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Background: Studies have shown good and excellent clinical and radiographic results after meniscal repair. Limited published information exists on the long-term outcomes, however, especially in a pediatric and adolescent population. Purpose: To determine long-term results of meniscal repair and concomitant anterior cruciate ligament (ACL) reconstruction in a pediatric and adolescent population. Specifically, the aims were to determine the clinical success rate of meniscal repair with concomitant ACL reconstruction, compare results with midterm outcomes, and analyze risk factors for failure. Study Design: Case series; Level of evidence, 4. Methods: Cases of meniscal repair with concomitant ACL reconstruction between 1990 and 2005 were reviewed among patients aged ≤18 years. Patient demographics, injury history, and surgical details were recorded, and risk factors for failure were analyzed. Physical examination findings and clinical outcomes at latest available follow-up were collected. Subjective knee outcomes were compared with midterm results. Descriptive statistics and univariate analysis were used to evaluate the available data. Results: Forty-seven patients (30 females, 17 males) with a mean age of 16 years (SD, 1.37) and a mean follow-up of 16.6 years (SD, 3.57) were included in this study. Overall, 13 patients (28%) failed meniscal repair and required repeat surgery at the time of final follow-up. Of the 13 failures, 9 underwent a subsequent meniscectomy; 2, meniscectomy and revision ACL reconstruction; 1, meniscal repair and revision ACL reconstruction; and 1, meniscal repair and subsequent meniscectomy. Mean International Knee Documentation Committee scores improved from 47.9 preoperatively to 87.7 postoperatively (P < .01), and the mean score at long-term follow-up (87.7) did not significantly differ from that at the midterm follow-up (88.5) at a mean 7.4 years (P = .97). Mean Tegner Activity Scale scores improved from 1.9 preoperatively to 6.3 postoperatively (P < .01) and decreased from 8.3 at preinjury to 6.3 at final long-term follow-up (P < .01). Conclusion: In conclusion, the long-term overall clinical success rate (failure-free survival) was 72% for repair of pediatric and adolescent meniscal tears in the setting of concomitant ACL reconstruction. Patients reported excellent knee subjective outcome scores that remained favorable when compared with midterm follow-up. [ABSTRACT FROM AUTHOR]

Parents completed the Behavior Assessment System for Children, Second Edition: Parent Rating Scale (BASC2 PRS) while their children (94 boys, 61 girls; M = 11 years 11 months) were given tests. Evidence-based profiles of multiple test scores and history (emergence and persistence) were used to assign to groups without specific learning disabilities in written language (SLDs-WL; n = 42 control) or with SLDs-WL (n = 29 dysgraphia, n = 65 dyslexia, or n = 19 oral and written language learning disability [OWL LD]). Parent ratings fell in the clinical or at-risk ranges for some individuals in all groups, but mean BASC2 PRS ratings showed nine significant main effects for group (n = 4): Behavioral Symptoms Index, Internalizing Problems Composite, Adaptive Skills Composite, two Clinical Scales (Atypicality and Attention Problems), and four Adaptive Scales (Adaptability, Activities of Daily Living, Leadership, and Functional Communication). Each SLDs-WL group differed significantly from the control group on these nine ratings, except dysgraphia on Atypicality and dyslexia on Adaptive Composite, Adaptability, and Leadership; and each correlated with one or more hallmark impairments associated with a specific SLD-WL. In a functional magnetic resonance imaging (fMRI) study (without OWL LD), the dysgraphia and dyslexia groups, but not control group, showed connectivity with amygdala; BASC2 PRS Internalizing Problems Composite (internal stress) correlated with amygdala connectivity from two cortical regions involved in written word processing and production for total sample (N = 40). Applications to assessing emotional and behavioral correlates of SLDs-WL for educational services and future research are discussed. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Osteochondral lesions of the Talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome, and this condition is associated with persistent ankle pain and disability. The incidence of osteochondral lesions of the talus is increasing in the pediatric and adolescent population. There are a few studies regarding surgical treatment. The aim of this study is to report that need for surgical treatment is higher than expected in aforementioned lesions. Methods: Osteochondral lesions of the Talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome, and this condition is associated with persistent ankle pain and disability. The incidence of osteochondral lesions of the talus is increasing in the pediatric and adolescent population. There are a few studies regarding surgical treatment. The aim of this study is to report that need for surgical treatment is higher than expected in aforementioned lesions. Results: Average age was 14,5 (10-18) at beginning of the treatment. 69,2% of our patients were female. Foundation of conservative treatment was activity modification. 9 of our 13 patients were treated surgically. Arthroscopic debridement and microfracture surgery as well as various techniques were applied to all operated patients. In 7 of the operated patients (n=9), the lesion was on the right side and there was a history of trauma before the complaints started. While the mean AOFAS scores of the operated patients were 47 (24-75) before the operation, it was 83.8 in the last follow-up. While the mean AOFAS scores of our conservatively treated patients were 38.2 (21-74) before treatment, the mean AOFAS scores at the last follow-up after treatment (mean follow-up 2 years) were 70 (17-100). There were no minor and major postoperative complications and no need of reoperation. At the final follow up there was significant improvement in clinical results in all patients treated surgically and conservatively. Conclusion: Talus osteochondral lesions at younger ages is an increasing problem. Conservative management with close follow up is the mainstay of the treatment. However, need of surgical treatment may be higher than expected and the short-term results of surgical with various techniques are successful [ABSTRACT FROM AUTHOR]

