Single season re-injury risk after concussion and lower extremity injury among male, collision sport, high school athletes.

OBJECTIVES: Research suggests that a recent concussion increases subsequent lower extremity injury risk; however, data in high school athletes is limited. This study evaluates the association between concussion and subsequent injury risk among male, collision sport, high school athletes over a single season. DESIGN: Retrospective cohort study. METHODS: Data were obtained from 2005/06-2014/15 in the High School Reporting Information Online database. A two stage, multi-method matching process was used to identify athletes who suffered multiple injuries over a single athletic season. Demographics and injury characteristics were compared with Chi square and Student's t-tests. Multiple Cox Proportional Hazards regression analysis was used to test whether index injury type was associated with hazard of subsequent injury following return to play from index injury. RESULTS: Overall 1364 HS athletes sustained 2 injuries over a single athletic season (subsequent injury within 45 days of the index injury). Index injuries included 686 (50.2%) lower extremity injuries, 417 (30.6%) upper extremity injuries, and 261 (19.1%) concussions. Hazard of subsequent concussion was increased in the index concussion group relative to the index lower extremity injury group [hazard ratio (HR): 1.60, 95% CI: 1.15-2.23, p = 0.0052]. Hazard of a subsequent lower extremity injury was not significantly different for the index lower extremity injury group relative to the index concussion group [HR: 1.27, 95% CI: 0.98-1.65, p = 0.0728]. CONCLUSIONS: History of recent concussion or recent lower extremity injury are both risk factors for subsequent lower extremity injury in male, collision sport, high school athletes.

The Potential for Cloth Masks to Protect Health Care Clinicians From SARS-CoV-2: A Rapid Review.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has led at times to a scarcity of personal protective equipment, including medical masks, for health care clinicians, especially in primary care settings. The objective of this review was to summarize current evidence regarding the use of cloth masks to prevent respiratory viral infections, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), among health care clinicians. METHODS: We searched 5 databases, the Centers for Disease Control and Prevention website, and the reference lists of identified articles on April 3, 2020. All identified publications were independently screened by 2 reviewers. Two authors independently extracted data and graded the studies. Randomized control trials (RCTs) were graded using the Consolidated Standards of Reporting Trials (CONSORT) checklist, and observational and nonhuman subject studies were graded using 11 domains common across frequently used critical appraisal tools. All discrepancies were resolved by consensus. RESULTS: Our search identified 136 original publications. Nine studies met inclusion criteria. We performed a qualitative synthesis of the data from these studies. Four nonrandomized trials, 3 laboratory studies, 1 single-case experiment, and 1 RCT were identified. The laboratory studies found that cloth materials provided measurable levels of particle filtration but were less efficacious at blocking biologic material than medical masks. The RCT found that cloth masks were associated with significantly more viral infections than medical masks. CONCLUSIONS: The current literature suggests that cloth materials are somewhat efficacious in filtering particulate matter and aerosols but provide a worse fit and inferior protection compared to medical masks in clinical environments. The quality and quantity of literature addressing this question are lacking. Cloth masks lack evidence for adequate protection of health care clinicians against respiratory viral infections.

Isometric Cervical Muscular Strength in Pediatric Athletes With Multiple Concussions.

