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Butler LS, Janosky J, Knell G, Ulman S, Latz K. Are Recreational Sports a Relic of the Past OR a Solution for the Future? Curr Sports Med Rep 2024; 23:62-68. [PMID: 38437489 DOI: 10.1249/jsr.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
ABSTRACT Children's participation in sport is a critical component to their physical and social development and as such, efforts should be made to provide all children with the opportunity to play. In recent years, there has been an observed shift in the focus of youth sports from that of participation for the health benefits of physical activity and fun to that of winning and competing. As a result, there has been a rise in club sports offerings and a subsequent reduction in recreational sports opportunities. This change presents unique challenges to children's access to sport and may not adequately support their overall physical, social, and emotional development. This commentary will discuss the benefits and barriers to increasing recreational sport opportunities using the Social Ecological Model as a framework. It also will propose solutions that can be implemented at the intrapersonal, interpersonal, organizational, community, and public policy levels to revive recreational sports.
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Adsit E, Albright J, Algan S, Beck J, Bowen RE, Brey J, Marc Cardelia J, Clark C, Coello P, Crepeau A, Edmonds E, Ellington M, Ellis HB, Fabricant PD, Frank JS, Ganley TJ, Green DW, Gupta A, Heyworth B, Kemper WC, Latz K, Mansour A, Mayer S, McKay SD, Milewski MD, Niu E, Pacicca DM, Parikh SN, Pupa L, Rhodes J, Saper M, Schmale GA, Schmitz M, Shea K, Silverstein RS, Storer S, Wilson PL. Relationship Between Age and Pathology With Treatment of Pediatric and Adolescent Discoid Lateral Meniscus: A Report From the SCORE Multicenter Database. Am J Sports Med 2023; 51:3493-3501. [PMID: 37899536 PMCID: PMC10623608 DOI: 10.1177/03635465231206173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 07/20/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Surgical treatment options of discoid lateral meniscus in pediatric patients consist of saucerization with or without meniscal repair, meniscocapular stabilization, and, less often, subtotal meniscectomy. PURPOSE To describe a large, prospectively collected multicenter cohort of discoid menisci undergoing surgical intervention, and further investigate corresponding treatment of discoid menisci. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A multicenter quality improvement registry (16 institutions, 26 surgeons), Sports Cohort Outcomes Registry, was queried. Patient characteristics, discoid type, presence and type of intrasubstance meniscal tear, peripheral rim instability, repair technique, and partial meniscectomy/debridement beyond saucerization were reviewed. Discoid meniscus characteristics were compared between age groups (<14 and >14 years old), based on receiver operating characteristic curve, and discoid morphology (complete and incomplete). RESULTS In total, 274 patients were identified (mean age, 12.4 years; range, 3-18 years), of whom 55.6% had complete discoid. Meniscal repairs were performed in 55.1% of patients. Overall, 48.5% of patients had rim instability and 36.8% had >1 location of peripheral rim instability. Of the patients, 21.5% underwent meniscal debridement beyond saucerization, with 8.4% undergoing a subtotal meniscectomy. Patients <14 years of age were more likely to have a complete discoid meniscus (P < .001), peripheral rim instability (P = .005), and longitudinal tears (P = .015) and require a meniscal repair (P < .001). Patients ≥14 years of age were more likely to have a radial/oblique tear (P = .015) and require additional debridement beyond the physiologic rim (P = .003). Overall, 70% of patients <14 years of age were found to have a complete discoid meniscus necessitating saucerization, and >50% in this young age group required peripheral stabilization/repair. CONCLUSION To preserve physiological "normal" meniscus, a repair may be indicated in >50% of patients <14 years of age but occurred in <50% of those >14 years. Additional resection beyond the physiological rim may be needed in 15% of younger patients and 30% of those aged >14 years.
