Single Sport Research Articles

Sport Specialization's Impact on Female Adolescent Athletes' Lower-Extremity Neuromuscular Control: A Critically Appraised Topic.

Nearly 60 million youth ages 6-18 participate in athletics within the United States. Over the last 30years, the outlook on youth sport participation has drastically changed, resulting in an increased emphasis on performance and college sport participation. These evolving expectations have created a sense of perfectionism, demanding more time and energy to be placed into a single sport, resulting in an increased prevalence of sport specialization, and consequently, an increased rate of injury. What is the impact of sport specialization on lower-extremity neuromuscular control in female adolescent athletes? Four studies were included, all comparing movement efficiency and movement patterns among multisport and sport-specialized female adolescent athletes. Three studies showed that sport specialization is associated with lower-extremity biomechanical alterations that are indicative of altered levels of neuromuscular control, which can predispose an individual to an increased risk of injury. One study concluded that no differences in neuromuscular control exist when comparing sport-specialized to multisport adolescent female athletes. Sport specialization has the potential to create negative alterations in a female adolescent athletes' lower-extremity biomechanics, leading to the creation of altered levels of neuromuscular control and a possible increased risk for injury. Level B evidence exists to support the conclusion that sport specialization negatively affects a female adolescent athlete's lower-extremity neuromuscular control.

Selectively Training in a Single Sport is Not Associated with Increased Injury in High School Female Athletes

Competing predominately in one sport instead of multiple sports has become increasingly prevalent in young athletes. However, there is a lack of data focused on female athletes who compete exclusively in one sport. We hypothesized that female athletes who selectively train in a single sport (SS) have higher rates of injury, body image concerns, and menstrual dysfunction compared to female athletes who play multiple sports (MS). Retrospective data was collected from a pre-physical questionnaire distributed among female athletes from five local high schools (n=611; 13-18 years of age). Odds ratios, 95% confidence intervals (CI), and effect size were calculated to investigate the association between SS training and injuries, irregular menses, and body image concerns (a priori p< 0.05). SS training was not associated with higher rates of injury (p=0.48) and were less likely to have a history of stress fractures compared to MS athletes (p=0.03). There was a decrease in the number of menstrual cycles within the last 12 months among SS athletes (p=0.02, d=0.34). Exclusively competing in a single sport is not associated with higher injury rates in female high school athletes but is associated with dissatisfaction with one’s weight.

Single and Especially Multisport Participation May Increase Physical Fitness in Younger Americans.

We sought to examine the associations between sports participation and physical fitness in younger Americans. The analytic sample included 1108 Americans aged 6-15 years. Muscular fitness assessments included handgrip strength, leg extension strength, and plank position. Cardiorespiratory fitness was examined with graded treadmill tests. Youth participating in any sports had increased physical fitness performance for each marker: 1.63 kg (CI: 0.91-2.35) for handgrip strength, 6.23 kg (CI: 3.15-9.32) for leg extension strength, 9.41 lbs. (CI: 4.51-14.31) for plank position held, and 3.02 mL/kg/min (CI: 1.23-4.80) for estimated maximal oxygen uptake. Participants engaging in a single sport had increased performance for most fitness markers: 1.52 kg (CI: 0.67-2.38) for handgrip strength, 5.16 kg (CI: 1.50-8.82) for leg extension strength, 5.98 s (CI: 0.17-11.78) for plank position held, and 2.67 mL/kg/min (CI: 0.58-4.77) for estimated maximal oxygen uptake. Youth engaging in multiple sports exhibited even steeper trends: 1.77 kg (CI: 0.83-2.70) for handgrip strength, 7.63 kg (CI: 3.62-11.65) for leg extension strength, 13.89 s (CI: 7.52-20.27) for plank position held, and 3.50 mL/kg/min (CI: 1.15-5.85) for estimated maximal oxygen uptake. Any sports participation, including single and multiple sports, is linked to increased physical fitness in American youth.

