Youth Sports Specialization: Does Practice Make Perfect?

Unraveling sex-specific risks of knee osteoarthritis before menopause: Do sex differences start early in life?

OBJECTIVE

Sufficient evidence within the past two decades have shown that osteoarthritis (OA) has a sex-specific component. However, efforts to reveal the biological causes of this disparity have emerged more gradually. In this narrative review, we discuss anatomical differences within the knee, incidence of injuries in youth sports, and metabolic factors that present early in life (childhood and early adulthood) that can contribute to a higher risk of OA in females.

DESIGN

We compiled clinical data from multiple tissues within the knee joint-since OA is a whole joint disorder-aiming to reveal relevant factors behind the sex differences from different perspectives.

RESULTS

The data gathered in this review indicate that sex differences in articular cartilage, meniscus, and anterior cruciate ligament are detected as early as childhood and are not only explained by sex hormones. Aiming to unveil the biological causes of the uneven sex-specific risks for knee OA, we review the current knowledge of sex differences mostly in young, but also including old populations, from the perspective of (i) human anatomy in both healthy and pathological conditions, (ii) physical activity and response to injury, and (iii) metabolic signatures.

CONCLUSIONS

We propose that to close the gap in health disparities, and specifically regarding OA, we should address sex-specific anatomic, biologic, and metabolic factors at early stages in life, as a way to prevent the higher severity and incidence of OA in women later in life.

An Activity Scale for All Youth Athletes? Clinical Considerations for the HSS Pedi-FABS

Background

The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) has demonstrated normally distributed scores in children aged 10 to 18 years. It has been used to evaluate knee injuries; however, there is limited information regarding its use in evaluating other injury types.

Purpose

To (1) assess the validity and utility of HSS Pedi-FABS in youth athletes with injuries to different parts of the body and (2) evaluate the association between the HSS Pedi-FABS and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health 7 (PGH), as well as PROMIS-Pain Interference (PGH-PI) and PROMIS-Fatigue (PGH-F) components.

Study Design

Cohort study (diagnosis); Level of evidence, 3.

Methods

The authors performed a retrospective review of youth athletes aged 10 to 18 years who completed the HSS Pedi-FABS as part of their previsit intake questionnaire between April 2016 and July 2020. HSS Pedi-FABS score distributions were compared and evaluated for ceiling effects in cohorts determined by demographic, injury characteristic, and sports participation variables; a ceiling effect was determined to be present if >15% of respondents received the highest possible score. HSS Pedi-FABS scores were analyzed for a correlation with PGH, PGH-PI, and PGH-F components.

Results

Included were 2274 patients (mean age, 14.6 ± 2.1 years; 53.0% female) participating in 21 distinct primary sports for 9.6 ± 7.9 hours per week. The mean HSS Pedi-FABS scores by injury group were as follows: elbow (22.7 ± 6.7), shoulder (21.0 ± 8.7), ankle (20.2 ± 8.8), knee (19.5 ± 9.1), and hip (15.4 ± 10.4) (P < .001). Broad distribution was seen in each cohort, with no floor or ceiling effects. The HSS Pedi-FABS score correlated with patient-reported hours per week (r = 0.33), days per week (r = 0.33), and years of participation (r = 0.21) (P < .001 for all). All 3 PROMIS components correlated with HSS Pedi-FABS: PGH (r = 0.28), PGH-PI (r = -0.11), and PGH-F (r = -0.15) (P < .001).

Conclusion

Study findings indicated that the HSS Pedi-FABS is a valid tool for measuring physical activity level in most injured youth athletes, not just those with knee injuries. The correlation of HSS Pedi-FABS with the PGH suggests a positive relationship of childhood physical activity with general health.

Psychosocial aspects of sports medicine in pediatric athletes: Current concepts in the 21st century

Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.

Outcomes in Pediatric Hip FAI Surgery: a Scoping Review

PURPOSE OF REVIEW

Femoracetabular impingement (FAI) is a common source of hip pain in children and adolescents. While nonoperative therapies and open surgical procedures can be effective, hip arthroscopy is a minimally invasive treatment option with substantial benefit. The purpose of this paper is to evaluate the current role of hip arthroscopy in treating FAI within the pediatric population. This article examines its efficacy through a review of hip arthroscopy outcomes in the contemporary orthopaedic literature.