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Affiliation(s)
| | | | - Jay Albright
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sheila Algan
- Department of Orthopedic Surgery, Oklahoma Children's Hospital, Oklahoma City, Oklahoma, USA
| | | | - Richard E. Bowen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Jennifer Brey
- Department of Orthopedics, Norton Children's Orthopedics of Louisville, Louisville, Kentucky, USA
| | - J. Marc Cardelia
- Department of Orthopedics and Sports Medicine, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Christian Clark
- OrthoCarolina Pediatric Orthopaedic Center, Charlotte, North Carolina, USA)
| | | | - Allison Crepeau
- Elite Sports Medicine at Connecticut Children's, Hartford, Connecticut, USA; Division of Sports Medicine, Department of Orthopedics, UConn Health, Farmington, Connecticut, USA
| | - Eric Edmonds
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Matthew Ellington
- Department of Orthopedics, Central Texas Pediatric Orthopedics, Austin, Texas, USA; Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Henry B. Ellis
- Investigation performed at Scottish Rite for Children, University of Texas Southwestern Medical Center, Dallas, USA
| | - Peter D. Fabricant
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA; Weill Cornell Medical College, New York, New York
| | - Jeremy S. Frank
- Division of Pediatric Orthopaedics and Spinal Deformities, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Theodore J. Ganley
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniel W. Green
- Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andrew Gupta
- Division of Pediatric Orthopaedics and Spinal Deformities, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Benton Heyworth
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - W. Craig Kemper
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kevin Latz
- Department of Orthopedics-Sports Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Alfred Mansour
- Department of Orthopedic Surgery, UTHealth Houston, McGovern Medical School, Houston, Texas, USA
| | - Stephanie Mayer
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Scott D. McKay
- Baylor College of Medicine, Houston, Texas, USA; Texas Children's Hospital, Houston, Texas, USA
| | - Matthew D. Milewski
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Emily Niu
- Department of Orthopedic Surgery and Sports Medicine, Children's National Medical Center, Washington, DC, USA
| | - Donna M. Pacicca
- Department of Orthopedics-Sports Medicine, Children's Mercy, Kansas City, Missouri, USA
| | - Shital N. Parikh
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lauren Pupa
- Baylor College of Medicine, Houston, Texas, USA
| | - Jason Rhodes
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Gregory A. Schmale
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Matthew Schmitz
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Kevin Shea
- Department of Orthopaedics, Stanford University School of Medicine, Stanford, California, USA
| | - Rachel S. Silverstein
- Baylor College of Medicine, Houston, Texas, USA; Texas Children's Hospital, Houston, Texas, USA
| | - Stephen Storer
- Division of Pediatric Orthopaedics and Spinal Deformities, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Philip L. Wilson
- University of Texas Southwestern Medical Center, Dallas, Texas, USA; Scottish Rite for Children, Dallas, Texas, USA)
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Butler LS, Sugimoto D, Erdman A, Yoder J, Greiner K, Larroque C, Latz K, Loewen A, Wyatt CW, DeVerna A, Ulman S. Highly Active Middle School Athletes Demonstrate Poor Motor Skill Proficiency. Sports Health 2023:19417381231178822. [PMID: 37329118 DOI: 10.1177/19417381231178822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Fundamental movement skills (FMS) are critical components to lifelong participation in sports and physical activity. With the rise in early sports specialization, mastery of motor skills may be limited in youth athletes. The purpose of this study was to assess FMS proficiency in highly active middle school athletes and determine whether proficiency differed between specialization levels and sex. HYPOTHESIS (1) Most athletes would fail to achieve proficiency in all domains of the Test of Gross Motor Development (TGMD-2), (2) highly specialized athletes would demonstrate lower proficiency in all domains of the TGMD-2, and (3) male athletes would demonstrate higher proficiency than female athletes. STUDY DESIGN Cross-sectional. LEVEL OF EVIDENCE Level 4. METHODS A total of 91 athletes were recruited (44 male, 12.6 ± 0.9 years). Activity level was quantified using the Hospital for Special Surgery (HSS) Pediatric Functional Activity Brief Scale (Pedi-FABS), specialization level was determined using the Jayanthi Specialization Scale, and the TGMD-2 was used to assess FMS proficiency. Descriptive statistics were used to describe gross motor, locomotor, and object control percentile rank. A 1-way analysis of variance (ANOVA) was used to assess differences in percentile rank between low, moderate, and high specialization groups and independent samples t tests were used to compare sexes (α < 0.05). RESULTS Mean Pedi-FABS score was 23.6 ± 4.9. In total, 24.2%, 38.5%, and 37.4% of athletes classified as low, moderate, and highly specialized, respectively. Mean percentile ranks were 56.2%, 64.7%, and 62.6% for locomotor, object control, and gross motor domains, respectively. No athlete achieved a percentile rank >99% in any domain of the TGMD-2, and there was no significant difference between specialization groups or sex. CONCLUSION Despite high activity levels, no athlete demonstrated proficiency in any domain of the TGMD-2, and there was no difference in proficiency between specialization levels or by sex. CLINICAL RELEVANCE Sport participation, regardless of level, does not ensure adequate mastery of FMS.