Concussion Recovery in Children and Adolescents: A Retrospective Study

Concussion is a common injury among children and adolescents, with a growing body of literature supporting a variety of diagnostic and treatment modalities. Recovery is variable and depends on multiple factors that can be evaluated through a clinic visit: a thorough history, physical examination, and use of the Post-concussion Symptom Scale (PCSS). The purpose of this study was to evaluate factors associated with overall recovery from concussion in children and adolescents in the clinical setting. It was hypothesized that the presence of 1 of a number of pre- or postinjury characteristics will be associated with poor concussion recovery. Case-control study; Level of evidence, 3. We conducted a retrospective chart review of adolescents and children aged 6 to 17 years with a diagnosis of concussion who were evaluated at a single sports medicine center between January 2015 and December 2019. Cases were categorized into recovered (PCSS <7) and poorly recovered (PCSS ≥7) cohorts based on the last PCSS scores during clinical follow-ups for concussion management. Of the 162 charts reviewed, 110 cases met inclusion criteria. Significant statistical differences were found between the recovered and poorly recovered cohorts regarding mean days from injury to last clinic visit, previous migraine diagnosis, and emergency room (ER) visit before the first clinic visit (P < .01 for all). Binary logistic regression analysis revealed that the most predictive factors associated with poorer recovery were having an ER visit before the first clinic evaluation (P = .01) and previous migraine diagnosis (P = .04). While many factors may contribute to overall recovery from concussion in pediatric populations, our study suggested that a history of migraine and an ER visit before clinic evaluation may be associated with poor recovery of concussive symptoms.

Early sport specialization in men's lacrosse: a survey of 158 professional lacrosse athletes

<h2>ABSTRACT</h2> <i>Introduction</i>: Across all youth sports, the trend of single sport specialization continues at a concerning pace and often at an increasingly younger age. <i>Objectives</i>: To determine the prevalence of youth single sport specialization among current professional lacrosse athletes. <i>Methods</i>: An online survey was distributed to each athlete of a men's professional lacrosse league. Athletes were asked if they specialized to play lacrosse at the exclusion of other sports. We analyzed the rate and age of early sport specialization, reasons for specialization, and the athlete's perceptions pertaining to this topic. <i>Results</i>: A total of 158 out of 164 athletes completed the survey, for a response rate of 96.3%. Less than one-third, (48/158 = 30.4%) of men's professional lacrosse athletes specialized to play lacrosse at the exclusion of other sports during their childhood/ adolescence. Of the athletes that did specialize, they did so at an average age of 16.5 ± 1.58 years old. Only 2.5% of professional lacrosse athletes specialized prior to the age of 13, with the majority (88.6%) of athletes classifying themselves as "multi-sport" athletes during high school. 96.8% of professional lacrosse athletes would not recommend single sport specialization to their own children. <i>Conclusion</i>: For the professional lacrosse athletes studied, single sport specialization was not necessary to achieve elite status in their sport. The majority of current professional lacrosse athletes were multi-sport athletes in high school. This study adds to the growing body of literature challenging the trend of single sport specialization among current youth athletes.

“My definition of community is community, and their definition is more around fan engagement”: balancing business and social logics of professional sport teams’ community activities

ABSTRACT Professional sport teams operate within an increasingly complex institutional environment and are required to often confront incompatible prescriptions from multiple institutional logics, such as performance and commercial goals (i.e., business logics) relative to community development and altruistic goals (i.e., social logics). The aim of this research is to investigate the influence of institutional complexity on managers perceptions of community-oriented practices across 12 professional teams within a single Australian sport league. Using Raynard’s (2016) configurations of institutional complexity, we identify two types of hybrid responses that professional teams utilise to address multiple logics: aligned and segregated. When community managers perceived social logics to be aligned with business logics, community activities were more aligned with commercial organisational outcomes such as brand, fan and sponsorship benefits. Alternatively, when managers perceived social logics to be segregated from business logics, community activities were more autonomous from commercial drivers, allowing a greater focus on community development outcomes including education, health and increased trust. Theoretically, our research adds to institutional logic scholarship by showing that multiple logics can be compatible with each other, central logics influence peripheral logics and organisational responses to institutional complexity can vary within a professional sport league.

A Comparison Of Motivators Between Youth Single-sport, Multi-sport, And Single-sport Specialized Athletes

