Visual representations of single- and multi-sport participation in a youth swimming sample: Implications for definitions and discussions of early specialization.

Academic literature and sport policy documents have cited concerns about an increasing prevalence of early sport specialization, with associated burnout, dropout, and injury. However, evidence to support such statements is limited. Definitions of early specialization vary, but a common criterion is continued participation in a single sport, prior to adolescence. We explored the prevalence of single-sport participation and other patterns of sport involvement from ages 6-12 in a Canadian swimming sample using retrospective longitudinal methods. Parents of 236 competitive swimmers (ages 12-17) completed surveys on their children's sport backgrounds, including the number of sports participated in annually from age 6-12. A cluster heat map elucidated single- and multi-sport patterns over time. Mixed analyses of variance tested for differences by gender and club type. Fourteen percent of our sample showed stable participation in either one sport or multiple sports per year over time, 25% decreased their annual number of sports, and 60% increased. This trend of increasing, rather than decreasing the number of sports in their annual activity roster when approaching age 12 was particularly pronounced for girls. Only 10 participants (4% of the sample) consistently engaged in a single sport each year from age 6-12. Summer (seasonal) swimmers consistently did more sports than year-round swimmers. Overall, our findings showed highly idiosyncratic longitudinal patterns of sport participation that did not easily conform to current sport activity guidelines. We also found similar idiosyncrasy in an ad-hoc analysis of participants who had dropped out of swimming a year later. If single-sport participation is considered a key criterion for defining early specialization, our findings suggest the prevailing narrative around early specialization may be overstated in relation to the number of single-sport athletes. Alternatively, other components of early specialization may be more prevalent and deserving of attention due to possible associations with harmful outcomes.

"Luggage Tag" Suture Modification for Closing the Quadriceps Tendon Autograft Harvest Site.

The quadriceps tendon (QT) is increasingly used as an autograft for anterior cruciate ligament reconstruction. Closure of the harvest site helps with fluid extravasation from the joint for the duration of the procedure. In addition, closure of the QT removes the palpable defect noticed by many patients and prevents superficial infections from spreading deep to the joint. This Technical Note describes how to perform the "luggage tag" suture modification to efficiently and reproducibly close the QT harvest site with an arthroscopic self-retrieving suture passer.

Healthcare costs of failed rotator cuff repairs.

Background: The goal of this study was to estimate the short-term (∼2 years) healthcare costs of failed primary arthroscopic rotator cuff repair (RCR) in the United States. Methods: A review of current literature was performed to estimate the number of RCR performed in the United States in the year 2022 and the rate of progression of these patients to lose repair continuity, reach clinical failure, and progress to nonoperative intervention and revision procedures. A review of the current literature was performed to estimate the costs incurred by these failures over the ensuing 2-year postoperative time period. Results: The direct and indirect healthcare costs of structural and clinical failure of primary RCR performed in 2022 are estimated to reach $438,892,670 in the short-term postoperative period. The majority of the costs come from the estimated $229,390,898 in nonoperative management that these patients undergo after they reach clinical failure. Conclusion: The short-term healthcare costs of failed arthroscopic RCR performed in the United States in 2022 are predicted to be $438,892,670. Although RCR improves quality of life, pain, function, and is cost-effective, there remains great potential for reducing the economic burden of failed RCR repairs on the US society. Investments into research aimed to improve RCR healing rates are warranted. Clinical Relevance: Although RCR improves quality of life, pain, function, and is cost-effective, this study provides evidence that there remains great potential for reducing the economic burden of failed RCR repairs on the US society. Investments into research aimed to improve RCR healing rates are warranted.

Editorial Commentary: Limited Preoperative Range of Motion Is Associated With Range of Motion Deficits After Anterior Cruciate Ligament Reconstruction: "If the Knee Is Not Straight, Wait".

Optimal timing of anterior cruciate ligament reconstruction (ACLR) remains under debate. Prolonging time between injury and ACLR risks damaging the meniscus and chondral surface, as well as delays return to play. Early ACLR may be associated with postoperative stiffness or arthrofibrosis. We emphasize that optimal timing for ACLR depends on criterion-based return of knee range of motion and quadriceps strength, not a quantitative temporal period. The length of time is far less important that the quality of prereconstruction care provided. Prereconstruction care includes "prehabilitation," including prone hangs focusing on optimizing knee range of motion, postinjury effusion resolution, and mentally preparing the patient for postoperative expectations. Defining preoperative criteria for proceeding with surgery is crucial to decrease the risk of arthrofibrosis. Some patients meet these criteria within 2 weeks, whereas others linger to 10 weeks. Reduction in arthrofibrosis requiring surgical intervention is multifactorial and not solely dependent on the length of time between injury and intervention.

