Single Sport Research Articles

Sports participation patterns throughout high school and their antecedents

This study aimed at identifying and describing patterns of sports participation during high school among a general population of students and examining individual, social, and environmental predictors of pattern membership. A sample of 287 high school students (61% girls) from Quebec (Canada) annually reported all the organized sports in which they had participated over the school year during five consecutive years (from Grade 7 to 11; in the Quebec school system, high school is comprised of five years). The predictors were assessed at the end of elementary school (Grade 6). Latent class analyses brought out four different patterns (specialized, moderate-sports, low-sports and no-sport participation). Multinomial logistic regressions revealed that adolescents’ sex, parental involvement, best friends’ participation in sports and family income were significant predictors of pattern membership. Parental involvement and family income significantly predicted membership in the specialized pattern relative to other patterns, suggesting that tangible support from parent is necessary for youth to maintain their long term commitment in a single sport. Findings highlight that efforts aimed at promoting sport participation during adolescence should target girls and encourage parents to get involved in their children’s organized sports.

Early Single Sport Specialization in a High-Achieving US Athlete Population: Comparing National Collegiate Athletic Association Student-Athletes and Undergraduate Students.

Early single-sport specialization and the relative age effect are often cited as improving the chances of sport success. Both concepts suggest that genetics and the environment have little influence on sport success. To compare National Collegiate Athletic Association Division I student-athletes (SAs) with their undergraduate nonathlete peers (NAs) in terms of birth month, age of sport initiation, and age of single-sport specialization. A family history of sport participation was examined as a potential marker for genetic and social influences. Cross-sectional survey. Large urban university. A total of 273 Division I SAs (138 women, 135 men) and 155 NAs (78 women, 77 men) participated. The NAs had been involved in competitive youth sports before entering the university. Participants were asked to complete a questionnaire that addressed the age of sport initiation, birth month, age of single-sport specialization, and parental and sibling sport achievement. Neither birth month nor the age of sport initiation differed between groups (age of sport initiation = 7.16 ± 2.6 years for the SAs versus 7.71 ± 3.5 for the NAs; P = .176). A larger proportion of SAs began participating before 10 years of age (80% versus 63%; P = .02). The parents of SAs were more likely to have participated in collegiate (32.4% versus 8.4%; P < .0001) and professional (10.9% versus 1.3%; P = .0005) sports. The SAs specialized in a single sport at an older age (15.38 ± 2.7 years versus 14.30 ± 2.6 years; P = .002). Both groups participated in multiple sports in childhood (SAs = 3.9 ± 1.8 sports, NAs = 3.2 ± 1.8 sports; P = .366). The Division I SAs did not specialize in a single sport at a younger age than the NAs. No evidence of a relative age effect was present. Importantly, higher levels of sport achievement among the parents and siblings of SAs suggest that genetic endowment and family or other environmental dynamics play a large role in athletic performance. Overall, the results are not consistent with deliberate practice theory and point toward an alternative model that includes not only sport-specific skill development but also genetic and social factors as key elements of long-term sport achievement.

Evaluating a Commonly Used Tool for Measuring Sport Specialization in Young Athletes.

Sport specialization has been defined as year-round intensive training in a single sport to the exclusion of other sports. A commonly used survey tool created by Jayanthi et al, which classifies athletes as having a low, moderate, or high level of specialization, categorizes only athletes answering yes to "Have you quit other sports to focus on a main sport?" as highly specialized. We hypothesized that a measureable number of year-round, single-sport athletes have never played other sports and, therefore, may be inaccurately classified as moderately specialized when using this tool, even though most experts would agree they should be viewed as highly specialized. To determine the proportion of athletes misclassified as moderately rather than highly specialized because they never played a previous sport. Cross-sectional study. Hospital-based pediatric outpatient sports medicine clinic. Injured athletes aged 12 to 17 years who presented to the clinic between 2015 and 2017 and completed a sports-participation survey (n = 917). Sport-specialization level. Of 917 participants, 299 (32.6%) played a single sport more than 8 months per year, and 208/299 (69.6%) had previously quit other sports (highly specialized), whereas 91 (30.4%) had never played other sports (highly specialized and misclassified as moderate). Individual-sport athletes had a 2.03 times greater risk of being highly specialized and misclassified as moderate than team-sport athletes (relative risk = 2.03 [95% confidence interval = 1.37, 3.00]). Females had a 1.70 times greater risk of being misclassified as moderately specialized than males (relative risk 1.70 [95% confidence interval = 1.07, 2.70]). Of the 3 sports with the largest number of athletes, artistic gymnastics had the highest proportion (51.2%) who had never played other sports. The commonly used specialization survey misclassified a substantial number of highly specialized athletes as moderately specialized. Researchers should consider adding a fourth survey question, "Have you only ever played 1 sport?" to identify and better study this unique subset of misclassified athletes.

