Pediatric Sports Research Articles

Association of Pediatric Hearing Quality and Sports Participation: A Population-Based Study.

Sports-related injuries, such as concussion, during childhood may result in considerable morbidity, including a range of negative developmental consequences. Auditory dysfunction is generally recognized to be a possible sequela of sports-related concussion; however, few epidemiologic studies have quantified the association between hearing quality and sports-related activity in the pediatric population. The National Health and Nutrition Examination Survey for the 2015-2016 cycle was utilized to determine the association of sports activities and hearing quality. Subjective abnormal hearing quality was more frequent among children who played football than those that did not (36.5% vs 26.8%; odds ratio, 1.56 [95% CI, 1.23-2.00]; P = .001). Other sports, such as basketball and soccer, did not have this association with hearing quality (P = .496 and P = .852, respectively). Our findings suggest a notable association between practice of a potentially high concussion sport and hearing quality. Children practicing football are 1.56 times more likely to report abnormal hearing quality.Level of Evidence: 4.

Improving the Diagnosis of Menstrual Dysfunction through Quality Improvement.

Introduction:Prevalence of menstrual dysfunction (MD) in high school athletes ranges from 7% to 54%. Early recognition and intervention are crucial to prevent future consequences. The purpose of this Quality Improvement project was to optimize the institution’s Epic Best Practice Advisory (BPA) screening tool and synthesize new patient questionnaires to diagnose MD in athletes greater than 12 years of age presenting to a pediatric sports medicine clinic.Methods:Using Quality Improvement methodology, we evaluated clinic flow, the Epic BPA tool, and actions by the physician following the appropriate triggering of the BPA. Diagnoses targeted were primary amenorrhea, oligomenorrhea, or irregular menstruation unspecified. Areas for intervention were global staff education, patient education, and provider alert fatigue. Our team implemented interventions using monthly Plan-Do-Study-Act cycles to address our key drivers. Proper implementation of questionnaire data and restructuring of the Epic BPA promoted identification and diagnosis of MD. The clinician discussed the diagnosis with the patient and family and provided an educational handout on MD.Results:The rate of appropriate diagnosis of MD in athletes greater than 12 years of age seen at a pediatric sports medicine clinic increased from a baseline of 2.1% to 30% over ten months. Identification of three key drivers ultimately drove the success and achievement of our aim.Conclusions:Using Quality Improvement methodology, we optimized the EPIC BPA and subsequently increased the rate of appropriate diagnosis of MD. Identification of the proper diagnosis improves our patient education. Ultimately, this project provided the framework for applicable discussion, interventions, and work-up for at-risk athletes.

Should headers be banned in children's and youth soccer?

A few months ago, a high school graduate contacted me with a request for an interview for her “Matura thesis”. The topic of her thesis was the (possible) ban on headers in children and adolescents in soccer. Shortly afterwards, the same question came up at the general assembly of the Society for Paediatric Sports Medicine (GPS): why are headers banned in youth soccer in England/US, but not in Germany and Switzerland? Reason enough to take a closer look at this topic and try to find evidence-based answers to this question. Soccer is the world’s most popular sport with more than 265 million players, of which 22 million are youth players [1]. Headers are deliberately used to influence the game. Headers are a fundamental part of the sport of soccer. It is also unique in sport to use a header to influence the game. However, there is a recurring question in the literature as to whether headers have an impact on brain function and brain structures [2-6]. In the US, headers were banned for children up to 11 years of age following a lawsuit by parents of children playing soccer.

Prevalence and Duration of Post-Concussive Headaches in a Pediatric Sports Clinic: A Cross-sectional Study