On the self-regulation of sport practice: Moving the narrative from theory and assessment toward practice.

This paper reviews theoretical developments specific to applied research around the "psychology of practice" in skill acquisition settings, which we argue is under-considered in applied sport psychology. Centered upon the Self-Regulation of Sport Practice Survey (SRSP), we explain how self-regulated learning conceptually underpins this survey and review recent data supporting its empirical validation for gauging athletes' psychological processes in relation to sport practice. This paper alternates between a review of applied research on self-regulated sport practice and new data analyses to: (a) show how scores on the SRSP combine to determine an expert practice advantage and (b) illustrate the large scope of self-organized or athlete-led time to which SRSP processes may apply. At this stage, the SRSP has been established as a reliable and valid tool in the empirical, theoretical domain. In order to move the narrative from theory and assessment toward applied practice, we present evidence to propose that it has relevance as a dialogue tool for fostering meaningful discussions between athletes and sport psychology consultants. We review initial case study insights on how the SRSP could be located in consultation in professional practice, propose initial considerations for its practical use and invite practitioners to examine its utility in applied settings.

The Mechanism of Anterior Cruciate Ligament Injuries in the National Football League: A Systematic Video Review.

Introduction Anterior cruciate ligament (ACL) injuries are common among American football athletes, although few studies have performed video analyses of ACL injuries to better understand the injury mechanism. This work aims to characterize the mechanism of ACL injury during professional football competitions using video analysis. We hypothesize that football-specific injury trends will emerge, including high rates of contact injuries and associations with shallow knee and hip flexion angles (0°-30°). Methods Videos of professional football players suffering ACL injuries from 2007 to 2016 were analyzed. Injured players were identified using the injured reserve (IR) lists of the National Football League (NFL), and videos were discovered via a systematic Google search. Descriptive statistics and frequency analyses were performed on all variables using the Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM SPSS Statistics, Armonk, NY, USA). Results Of the 429 ACL injuries identified, 53 (12%) videos were available. Deceleration was the most common injury maneuver, present in 32 (60%) athletes. Thirty-one (58%) players suffered contact injuries. Twenty-eight (53%) injuries demonstrated valgus collapse of the knee, and 26 (49%) had neutral knee rotation. Defensive backs (26%) and wide receivers (23%) were the most frequently injured positions. Conclusion Overall, we found that most ACL injuries had preceding contact, deceleration, shallow hip and knee flexion, and heel strike, and subsequent valgus collapse and neutral knee rotation. This understanding of American football-specific ACL tear mechanisms could help direct the focus of future injury prevention training modalities.

Onlay versus inlay humeral components in reverse shoulder arthroplasty: A systematic review and meta-analysis.

Background: Advances have been made to the traditional inlay Grammont Reverse Shoulder Arthroplasty (RSA) design such as the onlay humeral component prosthesis. Currently, there is no agreement in the literature regarding the best option for the humeral component when comparing inlay and onlay designs. This review compares the outcomes and complications between onlay versus inlay humeral components for RSA. Methods: A literature search was conducted using PubMed and Embase. Only studies reporting outcomes comparing onlay versus inlay RSA humeral components were included. Results: Four studies with 298 patients (306 shoulders) were included. Onlay humeral components were associated with better external rotation (ER) (p < 0.0001). No significant difference in forward flexion (FF) or abduction was found. Constant scores (CS) and VAS scores did not differ. Increased scapular notching was found in the inlay group (23.18%) versus the onlay group (7.74%) (p = 0.02). Postoperative scapular fractures and acromial fractures did not differ. Conclusion: Onlay and inlay RSA designs are associated with improved postoperative range of motion (ROM). Onlay humeral designs may be associated with greater ER and lower rate of scapular notching; however, no difference was found in Constant and VAS scores, so further studies are required to assess the clinical significance of these differences.

Examining the validity of the polish short form version of the self-regulated learning-sport practice survey among competitive athletes.

