High healing rate of stable femoral condyle osteochondritis dissecans in young patients placed in a hinged knee brace locked in extension: a retrospective study.

We report the rate of stable femoral condyle osteochondritis dissecans (OCD) lesion healing in adolescents using a locked hinged knee brace for a minimum of 6 weeks or until pain free, followed by physical therapy. Patients aged 5-18 at the time of a primary diagnosis of femoral condyle OCD were reviewed. Patients who presented with an unstable lesion necessitating surgery, lacked follow-up >6 months after diagnosis or before symptoms resolution, or were noncompliant were excluded. We assessed progression to surgery, association between surgery and lesion size, lesion grade, symptoms, laterality, and patient factors. Lesion width and depth and condyle size were measured on X-ray and MRI, and the scaled size of the lesion relative to the condyle was calculated. Sixty-four patients were included: 12.5% (n = 8; 50% female; mean age = 12.5 ± 1.0 years) progressed to surgery and 87.5% (n = 56; 20% female; mean age=11.5 ± 1.9 years) healed. No significant effects were identified between groups. The surgical group compared to the non-surgical group was braced for a similar amount of time (72.6 ± 51.4 vs. 54.9 ± 23.2 days; P = 0.09), presented initially with a similar lesion size (322.5 ± 298.7 vs. 211.2 ± 178.4 mm2; P = 0.14), and had a similar proportion of Grade 1 lesions (63% vs. 85%; P = 0.11). Female sex (P = 0.04) and longer time in the brace (P = 0.04) were associated with progression to surgery.

Sports participation volume and psychosocial outcomes among healthy high school athletes.

OBJECTIVES: We assessed the association between hours/week of sports participation and psychosocial outcomes among high school athletes. We hypothesized that more hours of participation would be associated with the lower levels of anxiety and depressive symptoms. METHODS: Participants completed the Patient-reported Outcomes Measurement Information System (PROMIS) Pediatric Profile 25 quality of life and other questionnaires to assess sports participation, socioeconomic status, and health history. We evaluated the multivariable relationship between hours/week in sport and PROMIS scores while adjusting for the independent effect of age and varsity team status. RESULTS: A total of 230 high school athletes participated in this study (mean=15.4±1.2 years of age). More hours/week playing sports were significantly associated with the lower levels of depressive symptoms (coefficient=-0.073, 95% CI=-0.137, -0.010; P=0.02). Sports participation was not significantly associated with any other psychosocial domain scores on the PROMIS questionnaire. CONCLUSION: More hours of sports participation were significantly associated with the lower depressive symptoms, but no other psychosocial domain. While our findings are cross-sectional, sport participation may play a role in attenuating symptoms of depression in high school athletes. RELEVANCE FOR PATIENTS: Sports participation may play a beneficial role in lessening depressive symptoms among healthy high school students.

Symptom profiles and postural control after concussion in female artistic athletes.

OBJECTIVES: The purpose of our investigation was to compare post-concussion symptom profiles and postural control measures among female youth artistic athletes (gymnasts and cheerleaders) relative to female ball sport athletes (volleyball or basketball). METHODS/FINDINGS: We compared 27 artistic athletes (median age = 15.0 years; evaluated median = 13 days post-injury) and 49 ball sport athletes (median age = 15.3 years; evaluated median = 10 days post-injury) within 21 days of sustaining a concussion on measures of symptom profiles and postural control (Balance Error Scoring System [BESS]), tandem gait, and Romberg tests. After adjusting for the independent effect of time from injury-evaluation, concussion history, and pre-morbid migraine history, we observed that artistic athletes performed the BESS tandem stance foam condition with fewer errors than ball sport athletes (ß = -2.4; 95% CI = -4.7, -0.2; p = .03). Artistic athletes demonstrated a higher, yet not statistically significant, headache severity than ball sport athletes (median = 4.5 vs 4.0, p = .07). CONCLUSIONS: Overall, artistic athletes had similar symptom profiles to ball sport athletes. Postural control measures, other than the BESS tandem stance foam condition, were not significantly different from ball sport athletes. This suggests that although their sports may require higher levels of balance, artistic athletes' performance on post-concussion balance tests may be similar to athletes of other disciplines.

Sleep Quality and Quality of Life Among Healthy High School Athletes.

We examined the association between sleep quality and quality of life (QOL) among uninjured high school athletes. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Profile 25 questionnaire. One hundred ten athletes reported poor sleep quality (mean PSQI: 6.6 ± 2.0; mean age: 15.3 ± 1.1; 62% female); 162 athletes reported good sleep quality (mean PSQI: 2.3 ± 1.3; mean age: 15.1 ± 1.7; 33% female). After adjusting for sex and age, worse sleep quality was associated with higher physical function/mobility (ß = 0.034; 95% confidence interval [CI] = 0.007-0.060; P = .01), anxiety (ß= 0.391; 95% CI = 0.263-0.520; P < .001), depressive symptom (ß = 0.456; 95% CI = 0.346-0.565; P < .001), fatigue (ß = 0.537; 95% CI = 0.438-0.636; P < .001), pain interference (ß = 0.247; 95% CI = 0.119-0.375; P < .001), and pain intensity (ß = 0.103; 95% CI = 0.029-0.177; P = .006) ratings. Poor self-reported sleep quality among adolescent athletes was associated with worse QOL ratings. Clinicians should consider assessing sleep hygiene to provide guidance on issues pertaining to reduced QOL.