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Affiliation(s)
| | - Dai Sugimoto
- Waseda University, Tokyo, Japan; The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
| | | | - Jason Yoder
- Children's Mercy Hospital, Kansas City, Missouri
| | | | | | - Kevin Latz
- Children's Mercy Hospital, Kansas City, Missouri
| | | | - Charles W Wyatt
- Scottish Rite Hospital, Dallas, Texas, and University of Texas Southwestern, Dallas, Texas
| | | | - Sophia Ulman
- Scottish Rite Hospital, Dallas, Texas, and University of Texas Southwestern, Dallas, Texas
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Rohde MS, Shea KG, Dawson T, Heyworth BE, Milewski MD, Edmonds EW, Adsit E, Wilson PL, Albright J, Algan S, Beck J, Bowen R, Brey J, Cardelia M, Clark C, Crepeau A, Edmonds EW, Ellington M, Ellis HB, Fabricant P, Frank J, Ganley T, Green D, Gupta A, Heyworth BE, Latz K, Mansour A, Mayer S, McKay S, Milewski M, Niu E, Pacicca D, Parikh S, Rhodes J, Saper M, Schmale G, Schmitz M, Shea K, Storer S, Wilson PL, Ellis HB. Age, Sex, and BMI Differences Related to Repairable Meniscal Tears in Pediatric and Adolescent Patients. Am J Sports Med 2023; 51:389-397. [PMID: 36629442 DOI: 10.1177/03635465221145939] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The incidence of meniscus tears and ACL tears in pediatric patients continues to rise, bringing to question the risk factors associated with these injuries. As meniscus tears are commonly repaired in pediatric populations, the epidemiology of repairable meniscus tears is an important for consideration for surgeons evaluating treatment options. PURPOSE To describe meniscal tear patterns in pediatric and adolescent patients who underwent meniscal repair across multiple institutions and surgeons, as well as to evaluate the relationship between age, sex, and body mass index (BMI) and their effect on the prevalence, type, and displacement of repaired pediatric meniscal tears. STUDY DESIGN Case series; Level of evidence, 4. METHODS Data within a prospective multicenter cohort registry for quality improvement, Sport Cohort Outcome Registry (SCORE), were reviewed to describe repaired meniscal tear patterns. All consecutive arthroscopic meniscal repairs from participating surgeons in patients aged <19 years were analyzed. Tear pattern, location, and displacement were evaluated by patient age, sex, and BMI. A subanalysis was also performed to investigate whether meniscal tear patterns differed between those occurring in isolation or those occurring with a concomitant anterior cruciate ligament (ACL) injury. Analysis of variance was used to generate a multivariate analysis of specified variables. Sex, age, and BMI results were compared across the cohort. RESULTS There were 1185 total meniscal repairs evaluated in as many patients, which included 656 (55.4%) male and 529 (44.6%) female patients. Patients underwent surgery at a mean age of 15.3 years (range, 5-19 years), with a mean BMI of 24.9 (range, 12.3-46.42). Of the 1185 patients, 816 (68.9%) had ACL + meniscal repair and 369 (31.1%) had isolated meniscal repair. The male patients underwent more lateral tear repairs than the female patients (54.3% to 40.9%; P < .001) and had a lower incidence of medial tear repair (32.1% vs 41.4%; P < .001). Patients with repaired lateral tears had a mean age of 15.0 years, compared with a mean age of 15.4 years for patients with repaired medial or bilateral tears (P = .001). Higher BMI was associated with "complex" and "radial" tear repairs of the lateral meniscus (P < .001) but was variable with regard to medial tear repairs. CONCLUSION In pediatric and adolescent populations, the data suggest that the surgical team treating knees with potential meniscal injury should be prepared to encounter more complex meniscal tears, commonly indicated in those with higher BMI, while higher rates of lateral meniscal tears were seen in male and younger patients. Future studies should analyze correlates for meniscal repair survival and outcomes in this pediatric cohort undergoing knee surgery.
