), adolescent (14-19 years), and young adult (20-35 years) cohorts. Logistic regression was used to determine predictors of concomitant injury to the menisci, medial collateral ligament (MCL), posterolateral corner (PLC), and posterior cruciate ligament (PCL). RESULTS: Between 2000 and 2020, 54% of pediatric, 71% of adolescent, and 70% of adult patients had ≥1 concomitant soft tissue injury. In children and adolescents, increased age was consistently predictive of sustaining a concomitant injury (P < .02). Female children had increased odds of concomitant medial meniscal injury, while female adults had decreased odds (P≤ .046). Adolescent and adult female patients had decreased odds of concomitant lateral meniscal injury (P≤ .027). Female children had increased odds of injury to the MCL (P = .015), whereas female children and adolescents had decreased odds of PCL injury (P≤ .044). Adolescents undergoing revision ACL surgery had increased odds of meniscal injury (P≤ .001) and decreased odds of concomitant MCL injury (P = .028). Increased body mass index (BMI) was associated with increased odds of concomitant medial meniscal injury in all cohorts (P≤ .041), lateral meniscal injury in adults (P = .045), and PLC injury in children (P = .016). Contact injuries were associated with increased odds of MCL injury in adolescents (P = .017) and PLC injury in adolescents and adults (P < .014). CONCLUSION: These findings support the hypothesis, as there were multiple factors that significantly affected the risk of concomitant injuries that differed between cohorts. Increased age, BMI, and contact injury history were generally associated with increased odds of sustaining a concomitant injury, whereas female sex and revision ACL surgery had mixed effects. Further studies are essential to investigate the sex-based differences in risk for concomitant injuries and to develop tailored treatment plans that minimize the risk of secondary ACL injury.
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Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Adolescente , Adulto Jovem , Humanos , Feminino , Criança , Adulto , Masculino , Ligamento Cruzado Anterior/cirurgia , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Prevalência , Estudos Transversais , Atenção Terciária à Saúde , Estudos Retrospectivos , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Meniscos Tibiais/cirurgia , HospitaisRESUMO
Background: The rate of concomitant meniscal procedures performed in conjunction with anterior cruciate ligament (ACL) reconstruction is increasing. Few studies have examined these procedures in high-risk pediatric cohorts. Hypotheses: That (1) the rates of meniscal repair compared with meniscectomy would increase throughout the study period and (2) patient-related factors would be able to predict the type of meniscal operation, which would differ according to age. Study Design: Cohort study (prevalence); Level of evidence, 2. Methods: Natural language processing was used to extract clinical variables from notes of patients who underwent ACL reconstruction between 2000 and 2020 at a single institution. Patients were stratified to pediatric (5-13 years) and adolescent (14-19 years) cohorts. Linear regression was used to evaluate changes in the prevalence of concomitant meniscal surgery during the study period. Logistic regression was used to determine predictors of the need for and type of meniscal procedure. Results: Of 4729 patients (mean age, 16 ± 2 years; 54.7% female) identified, 2458 patients (52%) underwent concomitant meniscal procedures (55% repair rate). The prevalence of lateral meniscal (LM) procedures increased in both pediatric and adolescent cohorts, whereas the prevalence of medial meniscal (MM) repair increased in the adolescent cohort (P = .02). In the adolescent cohort, older age was predictive of concomitant medial meniscectomy (P = .031). In the pediatric cohort, female sex was predictive of concomitant MM surgery and of undergoing lateral meniscectomy versus repair (P≤ .029). Female sex was associated with decreased odds of concomitant LM surgery in both cohorts (P≤ .018). Revision ACLR was predictive of concomitant MM surgery and of meniscectomy (medial and lateral) in the adolescent cohort (P < .001). Higher body mass index was associated with increased odds of undergoing medial meniscectomy versus repair in the pediatric cohort (P = .03). Conclusion: More than half of the young patients who underwent ACLR had meniscal pathology warranting surgical intervention. The prevalence of MM repair compared with meniscectomy in adolescents increased throughout the study period. Patients who underwent revision ACLR were more likely to undergo concomitant meniscal surgeries, which were more often meniscectomy. Female sex had mixed effects in both the pediatric and adolescent cohorts.