We aim to identify the potential risk factors associated with increased susceptibility for persistent post-concussive headaches. Concussions are common, but complex, traumatic brain injuries seen in pediatric athletes of all ages & skill levels & occur in a wide variety of athletic settings. These mild traumatic brain injuries often have neurologic sequelae, including headaches. Although athletes are advised to rest, duration of post-concussive symptoms is often unpredictable. We conducted a cross sectional study on patients with head injury aged 5-18 years presented to pediatric concussion clinic (N = 603) from September 2013 to Dec 2018. We excluded patients with skull fractures and intracranial hemorrhage. The data was compiled & analyzed using frequency, Pearson correlation test, chi square & ANOVA test using IBM SPSS- 26. Patient cohort consisted of 364 males & 239 females. The age range for males was 5-18 years (Mean age ± SD: 13.45 ± 2.86) & for females was 6-18 years (Mean age ± SD: 13.97 ± 2.84). There was statically significant association between various age groups & presence of headache at 3 & 6 months (p < 0.05). Out of all ages, age group 5-8 years had highest risk of persistent headache while the age group 14-18 years reported headaches at 3 months but then resolution of symptoms by one year (p < 0.05). Females were more likely than males (of all ages) to have persistent headaches despite treatment (p = 0.00). There was also a statistically significant difference between loss of consciousness, prior history of headaches & prior history of concussions towards the development of persistent headaches (p < 0.05). Furthermore, football, soccer and basketball had significantly more headaches compared to other sports related injuries (p = 0.001). There was a statistically higher risk of developing persistent headaches for females and those with a history of prior headache, prior concussion, younger age, and those playing football, soccer or basketball.

Retrospective study of patterns of vitamin D testing and status at a single institution paediatric orthopaedics and sports clinics

Objective(s)There has been a recent increase in awareness of the importance of bone health in children treated by paediatric orthopaedic and sports medicine providers. The purpose of this study was...

A Scale Measuring Academic-Related Anxiety Following Concussion

Does academic-related anxiety contribute to an adolescent’s recovery process and return to activity after experiencing a concussion? The authors created a novel measure of academic-related anxiety (Mularoni Measure of Academic Anxiety following Concussion [MMAAC]) and administered it to adolescents following concussion in outpatient pediatric sports medicine clinics. Two previously validated measures of anxiety were also administered, and results were compared with the MMAAC scores as well as the lengths of time for return to school and sports. Results show that higher MMAAC scores positively correlate with the length of time an adolescent needs to return to school. Study results indicate that the MMAAC reliably measures academic-related anxiety in adolescents suffering from concussions and can be helpful in predicting a basic timetable for return to school. The authors believe that this brief survey can be used by physicians in clinic to evaluate anxiety and assist with return to school expectations to provide comprehensive recovery support.

Symptom and clinical recovery outcomes for pediatric concussion following early physical activity.

Recent research supports initiating physical activity as soon as 24 to 48 hours after concussion to reduce persistent postconcussive symptoms. However, this practice has not been widely adopted. The objective of this study was to evaluate the association of early physical activity with patient-reported and functional outcomes for pediatric patients following a concussion. A retrospective cohort of patients who presented to a pediatric sports medicine clinic (48% female, mean age14.3 ± 2.6 years, and mean 9.8 ± 5.7 days postconcussion) were evaluated. Patients were grouped based on whether they reported engaging in physical activity prior to presenting to the clinic. Patient- and parent-reported symptom frequency (Health and Behavior Inventory), 11 different clinical outcomes (including missed school, memory recall, and balance assessments), the presence of symptoms persisting beyond 28 days, and a subgroup analysis of those patients receiving exercise versus symptom-limiting activity prescriptions were examined. Outcomes were compared between physical activity groups using the Mann-Whitney U-test and the chi-square test. To adjust for the effect of potential confounders, a logistic binary regression model was constructed. In total, 211 pediatric patients were included, 35 (17%) of whom reported early physical activity. A greater proportion of the no physical activity group reported a headache (85% vs 60%, p = 0.001). The no physical activity group also reported higher patient-reported (23.1 ± 13.4 vs 15.0 ± 13.4, p < 0.001) and parent-reported (19.4 ± 12.7 vs 11.2 ± 10.3, p = 0.001) symptom frequency at the initial visit. The early physical activity group had a lower proportion of patients with persistent symptoms (44% vs 22%, p = 0.02) and a shorter time to symptom resolution (15.6 ± 12.4 days vs 27.2 ± 24.2 days, p = 0.02). After adjusting for potential confounders, early physical activity was associated with 5.8 lower odds of experiencing persistent symptoms (adjusted OR 5.83, 95% CI 2.05-16.61; p = 0.001). A significant association between early physical activity and decreased symptom burden was observed. A lower proportion of those patients who engaged in early physical activity experienced persistent symptoms 28 days postinjury. However, low rates of early physical activity prior to the initial clinic visit were also observed, indicating that this approach may not be well known by acute care or primary care providers, or is not widely adopted by patients and families.