The motivation for youth sport involvement may differ for single-sport (non-specialists), multi-sport, and single-sport specialized athletes. PURPOSE: To investigate differences between adolescent single-sport athletes (SSA), multi-sport athletes (MSA), and single-sport specialized athletes (SSSA) on measures of sports enjoyment and motivation. A secondary aim was to compare these variables between age groups. METHODS: Adolescent sport participants in 6th, 7th, and 8th grade (n=306, age=13.0±1.0 yrs) completing the Sources of Enjoyment in Youth Sports Questionnaire (SEYSQ) that assesses sport enjoyment in the subscales of self-referenced competency (SRC), other-referenced competency and recognition (ORCR), effort expenditure (EE), competitive excitement (CE), affiliation with peers (AP), and positive parental involvement (PPI). The particpants also reported their age, gender, grade, years of sport participation and sport status (SSA, MSA, SSSA). RESULTS: SSSA reported significantly more enjoyment in all subscales except PPI when compared to SSA (p<0.05; ES 0.4 - 0.99). MSA and SSSA showed significant differences in the subscales of SRC and EE; however, effect size was small (0.37 and 0.33, respectively). Overall scores for intrinsic and extrinsic motivation were significantly lower among SSA compared to MSA and SSSA (p<0.01) with no differences between MSA and SSSA (p>0.05). Results revealed no significant differences in the SEYSQ 's subscales for age (p>0.05). CONCLUSION: Within the parameters of this study, adolescents that specialize in a single sport or those who compete in multiple sports both rely on intrinsic and extrinsic sources of enjoyment for motivation in very similar ways; whereas adolescent SSA are less motivated and experience less enjoyment from sport participation compared to MSA and SSSA. Key Words Adolescent Enjoyment SEYSQ

Description of sport participation profiles and transitions across profiles during adolescence

ABSTRACT Few studies describe sport participation profiles in the general population using multiple characteristics. Therefore, the objective of this study was to identify sport participation profiles during adolescence and to describe transitions across profiles from grades 5 to 12 (age 10 to 18 years). We used data from 916 participants (55% girls; age 10–12 years at inception) of the Monitoring Activities of Teenagers to Comprehend their Habits (MATCH) study. Participants self-reported involvement in 36 organized and unorganized physical activities three times/year from grades 5 to 12 (24 data collection cycles; 2011–2018). At each school grade, we derived four categorical variables of sport involvement: number of organized sports, number of unorganized activities, weekly sessions, and number of year-round activities. To identify sport participation profiles, we used latent class analysis at each grade. To characterize transitions between sport participation profiles across grades, we used latent transition analysis. Five distinct sport participation profiles emerged: “non-participants”, “unorganized activities only”, “single-sport low frequency”, “single sport high frequency”, and “multi-sport”. Only “multi-sport” participants were unlikely to be classified as “non-participants” over time. Encouraging multi-sport participation might help protect against later non-participation. This study helps identify important times to intervene for improving physical activity levels.

Manager, coach and sports club participant perceptions of health promotion

Objectives: Sports clubs’ investment in health promotion (HP) has so far been limited, and efforts to understand where gaps exist in implementation are few and far between. This mixed-method study analysed managers’, coaches’ and sports participants’ perceptions of HP in a single sports club. Design: A mixed-method cross sectional design was used. Setting: The goal was to assess HP perceptions at the macro (club), meso (managers) and micro (coaches) levels with respect to four key health determinants. Method: Quantitative data were collected from 237 participants using e-PROSCeSS questionnaires. Qualitative data collection included two meetings with managers and a focus group with sports club participants. Data analysis took place by means of a hybrid thematic analysis informed by the health promoting sports club (HPSC) model. Results: Similar answer patterns among managers, coaches and sports club participants illustrated that social and environmental determinants scored higher than organisational and economic determinants, which was consistent with qualitative findings. Only one significant difference was found between managers and sports club participants – for organisational determinants at the macro level. In others words, all club actors agreed that sports clubs needed to invest in HP policy and funding, and not only acknowledge that HP is an integral outcome of sports participation. Gender differences in HP perceptions were identified, while being a volunteer compared to a non-volunteer did not make any significant difference. Conclusion: Study findings raise questions about how best to implement and evaluate sports club HP, especially in relation to policies and resources. This is essential to understand the interactions between macro, meso and micro level health determinants and the temporal implications of implementing a HPSC’s approach.

"Balance Is Better": The Wellbeing Benefits of Participating in a Breadth of Sports across a Variety of Settings during Adolescence.