Conscious capitalism and sport: Exploring higher purpose in a professional sport organization

The higher purpose of a professional sport organization has been an elusive concept, with both sport organizational scholars and leaders seemingly ambiguous in their definitions of why such organizations exist (Newman, 2014; Zeigler, 2007). In contrast, management researchers (Sisodia et al., 2014) provided evidence that organizational leaders’ communication of an organization’s higher purpose profoundly benefits organizational performance. Thus, the purpose of this paper is to present the findings of a qualitative, descriptive case study of a single professional sport organization, whereby 13 participant leaders and employees espouse their organization’s higher purpose. Data including interviews, observation of organizational artifacts, and an analysis of organizational documents were analyzed by creating typologies based upon Mackey and Sisodia’s (2013) Conscious Capitalism framework that defines four types of higher purpose (i.e., The Good, The Beautiful, The True, The Heroic). Participants espoused several sources of higher purpose that related to The Good, The Beautiful, and The Heroic, and did not espouse any source of higher purpose related to The True. Moreover, participants espoused no definitive statement of the organization’s higher purpose and each participant’s espoused higher purpose varied. These findings suggest that leaders and scholars alike have an opportunity to collectively reflect upon and define the purpose of a professional sport organization.

A Comparison of Self‐Reported Unmet Healthcare Needs among Adaptive and Able‐Bodied Athletes

Studies have revealed a higher incidence of injury and illness among elite adaptive athletes when compared to able-bodied athletes in competition. However, individuals with disabilities report poorer access to health care. The purpose of this study is to identify differences in healthcare access, satisfaction, and unmet needs between recreational adaptive and able-bodied athletes in all sports and within a single sport (hockey). Cross-sectional, survey-based study. Recreation sports programs in Boston, MA and Chicago, IL. Adult, recreational, competitive adaptive, and able-bodied athletes. Not applicable. The Short-Form Patient Satisfaction Questionnaire (PSQ-18) for healthcare access and satisfaction; percentage of athletes reporting unmet sports-related healthcare needs in the prior year. Sixty adaptive athletes (78% male, age 35.7 ± 12.4 years) and 65 able-bodied athletes (40% male, age 34.9 ± 11.9 years) participated. Mean access and satisfaction scores were not significantly different between groups in all sports (P = .53 and P = .19, respectively) or hockey (P = .28 and P = .55, respectively). Unmet needs were more commonly reported among adaptive athletes (18.3% all sports, 20.0% hockey) as compared to able-bodied athletes (9.2% all sports, 4.0% hockey). This reached statistical significance in the hockey group (P = .03), but not all sports (P = .12). No differences were seen between groups in healthcare access or satisfaction scores. Adaptive athletes of the same sport reported a higher rate of unmet sports-related healthcare needs but with few doctor's visits in the preceding year, suggesting discrepancies in expectations and healthcare-seeking behavior. III.

From ‘philosophy of sport’ to ‘philosophies of sports’? History, identity and diversification of sport philosophy

ABSTRACTMy goal in this article is to give a portrait of how modern sport philosophy, which started in 1972, developed from relatively narrow paradigmatic borders to become a diverse and multi-paradigmatic international discipline. This development has included several changes but also some continuity. I identify three main tenets that may be viable in the future. One is to focus on the traditional sport philosophical paradigm, which had an ambition to identify the essence of sport. A second option is to develop more specific approaches, focusing on single sports or types of sport, like football or climbing. A third alternative is to develop a philosophy, not only of sport but of ‘homo movens’, studying the moving human being in different environmental and socio-cultural contexts. All three options are viable and should be welcomed.

Risk of Recurrent Instability After Arthroscopic Stabilization for Shoulder Instability in Adolescent Patients.