Current practice trends in the surgical management of patellofemoral instability: a survey of the Paediatric Research in Sports Medicine (PRiSM) Society.

PurposePatellofemoral instability (PFI) in young athletes presents both diagnostic and management dilemmas for which consensus often does not exist. The purpose of this study was to identify trends in management of PFI in children and adolescents in the United States and nationwide.MethodsA 27-question multiple choice survey was distributed in 2018 to the members of the Pediatric Research in Sports Medicine (PRiSM) Society regarding treatment of PFI in paediatric and adolescent patients.ResultsIn all, 56 of the respondents who were orthopaedic surgeons that manage patellar instability in children and adolescents and had performed PFI surgery more than five times in the past year completed the entire survey. A total of 41% of respondents reported that surgery for fragment refixation or loose body removal was indicated when a loose body or osteochondral fragment was evident, regardless of fragment size. Overall, 74% reported that if surgery was performed for an osteochondral loose body, primary repair (36%) or reconstruction (38%) of medial patellofemoral ligament (MPFL) was also completed. A total of 89% of members reported MPFL reconstruction in the absence of alignment or rotational abnormalities, tibial tubercle lateralization or trochlear dysplasia in skeletally immature patients; 59% reported performing the MPFL reconstruction with hamstring allograft, while 30% prefer autograft (hamstring, quadriceps). For patients with significant trochlear dysplasia, 87% reported no surgical management of trochlea in first-time or in revision surgery.ConclusionThere is a lack of consensus regarding optimal diagnostic and treatment algorithms in the management of PFI, however, consistent trends have emerged among paediatric sports medicine surgeons.Level of EvidenceLevel V – survey of expert opinion and experience

Coding Challenges in Common Pediatric Sports Surgeries of the Knee

Coding and billing for procedures is necessary but possibly the least enjoyable aspects of performing surgery. Additionally, proper documentation is crucial to support procedural coding and billing. Unfortunately, these are also areas in which orthopaedic surgeons receive the least consistent training, which can lead to enormous variability in how different surgeons code and bill for the same procedure. Pediatric sports medicine is a relatively younger subspecialty within pediatric orthopaedics and as such, techniques and approaches to surgery continue to evolve. As a result, many of the procedures performed may not have well established—or indeed any—corresponding CPT codes.&#x0D; This article presents case scenarios for common knee pathologies often treated surgically by pediatric orthopaedic surgeons. The intent is to clarify some discrepancies in coding for these procedures and aid the surgeon in proper billing. It is important to note that the following scenarios are hypothetical and therefore ultimate code selection should always reflect the operative report documentation.

Motivational Context and Perfectionism Traits in Pediatric Sports

In sports, one of the social agents who can pressure an athlete for perfection in their performance is their coach. However, perfectionism has many potential negative consequences such as excessive concerns over even minor mistakes. The purpose of this study is to test a sequential model: the motivational context (i.e., task- and ego-involving climates generated by the coach and a coach’s support for autonomy) and the facets that determine the level of perfectionism exhibited as a trait (i.e., perceived coach pressure—a facet of socially prescribed perfectionism—and concerns over mistakes—a facet of self-oriented perfectionism). The sample included 317 athletes (133 boys and 184 girls) aged between 10 and 14 years, who answered a battery of questionnaires that evaluated an athlete’s perception of their motivational climate, their perception of support for autonomy, their perceived coach pressure and their concerns over mistakes. Using the structural equations model, the results showed that the task-involving climate was negatively correlated with perceived coach pressure, whereas the ego-involving climate and support for autonomy were positively correlated with perceived coach pressure and were positively correlated with concerns over mistakes. Finally, perceived coach pressure did not influence concerns over mistakes from the motivational context. This study highlights the importance of considering motivational contexts as important motivational elements of perfectionism in youth sports.