Introduction: Self-regulated learning entails psychological processes that elite athletes employ to optimize their practice. Although self-regulated learning provides insights into athlete-led practice, research has been limited to few cultures, and the particularities of how SRL surveys perform in new cultural contexts require attention. Moreover, there exists no measure to assess SRL and its relationship to quality sport practice in Polish. Thus, we examined the Short Form of the Self-Regulated Learning-Sport Practice survey in Polish. Analyses addressed the factorial validity and reliability, the criterion validity (by assessing differences in scores between competition levels), and the concurrent validity (by correlating scores with conceptually related constructs) of a Polish Short Form survey. Methods: Athletes (N = 324, M age = 21.4, n females = 144, n males = 180) from amateur, regional, national, and international-elite levels completed the survey, along with concurrent subscales (General Self-Efficacy Scale; GSES; Metacognitive-Self Scale; MS-24; Action Control Scale; ACS-90). Results: Confirmatory factor analysis indicated a two-factor (metacognitive; motivational) model (RMSEA = 0.082, SRMR = 0.057, CFI = 0.89). Between-group tests showed international-elite scoring higher than all other groups on metacognitive and motivational subscales. On both subscales, significant trends indicated that more skilled levels consistently reported higher scores than lesser-skilled levels. The short form scores were associated with certain concurrent variables, including GSES (rmeta = 0.41, rmotiv = 0.48), MS-24 (rmeta = 0.39, rmotiv = 0 .24), and ACS-90 (AOF subscale: rmotiv = 0 .26). Discussion: On the basis of strong criterion validity, and moderate evidence for concurrent validity, we conclude that the Polish Short Form of the Self-Regulated Learning-Sport Practice survey is a promising tool for use in Polish sport and we discuss future avenues of work to enhance its validation. Limitations that inform future research include our reliance on a mixed-sport sample, the lack of priming of obstacles/challenge ahead of self-report, and a lack of consideration of sport-specific practice variables in analyses.

Investigation of the Superlattice Phases Formed in Ta72Ru28.

The Ta-Ru binary phase diagram has not been fully investigated, but shows potential for a two-phase region of A2 + B2. Given the high melting points of both Ta and Ru, such an alloy would have the potential for high temperature strength. A Ta72Ru28 alloy was arc melted and investigated in the as-cast and aged (at 1000 °C) states. The as cast alloy was composed of A2 and B2, albeit not in a superalloy-like morphology. A third phase was found in the aged alloy, which has not been reported before, and which is also a coherent superlattice phase of the Ta BCC matrix. The structure of this phase was found to be consistent with the tetragonal Cr2Al prototype structure, with lattice parameters of (a, a, 3a), where a is the Ta BCC lattice parameter.

Biomechanical comparison of Tibial-sided supplemental fixation techniques in Bone-Patellar Tendon-Bone anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to compare the biomechanical properties of a commercially available suture anchor and a screw post for supplemental tibial fixation of a bone-patellar tendon-bone (BTB) graft at time zero. We hypothesized that supplemental fixation using a suture anchor would demonstrate similar biomechanical performance in comparison with a screw post. METHODS: Sixteen fresh frozen, healthy human cadaveric knees underwent BTB autograft harvest, placement, and primary tibial-sided interference screw fixation using a standardized technique performed by a single surgeon. Specimens were randomly assigned to one of two tibial-sided supplemental fixation groups (suture anchor or screw post), yielding eight specimens in each group. Each specimen was affixed to a custom loading apparatus, with the tibial tunnel aligned in a vertical position that allowed for parallel "worst-case scenario" loading and eliminated loading variation due to tibial tunnel angle. Grafts were pretensioned to 30 N and biomechanical performance was compared with respect to cyclical loading between 50-250 N for 500 cycles at 0.5 Hz and pull-to-failure loading at 60 mm/min. RESULTS: The suture anchor and screw post supplemental constructs demonstrated similar performance with respect to all biomechanical parameters assessed, including yield strength (294.0 N [IQR 267.2-304.2 N] versus 332.1 N [IQR 313.8-350.4 N]; P = 0.079) and ultimate strength (330.1 N [IQR 306.9-418.7 N] versus 374.7 N [IQR 362.0-387.3 N]; P = 0.3798). However, of the eight original specimens in each group, one suture anchor specimen (12.5%) and six metallic screw post specimens (75%) failed during cyclical testing and were unable to undergo displacement and load to failure testing. CONCLUSION: This study provides preliminary evidence that supplemental tibial-sided fixation of a BTB ACL graft with a suture anchor has similar loading characteristics or load-to-failure strength when compared to supplemental fixation with a screw post construct. STUDY DESIGN: Laboratory Controlled Study. LEVEL OF EVIDENCE: Basic Science Study.