Background:With the rise of adolescent sports participation, there has been a concomitant increase in not only the incidence but also the treatment of traumatic shoulder instability. Yet, there have been limited data on the failure rates of arthroscopic shoulder stabilization in this population as well as the potential risk factors.Purpose/Hypothesis:The purpose of this study was to determine the failure rates of adolescent patients who underwent arthroscopic labral reconstruction for traumatic anterior shoulder instability. We hypothesized that adolescent failure rates would be significantly higher than what has been reported in the adult population with regard to recurrent instability after surgical intervention.Study Design:Case series; Level of evidence, 4.Methods:This was a retrospective cohort study performed at a single center. Inclusion criteria consisted of all adolescent-aged patients identified who (1) had traumatic anterior shoulder instability, (2) had radiographic findings consistent with anteroinferior capsulolabral injury, and (3) underwent arthroscopic shoulder stabilization. Patient demographics, clinical presentation, imaging, intraoperative findings, and postoperative outcomes were analyzed.Results:A total of 36 patients were identified, with a mean ± SD follow-up of 35.6 ± 13.8 months. The mean patient age at the time of the index procedure was 16.03 ± 1.67 years. All patients underwent arthroscopic shoulder stabilization consisting of arthroscopic Bankart repair. Twelve patients (33.3%) reported either recurrent instability or apprehension, of whom 9 (25.0%) developed recurrent dislocation/subluxation at a mean of 20.67 months postoperatively (range, 16-51 months). No single sport was associated with a statistically significant increased risk of redislocation, although a trend was seen toward those with postoperative participation in high-risk sporting activity. Patients who redislocated their shoulders had a higher frequency of a Hill-Sachs lesion on magnetic resonance imaging (89%) compared with those who did not (52%, P = .048). History of multiple preoperative dislocations, presence of bony Bankart pathology, off-track lesions, and number of anchors utilized were not associated with postoperative dislocation/subluxation.Conclusion:This study demonstrates that adolescent patients treated with arthroscopic shoulder stabilization have a high rate of recurrent instability. The adolescent population may benefit from other stabilization strategies and/or activity modification. Further studies are necessary to determine the reasons for the high rate of redislocation and to develop strategies for prevention.

Injury Risk Associated With Sports Specialization and Activity Volume in Youth.

Background:Sports specialization has become increasingly common among youth.Purpose/Hypothesis:To investigate the relative importance of specialization vs volume of activity in increasing risk of injury. Hypotheses were that specialization increases the risk of injury and that risk varies by sport.Study Design:Cohort study; Level of evidence, 2.Methods:A prospective analysis was conducted with data collected from 10,138 youth in the Growing Up Today Study—a prospective cohort study of youth throughout the United States—and their mothers. Activity was assessed via questionnaires in 1997, 1998, 1999, and 2001. Sports specialization was defined as engaging in a single sport in the fall, winter, and spring. Injury history was provided by participants’ mothers via questionnaire in 2004. The outcome was incident stress fracture, tendinitis, chondromalacia patella, anterior cruciate ligament tear, or osteochondritis dissecans or osteochondral defect.Results:Females who engaged in sports specialization were at increased risk of injury (hazard ratio [HR], 1.31; 95% CI, 1.07-1.61), but risk varied by sport. Sports specialization was associated with greater volume of physical activity in both sexes (P < .0001). Total hours per week of vigorous activity was predictive of developing injury, regardless of what other variables were included in the statistical model (males: HR, 1.04; 95% CI, 1.02-1.06; females: HR, 1.06; 95% CI, 1.05-1.08). Among females, even those engaging in 3 to 3.9 hours per week less than their age were at a significantly increased risk of injury (HR, 1.93; 95% CI, 1.34-2.77). In males, there was no clear pattern of risk.Conclusion:Sports specialization is associated with a greater volume of vigorous sports activity and increased risk of injury. Parents, coaches, and medical providers need to be made aware of the volume threshold above which physical activity is excessive.

Clinical Results of Ultrasound‐Guided Carpal Tunnel Release Performed by a Primary Care Sports Medicine Physician

The purpose of this study was to determine the safety and efficacy of ultrasound-guided carpal tunnel release (USCTR) in a consecutive group of patients treated by a single primary care sports medicine physician. The study group consisted of 35 USCTRs performed on 22 consecutive patients for whom clinical outcomes were available before USCTR and at 1 to 2 weeks, 1 month, and 3 months after USCTR. All procedures were performed by the same operator using a single USCTR technique. Outcomes included complications, Quick Disabilities of the Arm, Shoulder, and Hand scores, Boston Carpal Tunnel Questionnaire symptom severity and functional status scores, and a 5-point global satisfaction score. The 22 patients included 13 female and 9 male patients (ages 31-82 years). Eleven patients (22 wrists) had bilateral simultaneous USCTRs; 2 patients (4 wrists) had staged bilateral USCTRs; and 9 patients had unilateral USCTRs. No complications occurred in any patient. Statistically and clinically significant reductions in Quick Disabilities of the Arm, Shoulder, and Hand scores and Boston Carpal Tunnel Questionnaire symptom severity and functional status scores occurred by 1 to 2 weeks after USCTR (mean 1- to 2-week changes, -29.23, -1.74, and -1.18, respectively), and further improvements occurred during the 3-month follow-up period (mean 3-month changes, -51.11, -2.29, and -1.91; P < .0001 for all values versus before USCTR). Mean global satisfaction scores at 1 to 2 weeks and 3 months were 4.63 and 4.66. Ultrasound-guided CTR is a safe and effective procedure that can be performed by an experienced primary care sports medicine physician and typically results in significant improvements within the first 2 weeks after the procedure. Furthermore, bilateral simultaneous USCTRs are feasible and may provide significant advantages for patients who are candidates for bilateral CTRs.