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PURPOSE: Patellar dislocations in adolescents may cause osteochondral fractures of the patella. The aim of this study was to review the outcomes of adolescent patients who underwent surgical intervention for patellar osteochondral fracture following patellar dislocation. METHODS: Nine patients who underwent surgery for osteochondral fracture of the patella following dislocation were identified retrospectively. Following arthroscopic examination, if the fragment was large enough to support fixation, headless screws or bioabsorbable pins were used. Otherwise, the loose body was excised, and the donor site was managed with a microfracture. Postoperatively, patients were assessed using the International Knee Documentation Committee (IKDC) and Knee injury and Osteoarthritis Outcome Score (KOOS) outcome measures. RESULTS: The average age of the patients was 14.6 with average follow-up 30.2 months. Four of the nine patients underwent fixation, while five patients underwent removal of loose body with microfracture. The average defect size in the nonfixation group was 1.2 cm(2) compared with 3.2 cm(2) in the fixation group. The IKDC scores for fixation and nonfixation groups were 63.9 (SD = 18) and 76.1 (SD = 11.7), respectively. The KOOS subscale scores for symptoms, function in sports and recreation, and knee-related quality of life were higher for the nonfixation group when compared to the fixation group. CONCLUSIONS: This is the first known series examining surgical outcomes of osteochondral fractures of the patella following patellar dislocations in the adolescent population. While patients without fixation were less symptomatic in this series, this may be attributable to more severe injuries in patients undergoing fracture fixation. LEVEL OF EVIDENCE: Retrospective case series, Level IV.
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Fraturas Ósseas/cirurgia , Fraturas de Cartilagem/cirurgia , Patela/cirurgia , Luxação Patelar/complicações , Adolescente , Artroplastia Subcondral , Pinos Ortopédicos , Parafusos Ósseos , Criança , Feminino , Seguimentos , Fixação Interna de Fraturas , Fraturas Ósseas/etiologia , Fraturas de Cartilagem/etiologia , Humanos , Instabilidade Articular/cirurgia , Corpos Livres Articulares/cirurgia , Ligamentos Articulares/cirurgia , Imageamento por Ressonância Magnética , Masculino , Patela/lesões , Avaliação de Resultados da Assistência ao Paciente , Recidiva , Estudos RetrospectivosRESUMO
PURPOSE OF REVIEW: The aim of this review is to interpret the existing evidence regarding the psychological aspects of sport specialization within the context of a developmental framework. RECENT FINDINGS: The growing trend toward early sport specialization is associated with increased risk for injury and burnout, both of which have significant implications for mental health. Mental health literacy programs designed to promote awareness, decrease stigma, and encourage help-seeking behaviors can be an effective way to increase resilience and early recognition of those in need. The trend toward early sport specialization is likely motivated in large part by the expectation that it will increase the likelihood of long-term athletic success. However, recent studies suggest that the majority of elite athletes delay specialization at least until mid to late adolescence. It is essential to consider the developmental psychology of children and adolescents and to avoid imposing expectations that are beyond their neurocognitive capabilities. In addition to depression, anxiety, and burnout, young athletes who are pressured to perform to excessively high standards are likely to internalize athletic failures as feelings of shame. This can lead to maladaptive perfectionistic traits and potentially overtraining, clinical eating disorders, or other harmful behaviors that will result in declines in performance, physical health, and overall wellbeing. Further work is needed to better inform sport-specific recommendations regarding sport specialization and to optimize the beneficial effects of sport participation while limiting the risks of harm.
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Female athletes represent a unique population of competitors who face distinct stressors when compared with male athletes. These include sport inequities, violence, abuse, body image concerns, disordered eating, relative energy deficiency, family planning challenges, hormonal challenges, and mental distress. When combined with sports injuries, these stressors can negatively impact the mental health of female athletes as well as their injury recovery and return to sports. It is essential for orthopaedic surgeons to be familiar with the unique aspects inherent to being a female athlete, along with the psychological aspects of sports injuries. By integrating questions about female athletes' psychological well-being into their routine practice and collaborating with a multidisciplinary team, orthopaedic surgeons can better address these unique stressors, support female athletes in achieving optimal outcomes, and enhance return to sport rates. Level of Evidence: V, expert opinion.
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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.