Clinical and Radiologic Outcomes after Meniscal Root Repair: A Case Series.

This study aimed to describe the demographics, clinical outcomes, and radiologic outcomes of patients who underwent meniscal root repair at a single, large academic institution. Patients who underwent meniscal root repair between January 2011 and April 2015 were identified. Patient demographics, injury characteristics, and intraoperative findings of medial femoral condyle chondromalacia and other concomitant pathology were retrospectively recorded. Enrolled patients returned to clinic for prospectively collected International Knee Documentation Committee (IKDC) subjective and objective forms, knee radiographs, and magnetic resonance imaging (MRI). A total of 25 root injuries (23 patients) were included in the final analysis. Majority of root injuries were medial menisci (68%) and repaired using transosseous pull-out technique (80%). Most patients (65%) were male, relatively young (median age = 37 years), overweight (median body mass index [BMI] = 26 kg/m2), and reported a traumatic event associated with their injury (60%). Also, 36% (9/25) of root repairs were performed concomitantly with an anterior cruciate ligament (ACL) reconstruction; 100% (8/8) lateral meniscal root injuries were associated with a concomitant ACL injury compared with 6% (1/17) of medial root injuries. Overall, 53% (9/17) of medial meniscal root repairs were performed in the setting of high-grade (Outerbridge's grade III/IV) chondral pathology of the ipsilateral femoral condyle. Median follow-up was 16 months. The Kellgren-Lawrence radiographic scale progressed in two knees that underwent meniscal root repair based on comparison of preoperative to follow-up radiographs. MRI showed 88% (22/25) of meniscal roots had completely healed, 6% (1/17) of the medial root repairs showed evidence of extrusion, and 44% (11/25) of repairs were associated with progressive chondromalacia. All patients had normal or near normal IKDC objective scores at time of follow-up. Surgeons should have a high suspicion for concomitant ACL injuries in the setting of lateral meniscal root tears, and be wary of concomitant high-grade chondral damage in the setting of medial meniscal root tears. Most meniscal root repairs appeared completely healed with low rates of medial meniscal extrusion on MRI at short-term follow-up, despite a high rate of chondromalacia progression. Present study is a large case series with prospective follow-up and reflects level of evidence IV.

Arthroscopic-Assisted Lateral Extra-Articular Tenodesis With Knotless Anchor Fixation.

Recent studies have reported the biomechanical and clinical advantages of lateral extraarticular augmentation procedures including the modified lateral extra-articular tenodesis (LET) in the setting of anterior cruciate ligament reconstruction. LET has been shown to significantly decrease re-rupture rates in high-risk patients and decrease anterior cruciate ligament graft forces during pivoting loads and instrumented anterior laxity testing. Many variations of the modified LET approaches have been described. However, concerns including lateral hematoma, wound-healing complications, and increased operative time exist. This minimally invasive, arthroscopic-assisted approach using a knotless, all-suture anchor allows for direct visualization through a 2-cm incision and inherently decreases the morbidity associated with traditional LET techniques.

Trends in Repair vs. Biceps Tenodesis for Superior Labrum From Anterior to Posterior (SLAP) Tear: An Epidemiological Study.

Background The purpose of this epidemiologic study was to report general trends in the number of superior labrum from anterior to posterior (SLAP) tear repairs and biceps tenodesis performed along with the patient and hospital characteristics within the period of 2016-2018. Methods National Ambulatory Surgery Sample (NASS) database was used as the source of data for this epidemiologic study of the United States population. Current Procedural Terminology (CPT) codes were utilized to identify patients that underwent SLAP repair or biceps tenodesis between 2016 and 2018. Results The national estimates of encounters from the NASS database reported 29,931 SLAP repairs in 2016 and each subsequent year saw a decline to 26,509 repairs in 2017 and 23,451 repairs in 2018 (p<0.0001). Conversely, in 2016 there were 19,221 biceps tenodeses and each subsequent year saw an increase to 21,625 biceps tenodeses in 2017 and 22,867 biceps tenodeses in 2018 (p<0.0001). Conclusion The results of our epidemiologic study found that the total number of SLAP repairs is decreasing while biceps tenodesis is increasing. SLAP repairs were performed for younger patients and biceps tenodeses were performed for older patients. This study demonstrates that clinical practice reflective of recent evidence regarding optimal age for SLAP repair is slow to change. While there is ongoing debate as to the gold standard for the surgical management of SLAP tear lesions, our study confirms that there is an increasing trend among orthopedic surgeons favoring biceps tenodesis which may reflect the increasing literature evidence supporting better clinical outcomes after biceps tenodesis compared to SLAP repair.