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Affiliation(s)
- Matthew S Rohde
- Stanford University School of Medicine, Department of Orthopaedics, Stanford, California, USA
| | - Kevin G Shea
- Stanford University School of Medicine, Department of Orthopaedics, Stanford, California, USA
| | - Timothy Dawson
- Stanford University School of Medicine, Department of Orthopaedics, Stanford, California, USA
| | - Benton E Heyworth
- Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Matthew D Milewski
- Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Eric W Edmonds
- Rady Children's Hospital, Division of Orthopaedic Surgery, San Diego, California, USA
| | | | - Philip L Wilson
- Scottish Rite for Children, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Department of Orthopaedics, Dallas, Texas, USA
| | | | - Jay Albright
- Children's Hospital Colorado, Department of Orthopedics, Aurora, Colorado, USA
| | - Sheila Algan
- Oklahoma Children's Hospital, Department of Orthopedic Surgery, Oklahoma City, Oklahoma, USA
| | - Jennifer Beck
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA; Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Richard Bowen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA; Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Jennifer Brey
- Norton Children's Orthopedics of Louisville, Department of Orthopedics, Louisville, Kentucky, USA
| | - Marc Cardelia
- Children's Hospital of the King's Daughters, Department of Orthopedics and Sports Medicine, Norfolk, Virginia, USA
| | - Christian Clark
- OrthoCarolina Pediatric Orthopaedic Center, Charlotte, North Carolina, USA
| | - Allison Crepeau
- Elite Sports Medicine at Connecticut Children's, Hartford, Connecticut, USA; UConn Health, Division of Sports Medicine, Department of Orthopedics, Farmington, Connecticut, USA
| | - Eric W Edmonds
- Rady Children's Hospital, Division of Orthopaedic Surgery, San Diego, California, USA
| | - Matt Ellington
- Central Texas Pediatric Orthopedics, Department of Orthopedics, Austin, Texas, USA; Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Henry B Ellis
- Scottish Rite for Children, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Department of Orthopaedics, Dallas, Texas, USA
| | - Peter Fabricant
- Hospital for Special Surgery, Division of Pediatric Orthopaedic Surgery, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA
| | - Jeremy Frank
- Joe DiMaggio Children's Hospital, Division of Pediatric Orthopaedics and Spinal Deformities, Hollywood, Florida, USA
| | - Ted Ganley
- Children's Hospital of Philadelphia, Sports Medicine and Performance Center, Philadelphia, Pennsylvania, USA
| | - Dan Green
- Hospital for Special Surgery, Division of Pediatric Orthopaedic Surgery, New York, New York, USA
| | - Andrew Gupta
- Joe DiMaggio Children's Hospital, Division of Pediatric Orthopaedics and Spinal Deformities, Hollywood, Florida, USA
| | - Benton E Heyworth
- Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Kevin Latz
- Children's Mercy, Department of Orthopedics-Sports Medicine, Kansas City, Missouri, USA
| | - Alfred Mansour
- UTHealth Houston, McGovern Medical School, Department of Orthopedic Surgery, Houston, Texas, USA
| | - Stephanie Mayer
- Children's Hospital of Colorado, Department of Orthopaedic Surgery, Denver, Colorado, USA
| | - Scott McKay
- Texas Children's Hospital, Department of Orthopedic Surgery, Houston, Texas, USA
| | - Matt Milewski
- Boston Children's Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, USA
| | - Emily Niu
- Children's National Medical Center, Department of Orthopedic Surgery and Sports Medicine, Washington, DC, USA
| | - Donna Pacicca
- Children's Mercy, Department of Orthopedics-Sports Medicine, Kansas City, Missouri, USA
| | - Shital Parikh
- Cincinnati Children's Hospital Medical Center, Division of Orthopaedic Surgery, Cincinnati, Ohio, USA
| | - Jason Rhodes
- Children's Hospital Colorado, Department of Orthopedics, Aurora, Colorado, USA
| | - Michael Saper
- Seattle Children's Hospital, Department of Orthopedics and Sports Medicine, Seattle, Washington, USA
| | - Greg Schmale
- Seattle Children's Hospital, Department of Orthopedics and Sports Medicine, Seattle, Washington, USA
| | - Matthew Schmitz
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Kevin Shea
- Stanford University School of Medicine, Department of Orthopaedics, Stanford, California, USA
| | - Stephen Storer
- Joe DiMaggio Children's Hospital, Division of Pediatric Orthopaedics and Spinal Deformities, Hollywood, Florida, USA
| | - Philip L Wilson
- Scottish Rite for Children, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Department of Orthopaedics, Dallas, Texas, USA
| | - Henry B Ellis
- Scottish Rite for Children, Dallas, Texas, USA; University of Texas Southwestern Medical Center, Department of Orthopaedics, Dallas, Texas, USA.,Investigation performed at Scottish Rite for Children, University of Texas Southwestern, Dallas, Texas, USA