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Traumatismos em Atletas , COVID-19 , Masculino , Humanos , Feminino , Estados Unidos , Volta ao Esporte , Traumatismos em Atletas/epidemiologia , Pandemias , Atletas , UniversidadesRESUMO
CONTEXT: Psychological skills training improves performance in athletes. However, few studies have looked at the efficacy and satisfaction of mental skills training programs for collegiate athletes. OBJECTIVE: We aimed to evaluate satisfaction of collegiate athletes with a 6-session mental skills course, and to assess changes in mental toughness and coping skills before and after the course. DESIGN: Prospective cohort study following collegiate female athletes through a 6-session mental skills course. SETTING: Division 1 collegiate athletic teams. PATIENTS/PARTICIPANTS: 54 Division I female athletes (mean age =19.8) participated in the program and 42 (77.7 %) completed pre-course assessments, which subsequent evaluations were matched to. MAIN OUTCOME MEASURES: The Athletic Coping Skills Inventory (ACSI, range=0-84) and Mental Toughness Index (MTI, range=8-56) assessed coping skills and mental toughness pre-course, immediate post-course and 4-month post course. Satisfaction was assessed on a 10-point scale. RESULTS: For participants with paired pre- and immediate post-course data (n=37, 68.5%), MTI scores improved by a mean 2.6 points (95% CI=1.1-4.1; p=0.001) and ACSI scores improved by a mean 4.0 points (95% CI=0.6-7.4; p=0.02). At four-month follow-up (n=25, 46.2%), no change was detected from pre-course in mean MTI score (p=0.72), but there was a significant increase of 3.4 points in mean ACSI (95% CI=0.4-6.4; p=0.03). Overall satisfaction had a median score of 9/10 (IQR, 8-10) at post-course, and eighteen participants (48.6%) shared positive free-text comments regarding course delivery, content, and impact. No negative feedback was reported. CONCLUSIONS: Mental toughness and coping skills scores significantly improved at post-course assessment, with coping skills scores maintaining their effect at four months. The improvements identified spark the question of the potential impact of mental skills training programs when studied in larger athlete populations or over more sustained periods of time. Athletes reported being highly satisfied with course content and reported overall positive experiences.
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Background: Successful return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR) can be affected by a patient's physical and psychological state throughout the rehabilitation process. Purpose: To prospectively compare differences in patients at 6 months after primary ACLR with the ACL-Return to Sport after Injury (ACL-RSI), International Knee Documentation Committee (IKDC) or pediatric (Pedi)-IKDC, Hospital for Special Surgery Pediatric Functional Activity Brief Scale (Pedi-FABS), and Patient-Reported Outcomes Measurement Information System-Psychological Stress Experiences (PROMIS-PSE) scores. Study Design: Prospective cohort study; Level of evidence, 2. Methods: Patients enrolled were 8 to 35 years old who underwent primary ACLR and had their 6-month follow-up appointments between December 2018 and March 2020. Patients were divided into 3 age groups as follows: (1) preadolescents (10-14 years); (2) adolescents (15-18 years); and (3) adults (>18 years). Outcomes on the ACL-RSI, IKDC/Pedi-IKDC, Pedi-FABS, and PROMIS-PSE were compared according to age group, graft type (hamstring, patellar tendon, quadriceps, or iliotibial band autograft), and sex. Results: A total of 176 patients (69 male, 107 female), with a mean age of 17.1 ± 3.1 years were included in the study. The mean ACL-RSI scores were significantly different among age groups (preadolescents, 75 ± 18.9; adolescents, 61.5 ± 20.4; and adults, 52.5 ± 19.8 [P < .001]) and graft types (P = .024). The IKDC and PROMIS-PSE scores were also significantly different among age groups (P < .001 and P = .044, respectively) and graft types (P = .034 and P < .001, respectively), with the iliotibial graft and the younger age group performing the best. There was no significant difference in the Pedi-FABS either by age group (P = .127) or graft type (P = .198). Female patients had lower ACL-RSI scores and higher (worse) scores on PROMIS-PSE than their male counterparts (P = .019 and P < .001, respectively), with no sex-based differences on IKDC or Pedi-FABS scores. The ACL-RSI and IKDC were positively correlated (Spearman r = 0.57; P < .001), while the ACL-RSI and PROMIS-PSE were negatively correlated (Pearson r = -0.34; P < .001). Conclusion: This study suggests that psychological profiles and subjective perceptions of knee function 6 months after ACLR may vary in patients of different ages and between the sexes. Preadolescent patients had better scores on a majority of patient-reported outcomes compared with adolescent and adult patients.