The purpose of this study was to examine how wellbeing is associated with the setting in which sport participation takes place and the breadth of sport participation. Demographic characteristics (age, gender, ethnicity, deprivation, (dis)ability status), recreational physical activity, and wellbeing were assessed in cohorts of adolescents (11–17 years) between 2017 and 2019 in Aotearoa, New Zealand. Better wellbeing was associated with participation in any sport vs. none (OR = 1.57, 95% CI = 1.30–1.90). Better wellbeing was also associated with participating in any coached sport training (OR = 1.48, 95% CI = 1.33–1.66), competitive sport (OR = 1.33, 95% CI = 1.18–1.49), social sport (OR = 1.33, 95% CI = 1.18–1.49), and uncoached sport training (OR = 1.16, 95% CI = 1.03–1.31) compared to non-participation in the given setting. Wellbeing was not associated with participation in physical education or solo sport. Participating in sport in three to five different settings (3 settings: OR = 1.21, 95% CI = 1.01–1.44; 4 settings: OR = 1.33, 95% CI = 1.09–1.62; 5 settings: OR = 1.37, 95% CI = 1.07–1.75) or sports (3 sports: OR = 1.25, 95% CI = 1.04–1.51; 4 sports: OR = 1.31, 95% CI = 1.06–1.61; 5 sports: OR = 1.33, 95% CI = 1.05–1.69) was associated with better wellbeing compared to participation in a single setting or sport, respectively. A balanced approach to participating across a variety of sport settings and sports that are facilitated by quality coaches may offer the largest additional wellbeing value.

Poster 117: An Activity Scale for All Youth Athletes? An Analysis of The Hss Pedi-Fabs in 2274 Pediatric Sports Medicine Patients

Objectives:The HSS Pedi-FABS activity scale has become increasingly used in children age 10-18 since its development in 2013. Research reports on the utility of the measure in general youth athletes with knee injuries, however limited information is available regarding use in evaluating a variety of joint injuries, athletes who participate in sports with disparate biomechanics, or specialized competitive athletes. This study assessed the sensitivity and distribution of Pedi-FABS in an athletic youth population. Secondarily, this study evaluated Pedi-FABS association with PROMIS® Pediatric Global Health 7(PGH7) with Pain Interference(PGHPI) and Fatigue(PGHF) components.Methods:A retrospective review of youth athletes age 10-18 presenting for evaluation at a single pediatric sports medicine clinic between 4/2016-7/2020 was performed. Participants were included if they completed a pre-visit intake questionnaire and Pedi-FABS. Descriptive statistics were used to analyze Pedi-FABS for normal distribution and the presence of a floor or ceiling effect in subgroups determined by demographics, injury characteristics, and sports participation. A floor or ceiling effect was determined to be present if more than 15% of respondents scored the lowest or highest possible score. A Kruskal-Wallis test used to compare average scores in each subgroup. Spearman’s Correlations were calculated to assess the association of PGH with Pedi-FABS scores.Results:2274 sports medicine patients (14.6±2.1 years; 53.0% females) were included. Of these, 2010 youth athletes reported participating in sports for 9.6±7.9 hours per week during 32.3±15.7 weeks per year with 6.2±3.4 years of participation in 21 distinct primary sports. 80.3% of patients reported participation in only one sport. Pedi-FABS Score differences were found across demographic(Table 1) and sport participation(Table 2) subgroups. Broad distribution was seen in each subgroup with no floor or ceiling effects. Pedi-FABS score correlated with hours per week(r=0.20), days per week(r=0.28), weeks per year(r=0.12), and years of participation(r=0.16/p<0.01). An inverse correlation was observed between Pedi-FABS and Days from Injury to Presentation(r=-0.21/p<0.01). An association between general health and activity level was noted as all three PGH components correlated with Pedi-FABS(PGH7: r=0.28/PGHF: r=-0.16/PGHPI: r=-0.12, p<0.01).Conclusions:Correlations with multiple forms of self-reported activity without floor or ceiling effects demonstrates the validity and sensitivity of Pedi-FABS for use in athletes with a variety of primary sports and injury types. Additionally, mean differences between demographic and sport participation subgroups, as well as associations with days to presentation and a commonly used patient reported outcome measure, may demonstrate the utility of Pedi-FABS for sports medicine clinicians.Table 1.HSS Pedi-FABS Score Distributions by Study Cohort Demographics and Injury CharacteristicsTable 2.HSS Pedi-FABS Score Distributions by Sports Participation Characteristics Among Self-Reported Athletes in Study Cohort

Radial Extracorporeal Shockwave Therapy (rESWT) is not superior to “minimal-dose” rESWT for patients with chronic plantar fasciopathy; a double-blinded randomised controlled trial