HOW MANY PAIN PILLS DO WE PRESCRIBE: A SURVEY OF PARTICIPANTS IN SCORE: A QUALITY IMPROVEMENT INITIATIVE (204)

Objectives:The public health opioid abuse epidemic has led to nationwide interest in judicious use and close monitoring of opioid pain medication. Knee arthroscopy(KA) and anterior cruciate ligament reconstruction(ACLR) are common procedures in adolescent patients for which narcotics have been historically utilized for post-operative pain management. The purpose of this study is to investigate pain management strategies following basic KA or ACLR by pediatric sports surgeons who contribute to a multi-center quality improvement initiative(SCORE).Methods:Surgeon participants in SCORE represent fifteen U.S. institutions from primarily academic teaching hospitals who specialize in pediatric sports medicine. Surgeons contribute all ACLR and other KA-related cases. A RedCap survey was distributed to all SCORE surgeon participants in December 2019. A KA (defined as a knee arthroscopy that does not include a ligament reconstruction or a cartilage procedure other than chondroplasty) represented a less invasive procedure, while the ACLR represented a more invasive procedure. Survey results were collected and analyzed for both practice patterns of regional anesthesia utilization and post-operative narcotic prescribing volumes.Results:Twenty-eight SCORE surgeon participants completed the survey, a 100% response rate. A planned prescription of a mean of 16.4 pain pills (range 0-40 pills) were reported for pain management following a KA, only 32.1% of surgeons reported adjunctive regional anesthesia techniques for this procedure in addition to general anesthesia. Following an ACLR, surgeons reported a planned prescription of a mean 23.8 pain pills (range 0-40 pills) and most (92.3%) reported utilization of regional anesthesia for their peri-operative analgesia strategy. Of those using adjunctive regional anesthesia, significant variability was reported: 30.7% reported indwelling catheter placement for peripheral nerve block following ACLR as opposed to a single shot injection method, and several block locations were reported to be utilized of which adductor canal (67.9%) block was the most common (see Figure 1). For both procedure types, variability in multi-modal pain management was noted, with incomplete adoption of the use of additional non-narcotic medication (acetaminophen, 64.2%; and NSAIDS, 75%). Cryotherapy devices were applied/prescribed in 75.0% of knee arthroscopy procedures and 92.8% of ACLR.Conclusions:Despite evidence for effective adjunctive pain management strategies, incomplete adoption of multi-modal techniques and reliance on narcotic medication remains a significant component of pediatric sports surgical practice; with on average > 15 pills prescribed following these procedures. Opportunities for reducing practice variability, adoption of multi-modal analgesia strategies, and decreasing post-operative narcotic use following common adolescent knee procedures exist for this subset of pediatric sports medicine specialists

Medial Epicondyle Apophyseal Avulsion Fractures in Youth Throwers: A Severe Variant of Little League Elbow (132)

Objectives:Medial epicondyle apophyseal avulsion fractures sustained during throwing represent an understudied, severe variant of medial epicondyle apophysitis, or ‘Little League elbow’. The current study sought to characterize presenting features, treatment options, and clinical results of a large cohort of pre-adolescent and adolescent patients who presented with these fractures.Methods:Skeletally immature athletes with medial epicondyle apophyseal avulsion fractures sustained during throwing from 2003-2017 at a tertiary-care pediatric referral center were identified. Exclusion criteria were fractures sustained during non-throwing activity or prior elbow fracture. Medical records and radiographic images were reviewed for study variables. Treatment decisions were made independently by fellowship-trained pediatric orthopaedic surgeons or sports medicine physicians on a case-by-case basis. Patients treated with open reduction and internal fixation (ORIF) were compared to those treated non-operatively, and all fracture patients were compared to a larger control group of patients diagnosed with medial epicondyle apophysitis/Little League elbow with no fracture.Results:During the study period, a total of 317 patients were diagnosed with Little League elbow due to medial epicondyle apophyseal overuse injury, 50 of whom (16%) sustained a discreet, radiographically confirmed epicondyle fracture sustained during a single throw. Median age of the fracture cohort at presentation was 13.1 years (range 8 years – 16 years). Forty-nine fracture patients (98%) were male baseball pitchers and one (2%) was a male football quarterback. Fracture patients had significantly higher median BMI (21.3 kg/m2 vs. 19.2kg/m2, p=0.004) than the apophysitis control group, but there was no significant difference in age. Of the 37 patients with documentation regarding pre-injury symptoms, 31 patients (84%) described pre-existing medical elbow pain prior to their acute injury, while 6 (16%) denied pain prior to the inciting throw. Of the 12 patients (24%) with documented shoulder exams at presentation, 5 (42%) demonstrated glenohumeral internal rotation deficit (GIRD). Twenty-three patients (46%) were treated with ORIF (22 single screw fixation; 1 suture anchor fixation), while 27 (54%) were treated non-operatively. Median fracture displacement was significantly greater in operative patients than non-operative patients (5.0mm vs. 3.0mm, p=<.001), with all ‘minimally displaced’ (<4mm) fractures undergoing non-operative treatment (Figure 1). Multivariable analysis determined that for each additional mm of displacement, the odds of surgical intervention increased by 6.4 times (OR=6.36; 95% CI=1.83-22.07; p=.004), when controlling for age and BMI. All patients returned to their throwing sport (RTS) at a median of 12.8 weeks post-diagnosis, but 13 (26%) developed recurrent elbow pain, with no significant difference in in RTS time or recurrence rate between treatment cohorts. Nine of twenty-two (41%) screw ORIF patients underwent secondary implant removal, with no significant difference in this rate between those with or without a washer.Conclusions:Medial epicondyle apophyseal avulsion fractures in youth throwers represent a severe variant of Little League elbow, constituting approximately 16% of cases within the condition’s spectrum. These fractures may be effectively treated with either non-operative measures, particularly minimally displaced fractures <4mm, or ORIF, though >40% of operative patients may require implant removal. A large majority of patients reported medial elbow pain prior to fracture, suggesting this severe presentation of Little League elbow may be preventable.