OBJECTIVE: To compare maximal cervical muscle strength among athletes with a history of 2 or more concussions relative to athletes with no history of a previous concussion. DESIGN: Athletes in the 2 groups were frequency-matched. Linear mixed models were used to test for differences in peak isometric flexion, extension, left lateral flexion, and right lateral flexion cervical muscle torque between groups. SETTING: Pediatric sports medicine clinic. PARTICIPANTS: Athletes with a history of multiple concussions (n = 16) and athletes with no previous concussion history (n = 17). INTERVENTIONS (OR ASSESSMENT OF RISK FACTORS OR INDEPENDENT VARIABLES):: Concussion history (group), age, sex, neck girth, and height. MAIN OUTCOME MEASURES: Peak isometric torque measured with a stationary isokinetic dynamometer during a 3-second isometric hold. RESULTS: There was no significant difference in peak flexion [mean difference: 21.2%, 95% confidence interval (CI): -6.6% to 57.4%, P = 0.1413], extension (mean difference: 17%, 95% CI, -6.8% to 47.1%, P = 0.1667), left lateral (mean difference: 4.4%, 95% CI, -16.9% to 31.1%, P = 0.7011), or right lateral (mean difference: 9.3%, 95% CI, -14.5% to 39.8%, P = 0.4627) isometric torque in the concussion group relative to the control group. Across all muscle actions, neck torque was significantly (P < 0.05) higher in male compared with female athletes. Increasing neck girth was also associated with a significant (P < 0.05) increase in neck torque. CONCLUSIONS: There was no evidence of a consistent cervical muscle strength deficit among athletes with a history of 2 or more concussions relative to athletes with no previous history of a concussion. Age, neck girth, and sex were significantly associated with cervical muscle strength. CLINICAL RELEVANCE: Isometric cervical muscle strength testing may not be a reliable test for differentiating athletes with a history of multiple concussions relative to athletes with no history of concussions in the pediatric and adolescent population. Our study presents a reliable methodology for testing cervical muscle strength among young athletes.

Patient expectations and perceived social support related to return to sport after anterior cruciate ligament reconstruction in adolescent athletes.

OBJECTIVE: Examine the relationship between pre-operative competitive status and return to sport expectations post-operatively among adolescents undergoing ACL reconstruction. Assess the association between perceived levels of social support and doubts in returning to sport after ACL reconstruction. DESIGN: Cross-sectional. SETTING: Outpatient sports medicine clinic at a single institution. PARTICIPANTS: 12-18 years old with an ACL tear who were planning to undergo ACL reconstruction. MAIN OUTCOME MEASURES: Psychovitality questionnaire responses and Multidimensional Scale of Perceived Social Support (MSPSS) questionnaire scores. RESULTS: 86% of participants expected to return to sports in six months or less after surgery; there was no significant difference in expected time to return to sport between competitive vs. recreational athletes. Competitive athletes were less likely to be content returning to a lower activity level after surgery compared to recreational athletes. There were no significant differences in MSPSS scores between those who did and did not report doubts in their ability to return to their previous sports. CONCLUSION: Most of our adolescent athlete population expected to return to sport after ACL reconstruction within six months of surgery. Those with and without doubts in their ability to return to sports did not significantly differ in levels of perceived social support.

A characterization of sun protection attitudes and behaviors among children and adolescents in the United States.

Children and adolescents may be vulnerable to increased ultraviolet radiation exposure and greater risk for subsequent sun-related pathologies. This study examined the demographic, geographic, and phenotypic factors influencing sun exposure and protective behaviors among children and adolescents living in the United States. A cross-sectional survey on perceived sun exposure and protective behaviors was administered at three sports medicine clinics in California, Colorado, and Hawaii. Responses were measured with a 5-item frequency scale: Never, Rarely (25% of the time or less), Sometimes (50% of the time), Often (75% of the time or more), and Always. Sun protective behavior was examined using univariate and multivariate analyses. In total, 860 surveys were collected (52% female, 48% male; mean age 12.7 years). Females reported significantly greater frequency of using sunscreen (p = 0.001), staying in the shade or using an umbrella while in the sun (p = 0.004), and tanning (p < 0.001). Age was inversely associated with sunscreen use frequency (p < 0.001); the percentage of participants who reported always wearing sunscreen decreased as age increased. Participants in Hawaii reported using sunscreen less frequently than those in California and Colorado (p < 0.001). These results identify high-risk populations such as males, older adolescents, and Hawaii's youth who may not be practicing frequent sun protective behaviors. While it is important for youth to stay active, they must also be reminded to adopt protective behaviors while outdoors to prevent unnecessary sun damage and lower the risk of sun exposure complications.