The perception that children and adolescents have of injuries may be influenced by their depiction in sport-related films. The objective of this study was to determine the depiction of injuries in a select number of sport-related films. Forty-four films were analyzed. Injury category, on-the-field management, and long-term management were determined for each injury. Major injuries were defined as injuries requiring prompt intervention and immediate discontinuation of sport participation. A total of 49 injuries were depicted, categorized as fracture (n = 11), contusion (n = 10), brain concussion (n = 8), muscle cramps (n = 5), laceration/abrasion (n = 4), ligamentous knee injury (n = 4), shoulder dislocation (n = 2), rotator cuff injury (n = 2), ankle sprain (n = 2), and unspecified injury (n = 1). Of the 38 (78%) injuries considered major, immediate return to the game was the disposition for 13 injuries (34%). Pediatric health care providers, coaching staff, and parents should stress the importance of injury recognition/ disclosure and realistic expectations for rehabilitation to pediatric athletes. [ABSTRACT FROM AUTHOR]

Symptoms of autism spectrum disorder may influence alliance in psychotherapy. This study examined therapeutic alliance and its relationship with child characteristics and anxiety treatment outcomes in youth with autism spectrum disorder. Youth (N = 64) with autism spectrum disorder and co-occurring anxiety (7–16 years, IQ > 70) received 16 sessions of modular cognitive-behavioral therapy. Post-treatment therapist, youth and parent ratings of alliance as well as pre- and post-treatment ratings of child behavior were gathered. Ratings of alliance were commensurate to ratings seen in children without autism spectrum disorder. Measures of treatment outcome, but not pretreatment characteristics, were significantly associated with therapist ratings of alliance strength. Data suggest that therapeutic alliance may not be impaired in anxious youth with autism spectrum disorder and may be associated with treatment outcome. [ABSTRACT FROM AUTHOR]

Statement of context: A retrospective single case study reflecting on a child relearning handwriting following a traumatic brain injury as part of an inpatient neuro-rehabilitation programme. Applying evidence-based handwriting guidelines and comparisons with community experiences are explored. Critical reflection on practice: Relearning to write following a traumatic brain injury showed dramatic improvements in 36 sessions over 12 weeks, supporting the evidence. Progress in this timeframe contrasts with clinical experiences of working with children's community services. Implications for practice: Whilst the literature on handwriting interventions does not include children with traumatic brain injury, following the recommendations was an effective intervention for this individual. [ABSTRACT FROM AUTHOR]

The widespread availability and use of E-Cigarettes in many countries has established the need for an assessment of their effect on children. By the end of 2017 the number published annually on E-Cigarettes had increased to 2976 and included 171 papers on E-Cigarettes and children. The objective of this commentary is to provide a review and public health perspective on the effects of E-cigarettes on children. There are four public health questions to be answered:1. Are E-Cigarettes and replenishing fluids toxic on accidental ingestion?2. If children smoke E-Cigarettes is this harmful?3. Does exposure to second hand vapour from E-Cigarettes cause harm to children?4. Are children (adolescents) who use E Cigarettes more likely to begin smoking conventional cigarettes?There were 2229 reported exposures to e-cigarette fluids and liquid nicotine in the USA in 2017 causing cardiovascular symptoms of varying severity. No deaths were reported although the potential is always there. Exposure to E-Cigarette vapor is less dangerous than cigarette smoke. However it does damage pulmonary endothelium in experimental models. No long term studies are yet available on chronic diseases although vapor does contain carcinogens. Adolescents who use E-Cigarettes are more likely to become tobacco smokers. Because of the accumulating evidence of harm to children great caution should be exercised in widening the public promotion and usage of E-Cigarettes. Children should avoid any contact with E-cigarettes or their vapour. [ABSTRACT FROM AUTHOR]