ФІЗКУЛЬТУРНО-СПОРТИВНА ОСВІТА В СИСТЕМІ СПОРТИВНИХ ЦІННОСТЕЙ

This article is devoted to sporting values that serve as the axiological soil selection needs, interests, experiences, goals, plans, ways to implement sports activities. Sporting values reflect the internal state of human existence in the national aspect, since they are a form of existence of the nation, individual and universal. Social-philosophical analysis shows that this is why the sport as a basis for the substantial development of the individual is the sense of individual existence is always transformed in certain types of sports practice and is an element of the life process of the individual. Through sport established contacts not only with professional athletes from different countries, but also among ordinary citizens of different countries. Regarding the role of professional athletes, they on the one hand, facilitate the identification of citizens with their own nation-states, and on the other, force to think in supranational and global categories. Participation of representatives of different ethnic groups within a single sports team strengthens ethnic solidarity and tolerance in society. In addition, people who participate in sports during their&nbsp;&nbsp; free time overcome outside national boundaries. Thus, if "taking into account the size of the sports industry in Europe, the sport, cultivated at pan-European level, able to play a unifying role". Social and philosophical analysis shows that this is why sports as substantial basis for the development of the individual, provides the sense of individual existence. Sport always transforms in certain types of sports practice and acts as a consistant part of the life process of the individual. Intrinsic relationship of sport and spirituality serves the mediated beginning between intelligence and instinct, experience of man's relation to the world of sport to other people. Sports and ultimately lead to the sense of harmony, combining images of the world with the moral laws of the individual. As a spiritual-existential sense, sport&nbsp;is a harmony of the soul of the individual world implementation of the principles in sports activities. Sport is a substantial basis for the development of the individual,&nbsp;including&nbsp;aunity of material and spiritual elements of human activity in which the principal place is occupied by sport (physical) of the dominant culture, moral components that generally lead the improvement of&nbsp;&nbsp; sports community.

Civilization and Sport in Colombia’s Drive to Modernization

This paper discusses the manner in which modern spectator sports developed in Colombia in the decade of the 1920s as part of the country’s efforts to modernize. An examination of the dominant theories of the diffusion of European sports to the Latin American elites and eventually to the populace as a technique for social control is undertaken. Scant immigration into the country as well as high mortality rates for men and women resulting from civil war and disease make Colombia a case of special interest. Rather than the introduction of a single sport, we embark on an analysis of leisure, scouting, gymnastics, and sports to describe the matrix from which sporting practices develop. A careful examination of the 1920s press reports allows for a careful description of the roots of these physical activities, the emergence of a new social actor, the sportsperson, and the role of state regulation in the field of sports.

Early Sports Specialization Is Associated With Upper Extremity Injuries in Throwers and Fewer Games Played in Major League Baseball.