BackgroundInvestigating outcomes following radial-extra-corporeal-shockwave-therapy (rESWT) in patients with chronic plantar fasciopathy MethodsThis double-blinded RCT in a single NHS Sports medicine clinic recruited 117 patients with chronic plantar fasciopathy randomised equally to either 3 sessions of rESWT or “minimal-dose” respectively. Mean age 51.7 ± 9.6 years, 66 % female, symptom duration: 32.6 ± 30.8 months. Results“Average pain” improved by 50 % at 6-months, (>1/3 at interim time-points). Statistically significant within-group improvements were identified in pain, local function, and “ability” PROMs in both groups. Fewer benefits in activity levels or mood. No between-group differences were seen at the interim or final time-points. Conclusion3 sessions of “recommended-dose” rESWT is non-superior to “minimal-dose” rESWT in patients with chronic plantar fasciopathy. rESWT may be ineffective in the treatment of patients with chronic plantar fasciopathy, “minimal-dose” rESWT may be sufficient for a therapeutic effect, or a greater number of treatment sessions may be required for benefit. Level of evidenceLevel I – Randomised controlled trial

Paper 41: Suture-Bridge Fixation of Osteochondral Fractures and Osteochondritis Dissecans in the Knee: Excellent Rates of Early Lesion Stability and Osseous Union

Objectives:Preservation of articular cartilage in the setting of acute or chronic injury in the knee is paramount for long-term joint health. Achieving osseous union, minimizing implant related injury, and eliminating the need for reoperation for osteochondral fracture lesions (OCL) and osteochondritis dissecans (OCD) remain a challenge for the orthopedic surgeon. To evaluate osseous and chondral integration following a suture and non-metallic anchor (suture-bridge) construct utilizing magnetic resonance imaging (MRI). A secondary purpose was to assess the outcomes and short-term complications of suture bridge fixation of OCL and OCD in the knee.Methods:Consecutive patients (n=39, 41 knees) treated within a single academic sports medicine institution who underwent suture-bridge fixation of an OCL or OCD of the knee from initiation of the technique in 10/2019 through 03/2021 were reviewed with IRB approval. The suture-bridge technique employed 1.5 or2.9mm bioabsorbable knotless anchors (avg n= 3.93; 3-6) placed on the outside margins of the lesion with multiple strands (2-8) of hand-tensioned absorbable (87.5%; #0 or #1Vicryl) or non-absorbable (2-0 braided polyester) bridging suture. A minimum of six months follow up to assess bony union was required for inclusion, resulting in 40 knees in 38 patients available for study. Demographics, pre-operative MRI lesion characteristics, including lesion type (OCL vs OCD), presence of bone in within the fragment, size, and location, were documented. Healing was assessed by radiographs and MRI, with MRI obtained on all OCDs and any chondral-only OCL lesions. MRI was available on 33/40 (82.5%) knees within one year of surgery and was rated for lesion healing: Full Union = 100% cancellous or cancellous-chondral lesion continuity, Stable Union = >50% continuity with some fibrous tissue present, Un-united = < 50% continuity and extensive fibrous signal or fluid below the lesion. Complications, and rates and timing of return to sport (RTS) were evaluated. For assessment of early pain and functional improvement in the setting of isolated osteochondral treatment (without confounding concurrent patellar instability, or other treatment in conjunction with OCL), KOOS patient reported outcomes were analyzed in the OCD cohort at 6 and 12 months.Results:33 (82.5%) of all lesions demonstrated Full Union and no lesions failed treatment. MRI assessment of healing (5.8 months; 3-12 months) demonstrated 9 (64.3%) OCDs with Full union, 5 (35.7%) OCDs with Stable union, and none un-united (Figure 1); while OCLs demonstrated 17 (89.5%) with Full union, 2 (10.5%) with Stable union, and none un-united. (Figure 2) All 7 bony OCL without an MRI demonstrated radiographic union. 30 (75%) lesions returned to sports at an average of 6.5 months (3.8-10.2). KOOS Daily Living, Pain, Quality of Life, and Symptom scores all demonstrated significant improvement from baseline at 6months and 1 year. (Table 2). There were 2 (5%) complications consisting of re-operation for marginal chondroplasty on otherwise stable lesions, and no re-operations for failure or revision of the suture-bridge construct.Conclusions:In this series of OCL and OCD of the knee, suture-bridge fixation demonstrates excellent rates of MRI and radiographic union and good early outcomes with minimal short-term complications. This technique may be utilized for lesion salvage as preferred over loose body removal and marrow-stimulation and may have significant benefits in comparison to metallic and non-metallic screw/tack constructs in the treatment of these challenging lesions. Longer term follow-up and investigation is warranted.UPLOAD-https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/96288f30-99be-431a-9937-0218d3245043/1/Suture_Bridge_AOSSMFinalfigures.docx