This study investigated the associations among peer status, friendship jealousy, and relational aggression in early adolescence, with a focus on peer status as a moderator of the association between relational aggression and friendship jealousy. Three hundred eighteen sixth-, seventh-, and eighth-grade students completed a sociometric assessment of relational aggression, popularity, and peer preference, and a self-report friendship jealousy measure. Relational aggression was negatively correlated with peer preference, but positively correlated with popularity for boys and girls. Regression analyses showed that peer status moderated the association between friendship jealousy and relational aggression for girls and boys. At low levels of peer preference, high friendship jealousy was positively associated with relational aggression for girls, but negatively associated with relational aggression for boys. Findings are discussed in light of friendship and social status maintenance processes. [ABSTRACT FROM AUTHOR]

Background. Water-related injuries and fatalities pose serious public health issues, especially to African American youth, a demographic group that drowns at disproportionately high rates. Aim. The purpose of this study was to determine if a social marketing intervention targeting the parents and guardians of inner-city youth (U.S. Midwest) could positively influence their perceptions concerning water safety. Method. Researchers employed a quasi-experimental design using matched pairs to evaluate the intervention. Participants consisted of parents who enrolled their children in a six-session survival-swimming course. Guided by the Health Belief Model, the researchers disseminated six prevention messages using six different channels (brochure, e-mail, SMS text message, postcard, Facebook, and window cling). Results. The findings from a two-way analysis of covariance revealed that treatment group participants’ knowledge and perceptions of water-related threat all changed favorably. Additionally, all participants planned to reenroll their children in swim lessons. Discussion. A social marketing campaign using the Health Belief Model improved inner-city parents’ knowledge regarding water safety and enhanced their self-efficacy. Conclusion. This study provides practitioners with feasible strategies (prevention messages) to supplement swim lessons, with the ultimate goal of preventing drowning among at-risk youth. [ABSTRACT FROM AUTHOR]

Many populations served by special education, including those identified with autism, emotional impairments, or students identified as not ready to learn, experience social competence deficits. The Social Competence Intervention-Adolescents’ (SCI-A) methods, content, and materials were designed to be maximally pertinent and applicable to the social competence needs of early adolescents (i.e., age 11-14 years) identified as having scholastic potential but experiencing significant social competence deficits. Given the importance of establishing intervention efficacy, the current paper highlights the results from a four-year cluster randomized trial (CRT) to examine the efficacy of SCI-A (n = 146 students) relative to Business As Usual (n = 123 students) school-based programming. Educational personnel delivered all programming including both intervention and BAU conditions. Student functioning was assessed across multiple time points, including pre-, mid-, and post-intervention. Outcomes of interest included social competence behaviors, which were assessed via both systematic direct observation and teacher behavior rating scales. Data were analyzed using multilevel models, with students nested within schools. Results suggested after controlling for baseline behavior and student IQ, BAU and SCI students differed to a statistically significant degree across multiple indicators of social performance. Further consideration of standardized mean difference effect sizes revealed these between-group differences to be representative of medium effects (d > .50). Such outcomes pertained to student (a) awareness of social cues and information, and (b) capacity to appropriately interact with teachers and peers. The need for additional power and the investigation of potential moderators and mediators of social competence effectiveness are explored. [ABSTRACT FROM AUTHOR]

The conceptual framework of quality of life (QOL) have received considerable attention within students with visual impairment. The main purpose of this study was to analyse the QOL of children and adolescents with low vision and blindness. Data were collected from 18 children and adolescents, and respective parents (n = 18). QOL was assessed by the KIDSCREEN 52 questionnaire. Cronbach’s alpha and correlations were calculated to examine the psychometric properties of the scale in the visual impairment field. The scale showed suitable internal consistency and construct validity. The findings highlighted that the mean scores were higher in participants with low vision, in male group, and in children. Furthermore, children and adolescents reported higher scores regarding their QOL than their parents. The results emphasized the importance of collecting information from the person about his or her own life to know the personal outcomes, as well as the perception of their parents. [ABSTRACT FROM AUTHOR]