Background:Single-sport athletes who specialize in baseball at a young age may have a greater predisposition to overuse injury, burnout, and decreased career longevity when compared with multiple-sport athletes. The effect of sport specialization has not been studied in professional baseball players.Hypothesis:Major League Baseball (MLB) players who played multiple sports in high school would experience fewer injuries, spend less time on the disabled list, play more games, and have a longer career than athletes who played only baseball in high school.Study Design:Descriptive epidemiology study.Methods:First- and second-round MLB draft picks from 2008 to 2016 who played in at least 1 professional game were included in this study. Athletes who participated in 1 or more sports in addition to baseball during high school were considered multisport athletes, and athletes who participated in only baseball were considered single-sport athletes. For each athlete, participation in high school sports, injuries sustained in MLB and Minor League Baseball, number of days on the disabled list for each injury, number of games played in both leagues, and whether the athlete was still active were collected from publicly available records.Results:A total of 746 athletes were included in this study: 240 (32%) multisport and 506 (68%) single sport. Multisport athletes played in significantly more mean total games (362.8 vs 300.8; P < .01) as well as more mean MLB games (95.9 vs 71.6; P = .04) than single-sport athletes. There was no difference in the mean number of seasons played in the major leagues (1.8 vs 1.6; P = .15) or minor league (5.25 vs 5.20; P = .23) between multisport and single-sport athletes. Single-sport athletes had a significantly higher prevalence of upper extremity injuries compared with multisport athletes (136 [63%] vs 55 [50%]; P = .009). Single-sport pitchers also had a higher prevalence of shoulder and elbow injuries (86 vs 27; P = .008) and were more likely to have recurrent elbow injuries (33% vs 17% recurrence; P = .002) compared with multisport pitchers.Conclusion:Professional baseball players who participated in multiple sports in high school played in more major league games and experienced lower rates of upper and lower extremity injuries than players who played only baseball in high school.

The Effect of Single Sport Specialization in Youth Sports: Does It Increase the Risk of Injury? A Prospective Study

Objectives:Fifty-three percent of children play individual sports and 42% participate in team sports. As youth sports continue to gain popularity, sports specialization is becoming popular among young athletes. The reasons for sport specialization vary, but the most common reason offered is to gain a competitive advantage at a younger age to allow for higher level play in college and potentially at the professional level. However, there is concern that early sports specialization increases the risk of overuse injuries in youth athletes. The purpose of this investigation was to determine the prevalence of sport specialization in youth athletes, and prospectively examine whether specialization correlates with an increased incidence of athletic injury.Methods:We prospectively enrolled 602 high school students with the intent of following them through their four years of high school. Sports specialization was defined as participating in one sport for more than 6 months of the year, while excluding other sports. Freshman and sophomore athletes completed a sports specialization and injury survey at the beginning of each sport season. Athletes’ demographic information, sport commitment, injury history and future athletic plans were collected. The same athletes were queried again at the conclusion of each season to collect injury information including but not limited to fractures, ligamentous injuries, dislocations and concussions. Athletic training records were reviewed and corroborated with covering team physician records to ensure capture of all injuries reported to health care personnel during the years of the investigation. Categorical data was analyzed via chi-squared tests.Results:At the two year time point, of the 602 athletes, 255 (42.4%) reported sport specialization. Soccer (26.9%), baseball (20.6%), softball (18.3%) and swimming (15.6%) had the highest rates of specialization among participants. Ninety-five (37.3%) specialized athletes reported spending more than 10 hours a week participating in sports related activities, compared to 105 (30.3%) non-specialized athletes, p= 0.072. Of the specialized athletes, 56.5% had been injured playing their primary sport in the past, compared to 43.5% of non-specialized athletes, p= 0.046. Seventy-eight percent of the specialized athletes sustained an injury before the study period that prevented them from participating in sports for part or the whole season, whereas only 40% of the non-specialized athletes sustained these types of injuries, p= 0.055. Finally, during the study period, 9.0% of specialized athletes sustained injuries compared to 5.2% of non-specialized athletes, p= 0.065. The most common injuries were concussions (43.9% of injuries) and lateral ankle sprains (12.2% of injuries).Conclusion:A considerable number of high school athletes specialize in one sport during their underclass years (42.4%). Specialized student athletes spend more time participating in sports related activities than non-specialized athletes, which may account for the increased frequency of injuries, compared to non-specialized athletes. Although not statistically significant at the 2 year time point, this relationship warrants further investigation into the potential health effects of early sports specialization.

Is Brace Immobilization Needed Following Surgical Repair Of Proximal Hamstring Tears?