Treatment Decisions in Pediatric Sports Medicine: Do Personal and Professional Bias Affect Decision-Making?

Background:Personal and professional biases can affect decision-making regarding important issues in pediatric sports medicine. Gaining insight into the opinions of health care professionals who specialize in pediatric sports medicine will provide information that may be useful for directing ongoing research in this field.Hypothesis:It was hypothesized that surgeons would demonstrate bias toward early surgical intervention versus nonsurgeons. In addition, it was hypothesized that youth sports medicine professionals who were parents of a child with a previous major sports injury or concussion would be less likely to allow their child to play American tackle football or return to football after a concussion.Study Design:Cross-sectional study.Methods:An online survey was provided to the active members of the Pediatric Research in Sports Medicine Society. We used both professional background information and responses to questions related to personal experiences with youth sports injuries to determine potential factors associated with underlying biases. Survey responses among subgroups were compared using the Fisher exact test. The Pearson correlation coefficient was used to evaluate years in practice versus opioid use.Results:Of the survey participants, 62.5% were pediatric surgeons, and 37.5% represented different nonsurgical youth sports medicine professions. Surgeons were less likely than nonsurgeons to agree to allow their child to return to football after sustaining a concussion and completing a concussion protocol (48% vs 76%, P = .013). Surgeons were more likely than nonsurgeons to agree to both elective shoulder stabilization after a first-time dislocation and elective drilling of a stable knee osteochondritis dissecans (OCD) before nonoperative treatment (41% vs 10%, P = .003 and 52% vs 23%, P = .013, respectively). Those who reported having a child with a concussion history were more likely to support him or her returning to football after a concussion (65% vs 33%, P = .026).Conclusion:Surgeons were more likely to favor elective shoulder-stabilization surgery after a first-time dislocation and drilling of a stable knee OCD instead of nonoperative management. Personal experience of having a child who sustained a major sports injury or concussion did not demonstrate a bias against participation in football or return to football after a concussion.

Individual and Team Sports-related Hospitalizations for Traumatic Brain Injuries in Pediatric Patients (104)