The role of athlete support personnel in preventing doping: a qualitative study of a rugby union academy

ABSTRACT Global anti-doping policy indicates that athlete support personnel (ASP, e.g. doctors, nutritionists) can play an important role in fostering supportive environments that protect against intentional and inadvertent doping. Yet, research into ASP anti-doping roles is limited and no study has examined how (if at all) different members of ASP work together. Therefore, this study investigated anti-doping roles of ASP in a single sports club environment via semi-structured interviews. Through inductive reflexive thematic analysis, three overarching themes were constructed: 1) Everyone has responsibility for anti-doping, but most of the work rests unevenly on a few shoulders, 2) Education is fundamental to doping prevention, and 3) (Preventing doping) It’s all about the way we work with players and each other. As the first study of its kind, the findings indicated that actions taken to prevent doping varied across ASP working together in the same environment. The nutritionist and medical staff were most active in anti-doping efforts and least active were strength and conditioning coaches. Factors underpinning anti-doping roles were individuals’ relevant expertise/training and overall job responsibilities (e.g. supplements, medications) related to risk of doping. Staff also connected their doping prevention efforts to the club’s person-centred philosophy, which prioritised ‘individualisation’ and supportive relationships. While the data indicates potential for anti-doping responsibilities to be shared amongst ASP who work well together and trust one another, it revealed that reliance on one or two ASP in any environment might allow other ASP to neglect their opportunity to have a positive influence on players’ doping-related decisions.

Word of Mouth and Online Reviews Are More Influential Than Social Media for Patients When Selecting a Sports Medicine Physician

PurposeTo (1) identify the percentage of patients seen in an orthopaedic sports medicine practice who use social media and (2) identify the role that social media has in physician selection as compared with other factors.MethodsAfter institutional review board approval was received, new patients aged 18 years or older who attended a single orthopaedic sports medicine office from February 2020 to May 2021 were identified for inclusion. Sociodemographic information was recorded, and each patient was asked to fill out a questionnaire that assessed social media usage and online resources used to choose and formulate opinions regarding the patient’s provider.ResultsTwo hundred patients met the inclusion criteria and completed the questionnaire. Of these, 96.5% reported social media use. The most common online method of searching for and identifying a physician was Google (50.5%). Social media outlets such as Facebook, Instagram, or LinkedIn were only used 15.5% of the time to search for and select a physician. Older patients were more likely to use recommendations from friends and family in their consideration when selecting a physician.ConclusionsDespite almost all participants stating that they use social media, only 15.5% of patients reported that they used social media to search for and potentially select their physician. Our study suggests that although social media can be a helpful tool for patient education, other factors such as physician education and physician reputation through word-of-mouth referrals, online reviews, and online ratings seem to play a larger role in the patient’s selection of his or her physician.Clinical RelevanceThis information may be of value to orthopaedic surgeons looking for ways to build their patient base, online reputation, or other aspects of their practice on the Internet.

A Biomechanical Comparison of the LaPrade Technique Versus a Novel Technique for Reconstruction of Medial-Sided Knee Injuries