RECENT FINDINGS

Morphologic changes in the acetabulum and proximal femur seen in FAI can be attributed to a multitude of etiologies-including idiopathic FAI, Legg-Calve-Perthes, and slipped capital femoral epiphysis. In general, arthroscopic treatment of FAI secondary to these conditions leads to statistically significant improvements in pain and patient-reported outcomes in the short and long term. In the pediatric athlete, repetitive stress on the hip perpetuates FAI and can drastically hinder performance. Hip arthroscopy allows for a high rate of return to sport with minimal morbidity in this population. Overall, pediatric hip arthroscopy is effective in treating FAI secondary to a wide variety of conditions. Despite its clinical benefits, patients and their families should be counseled regarding alternative treatments, potential complications, and return to play.

SCIENTIFIC PHYSICAL EXERCISE IN MAINTAINING HEALTH

ABSTRACT Introduction According to the 2015 National Physical Health Monitoring Report, most of the national physical health indicators have begun to rebound, but some people’s physical health is still declining. Object The thesis studies the problems existing in people’s physical exercise and guides the development of these people’s habits. Methods Our mathematical statistics and other research methods investigate the current situation of people’s physical exercise habits, and explore the factors that restrict habits from the factors that affect the formation of sports and fitness concepts. Result The proportion of people developing physical exercise habits is low. People invest less time and energy in physical exercise. Conclusion The less time and energy that people invest in physical exercise is the main reason that affects their belief in exercise and fitness and physical exercise habits. Level of evidence II; Therapeutic studies - investigation of treatment results.

What Defines Early Specialization: A Systematic Review of Literature

Introduction: While practitioners and organizations advise against early specialization, the lack of a consistent and clear definition of early specialization reduces the impact of recommendations and policies in youth sport. An important first step in understanding the consequences of early specialization is establishing what early specialization is. Objectives: This PRISMA-guided systematic review aimed to determine the types, characteristics, and general content of early specialization papers within the literature, and examine how early specialization has been defined and measured in order to advance knowledge toward a clear and consistent definition of early specialization. Data sources: Four different electronic databases were searched (SPORTDiscus, Web of Science, Sports Medicine and Education Index, and Scopus). Both non data-driven and data-driven studies were included to ensure a comprehensive understanding of the literature. Eligibility Criteria: In order to be included in the review, the paper must: (a) Focus on specialization and explicitly use the term "specialization" (b) Focus on sport and athletes (c) Be papers from a peer-reviewed (d) Be in English. And finally, (e) be available in full text. Results: One thousand three hundred and seventy one articles were screened resulting in 129 articles included in the review after applying inclusion/exclusion criteria. Results indicated a clear discrepancy between key components of early specialization and the approaches used to classify early specializers. Conclusion: Future research should work toward developing a valid and reliable approach to classifying early specializers and establishing a consistent definition across studies.

Risk of intra-articular hip injury in adolescent athletes: a five-year multicentre cohort study

PURPOSE

The purpose of the current study was to establish a risk stratification for hip injury by presenting the classification of sports among adolescent athletes undergoing hip arthroscopy.

METHODS

A multicentre registry was queried to examine the incidence of adolescent athletes undergoing hip arthroscopy. Patients were identified and grouped according to their sport-specific risk classification (level I-III). Chi-square analysis was performed to determine the relationship of classification of sport and gender in adolescent athletes to hip arthroscopy. A second chi-square analysis was performed to determine the relationship of classification of sport and number of sports the adolescent athlete was participating in prior to arthroscopic hip surgery.

RESULTS

A total of 297 adolescent athletes were included in the study with 129 (43.4%) participating in level I sports compared with 84 (28.3%) in level II and 84(28.3%) in level III sports. Chi-square testing demonstrated a significant effect on gender and sport classification, X2 (2, N = 297) = 31.18, p < 0.01. There was a greater percentage of athletes participating in a single sport (65.3%) compared with multiple sports (34.6%), but was not statistically significant, X2 (1, N = 297) = 1.88, p = 0.17.

CONCLUSION

The current study was successful in stratifying a large, multicentre cohort of adolescent athletes requiring hip arthroscopy based on classification levels of sport. There were more male athletes participating in level I sports, while more female athletes participated in level II and level III sports.