Objectives:Braces are commonly used in Orthopaedic to protect repaired tissue from excessive stress that can compromise the healing process. Some of these braces can become a nuisance, especially the ones commonly used following proximal hamstring repairs. The idea is to limit hip flexion and knee extension to avoid stretching of the hamstrings. However, this immobilization creates discomfort and limitation during the basic daily needs, possibly compromising patient satisfaction. We hypothesis that proximal hamstring repairs can be safely managed, without brace immobilization and allowing partial weight bearing immediately after surgery, and result in excellent outcomes with minimal complications.Methods:We identify 57 patients that underwent surgical repair of proximal hamstring injuries. The repairs were fixed using suture anchors, and the same surgical technique were performed by a single sport medicine fellowship trained Orthopaedic surgeon. During the postoperative period the patient were allowed to bear partial weight with the assistance of crutches for 6 weeks. At the fourth week, light stretches begin with assistance of the physical therapist. Brace immobilization is not utilize at all, instead detail instruction are provide to the patient to avoid simultaneous hip flexion and knee extension. Subjective outcome measures included: the single assessment numeric evaluation (SANE); I-Holt 12 and KJOC hip scores. Clinical data was obtained from the electronic medical records.Results:Mean patient age was 52 years (range 29-69). The injury was chronic (> 6 weeks) in 55% of the patients. Mean length of follow-up was 32 months ( range 14-60). One patient failed repair, requiring revision surgery. The average SANE score were excellent at 97points, and representing a 43 points increase from the preoperative assessment. Similarly, the mean score for the I-Holt 12 and KJOC hip scores were very good with 99 and 83 points, respectively. In 68% of the patient the injury was sport related, and they all return to sport at an average of 7 months.Conclusion:A post-operative protocol that included immediate partial weight bearing and does not utilized immobilization brace can result in excellent subjective outcomes, high rate to return to sport in a timely matter and low failure rates. Based in our findings, brace immobilization following surgical repair of proximal hamstring appear to be excessive and may not provide additional benefit.

Medial Patellofemoral Ligament Reconstruction with and without Tibial Tubercle Osteotomy

Objectives: The medial patellofemoral ligament (MPFL) is the primary soft-tissue restraint against lateral patellar displacement. Surgery to address MPFL incompetence is the current gold standard for recurrent patellofemoral instability. The role of tibial tubercle osteotomy (TTO) as an adjunct to MPFL reconstruction remains controversial. Our purpose was to evaluate a cohort of patella instability patients undergoing surgical soft tissue stabilization with or without concomitant TTO. Our hypothesis was that there would be no difference between cohorts in baseline values, subjective outcome scores at final follow-up, or complication profile. Methods: Following IRB approval, retrospective review of prospectively collected data identified a consecutive cohort of patients undergoing soft tissue stabilization for recurrent patella instability, with or without concomitant TTO. Indications for TTO were at the surgeon’s discretion, including elevated TT-TG, Caton-Deschamps ratio, and/or unloading chondral lesion(s). Surgery was performed by a single sports fellowship trained surgeon. Pre-surgical and post-surgical patient reported outcomes were collected including KOOS domains, PROMIS (global health, mental health, physical function, pain interference), IKDC, SANE, and Marx scores. Complications requiring re-operation (infection, stiffness, recurrent instability) were recorded. Results were analyzed statistically. Results: The cohort was comprised of 87 patients (95 knees), with 25 males (28.7%) and 62 females (71.3%). The MPFL-TTO cohort had 32 patients (38 knees) and the MPFL-Iso had 55 patients (57 knees). The average age of the MPFL-TTO cohort was 28.3 (range 19.5-44.6) and the average age of the MPFL-Iso group was 29.8 (18.7-55.3). There was no significant difference in pre-operation outcome scores between groups (p&gt;.05). Significant improvements were seen for all KOOS domains in both patient cohorts with no significant differences detected between groups. SANE, IKDC, and PROMIS scores improved significantly with no differences detected between groups. Marx activity score at 6 months post-operatively was significantly different between the groups favoring the isolate MPFL reconstruction cohort. (MPFL-TTO 0.79 +/- 2.15 vs. 4.61 +/- 5.44 in the MPFL-Iso group (p=0.01)). In terms of complications, 4 knees in the MPFL-TTO group required further surgery (2 for stiffness, 1 for infection, and 1 for fracture) and 6 knees in the MPFL-Iso cohort required surgery (4 for stiffness, 1 for infection, and 1 for recurrent instability). Neither the overall complication rate of 4 vs. 6 (p=1) nor the recurrent instability rate of 0 vs. 1 (p=0.41) was significant. Conclusion: In a cohort of patients undergoing MPFL reconstruction, the addition of an appropriately indicated TTO appears to be both safe and effective. Both MPFL-TTO and MPFL-Iso groups demonstrated significant improvement in the majority of subjective outcome scores without major difference between groups. Marx activity scores were higher for the isolated MPFL reconstruction cohort at relatively short term follow-up. The surgical complication profile was similar between groups. Further work is needed to clearly define the role of TTO as an adjunct procedure to MPFL reconstruction.

Lower Extremity Biomechanics Are Altered Across Maturation in Sport-Specialized Female Adolescent Athletes.

