Pitching Behaviors in Youth Fast-Pitched Softball: High Pitching Volumes With Unequal Pitch Counts Among Pitchers are Common.

BACKGROUND: Softball is a popular sport among youth female athletes. While youth baseball has well-established, evidence-based pitching guidelines, youth softball pitching guidelines lack both evidence and enforcement. Adherence to pitch count limits in youth softball is infrequent and results in pitchers with exceedingly high pitching volumes. METHODS: Pitch counts for youth fast-pitch softball teams competing for 1 consecutive year between January 2018 to December 2019 in age groups 8 and under (8U) to 14 and under (14U) were collected. Pitching volume was assessed based on individual games, single calendar days, and tournaments in which games are played on 2 or more consecutive days. Pitchers on teams were subdivided based on pitch count volumes and compared using a logarithmic transformation and geometric mean. RESULTS: Data was collected for 10 teams from each age division resulting in analysis of 538 pitchers on 70 teams. The average pitcher threw 813 pitches per year and appeared in 20.0% of games while the average highest volume pitcher threw 2500 pitches per year and appeared in 54.5% of games. On average, the highest volume pitcher on each team threw 40% of all team pitches, while the 3 highest volume pitchers combined threw 82% of all team pitches. The average and high-volume pitcher threw pitches in 2 or more games on the same day in 37.5% and 48.6% of possible games while pitching 2 or more consecutive days in 64.0% and 79.6% of possible games, respectively. CONCLUSIONS: Softball pitchers throw high volumes of pitches while also pitching multiple days consecutively. A disparity among pitchers on softball teams exists as 40% of team pitches are thrown by 1 player and over 80% of team pitches are thrown by the top 3 pitchers. These high-volume pitchers may be engaging in unsustainable pitching practices that could predispose to injury. LEVEL OF EVIDENCE: Level IV-cross-sectional.

Normative Values of the Sport Concussion Assessment Tool 3 (SCAT3) in High School Athletes.

OBJECTIVE: Establish sex, age, and concussion history-specific normative baseline sport concussion assessment tool 3 (SCAT3) values in adolescent athletes. DESIGN: Prospective cohort. SETTING: Seven Wisconsin high schools. PARTICIPANTS: Seven hundred fifty-eight high school athletes participating in 19 sports. INDEPENDENT VARIABLES: Sex, age, and concussion history. MAIN OUTCOME MEASURES: Sport Concussion Assessment Tool 3 (SCAT3): total number of symptoms; symptom severity; total Standardized Assessment of Concussion (SAC); and each SAC component (orientation, immediate memory, concentration, delayed recall); Balance Error Scoring System (BESS) total errors (BESS, floor and foam pad). RESULTS: Males reported a higher total number of symptoms [median (interquartile range): 0 (0-2) vs 0 (0-1), P = 0.001] and severity of symptoms [0 (0-3) vs 0 (0-2), P = 0.001] and a lower mean (SD) total SAC [26.0 (2.3) vs 26.4 (2.0), P = 0.026], and orientation [5 (4-5) vs 5 (5-5), P = 0.021]. There was no difference in baseline scores between sex for immediate memory, concentration, delayed recall or BESS total errors. No differences were found for any test domain based on age. Previously, concussed athletes reported a higher total number of symptoms [1 (0-4) vs 0 (0-2), P = 0.001] and symptom severity [2 (0-5) vs 0 (0-2), P = 0.001]. BESS total scores did not differ by concussion history. CONCLUSION: This study represents the first published normative baseline SCAT3 values in high school athletes. Results varied by sex and history of previous concussion but not by age. The normative baseline values generated from this study will help clinicians better evaluate and interpret SCAT3 results of concussed adolescent athletes.

Short-term clinical importance of osseous injuries diagnosed at MR imaging in patients with anterior cruciate ligament tear.

PURPOSE: To determine the association between osseous injuries and short-term clinical outcome in patients with anterior cruciate ligament (ACL) tear. MATERIALS AND METHODS: The retrospective study was performed with institutional review board approval, and the requirement to obtain informed consent was waived. The study group consisted of 114 patients (57 male and 57 female patients with a mean age of 26.1 and 25.1 years, respectively) with ACL tear who underwent magnetic resonance (MR) imaging and ACL reconstruction surgery and who filled out International Knee Documentation Committee (IKDC) knee evaluation questionnaires before and 1 year after surgery. All MR images were independently reviewed by two radiologists to determine the presence of a cortical depression fracture on each surface of the knee joint. Bone marrow edema volume was quantified by using segmentation software. Correlation coefficients were used to determine the association between bone marrow edema volume and IKDC score. A multivariate analysis model was used to compare IKDC scores in patients without fracture, patients with a single fracture, and patients with multiple fractures. RESULTS: There was no significant association between total bone marrow edema volume and preoperative or postoperative IKDC score (P = .32 and P = .91, respectively). The mean preoperative and postoperative IKDC scores were 53.4 ± 18.6 and 93.0 ± 5.0, respectively, for patients without fracture, 54.8 ± 13.6 and 87.3 ± 10.8 for patients with a single fracture, and 53.1 ± 17.2 and 83.4 ± 12.7 for patients with multiple fractures. Patients with single and multiple fractures had similar (P = .91) preoperative IKDC scores but significantly lower (P < .001) postoperative IKDC scores compared to patients without fracture. CONCLUSION: Cortical depression fractures in patients with ACL tear are associated with decreased clinical outcome scores 1 year after ACL reconstruction surgery.