Background: Medial-sided knee injuries can lead to symptomatic valgus laxity or anteromedial rotatory instability and may require surgery, particularly in the setting of cruciate tears and tibial-sided medial collateral ligament (MCL) avulsions. The LaPrade (LP) technique utilizes 2 free grafts to reconstruct the superficial MCL (sMCL) and the posterior oblique ligament (POL). An alternative MCL reconstruction devised by the senior author comprises an anatomic single-bundle reconstruction using a free graft to reconstruct the sMCL with advancement and imbrication of the posteromedial capsule/POL (MCL anatomic reconstruction with capsular imbrication [MARCI] technique). These techniques have not been biomechanically compared with one another. Purpose: To identify if one of these reconstruction techniques better restores valgus and rotational medial knee stability throughout the range of motion. Study Design: Controlled laboratory study. Methods: A total of 20 fresh-frozen, male (mean age, 43.7 years [range, 20-63 years]), midfemur-to-toe-matched cadaveric knees were utilized. All reconstructions were performed by a single fellowship-trained sports medicine surgeon. Left and right specimens within matched pairs were randomized to 1 of the 2 treatment groups: LP or MARCI. Each specimen was tested in 3 phases: (1) intact knee, (2) destabilized (MCL and POL completely severed), and (3) reconstructed (post-LP or post-MARCI reconstruction). We quantified valgus angulation defined by medial joint line opening, as well as internal and external tibial rotation at 0°, 20°, 30°, 60°, and 90° of knee flexion under applied external moments/torques at each phase. Results: There were significant differences between the MARCI and LP reconstruction groups in valgus stability compared with the intact state (P = .021), with the MARCI reconstruction more closely approximating the intact knee. There was no overall difference between the MARCI and LP reconstruction techniques for internal rotation (P = .163), with both closely resembling the intact state. For external rotation, the effect of the reconstruction technique was dependent on the knee flexion angle (P < .001). At the highest angles, there were no differences between reconstructions; however, for lower knee flexion angles, the MARCI technique more closely resembled the intact state. Conclusion: Although both techniques improved knee stability compared with destabilized conditions, the MARCI technique better approximated intact stability during valgus at knee flexion angles from 0° to 90° and external rotation loads at knee flexion angles ≤30° in a cadaveric model. Clinical Relevance: The MARCI technique provides an alternative option to improve valgus stability throughout the range of motion. It utilizes a POL advancement without the potential limitations seen in the LP technique, such as multiple tunnel complexity and collision, particularly in the multiple ligament–injured knee.

Supraspinatus Fatty Infiltration Correlation with Handgrip Strength, Shoulder Strength, and Validated Patient-Reported Outcome Measures in Patients with Rotator Cuff Tears.

IntroductionThe purpose of this study was to investigate the relationships between supraspinatus atrophy on magnetic resonance imaging (MRI) and other objective parameters in patients with rotator cuff tears. It was hypothesized that high-grade supraspinatus fatty infiltration would be correlated negatively with handgrip strength, shoulder strength, and patient-reported outcome measures (PROMs).MethodsPatients with MRI-proven rotator cuff tears treated by a single sports medicine fellowship-trained orthopaedist at a single institution underwent comprehensive preoperative evaluation including bilateral handgrip and shoulder strength measurements with dynamometers and multiple online questionnaires from the Surgical Outcomes SystemTM (Arthrex, Naples, FL). Available shoulder MRIs were reviewed to grade supraspinatus fatty infiltration severity according to the 5-tier Goutallier system and an alternate 3-tier classification scheme. Difference analysis and Spearman (rho) rank order correlation were applied to the collected data to define the relationships between supraspinatus fatty infiltration and key variables including handgrip strength, shoulder strength, and scores derived from the shoulder PROMs.ResultsNinety of the 121 patients enrolled in the study had shoulder MRIs available for review. There was no correlation found between supraspinatus fatty infiltration and handgrip strength, shoulder abduction strength, or any of the seven common shoulder PROM scores evaluated. There was statistically significant, albeit weak, correlation between MRI-derived fatty infiltration and shoulder external rotation strength.ConclusionsContrary to the hypothesis, high-grade supraspinatus fatty infiltration is largely unrelated to and should not be considered predictive of handgrip strength, shoulder strength, or common shoulder PROM scores.

Body Height Trajectories in Pediatric Competitive Athletes from 46 Different Sport Types

There is some concern that competitive sports in children and adolescents might hinder their growth. This study’s purpose was to examine height changes in pediatric competitive athletes from 46 different sports. Clinical data from athletes aged &lt;18 years that underwent annual preparticipation examinations at a single sports medicine center were extracted from computerized medical records. Height was transformed into standard deviation scores (SDS). Generalized estimating equations were used to analyze height SDS changes over time in the total cohort and in subgroups of age, sex and several sport types. Data on 2276 athletes were available (71.3% males, age: 12.3 ± 2.6 years), of which 688 had repeated measurements. The median duration between examinations was 1.9 years (interquartile range: 1.0–2.9, maximum: 9.3 years). Height SDS neither significantly changed throughout follow up in the total cohort (−0.01 per year, 95%CI = −0.48–0.03, p = 0.62) nor in subgroups of age and sex. However, height SDS was significantly reduced by −0.12 to −0.23 per year in athletes engaged in endurance sports (i.e., swimming, cycling and triathlon) but not in gymnastics, tennis, basketball or football. We conclude that competitive sports in youth are generally not associated with significant changes in body height relative to age. However, this might occur in endurance sports, possibly due to low energy availability.