The Movement Assessment Battery for Children--2nd Edition (MABC-2) is a test of motor development, widely used in clinical and research settings. To address which motor abilities are actually captured by the motor tasks in the two age versions of the MABC-2, the AB2 for 7- 10-year-olds and the AB3 for 11- 16-year-olds, we examined AB2 and AB3 factorial validity. We conducted confirmatory factor analysis (SPSS AMOS 22.0) on data from the test's standardization samples of children aged 7-10, n = 483, and 11-16, n = 674, in order to find the best fitting models. The covariance matrix of AB2 and AB3 fit a three-factor model that included tasks of manual dexterity, aiming and catching, and balance. However, factor analytic models fitting AB2 and AB3 did not involve the dynamic balance tasks of hopping with the better leg and hopping with the other leg; and the drawing trail showed very low factor validity. In sum, both AB2 and AB3 of the MABC-2 test are able to discriminate between the three specific motor abilities; but due to questionable psychometric quality, the drawing trail and hopping tasks should be modified to improve the construct validity for both age versions of the MABC-2. [ABSTRACT FROM AUTHOR]

Active commuting to school has health implications among young people. We aimed to (a) examine the patterns of commuting to school in children and adolescents regarding gender and area of residence, (b) study the association between distance from home to school and mode of commuting, and (c) identify the threshold distance below which young people are more likely to walk to school. A total of 6,004 students aged 7 to 18 years from Spain participated in this study. Mode of commuting was self-reported and distance was objectively measured using Google Maps software. Associations were examined using binary logistic regression and receiver operating characteristic curves analysis. Around 67% of children and 60% of adolescents commuted to school actively (mainly walking). The threshold distance for walking to school was 875 m, 0.54 miles, in children, and it was higher among urban (1,250 m, 0.78 miles) than in rural participants (675 m, 0.42 miles). The threshold distance for walking to school was 1,350 m, 0.84 miles, in adolescents, and it was lower among urban (1,350 m, 0.84 miles) than in rural participants (1,550 m, 0.96 miles). Future interventions on active commuting to school should consider this threshold distance, and chances of promoting an active commuting to school could have as a goal the increase of this threshold distance. [ABSTRACT FROM AUTHOR]

Background: The natural history of femoroacetabular impingement (FAI) remains incompletely understood. In particular, there is limited documentation of joint damage in adolescent patients with limited range of motion (LROM) of the hip, which is commonly associated with FAI. Purpose: To evaluate changes in magnetic resonance imaging (MRI), radiographs, and clinical examinations over 5 years in a group of athletes from a wide variety of sports with asymptomatic LROM of the hip compared with matched controls. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: The authors screened 226 male and female athletes aged 12 to 18 years presenting for preparticipation sports physical examinations. Using a goniometer, we identified 13 participants with at least one hip having internal rotation <10° with the hip flexed to 90°. Overall, 21 of 26 hips (81%) had internal rotation <10°. These participants were age- and sex-matched to 13 controls with internal rotation >10°. At the time of enrollment, all participants were asymptomatic and underwent a complete hip examination and radiographic imaging with radiographs (anteroposterior [AP] and von Rosen views) and non-arthrogram MRI. Participants returned at 5-year follow-up and underwent repeat hip examinations, imaging (AP and lateral radiographs and non-arthrogram MRI), and hip function questionnaires. MRI scans were classified as “normal” versus “abnormal” based on the presence of any of 13 scored chondral, labral, or osseous abnormalities. Comparisons between the LROM group and control group were performed using generalized linear models (either linear, logistic, or log-binomial regression as appropriate for the outcome) with generalized estimating equations to account for the within-participant correlation due to patients having both hips included. Relative risk (RR) estimates are reported with 95% CIs. Results: At the time of study enrollment, 16 of 26 hips (62%) in the LROM group had abnormal MRI findings within the acetabular labrum or cartilage compared with 8 of 26 hips (31%) in the control group (RR, 2.0; 95% CI, 0.95-4.2; P = .067). The mean alpha angle measured from radial MRI sequences was 58° in the LROM group versus 44° in the control group (P < .0001). In the LROM group, 13 of 26 hips (50%) had a positive anterior impingement sign, whereas 0 of 26 hips (0%) had a positive anterior impingement sign in the control group. At 5-year follow-up, 18 of 19 hips (95%) in the LROM group had abnormal MRI findings compared with 14 of 26 hips (54%) in the control group (RR, 1.7; 95% CI, 1.1-2.7; P = .014). New or progressive findings were documented on MRI in 15 of 20 hips in the LROM group compared with 8 of 26 hips in the control group (RR, 2.4; 95% CI, 1.2-4.8; P = .011). Six of 22 hips (27%) in the LROM group progressed from Tönnis grade 0 to Tönnis grade 1 in degenerative changes, whereas all 26 hips in the control group remained at Tönnis grade 0 on hip radiographs. In the LROM group, 11 of 22 hips (50%) had a positive anterior impingement sign, whereas 1 of 26 hips (4%) had a positive anterior impingement sign in the control group. A cam deformity (alpha angle >55° on lateral radiographs) was present in 20 of 22 hips (91%) in the LROM group and 12 of 26 hips (46%) in the control group (P = .0165). The following variables at baseline were associated with an increased risk of degenerative changes at 5-year follow-up for the entire cohort: decreased hip internal rotation, positive anterior impingement sign, decreased hip flexion, increased alpha angle, and presence of a cam lesion. Conclusion: At 5 years, young athletes with LROM of the hip showed increased progressive degenerative changes on MRI and radiographs compared with matched controls. Although the majority of these participants remained asymptomatic, those with features of FAI had radiographic findings consistent with early osteoarthritis. These outcomes suggest that more aggressive screening and counseling of young active patients may be helpful to prevent hip osteoarthritis in those with FAI. [ABSTRACT FROM AUTHOR]