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Butler LS, Milian EK, DeVerna A, Latz K, Ellis HB, Martinez AR, Hayden K, Gerstenkorn C, Carpenito SC, Wyatt CW, Sugimoto D. Reliability of the Cutting Alignment Scoring Tool (CAST) to Assess Trunk and Limb Alignment During a 45-Degree Side-Step Cut. Int J Sports Phys Ther 2021; 16:312-321. [PMID: 33842027 PMCID: PMC8016420 DOI: 10.26603/001c.21419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 10/10/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) motion analysis is considered the gold standard for evaluating human movement. However, its clinical utility is limited due to cost, operating expertise, and lengthy data processing time. Numerous qualitative scoring systems have been introduced to assess trunk and lower extremity biomechanics during functional tasks. However, the reliability of qualitative scoring systems to evaluate cutting movements is understudied. Purpose/Hypotheses: To assess the inter-rater and intra-rater reliability of the Cutting Alignment Scoring Tool (CAST) among sports medicine providers and to evaluate rater agreement of each component of the CAST. The hypotheses were: 1) there would be good-to-excellent inter-rater and intra-rater reliability among sports medicine providers, 2) there would be good to almost perfect agreement for cut width and trunk lean variables and moderate to good agreement for valgus variables of the CAST. STUDY DESIGN Repeated Measures. METHODS Ten videos of a 45-degree side-step cut performed by adolescent athletes were independently rated on two occasions by six raters (2 medical doctors, 2 physical therapists, and 2 athletic trainers). The variables assessed include trunk lean to the opposite direction of the cut, increased cut width, knee valgus at initial load acceptance (static), and knee valgus throughout the task (dynamic). Variables were scored as either present, which were given a score of "1", or not present, which were given a score of "0". Video sequence was randomized in each rating session, and a two-week wash out period was given. RESULTS The cumulative inter-rater and intra-rater reliabilities were good (ICC: 0.808 and ICC: 0.753). Almost perfect kappa coefficients were recorded for cut width (k=0.949). Moderate kappa coefficients were found for trunk lean (k= 0.632) and fair kappa coefficients were noted for dynamic and static valgus (k=0.462 and k= 0.533 respectively). CONCLUSION These findings suggest that the CAST is a reliable tool to evaluate trunk and LE alignment during a cutting task by sports medicine providers. LEVEL OF EVIDENCE Level 2 Diagnosis.
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Affiliation(s)
| | | | | | | | - Henry B Ellis
- Scottish Rite Hospital; University of Texas Southwestern Medical Center
| | | | | | | | - Sara C Carpenito
- Boston Children's Hospital; The Micheli Center for Sports Injury Prevention
| | - Charles W Wyatt
- Scottish Rite Hospital; University of Texas Southwestern Medical Center
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention; Waseda University
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Lilyquist M, Shaw A, Latz K, Bogener J, Wentz B. Response to "Letter Regarding: Cadaveric Analysis of the Distal Tibiofibular Syndesmosis". Foot Ankle Int 2017; 38:346. [PMID: 28238278 DOI: 10.1177/1071100717690428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
BACKGROUND Unstable ankle fractures with syndesmotic injuries commonly occur and can result in significant morbidity. Although the need for an anatomic reduction is clear, there is still debate surrounding the optimal operative treatment. Recent literature shows an increasing interest in anatomic ligament repair or reconstruction in the acute and chronic syndesmosis injury. Despite this trend, there is insufficient literature detailing anatomy of the distal tibiofibular syndesmosis. In the literature that does exist, there is controversy regarding the ligamentous anatomy of the syndesmosis. None of the current literature describes an anatomic constant that may be used as an intraoperative reference for anatomic ligament reconstructions. METHODS Ten sets of tibia and fibula free of all soft tissue were used to analyze osseous structures. Another 10 nonpaired, fresh-frozen specimens were used to study the distal tibiofibular syndesmosis. These were measured using a 3-dimensional tracking system. Measurement of each ligament width at origin and insertion, length, and distance from the tibial articular cartilage was performed. RESULTS The superior and inferior insertions of the anterior inferior tibiofibular ligament measured 22.7 mm and 3.4 mm proximal to the distal articular cartilage of the tibia, respectively. The superior insertion of the posterior inferior tibiofibular ligament measured 15.2 mm proximal to the articular cartilage. The superior and inferior insertions of the interosseous ligament measured 31.8 mm and 9.2 mm proximal to the distal articular cartilage, respectively. The inferior transverse ligament was a prominent identifiable structure in 70% of specimens. CONCLUSIONS The superior margin of the distal articular cartilage could serve as a consistent anatomic landmark for reconstruction. The inferior transverse ligament is an identifiable structure in 70% of the specimens studied. CLINICAL RELEVANCE This article clarifies the anatomy and provides measurements from an anatomic constant that can guide reconstruction and intraoperative evaluation of the syndesmosis.