Association Between Flexibility and Low Back Pain in Female Adolescent Gymnasts.

OBJECTIVE: To determine the relationship between low back pain (LBP), flexibility, and individual demographic characteristics in competitive adolescent female gymnasts. DESIGN: Cross-sectional observational study. SETTING: Gymnastics facilities in Colorado. PARTICIPANTS: Six- to 18-year-old gymnasts who participate in the USA Gymnastics Women's Artistic Junior Olympic Program levels 3 to 10. INDEPENDENT VARIABLES: Demographic data included height, weight, menstrual status, gymnastics level, and participation hours per week. Flexibility measurements were obtained on the gymnasts. Gymnasts also completed a questionnaire documenting LBP in the past 12 months. Univariable (t test and χ) analyses were used to assess between-group differences; multivariable logistic regression model was used to assess the association between LBP, flexibility, and demographics/injury history. MAIN OUTCOME MEASURES: Low back pain within the past 12 months. RESULTS: Thirty (45%) of 67 gymnasts reported LBP within the past year. Those who reported LBP were older (11.7 vs 13.7 years, P = 0.005), heavier (37.5 vs 43.4 kg, P = 0.049), and participated in gymnastics more often (19.1 vs 22.4 h/wk, P = 0.017). A greater proportion of gymnasts with LBP had experienced menarche compared with those without LBP (47% vs 16%; P = 0.008). On multivariable analysis, gymnasts with LBP were less likely to have left Iliotibial (IT) band tightness compared with those without LBP [adjusted odds ratio (aOR) = 0.186; 95% confidence interval (CI), 0.04-0.82] and more likely to have experienced menarche (aOR = 8.0; 95% CI, 1.2-50.9). CONCLUSIONS: Low back pain is more common in gymnasts who experienced menarche, whereas limited joint flexibility does not seem to be associated with LBP in this population.

Combined Femoral-Sciatic Nerve Block is Superior to Continuous Femoral Nerve Block During Anterior Cruciate Ligament Reconstruction in the Pediatric Population.

Background: Despite advancements in minimally invasive arthroscopic surgical techniques, post-operative pain management following ACL reconstruction remains a concern. This study compares the effectiveness of two common intraoperative pain management strategies - a femoral nerve catheter (FC) versus a combined femoral nerve catheter and single injection sciatic nerve block (FSB) - in pediatric patients undergoing ACL reconstruction. Methods: The medical records of patients age 8 to 18 who underwent ACL reconstruction at our institution were reviewed retrospectively. All subjects underwent general anesthesia with either FC or FSB. Multivariable linear regression, or modified Poisson regression were used to compare outcome variables across groups. Propensity scores were used to minimize bias due to the non-randomized allocation of the regional anesthesia protocol. Results: The study population included 18 subjects in the FC group and 32 subjects in the FSB group. There was no difference in incidence of nausea or opioid prescription refill requests between groups. Total intravenous (IV) morphine equivalent dose, maximum numerical rating scale (NRS) pain score, and percentage of subjects requiring one or more opioid doses in the PACU were significantly greater in the FC group relative to the FSB group. PACU length of stay (LOS) was also significantly greater in the FC group than the FSB group. Conclusion: This study suggests that FSB may be a more effective pain management technique for reducing the total IV morphine equivalent dose, maximum NRS pain scores, number of PACU postoperative opioid doses, and PACU LOS following ACL reconstruction in the pediatric population.Level of Evidence: III.

Microfracture and Microfracture Plus.

Articular cartilage damage remains a significant cause for early osteoarthritis in adolescents and young adults. After chondroplasty alone, the mainstay procedure for cartilage injuries is microfracture. Although in small lesions this may be successful long-term, positive results of treating larger lesions this way are less certain. This inconsistency in outcomes has led to augmentation of these defects with scaffolding for autograft regeneration or for allograft cartilage to fill the defect with a hyaline cartilage. This discussion includes current techniques for the addition of scaffolding to the microfracture defect for larger lesions, the rationale, and preliminary results.