Although religiousness has been identified as a protective factor against adolescent substance use, processes through which these effects may operate are unclear. The current longitudinal study examined sequential mediation of afterlife beliefs and future orientation in the relation between adolescent religiousness and cigarette, alcohol, and marijuana use. Participants included 131 adolescents ( X ¯ age at Time 1 = 12 years) at three time points with approximately 2-year time intervals. Structural equation modeling indicated that higher religiousness at Time 1 was associated with higher afterlife beliefs at Time 2. Higher afterlife beliefs at Time 2 were associated with higher future orientation at Time 2, which in turn was associated with lower use of cigarettes, alcohol, and marijuana at Time 3. Our findings highlight the roles of afterlife beliefs and future orientation in explaining the beneficial effects of religiousness against adolescent substance use. [ABSTRACT FROM AUTHOR]

Objective: To examine the efficacy of a multi-modal web-based therapy program, Move it to improve it (Mitii™) delivered at home to improve Executive Functioning (EF) in children with an acquired brain injury (ABI). Design: Randomised Waitlist controlled trial. Setting: Home environment. Participants: Sixty children with an ABI were matched in pairs by age and intelligence quotient then randomised to either 20-weeks of Mitii™ training or 20 weeks of Care As Usual (waitlist control; n=30; 17 males; mean age=11y, 11m (±2y, 6m); Full Scale IQ=76.24± 17.84). Fifty-eight children completed baseline assessments (32 males; mean age=11.87±2.47; Full Scale IQ=75.21±16.76). Main Measures: Executive functioning was assessed on four domains: attentional control, cognitive flexibility, goal setting, and information processing using subtests from the Wechsler Intelligence Scale for Children (WISC-IV), Delis-Kaplan Executive Functioning System (D-KEFS), Comprehensive Trail Making Test (CTMT), Tower of London (TOL), and Test of Everyday Attention for Children (Tea-Ch). Executive functioning performance in everyday life was assessed via parent questionnaire (Behaviour Rating Inventory of Executive Functioning; BRIEF). Results: No differences were observed at baseline measures. Groups were compared at 20-weeks using linear regression with no significant differences found between groups on all measures of EF. Out of a potential total dose of 60 hours, children in the Mitii™ group completed a mean of 17 hours of Mitii™ intervention. Conclusion: Results indicate no additional benefit to receiving Mitii™ compared to standard care. Mitii™, in its current form, was not shown to improve EF in children with ABI. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the safety and efficacy of performing a lateral extra-articular tenodesis (LET) with a modified Lemaire technique (MLT) in conjunction with anterior cruciate ligament reconstruction (ACLR) in children and adolescents at increased risk for failed ACLR. Methods: A consecutive series of patients ≤19 years who underwent simultaneous ACLR and LET with minimum two-year follow-up data were reviewed. Patients were indicated for LET when one or more of the following risk factors were present: participant in high-risk competitive sport such as football, lacrosse, soccer or basketball, grade 3 pivot shift, hyperlaxity (Beighton score > 6), recurvatum, revision ACLR, contralateral ACLR, or chronic ACL insufficiency. ACLR was performed using either full-thickness quadriceps tendon (QUAD) for skeletally immature patients or bone-patellar tendon-bone (BTB) autograft for skeletally mature patients. All-epiphyseal (AE) or complete transphyseal (CT) techniques were used depending on patients' skeletal maturity. At a minimum two-year follow-up, patient-reported outcome measures included Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC), and the HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores. Return-to-sport (RTS) data and second surgeries were also obtained. Results: Sixty-one consecutive patients (mean age 15.17 ±1.73 years, range 11-19 years, 62% female) were analyzed (Table 1). 59 patients (97%) participated in organized sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. The average grade at the time of surgery was 9th grade. Ten patients (16%) were revision ACLR procedures. Seven (11%) patients underwent AE and 54 (89%) underwent CT ACLR. Forty-two (69%) cases employed a QUAD autograft, while 19 (31%) utilized a BTB autograft. All patients underwent a LET with a MLT and 2 patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum. At two-year follow-up, mean SANE score was 95, median Pedi-IKDC score was 91, and median HSS-Pedi Fabs score was 27. RTS rate was 91.8%. Ten patients had subsequent surgical procedures, including two hardware removal procedures for hemiepiphysiodesis, three contralateral ACLR, three meniscus surgeries, one lysis of adhesions, and one revision ACLR for BTB graft re-rupture. Two patients were lost to follow-up and excluded from the study. Conclusions: The findings suggest that concomitant LET and ACLR in adolescent patients with risk factors for failed ACLR is associated with favorable patient-reported outcomes, high return to sports participation, and low ACL re-rupture rate at two years follow-up. Table 1. Patient Demographics and Surgical Characteristics. [ABSTRACT FROM AUTHOR]