Objectives:Pediatric sport participation continues to increase in the United States with a corresponding increase in sports related concussions or traumatic brain injuries (TBIs). Based on this impact, it is important to recognize which sports are at elevated risk, identify patient and hospital-associated risk factors for hospital admission and length of stay, as well as understand billing costs for both individual and team sport participants. Improved awareness may help avoid disproportionate treatments, reduce economic burdens, and allow physicians to more effectively manage these injuries.Methods:Pediatric patients (ages 5-18) from 2008 to 2014 were identified from the Healthcare Cost and Utilization Project (HCUP) National (Nationwide) Inpatient Sample (NIS). ICD-9 CM codes were used to include 894 patients who were hospitalized with a concussion resulting from either participating in an individual (N = 451) or team sport (N = 443) (Figure 1). An adjusted odds ratio was calculated using demographic and hospital information. Welch ANOVA was performed to evaluate differences in length of hospital stay and total charges between cohorts. This was repeated for a loss of consciousness subgroup analysis within each cohort.Results:Younger athletes in individual sports were more likely to have associated loss of consciousness, be self-pay, experience a greater number of procedures, and require an operating room procedure. (Table 1). When compared to team sports, TBI patients in individual sports had significantly longer (p < 0.001) and costlier (p < 0.001) hospital stays (Table 2). The only significant finding that was worse in team sports was that loss of consciousness led to greater total charges (p < 0.001) (Table 2). For team sports, American tackle football, (43.6%) and for individual sports, bike riding, (28.2%) were the most frequent sports associated with TBIs in their respective cohorts (Table 3).Conclusions:Individual sport TBIs may be associated with longer and more expensive hospitalizations. The explanation is likely multifactorial but may be complicated by reduced awareness and reduced compliance with strict return to play protocols in individual sports. Safety education information at a young age, clear discharge instructions, and baseline health assessments when possible may help mitigate these findings.

Exploring Vestibular/Ocular and Cognitive Dysfunction as Prognostic Factors for Protracted Recovery in Sports-Related Concussion Patients Aged 8 to 12 Years.

To explore the prognostic ability of the vestibular/ocular motor screening (VOMS), King-Devick (K-D) Test, and C3 Logix Trails A and B to identify protracted recovery from sports-related concussion (SRC) in patients aged 8 to 12 years. Retrospective cohort analysis. Specialty pediatric sports concussion clinic. A total of 114 youth athletes aged 8 to 12 years who were diagnosed with an SRC within 7 days of injury. A positive screen on the VOMS, K-D, and C3 Logix Trails A and Trails B. Combined positive screens on multiple tests (ie, 2, 3, or all 4 positive screens of 4 possible). Recovery time in days and protracted recovery (recovery time ≥30-days) were the primary outcomes of interest. A positive VOMS screen was associated with 1.31 greater days to SRC recovery ( P = 0.02) than a negative VOMS screen. The K-D and C3 Logix tests were not significantly associated with recovery time, nor were any combinations of tests ( P > 0.05). The VOMS demonstrated moderate prognostic ability to predict normal recovery (negative predictive value = 80.78% [95% CI = 63.73-90.95]). Overall predictive accuracy of normal versus protracted recovery was strongest when a participant screened positive on all 4 tests (Accuracy = 76.32% [95% CI = 67.45-83.78]). The VOMS was associated with overall recovery time and proved to be a useful test to identify those who would experience a normal recovery time. Combining the 4 tests improved the prognostic accuracy of the protocol in predicting protracted versus normal recovery. These findings suggest that combining multiple, varied assessments of cognition and vestibular/ocular functions may better explain factors contributing to protracted recovery.

Continued play following adolescent sport-related concussion: Prospective data from the North Texas Concussion Registry (ConTex)

Our study aims were to identify the frequency of continued play following sport-related concussion (SRC), defined as continuing athletic activity on the same day following a suspected SRC, characteristics associated with continued play, and whether continued play was associated with worse outcomes. A prospective study of participants ages 13–18 years diagnosed with SRC at a pediatric sports medicine clinic over a 4-year period was conducted. A comparison was performed between athletes who reported continued play following SRC (PLAY) and those who did not (NO PLAY). Of 441 participants, 231 (52.4%) were in the PLAY group. The PLAY group recalled less severe balance problems from the day of injury (p = 0.02), but reported greater symptoms of trouble falling asleep, concentrating, and remembering at their initial clinic visit (p < 0.05). There was no difference in recovery time between groups. Greater symptom severity score at the initial clinic visit and longer time to presentation were associated with prolonged recovery in both groups (p < 0.01). In conclusion, more than half of the athletes in this sample continued to play on the same day following SRC. Our results indicate the need for a heightened focus on education and additional efforts to reduce continued play following SRC in adolescents.

Retrospective study of the effect of opioid prescribing guidelines on prescribing practices in pediatric orthopedic sports medicine patients having knee surgery: A single institution's experience.