Sport specialization is a growing trend in youth athletes and may contribute to increased injury risk. The neuromuscular deficits that often manifest during maturation in young, female athletes may be exacerbated in athletes who specialize in a single sport. The purpose of this study was to investigate if sport specialization is associated with increased lower extremity biomechanical deficits pre- to post-puberty in adolescent female athletes. Seventy-nine sport-specialized female adolescent (Mean ± SD age = 13.4 ± 1.8 years) basketball, soccer, and volleyball athletes were identified and matched with seventy-nine multi-sport (soccer, basketball, and volleyball) female athletes from a database of 1,116 female adolescent basketball, soccer, and volleyball athletes who were enrolled in one of two large prospective, longitudinal studies. The athletes were assessed over two visits (Mean ± SD time = 724.5 ± 388.7 days) in which they were classified as pre-pubertal and post-pubertal, respectively. Separate 2 × 2 analyses of covariance were used to compare sport-specialized and multi-sport groups and dominant/non-dominant limbs with respect to pubertal changes in peak knee sagittal, frontal, and transverse plane joint angular measures and moments of force recorded while performing a drop vertical jump task. The sport-specialized group were found to exhibit significantly larger post-pubertal increases in peak knee abduction angle (p = 0.005) and knee abduction moment (p = 0.006), as well as a smaller increase in peak knee extensor moment (p = 0.032) during landing when compared to the multi-sport group. These biomechanical changes are indicative of potentially compromised neuromuscular control that may increase injury risk pre- to post-puberty in sport-specialized female athletes. Consideration of maturation status may be an important factor in assessing the injury risk profiles of adolescent athletes who specialize in sport.

Relationship Between Sports Participation After Revision Anterior Cruciate Ligament Reconstruction and 2-Year Patient-Reported Outcome Measures

Background: Anterior cruciate ligament (ACL) revision cohorts continually report lower outcome scores on validated knee questionnaires than primary ACL cohorts at similar time points after surgery. It is unclear how these outcomes are associated with physical activity after physician clearance for return to recreational or competitive sports after ACL revision surgery. Hypotheses: Participants who return to either multiple sports or a singular sport after revision ACL surgery will report decreased knee symptoms, increased activity level, and improved knee function as measured by validated patient-reported outcome measures (PROMs) and compared with no sports participation. Multisport participation as compared with singular sport participation will result in similar increased PROMs and activity level. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 1205 patients who underwent revision ACL reconstruction were enrolled by 83 surgeons at 52 clinical sites. At the time of revision, baseline data collected included the following: demographics, surgical characteristics, previous knee treatment and PROMs, the International Knee Documentation Committee (IKDC) questionnaire, Marx activity score, Knee injury and Osteoarthritis Outcome Score (KOOS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A series of multivariate regression models were used to evaluate the association of IKDC, KOOS, WOMAC, and Marx Activity Rating Scale scores at 2 years after revision surgery by sports participation category, controlling for known significant covariates. Results: Two-year follow-up was obtained on 82% (986 of 1205) of the original cohort. Patients who reported not participating in sports after revision surgery had lower median PROMs both at baseline and at 2 years as compared with patients who participated in either a single sport or multiple sports. Significant differences were found in the change of scores among groups on the IKDC (P < .0001), KOOS-Symptoms (P = .01), KOOS–Sports and Recreation (P = .04), and KOOS–Quality of Life (P < .0001). Patients with no sports participation were 2.0 to 5.7 times more likely than multiple-sport participants to report significantly lower PROMs, depending on the specific outcome measure assessed, and 1.8 to 3.8 times more likely than single-sport participants (except for WOMAC-Stiffness, P = .18), after controlling for known covariates. Conclusion: Participation in either a single sport or multiple sports in the 2 years after ACL revision surgery was found to be significantly associated with higher PROMs across multiple validated self-reported assessment tools. During follow-up appointments, surgeons should continue to expect that patients who report returning to physical activity after surgery will self-report better functional outcomes, regardless of baseline activity levels.