Sport Specialization, Club Sport Participation, Quality of Life, and Injury History Among High School Athletes.

CONTEXT: Many factors can affect the injury risk and quality of life among high school athletes. Early sport specialization and club sport participation may be components to consider when assessing the injury risk and quality of life. OBJECTIVE: To investigate patient-reported quality-of-life and injury-history measures among adolescent athletes at different sport-specialization levels and to compare these measures between those who did and those who did not report participating in club sports. DESIGN: Cross-sectional study. SETTING: High school athletic facility. PATIENTS OR OTHER PARTICIPANTS: High school student athletes 13 to 18 years of age were recruited and tested during their annual preseason athletic physical examinations. MAIN OUTCOME MEASURE(S): Our primary grouping variables were sport-specialization level (classified as low, moderate, or high) and club sport participation (organized sport outside of traditional school athletics). Our outcome variables were the Patient-Reported Outcome Measurement Information System Pediatric Profile-37 rating, Severity Measure for Depression-Child score, and injury history. RESULTS: A total of 97 individuals participated (mean age = 15.2 ± 1.1 years; 38% female). Relatively similar proportions of individuals reported participating at each level of sport specialization (low = 34%, moderate = 40%, high = 26%). Forty-six (48%) participants stated they participated in club sports. No differences were evident in quality of life (P values = .15-.92 across domains), depression (P = .60), or injury history (P > .70) among the specialization groups. Those who described participating in club sports had a higher proportion of time-loss musculoskeletal injuries (63% versus 29%; P = .002) and of injuries requiring imaging, injection, a cast, a brace, or crutches (72% versus 46%; P = .013) than those who did not. CONCLUSIONS: Although no injury-history differences were found among the sport-specialization groups, a higher proportion of club sport athletes than nonclub sport athletes reported a history of injury. Club sports are generally seen as more competitive, and the higher number of injuries seen in this setting could be related to a higher level of play among club sport athletes.

Musculoskeletal Overuse Injuries in the Pediatric Population.

In pediatric patients, musculoskeletal overuse injuries are common clinical complaints. Recently, the number of youth who are engaged in formal competition has increased. A National Council of Youth Sports survey found that 60 million children aged 6 to 18 yr participate in some form of organized athletics. Surveillance reporting systems, such as the National High School Sports-Related Injury Surveillance System and the High School Reporting Information Online (high school RIO), an Internet-based sports injury surveillance tool, have suggested an increase in the rates of overuse injuries. This article will focus on potential risk factors for overuse injuries, including those that are intrinsic and extrinsic in youth athletes. We also make note of some of the more common overuse injuries seen in the outpatient clinical setting, their diagnoses, and treatment based on current evidence-based literature.

Is there an association between superolateral Hoffa fat pad edema on MRI and clinical evidence of fat pad impingement?

OBJECTIVE: Patients with symptomatic Hoffa fat pad impingement often exhibit fat pad edema on MRI. We studied two patient groups to determine the association between MRI fat pad edema and clinical symptoms of Hoffa fat pad impingement. MATERIALS AND METHODS: We studied 34 consecutive patients with an MRI diagnosis of fat pad edema and no injury in the prior year (group 1) and 47 consecutive patients with a knee MRI examination and no injury in the prior year (group 2). Two sports medicine physicians reviewed the clinical records to confirm or exclude symptomatic fat pad impingement. Two musculoskeletal radiologists independently scored 12 Hoffa fat pad locations for the presence of edema, noting the epicenter. RESULTS: Seventeen of the 34 patients in group 1 had clinical symptoms of fat pad impingement, with all 34 having fat pad edema. There was no association between clinical fat pad impingement and fat pad edema in any specific location (p > 0.183), but patients with fat pad impingement had a greater number of regions of edema (p = 0.005, 0.026 for two observers). In group 2, all four patients with clinical fat pad impingement had MRI fat pad edema, but 38 of the 43 patients without clinical impingement had MRI fat edema; 11 of the 38 had edema centered in the superolateral fat pad. CONCLUSION: Edema is present on MRI in the superolateral region of Hoffa fat pad in patients with clinical fat pad impingement. However, such edema can also be present in patients without symptoms of fat pad impingement.

Strength training in children and adolescents: raising the bar for young athletes?

CONTEXT: Strength training in children, in combination with plyometric and/or agility training, has become an increasingly popular tactic for athletes to gain a competitive edge during the off-season. The present review clarifies some common myths associated with strength training in children, and it outlines the most current recommendations. EVIDENCE ACQUISITION: Relevant studies on strength training in children and adolescents were reviewed (search results included studies indexed in PubMed and MEDLINE from 1980 through 2008). Also reviewed were recommendations from consensus guidelines and position statements applicable to strength training in youth. RESULTS: Children can improve strength by 30% to 50% after just 8 to 12 weeks of a well-designed strength training program. Youth need to continue to train at least 2 times per week to maintain strength. The case reports of injuries related to strength training, including epiphyseal plate fractures and lower back injuries, are primarily attributed to the misuse of equipment, inappropriate weight, improper technique, or lack of qualified adult supervision. CONCLUSION: Youth-athletes and nonathletes alike-can successfully and safely improve their strength and overall health by participating in a well-supervised program. Trained fitness professionals play an essential role in ensuring proper technique, form, progression of exercises, and safety in this age group.