Comorbidity scores reported in anatomic and reverse total shoulder arthroplasty: a systematic review.

BACKGROUND: Due to the aging population, the number of reverse shoulder arthroplasty (RSA) and anatomic shoulder arthroplasty (TSA) continue to increase annually. Although outcome measures are frequently reported in literature for patients who undergo shoulder arthroplasty, no studies have analyzed reporting of patient comorbidities in this population. The purpose of this study was to evaluate reporting of comorbidity indices in shoulder arthroplasty literature and assess how this reporting may inform management and outcomes. METHODS: A database was compiled systematically using PubMed to identify articles pertaining to shoulder arthroplasty published between 2019 and 2021. The search terms, "reverse shoulder arthroplasty" and "anatomic shoulder arthroplasty," were used to identify clinical studies. Non-clinical (e.g., translational and basic science) and review articles were excluded. Included studies were then analyzed for reporting of comorbidity indices. RESULTS: A total of 199 articles were included in this review and reported comorbidities. Of these, 15.6% (31 of 199) pertained to TSA, while 84.4% (168 of 199) pertained to RSA. Within this review, 57.8% (115 of 199) articles utilized comorbidity scores, while 42.2% (84 of 199) reported only comorbid diagnoses. Among the scores utilized, the American Society of Anesthesiologists (ASA) physical status classification system was the most widely used among both the TSA (52.9%, 9 of 17) and the RSA studies (58.2%, 57 of 98). Additional scores within the RSA literature included the Charlson Comorbidity Index (CCI) (35.3%, 6 of 17), the Charlson Comorbidity Index by Deyo et al. (J Clin Epidemiol. 45(6):613-9, 1992) (CCI-Deyo; 5.9%, 1 of 17), the Modified Charlson Comorbidity Index (modified-CCI) (5.9%, 1 of 17), the Elixhauser et al. (Med Care. 36(1):8-27, 1998) Comorbidity Measure (ECM) (11.8%, 2 of 17), and the Modified Frailty Index (mFI) (5.9%, 1 of 17). With the TSA literature, the additional comorbidity scores included the CCI (30.6%, 30 of 98), the CCI-Deyo (6.1%, 6 of 98), the modified-CCI (1.0%, 1 of 98), the ECM (8.2%, 8 of 98), the Factor-5 modified Frailty Index (mFI-5) (1.0%, 1 of 98), and the mFI (1.0%, 1 of 98). CONCLUSION: The reporting of comorbidity indices is an important factor when considering patient outcomes and complications reported in shoulder arthroplasty literature. Although the reporting of these scores appears to be more prevalent in current literature, there is no standard or consistency in terms of which scores are reported. Given this diversity in comorbidity scores, further research is necessary to develop a single standardized score to properly analyze the effect of comorbidities on shoulder arthroplasty patient outcomes.

Caffeine intake does not appear to impair tendon-to-bone healing strength in a rat rotator cuff repair model.

Background: Tendon-to-bone (TtB) healing is essential for successful rotator cuff repair (RCR). This study aimed to investigate if caffeine intake impaired TtB healing in a rat RCR model. Methods: Seventy-two rats were randomized into a caffeinated group or a noncaffeinated group. Specimens received one week of oral caffeine solution or normal saline before RCR. All rats then underwent bilateral RCR. Caffeination or saline gavages continued until rats were sacrificed at 2, 4, and 8 weeks postoperatively. Load-to-failure (primary outcomes measure), maximum stress, and stiffness of the TtB interface were measured for one shoulder of each specimen. Six random shoulders from each group underwent histological assessment of TtB healing. Results: Load-to-failure and maximum stress of RCR did not appear to differ between groups at any time point. No difference in RCR stiffness was found between groups at 2 and 4 weeks; however, stiffness in the caffeinated group did appear to lower at 8 weeks (P = .04). Conclusion: Perioperative caffeine intake did not appear to affect load-to-failure strength of RCR in an animal model. Although our secondary outcome measures of maximum stress and stiffness also did not appear to be influenced by perioperative caffeine intake, there did appear to be a trend toward decreased RCR stiffness at 8 weeks postoperatively in specimens that received caffeine.