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Affiliation(s)
- Michael Lilyquist
- University of Missouri-Kansas City, Orthopaedic Surgery Residency, MO, USA
| | - Adam Shaw
- University of Missouri-Kansas City, Orthopaedic Surgery Residency, MO, USA
| | - Kevin Latz
- Children's Mercy Hospital, Kansas City, MO, USA
| | - James Bogener
- University of Missouri-Kansas City, Orthopaedic Surgery Residency, MO, USA
| | - Brock Wentz
- University of Nevada School of Medicine, Las Vegas, NV, USA
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Latz K. Overuse injuries in the pediatric and adolescent athlete. Mo Med 2006; 103:81-5. [PMID: 16579311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
A growing number of pediatric orthopedic patients fall into two dissimilar groups: the obese patient with problems related to obesity, and the young athlete injured during sports. While there is widespread recognition of pediatric orthopedic diseases related to obesity, the injuries resulting from "overuse" or over participation in sports are less understood and recognized. The majority of athletes involved in team sports in the Unites States are grade school and interscholastic athletes. The motivation for participation in sports varies greatly. Young athletes at risk for injury include the reluctant athlete who is not in the aerobic condition necessary to participate in sports, the eager athlete who initiates participation too vigorously, and the ambitious athlete who chronically "overtrains".
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Affiliation(s)
- Kevin Latz
- University of Missouri-Kansas City School of Medicine, USA
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9
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Olney B, Latz K, Asher M. Treatment of hip dysplasia in older children with a combined one-stage procedure. Clin Orthop Relat Res 1998:215-23. [PMID: 9520893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This retrospective study was conducted to determine the efficacy and complication rates associated with treating children of ambulatory age with idiopathic developmental dysplasia of the hip with open reduction and combined femoral and pelvic osteotomies. Eighteen hips were reviewed in 13 patients. The average patient age at surgery was 29 months (range, 15-117 months), with an average followup of 43 months (range, 24-78 months). Preoperative Tonnis classification identified six Class II, seven Class III, and five Class IV hips. Followup Severin classification identified 16 Class 1A and two Class 2A hips. The average center edge angle on most recent followup was 47 degrees (range, 25 degrees-70 degrees), and the acetabular index was 5 degrees (range, 0 degree-20 degrees). Avascular necrosis developed in one (5.5%) patient. Clinically, all patients were pain free with ambulation and had excellent results by McKay criteria. No patient required a second surgical procedure for recurrent subluxation or persistent acetabular dysplasia. The treatment of children who are of ambulatory age with developmental dysplasia of the hip using open reduction and combined osteotomies was safe and effective.
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Affiliation(s)
- B Olney
- Orthopedic Section, University of Kansas Medical Center, Kansas City 66160-7387, USA
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10
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Abstract
In a retrospective study of 1126 children with fractures of the proximal third of the femur, three children were found to have isolated fractures of the lesser trochanter. This fracture occurred from a fall in one child and following sporting activities, without a history of injury, in the others. In the latter children, the clinical presentations were similar to those of children with transient synovitis of the hip or Perthes disease. In each child, plain radiographs showed an avulsion fracture of the bony portion of the lesser trochanter. Early and complete recovery followed symptomatic treatment even when there was marked proximal displacement of the avulsed segment of the lesser trochanter.
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Affiliation(s)
- T N Theologis
- Division of Orthopaedics, Hospital for Sick Children, Toronto, Ontario, Canada
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