National Football League (NFL) quarterbacks who were multisport high school athletes have better in-season performance statistics and career success

ABSTRACT Objectives To determine (1) the proportion of National Football League (NFL) quarterbacks (QBs) who were multisport high school athletes (2) whether performance metrics in NFL QBs differed by playing multiple high school sports versus the single sport of football. Methods A comprehensive online search identified NFL QBs from 1995 to 2020, classifying them as single or multisport high school athletes. Performance data were collected for regular season and playoffs when applicable and were calculated as rates. Regular season comparisons were limited to players playing at least eight games. Accolades (Pro Bowls, MVP awards, and Super Bowl victories) were also recorded. Mann-Whitney U was utilized to compare performance metrics between multisport and single sport athletes. Results 403 QBs (223, 55.3% multisport) were included. In the regular season, multisport QBs played in more games (median 6.8, IQR 4–10.6 vs median 5, IQR 2.5–8.3; p = 0.0001), and had higher touchdowns/game (median 0.87, IQR 0.5–1.25 vs median 0.67, IQR 0.42–1; p = 0.0063), pass yards/game (median 159.4, IQR 103.9–206.7 vs median 139.4, IQR 96.3–179.6; p = 0.0392), and QB rating (median 78.5, IQR 69.4–85.2 vs median 74.4, IQR 66.7–81.2; p = 0.0063). There were no differences in pass completion %, interceptions/game, or rush yards/game. Multisport QBs played in more playoff games (median 0.5, IQR 0.22–0.81 vs median 0.33, IQR 0.2–0.62; p = 0.027), and had more Pro Bowl appearances, MVP awards, and Super Bowl victories per athlete (p < 0.05). Conclusion Over half of NFL QBs played multiple high school sports. Multisport involvement is associated with benefits in regular season including a higher proportion of games played, and more touchdowns/game, pass yards/game, and QB rating. Playing multiple sports was also associated with playing more playoff games and having more Pro Bowl appearances, MVP awards, and Super Bowl victories. This data supports the benefits of youth multisport training.

Sport Participation and Specialization Characteristics in a Pediatric Sports Medicine Clinic

Background:Recent trends in youth sports demonstrate athletes specializing in a single sport at younger ages in an effort to increase athletic success. Research suggests that increased training volume and early sport specialization are associated with increased injury risk, overuse injury, and athlete burnout. Although the exact threshold to avoid injuries has not been elucidated, some pediatric studies have shown increased risk of overuse injury with training more hours per week than their age in years.Hypothesis/Purpose:To determine if athletes presenting to a pediatric sports medicine clinic are participating in more hours per week than their age in years and associated factors related to sport participation.Methods:Data were prospectively collected from participants who presented to a tertiary sports medicine clinic for injury evaluation between October 2016-May 2021. Participants aged 5-<19 years who reported playing sports and had hours per week in their primary sport documented were included. Demographic and sport-related variables were reviewed. Participants were separated into two groups based on whether number of hours per week in their primary sport exceeded their age: UNDER (chronologic age and under) and OVER.Results:10,586 total participants: 8846 (83.6%) UNDER and 1740 (16.4%) OVER. There was no difference in age (13.7±2.6 vs 13.6±2.6 years, p=0.27) between the UNDER and OVER group. There were more males (49.7 vs 38.5%, p<0.0001) and more Hispanic or Latinos (20.2 vs 16.4%, p<0.0001) in the UNDER compared to the OVER group. Soccer (23.0%) was the most common primary sport for the UNDER group while gymnastics (27.1%) was for the OVER group. More participants considered themselves single-sport athletes (68.5 vs 54.1%, p<0.0001) and reported their highest level of competition as club/select/travel (52.0 vs 38.2%, p<0.0001) in the OVER group than the UNDER group. The OVER group reported a significantly higher number of sport participation hours per week than the UNDER group (20.5±8.2 vs 6.9±3.7 hours, p<0.0001, Figure 1), an additional year (6.8±3.2 vs 5.6±3.3 years, p<0.0001), and weeks per year participating in their primary sport (41.7±13.4 vs 32.0±15.5 weeks, p<0.0001).Conclusion:About 15% of athletes seen at the sports medicine clinic reported participating in more hours per week than their age. These athletes were more likely to report being single-sport athletes and participating in club-style teams. Understanding this information may aid providers in educating families in the OVER group about potential increased risk for injury due to high weekly participation volumes and sport specialization.Figure 1.Average number of participation hours per week in the OVER compared to the UNDER group