Outcomes and failure rates after revision meniscal repair: a systematic review and meta-analysis.

PURPOSE: The purpose of this meta-analysis is to determine the outcomes and failure rates for revision meniscus repairs in patients with re-tears after primary repair failure. METHODS: A literature search was conducted using PubMed and Embase with the terms "Meniscus," "Meniscal," "Revised," and "Revision." The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol and included four articles (79 patients). The search criteria were limited to studies reporting outcomes and failure rates. The exclusion criteria included languages other than English, biomechanical studies, letters to editors, non-full text, review articles, meta-analysis, and case reports. RESULTS: Four comparative studies with 79 patients (53 males, 26 females) with a mean age of 23.9 ± 6.4 years treated with a revision meniscus repair were included in the final analysis. Within this analysis, we found a failure rate of 25.3% (20 of 79 patients). Of these failed repairs, 30.95% (13 of 42) were of the medial meniscus, and 18.9% (7 of 37) were of the lateral meniscus. In the four articles, the postoperative Tegner sports activity score was found to be 6.1 ± 1.6 (range, 2 to 10). The post-operative Lysholm score was reported in three articles (45 patients). At a mean follow-up of 58.3 ± 23.9 months, the mean post-operative Lysholm score was 89.1 ± 7.6 (range, 38 to 100). The Coleman score for the included articles ranged between 52 and 59. CONCLUSION: This analysis found that revision meniscus repairs in patients with re-tears after primary repair failure result in clinical outcomes similar to that of primary repairs.

Distal Clavicle Excision: An Epidemiologic Study Using the National Ambulatory Surgery Sample Database.

BACKGROUND: This study aimed to examine national trends pertaining to patient demographics and hospital characteristics among distal clavicle excision (DCE) procedures performed in the United States. METHODS: The National Ambulatory Surgery Sample (NASS) database was queried for data. Encounters with Current Procedural Terminology (CPT) code 29824 were selected. Metrics derived from these encounters included patient demographic information such as age, geographic location, median household income per zip code, and primary expected insurance payer. Hospital characteristics derived included total charges for DCE procedures, location of the hospital, disposition of the patient, hospital census region, control/ownership of the hospital, and location/teaching status of the hospital. The proportion of DCE performed concomitantly with rotator cuff repair (RCR) was also analyzed. P-values were obtained from continuous variables using a t-test with a linear regression model. P-values were obtained from event variables using chi-square analysis. RESULTS: The incidence of arthroscopic DCE in the US decreased from 99,070 in 2016 to 93,678 (5.5%) in 2018. Of note, the proportion of DCE performed concomitantly with RCR significantly increased from 50.4% in 2016 to 52.8% in 2018 (P < 0.0001). Median patient age increased from 2016 to 2018 (56.4 to 57.2; P < 0.0001). The income quartile that saw the highest number of encounters was between $43,000 and $53,999 (P < 0.0001). Hospital trends display an increasing cost from $16,944 to $18,855 over the study period (P = 0.0016). Private insurance, including health maintenance organizations (HMOs), were the largest payers for this procedure; however, a decreasing trend in DCE covered by private insurance was noticed (50.2% to 47.3%; P < 0.0001). Medicare was the second-largest payer ranging from 27.9% in 2016 to 29.9% in 2018. The urban teaching model of hospitals continues to see the highest number of encounters for this procedure. CONCLUSIONS: In both 2016 and 2018, private insurance was the most common payer, most DCEs were performed in urban teaching hospitals, and most patients undergoing the procedure had a median household income between $43,000 and $59,000. Between 2016 and 2018, there was a significant increase in costs associated with DCE, as well as an increase in the median age of patients undergoing the procedure. The proportion of DCE performed concurrently with RCR also significantly increased during the study period.

Intermediate and Long-term Outcomes Following Surgical Decompression of Neurogenic Thoracic Outlet Syndrome in an Adolescent Patient Population.