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Knee injuries are prevalent in pediatric and adolescent athletes, leading to both physical and psychological disturbances following injury. Various preoperative psychological measures of maladaptive beliefs-including kinesiophobia, fear avoidance, and pain catastrophizing-can predict responses to recovery, such as knee function, knee-related quality of life, and return-to-sport. Treatment recommendations for the psychological aspect of adolescent knee injuries can include screening patients to identify those at high risk for poor recovery. These patients can be targeted with psychologically informed media or cognitive-behavioral therapy models aimed at reducing maladaptive beliefs and supporting individualized motivations and recovery goals.
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Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Adolescente , Catastrofização , Criança , Humanos , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/terapia , Articulação do Joelho/cirurgia , Qualidade de Vida , Volta ao EsporteRESUMO
Purpose: The purpose of this study was to evaluate the physical and psychological effects of COVID-related elective surgery delays on young sports medicine patients. Methods: We conducted a cross-sectional study of patients (10-25 years old) who had elective sports medicine surgery delayed due to the COVID crisis. Electronic surveys were sent to patients and included the 12-item Short Form Health Survey (SF-12), which yields a physical component score (SF12-PCS) and a mental component score (SF12-MCS), the PROMIS Psychological Stress Experience survey (PROMIS-PSE), and self-designed questions about patient concerns regarding the COVID crisis and delayed surgery. Results: Of the 194 eligible patients with delayed elective sports surgeries, 107 patients (55%) elected to participate (mean age 17.6 ± 3.09 years, 30% male). The mean surgical delay was 76 days (CI 57-98). Delayed surgery patients scored significantly lower than population norms on the SF12-PCS (mean 39.3, CI 37.0-41.7; P < .001). Males scored significantly higher than females on the SF12-MCS (52.8 vs 45.7; P = .002), but the overall SF12-MCS mean was not significantly different from the general population (47.4; P =.07). The mean PSE score was significantly higher than population norms (57.7, CI 56.1-59.3; P < .001), but they did not differ by age or gender. Patients who reported higher levels of concern about their surgical delay endorsed significantly lower scores on the SF-MCS (P = .006) and higher scores on the PROMIS-PSE (P < .001), indicating greater emotional symptoms. The biggest concern with COVID-related surgical delays was a concern about not being back in time for a sports season. Conclusions: Young sports medicine patients reported significant physical and emotional symptoms associated with COVID-related surgical delays. Patients were most concerned about delays resulting in missed sport seasons. Those who reported greater levels of concern with surgical delays reported more emotional symptoms and higher levels of psychological stress. Clinical Relevance: It is important to understand the impact of delayed elective surgical treatment on young patients due to COVID. This study will allow us to make more informed choices for patients during the pandemic.
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BACKGROUND: Previous clinical studies have shown that psychological factors have significant effects on an athlete's readiness to return to sport after anterior cruciate ligament (ACL) reconstruction (ACLR). HYPOTHESIS: We hypothesized that patients who underwent bridge-enhanced ACL restoration (BEAR) would have higher levels of psychological readiness to return to sport compared with patients who underwent ACLR. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 100 patients (median age, 17 years; median preoperative Marx activity score, 16) with complete midsubstance ACL injuries were randomized to either the BEAR procedure (n = 65) or autograft ACLR (n = 35 [33 hamstring and 2 bone--patellar tendon-bone]) and underwent surgery within 45 days of injury. Objective, functional, and patient-reported outcomes, including the ACL--Return to Sport after Injury (ACL-RSI) scale, were assessed at 6, 12, and 24 months postoperatively. RESULTS: Patients who underwent the BEAR procedure had significantly higher ACL-RSI scores at 6 months compared with those who underwent ACLR (71.1 vs 58.2; P = .008); scores were similar at 12 and 24 months. Baseline factors independently predictive of higher ACL-RSI scores at 6 months were having a BEAR procedure and participating in level 1 sports prior to injury, explaining 15% of the variability in the scores. Regression analysis of baseline and 6-month outcomes as predictors indicated that the International Knee Documentation Committee (IKDC) score at 6 months explained 45% of the 6-month ACL-RSI variance. Subsequent analysis with IKDC excluded from the model indicated that decreased pain, increased hamstring and quadriceps strength in the surgical limb, and decreased side-to-side difference in anteroposterior knee laxity were significant predictors of a higher ACL-RSI score at 6 months, explaining 34% of the variability in scores. Higher ACL-RSI score at 6 months was associated with earlier clearance to return to sports. CONCLUSION: Patients who underwent the BEAR procedure had higher ACL-RSI scores at 6 months postoperatively. Better ACL-RSI scores at 6 months were related most strongly to higher IKDC scores at 6 months and were also associated with lower pain levels, better muscle recovery, and less knee laxity at 6 months. REGISTRATION: NCT02664545 (ClinicalTrials.gov identifier).