Sport-Specific Associations of Sport Specialization and Sport Volume with Overuse Injury in Youth Athletes

Year-round participation in a single sport at the exclusion of other sports, also known as sport specialization, is associated with increased risk of overuse injury in youth athletes. To reduce this risk, several recommendations for participation volume have been developed. However, risk of overuse injuries may be dependent on specific movement profiles required by a given sport. PURPOSE: To examine sport-specific associations of sport specialization and exceeding sport volume recommendations with overuse injuries in adolescent basketball, soccer, and volleyball athletes. METHODS: 716 youth athletes (70.8% female, age 14.21.5 years old, 43.2% basketball, 19.4% soccer, 37.4% volleyball) were recruited to complete an anonymous questionnaire regarding their sport participation patterns and previous injury history. Sport specialization status was classified as low, moderate, or high using a widely utilized 3-point scale. Self-reported sport volume was used to classify athletes as either meeting or exceeding sport volume recommendations (playing their primary sport >8 months/year, hours/week of organized sport > age, days of sport participation per week >5). Multivariable logistic regression analyses were utilized to examine associations between variables of interest and overuse injury in the previous year. RESULTS: Highly specialized volleyball athletes were more likely to report an overuse injury compared to low specialization volleyball athletes (OR [95% CI]: 2.3 [1.1-4.8], p<.01). Volleyball athletes who trained: more than 8 months per year (OR [95% CI]: 2.0 [1.1-3.5], p<.05), more hours per week than their age (OR [95% CI]: 2.0 [1.2-3.4], p<.01), or more than 5 days per week (OR [95% CI]: 2.1 [1.2-3.9], p<.05) were more likely to report an overuse injury compared to volleyball athletes who did not violate these recommendations. No significant associations were observed in soccer or basketball athletes (P>0.05). CONCLUSIONS: The association between sport specialization, excessive sport volume, and overuse injuries may be specific to sports that are more repetitive or technical in nature, such as volleyball. Dissemination of sport-volume recommendations should be focused towards athletes, parents, and coaches in these sports.

Elbow Pain in an Adolescent Pitcher

HPI: Patient is a 16 year old right-hand dominant male baseball pitcher with past medical history of partial tear of the right UCL and OCD of the right lateral trochlea managed with casting 9 months prior. He presented to our clinic with insidious onset right posterolateral elbow and arm pain 2 months after returning to pitching in summer baseball in May. He described sharp pain in the right lateral elbow with radiation into the posterolateral arm exacerbated with push-ups and bench press. He noticed a painless popping sensation with elbow extension, but denied weakness or sensory changes. The pain was not specifically associated with baseball or pitching and was different from his previous pain. PHYSICAL EXAM: Mild tenderness at right common extensor tendon origin worsened with 5 push-ups and improved with rest. Mild tenderness at right posterolateral triceps border. Slight weakness of the right triceps with pain. Varus and valgus stress caused no pain, but there was asymmetry with minimally increased laxity during valgus stress on the right. Negative extensor wad stress tests including Cozens, middle finger extension and Mills. No pain with flexor-pronator stretching. No pain with resisted pronation or supination. DIFFERENTIAL DIAGNOSIS: 1. Triceps tendinitis 2. Lateral epicondylosis 3. Radial nerve irritation 4. OCD radiocapitellar joint 5. Intraarticular loose body 6. Stress reaction/stress fracture distal humerus 7. Bony tumor/infection TEST AND RESULTS: Right elbow non-contrast MRI- Bone marrow edema within the olecranon and distal humerus medially as a result of stress reaction from excessive valgus stress. Thickening of the UCL. Healed osteochondral lesion of the right elbow trochlea. FINAL DIAGNOSIS: Valgus overload stress injury to distal humerus TREATMENT AND OUTCOMES: 3 months of rest from pitching followed by throwing progression via a pitching rehabilitation program. The program consists of focused strength training (RTC, scapular stabilizers) followed by normalizing throwing mechanics with gradual return to pain free baseball. We discussed with the patient the harmful effects on single sports athletes, particularly pitchers. We recommended he watch his pitch counts closely in the future (he admitted he hadn’t been doing that) and take at least 2 months off of baseball during the year.

A Clinician's Guide to Analysis of the Pitching Motion.

This review examines recent literature regarding analysis of the throwing motion in baseball players and how modern technology may be used to predict or prevent injury. Proper throwing technique is vitally important to prevent injury and it is easier to correct poor mechanics prior to foot strike. Recent findings suggest that the inverted-W position may not lead to an increased risk of injury, but incorrect trunk or pelvis rotation does. Three-dimensional motion analysis in a laboratory setting is most commonly used to evaluate the throwing motion, but it does not allow for assessment in real game scenarios. Wearable monitors allow for this and have proven to reliably assess pitching workload, kinematics, and kinetics. Injuries in youth baseball pitchers have increased along with the trend towards more single sport specialization. To prevent injury, assessment of a pitcher's throwing motion should be performed early to prevent development of poor mechanics. Classically, three-dimensional motion analysis has been used to evaluate throwing mechanics and is considered the gold standard. Newer technology, such as wearable monitors, may provide an alternative and allow for assessment during actual competition.