Guidelines for opioid prescription post-operatively exist; however, the majority of these are for adults. Nevertheless, opioid risks are present for pediatric patients also. This study investigates the effect of a single institution's guidelines on post-operative opioid prescribing for pediatric orthopedic patients undergoing knee surgery. We hypothesized that a standardized set of prescribing guidelines would result in a decrease in opioids prescribed at discharge home after these surgeries. Retrospective observational. Urban, tertiary care, academic orthopedic hospital. Pediatric, sports knee surgery, 23-month period. Guidelines were implemented institutionally for post-operative opioid prescribing practices. We reviewed all post-operative opioid prescriptions for pediatric patients undergoing sports knee surgery with two pediatric sports surgeons for the 11 months prior to the guidelines and 12 months afterwards, totaling 316 surgeries. Oral morphine equivalents (OMEs) prescribed on discharge from the hospital before and after implementation of guidelines. There was a significant reduction in OMEs from 229 OMEs to 175 OMEs before and after opioid prescribing guidelines (p < 0.001). This is a decrease in approximately seven 5 mg oxycodone tablets per patient. This study demonstrates that at our institution, with a pediatric patient population having sports knee surgery, prescribing guidelines reduced the number of opioids prescribed at discharge.

THE BENEFITS CONFERRED BY MULTI-SPORT PARTICIPATION MAY NOT INCLUDE IMPROVED FUNCTIONAL AND PSYCHOLOGICAL READINESS FOLLOWING INJURY

Background:Multi-sport participation has been advocated for youth as a means to foster athletic development and reduce over-use injury. Whether this sport variety may influence functional and psychological readiness after injury is unclear.Purpose:The purpose of this study was to compare presentation, and functional and psychological recovery between single sport and multi-sport pediatric athletes following an ACL reconstruction (ACLR).Methods:Following IRB approval, prospectively collected data in consecutive patients treated for ACL injury (1/2015-2/2017) in a pediatric sports medicine clinic was reviewed. Inclusion required primary ACLR. Injury and surgical data, patient reported outcome measures (PROM) including both functional (Pedi-IKDC) and psychological PROM (ACSI-28 and ACL-RSI), functional clearance data (Y balance testing), timing of return to play clearance, and any re-injuries were reviewed. Comparison of multi-sport and single sport athletes was performed using a Kruskal-Wallis test and ANOVA analysis followed by T-tests for multiple comparisons.Results:81.5% of patients who underwent an ACL reconstruction were single sport athletes. Single sport athletes presented with a higher initial BMI (24.47 ± 5.67 vs 22.45 ± 3.81, p = 0.03) than multi-sport athletes. In this cohort, soccer players (89%) were more likely to be specialized compared to football (61%) or basketball players (69%, p<0.01). No differences between groups were noted regarding surgical procedures or concomitant injuries.While no significant differences were found between the groups in time to functional clearance or clearance scores, it was noted that only ¾ of single sport athletes returned to sports (74.0% vs 92.3%, p = 0.06). Reported confidence in functional and psychological recovery improved in both groups throughout rehabilitation (see Table 1). Multi-sport athletes in this cohort demonstrated no advantage in either phase of recovery.Conclusion:Although multi-sport participation has been established to improve athletic development, and decrease burnout and over-use injury; it may not confer advantages in comparison to the specialized athlete for functional or psychological recovery following ACL reconstruction.