Longitudinal Assessment of Depressive Symptoms After Sport-Related Concussion in a Cohort of High School Athletes.

BACKGROUND: The long-term effect of sport-related concussion on mood in adolescent athletes is largely unknown. HYPOTHESIS: Longitudinal measures of depression will worsen acutely after sport-related concussion and improve with concussion symptom resolution. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A population-based sample of 2160 high school athletes from 31 urban, suburban, and rural high schools completed preseason baseline concussion symptom evaluation and Patient Health Questionnaire-9 (PHQ-9) assessments over 2 years. Athletic trainers recorded onset of sport-related concussion, and concussed athletes completed the PHQ-9 assessment within 24 to 72 hours, 7 days, date of return to sport, 3 months, 6 months, and 12 months after sport-related concussion. Scores at each time point were compared to baseline with mixed-effects models and repeated-measures analysis of variance. Sex-based differences were assessed using mixed-effect models. RESULTS: Of the 2160 athletes enrolled in the study, 125 (5.8%; 80 males, 45 females) sustained a sport-related concussion. PHQ-9 scores worsened from baseline at 24 to 72 hours (+1.05; 95% CI, 0.26-1.84; P = 0.003) and 7 days (+0.91; 95% CI, 0.23-1.60; P = 0.006). However, PHQ-9 scores improved from baseline to date of return to sport (-1.38; 95% CI, -2.20 to -0.55; P < 0.001), 3 months (-1.08; 95% CI, -1.88 to -0.28; P = 0.003), 6 months (-1.19; 95% CI, -2.04 to -0.34; P = 0.001), and 12 months after sport-related concussion (-0.76; 95% CI, -1.43 to -0.08; P = 0.028). Female athletes reported more severe concussion symptoms 24 to 72 hours after sport-related concussion compared with male athletes (female, 20.5 [interquartile range (IQR), 10.0-36.2]; male, 9.0 [IQR, 4.0-19.5]; P = 0.003). Neither PHQ-9 scores nor change in PHQ-9 scores differed between male and female athletes at any time point. CONCLUSION: Sport-related concussion did not worsen longitudinal measures of depressed mood in this cohort of high school athletes. CLINICAL RELEVANCE: Emotional symptoms are common after sport-related concussion, but typically resolve by return to sport.

Evaluation of adolescent sport specialization and injury mechanism by sex: A secondary analysis.

OBJECTIVES: The purpose of this study was to compare the association of sport specialization with previous overuse and acute injuries between male and female adolescent athletes. DESIGN: Cross-sectional study. METHODS: Questionnaires were completed by adolescent athletes from various sports at sport club summer events in the state of Wisconsin. Adolescent athletes (12-18 years old) who were active in organized sports in the previous year were recruited. The questionnaire contained demographics, sport participation, sport specialization classification, and previous injury history. Sport specialization classification was determined using common methods in sport specialization research. Previous injury was restricted to athletic injuries that occurred in the past year. RESULTS: Two-thousand and eleven participants (age=13.7±1.6 years, females=989) completed the questionnaire. Highly specialized athletes were more likely to report both acute and overuse injuries compared to low specialization athletes. However, this relationship differed by sex, with only moderate and highly specialized females being more likely (Moderate: OR [95%CI]=1.74 [1.18-2.58], p=0.005; High: OR [95%CI]=1.69 [1.14-2.53], p=0.010) to report an overuse injury compared to low specialization females. Highly specialized female athletes were more likely to report an acute injury (High: OR [95%CI]=1.46 [1.06-2.02], p=0.022) compared to low specialization females. Highly specialized male athletes were not associated with overuse or acute injuries. CONCLUSIONS: Highly specialized athletes were more likely to report acute and overuse injuries. However, when this analysis was separated by sex, only highly specialized females were more likely to report a previous overuse or acute injury.

Sports injuries in high school athletes: a review of injury-risk and injury-prevention research.

OBJECTIVE: The objective of this review is to identify the available research regarding the risk factors and prevention of injuries in high school athletes (ages 14 to 18 years). DATA SOURCES: Relevant manuscripts were identified by searching six electronic databases with a combination of key words and medical subject headings (high school, adolescent, athletic injury, sports injury, risk factors, prevention, and prospective). STUDY SELECTION: Original research that reported prospective data on high school athletes (ages 14 to 18), reported injury and exposure data, and used data collected throughout the entire sport season or school year. DATA EXTRACTION: Twenty-nine studies that identified injury risk factors or injury prevention strategies were reviewed and summarized. Data extracted from the studies included a) sport(s) or injuries studied, b) year of publication, c) lead author, d) description of the subjects, e) sample-size calculation, f) variables studied (baseline demographic or performance variables), g) whether multivariate analyses were used, h) data reported (injury rates, risk ratios, and 95% CI), and i) results. Studies that introduced an intervention were characterized by the same data as well as the type of intervention employed and randomization procedures used. DATA SYNTHESIS: The quality of each injury-risk and injury-prevention study was assessed, and the results were summarized. CONCLUSIONS: The risk factors for injury in several specific sports such as soccer, American football, and basketball have been documented. Other sports are less well represented in the current literature. The risk factors for injuries to the ankle, head, and knee have been identified, to a limited degree. Upper-extremity injury risk factors are less well known. There is a need for high-quality prospective studies to further identify injury risk factors and injury-prevention strategies for high school athletes.