Background: Although the diagnosis of thoracic outlet syndrome (TOS) is often missed, outcomes from surgical intervention significantly improve patient satisfaction. This article seeks to highlight patient characteristics, intraoperative findings, and both short and long-term outcomes of thoracic outlet decompression in the adolescent population. Methods: A retrospective chart review of patients between the ages of 13 and 21 years with a clinical diagnosis of neurogenic thoracic outlet syndrome (NTOS) who were treated surgically between 2000 and 2015 was performed. Data points including preoperative patient characteristics and intraoperative findings were collected. In addition, patient-reported outcome scores, including Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, Cervical Brachial Symptom Questionnaire (CBSQ), and NTOS index, were obtained for a cohort of patients with follow-up ranging from 2 to 15 years. Results: The study population consisted of 54 patients involving 61 extremities. The most common procedures included neurolysis of the supraclavicular brachial plexus (60, 98.4%), anterior scalenectomy (59, 96.7%), and middle scalenectomy (54, 88.5%). First rib resection (FRR) was performed in 28 patients (45.9%). Long-term outcomes were collected for 24 (44%) of 54 patients with an average follow-up of 69.5 months (range, 24-180 months). The average VAS improved from 7.5 preoperatively to 1.8 postoperatively. The average SANE increased from 28.9 preoperatively to 85.4 postoperatively. The average postoperative scores were 11.4 for the QuickDASH, 27.4 for the CBSQ, and 17.2 for the NTOS index. Subgroup analysis of patients having FRR (28, 45.9%) demonstrated no difference in clinical outcome measures compared with patients who did not have FRR. Conclusion: Surgical treatment of NTOS in adolescent patients has favorable intermediate and long-term outcomes.

Mental Performance Consultants' Perspectives on Content and Delivery of Sport Psychology Services to Masters Athletes.

In the absence of sport psychology resources for Masters Athletes, mental performance consultants could benefit from information to assist consultancy with older adult athletes. We conducted semistructured interviews to explore 10 Canadian professional mental performance consultants' (two men and eight women) perspectives of targeted content and the nature of service delivery to Masters Athletes. Following inductive thematic analysis, results for Content of Sport Psychology related to performance readiness (e.g., preparatory routines, mental focus plans); prioritizing sport (e.g., balance/time management, recruiting social support); preserving sport enjoyment (e.g., self-reflection, gratitude/sport as opportunity); and age-related considerations (e.g., managing changing physical realities). Results pertaining to Addressing and Delivering Sport Psychology Services included considerations toward age-related attributes (e.g., values/identity, engaged/invested clients) and accommodating barriers/constraints (e.g., time, stigma). Our results show there are novel considerations when consulting with Masters Athletes, and we discuss what these findings mean for adult-oriented approaches in applied practice.

Distal clavicle "A-frame" morphology: a reliable intraoperative guide for arthroscopic distal clavicle excision.

BACKGROUND: The purpose of this cadaveric study was to describe the characteristics of the "A-frame" morphology of the distal clavicle via computed tomography (CT) to determine whether it can be used as a reliable intraoperative guide for arthroscopic distal clavicle excision. METHODS: Twenty-eight fresh-frozen human cadaveric clavicles underwent a 3-dimensional CT scan using 1.0-mm cuts. The distance from the most lateral aspect of the clavicle to the point at which the superior cortex of the clavicle paralleled the inferior cortex was measured. Measurements were performed in a blinded fashion by a single author on 2 separate occasions. RESULTS: The A-frame was present in all specimens (28 of 28). On the first measurement, the mean distance from the distal clavicle to the point at which the A-frame disappeared was 1.00 cm (range, 0.90-1.08 cm; standard deviation, 0.5 mm). On the second measurement, the mean distance was 1.02 cm (range, 0.90-1.11 cm; standard deviation, 0.6 mm). The intrarater reliability between measurement occasions was 0.65 (95% confidence interval, 0.36-0.82; P < .001). CONCLUSIONS: This study demonstrated that the cross-sectional A-frame morphology of the distal clavicle was consistently visualized on CT scans. The A-frame disappeared 1.00-1.02 cm medial to the most lateral extent of the clavicle on CT scans. The disappearance of the A-frame morphology of the distal clavicle can serve as a reliable intraoperative guide for arthroscopic distal clavicle excision.