BIOPSYCHOSOCIAL RISK FACTORS ASSOCIATED WITH SUBOPTIMAL OUTCOMES FOLLOWING ACLR IN THE PEDIATRIC ATHLETE

Background:Anterior cruciate ligament reconstruction (ACLR) is associated with acute postoperative pain, decreased function, and psychological distress. Studies examining risk factors in pediatric populations following ACLR are limited; however, pediatric studies have found low socioeconomic status and fear of re-injury associated with poor outcomes.Hypothesis/Purpose:This study aims to expand the understanding of biopsychosocial risk factors for postoperative outcomes in pediatric ACLR populations.Methods:A retrospective review of patients that underwent ACLR at a pediatric sports medicine clinic from 5/12/17-5/15/19 was performed. Patients were included in the retrospective chart review if they were between the ages of 12 to 18 years, completed the ACSI-28, PROMIS Global Health 7+2 (PGH-7+2), Pedi-IKDC, and HSS Pedi-FABS, and underwent arthroscopic ACLR for a primary ACL lesion. Medical records were reviewed for demographic, sport involvement, injury, and treatment data collected at initial, pre-operative, first post-operative, one-year post-operative, and final post-operative visits.Results:107 patients (55F) with an average age of 15.69 years (range 12-18), meeting inclusion criteria were included in this review. Patients were cleared to return to sport (RTS) on average 350.23 days post-surgery.Both days between injury and surgery (109.65 days) and days between initial presentation and surgery (92.64 days) were found to be moderately correlated with RTS (r=0.478; p<0.001 and r=0.525; p<0.001, respectively).Between group comparisons were conducted comparing younger (<14yos) and older (≥14yos) patients. When looking at the PGH-7+2; the <14yos cohort reported significantly higher self-evaluation of health than the ≥14yos cohort (54.93 v 50.08; p=0.004). This younger cohort passed their functional test whereas older counterparts did not (n=13; 1 v 1.15; p=0.045).Patients who passed the functional test during their treatment course (i.e., through final follow-up) reported better pre-operative overall and physical health than those who ultimately failed (PGH-7+2Q1; 4.18 v 3.38, p=0.012; Q3; 4.03 v 3.15, p=0.002). Younger patients were more likely to pass the functional test (15.49 v 17.07 years, p=0.002).Lastly, a comparison between patients who did and did not reinjure their knee post-operatively was reviewed. Reinjured patients reported having increased levels of performance related worry pre-operatively (ACSI-28, FFW; 5.22 v 7.36, p=0.034).Conclusion:These findings suggest older athletes (≥14yos), those with lower perceived overall and physical health ratings, with performance related worry, and/or longer time between injury or initial presentation and surgery will need more pre-, peri-, and post-operative support and resources for optimal outcomes.

PEDIATRIC SPORTS INJURY EPIDEMIOLOGY DURING COVID-19 PANDEMIC

Background:The COVID-19 pandemic has prompted a multitude of public health response measures including social distancing, school cancellations, and cessation of organized sports. A change in the epidemiology of injuries commonly caused by sporting activities is expected.Hypothesis/Purpose:Examine the effect of public health measures on the incidence and characteristics of common pediatric sports injuries.Methods:This is a retrospective cohort study comparing sporting injuries presenting to a level I pediatric trauma hospital during the COVID-19 pandemic to sporting injuries during a pre-pandemic period at the same institution. Nine specific injury types were evaluated including ACL injury, meniscus injury, patellar dislocation, osteochondritis dissecans (OCD), shoulder dislocation, ankle sprain, clavicle fracture, medial epicondyle fracture, and tibial spine fracture. Patients were included if they presented for initial care between 3/15/20 and 4/15/20 for the “pandemic” group and the same time window in 2018 and 2019 for the “pre-pandemic” group.Results:487 patients were included in our study with an average of 222.5 patients in 2018 and 2019 compared to 42 patients in 2020. The average patient age decreased during the pandemic compared to the pre-pandemic period (9.4 ± 6.0 vs 12.4 ± 4.2, p=0.007). Additionally, a decrease in the proportion of injuries attributed to sports (26.2% vs 47.6%, p=0.005) and those occurring at school/daycare (4.8% vs 10.3%, p<0.001) were observed. During the pandemic there was an increase in the proportion of injuries occurring at the patients home (50.0% vs 16.9%, p<0.001)(Table 1). The distribution was significantly different across the nine injury types included with a decrease in the proportion of ankle sprains (31.0% vs 59.8%, p<0.001) and an increase in the proportion of clavicle fractures (50.0% vs 16.2%, p<0.001)(Figure 1). For ankle sprains, there was no significant difference in the proportion of anterior talofibular ligament injuries to high ankle sprains (p=0.898). There was no delay in presentation in the “pandemic” group compared to the “pre-pandemic” group (6.6 ± 9.6 vs 5.4 ±9.9, p=0.424).Conclusion:At our institution, we observed an over fivefold reduction in presentation for common pediatric musculoskeletal injuries typically associated with sports. The dramatic drop off in injuries occurring across both sports and non-sports injury mechanisms raises concern for presentation of untreated injuries in the future. Additionally, the increased proportion of injuries occurring in the home setting creates an opportunity for emphasis to be placed on basic safety precautions, especially for young children.Tables/Figures:Figure 1.Injury Distribution of Pre-Pandemic and Pandemic Time Periods