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BACKGROUND: Growth disturbance is an uncommon but potentially serious complication after anterior cruciate ligament (ACL) reconstruction in skeletally immature patients. PURPOSE: To describe how the pediatric ACL literature has assessed preoperative skeletal maturity and the amount of growth remaining and to comprehensively review the incidence, reporting, and monitoring of postoperative growth disturbance. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: This review included studies reporting original research of clinical outcomes of skeletally immature patients after ACL reconstruction. Patient characteristics, surgical techniques, preoperative assessments of skeletal maturity or growth remaining, and postoperative assessments of growth disturbances were extracted. RESULTS: A total of 100 studies met inclusion criteria. All studies reported chronological age, and 28 studies (28%) assessed skeletal age. A total of 44 studies (44%) used Tanner staging, and 12 studies (12%) obtained standing hip-to-ankle radiographs preoperatively. In total, 42 patients (2.1%) demonstrated a leg length discrepancy (LLD) >10 mm postoperatively, including 9 patients (0.5%) with LLD >20 mm; furthermore, 11 patients (0.6%) with LLD underwent growth modulation. Shortening was the most common deformity overall, but overgrowth was reported more frequently in patients who had undergone all-epiphyseal techniques. Most LLDs involved the femur (83%). A total of 26 patients (1.3%) demonstrated a postoperative angular deformity ≥5°, and 9 of these patients underwent growth modulation. The most common deformities were femoral valgus (41%), tibial recurvatum (33%), and tibial varus (22%). Although standing hip-to-ankle radiographs were the most common radiographic assessment of growth disturbance, most studies inadequately reported the clinical and radiographic methods of assessment for growth disturbance. Additionally, only 35% of studies explicitly followed patients to skeletal maturity. CONCLUSION: This systematic review described significant variability in the reporting and monitoring of growth-related complications after ACL reconstruction in skeletally immature patients. The incidence of LLD and angular deformity appeared to be low, but the quality of research was not comprehensive enough for accurate assessment. REGISTRATION: CRD42019136059 (PROSPERO).
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Criança , Epífises/cirurgia , Fêmur/cirurgia , Humanos , Desigualdade de Membros Inferiores , Tíbia/cirurgiaRESUMO
The psychosocial benefits of participating in sports have long been appreciated. However, athletes are often faced with circumstances that make them susceptible to psychological challenges unique to the athletic population. One such circumstance is injury in sport, which can be a source of notable distress and may precipitate the emergence of new or exacerbation of underlying psychological disorders. In athletes who are injured, particularly those undergoing surgical intervention, psychological factors play a substantial role in the recovery process. A more comprehensive understanding of the complex interplay between psychological and physical health in the setting of an injury is essential to optimize patient care. The aim of this review was to highlight the impact of psychological factors on measurable outcomes after orthopaedic surgical interventions and to explore interventions that can be implemented to improve surgical outcomes and the overall care of injured athletes.
Assuntos
Traumatismos em Atletas , Esportes , Atletas , HumanosRESUMO
Athletic identity (AI), the degree of personal connection to sport, is well-described in adult research; however, this social trait has been less studied in younger age groups. This systematic review describes epidemiological characteristics of AI in youth athletes. PubMed, Embase and PsycInfo were searched to identify AI studies involving quantitative athlete identity outcomes and cohorts 22 years and younger. The search strategy was developed for each database using the Boolean method. PRISMA guidelines and the Appraisal Tool for Cross-Sectional Studies (AXIS) were utilized. Ten out of ninety-one studies met inclusion criteria. AI scores differed by race/ethnicity. Two studies found increased AI during adolescence compared to later in ones' training. Mental health-focused studies revealed higher AI levels protect against burnout, but in injured athletes, increased depression risk. Transitioning to a higher level of play during adolescence can correlate with stronger senses of AI. Further research should explore the concept of athletic identity saliency as one moves through an athletic career or training program and how thoughts of perceived success, professional progression, recruitment prospect or injury affect levels of athletic identity.