Objectives: Recent literature has suggested a marked shift towards increased meniscus repair relative to meniscectomy over the last decade in younger populations. Children and adolescents are more profoundly impacted by the outcomes of meniscus preservation, in terms of long-term joint health, given the subsequent decades of high activity levels, risk of meniscus re-injury, and progression towards degenerative joint disease in the setting of meniscus deficiency. The purpose of this study was to provide a comprehensive assessment of meniscus tear patterns and repair techniques utilized in children and adolescents to better elucidate features of this common injury and national trends in treatment. Methods: A prospective, multi-center registry of 4 different arthroscopic surgeries—discoid meniscus surgery, non-discoid meniscus repair [medial meniscus repair (MMR) or lateral meniscus tear (LMR)], anterior cruciate ligament reconstruction (ACLR), and tibial spine repair (TSR)—performed by 32 surgeon-investigators at 20 different academic centers over 30 months, was queried for all cases of non-discoid meniscus repair, which were further categorized according to whether they were performed in isolation (I-MR), or in conjunction with ACLR or TSR. Variables collected included patient demographic features (age, sex, BMI), compartment (lateral, LMT; medial, MMT), zone (white-white, red-white, red-red), pattern (longitudinal/vertical, complex/degenerative, radial, oblique/parrot's beak, horizontal/cleavage), displacement (yes/no), location (anterior, body, posterior, root), repair technique (all-inside, inside-out, outside-in, other), repair implant/construct (menisco-capsular implants/sutures, meniscal-based sutures), and number of implants/sutures. Descriptive statistics and comparative analysis were performed for I-MR vs. ACLR-MR vs. TSR-MR and MMR vs. LMR. Results: Of 1374 meniscus repairs (mean 15.1 years old, range 5-19, 44% Female), 763 (55.5%) were performed for LMT and 611 (44.5%) for MMT, with 184 of all cases (15%) representing bicompartmental meniscus repair (LMR+MMR). ACLR-MR (n=817, 66.9%) was significantly more common than I-MR (n=373, 30.6%), which was significantly more common than TSR-MR (n=31, 2.5%, p=0.001). I-MR had a higher incidence of anterior horn, meniscal body tears, inside out repairs, and outside in repairs (all p<0.001). Of MMTs that underwent repair 81.2% were vertical/longitudinal, while LMTs that underwent repair were comprised of 49.6% vertical/longitudinal, 24.2% complex/degenerative, and 13.9% radial (Table 1). While the most common tear zone for repaired menisci was the red-white zone, 18% of LMR and 13.4% of MMR were in the white-white zone. The posterior horn was one of the most common locations of a repairable lesion (45.1% LMT and 43.9% MMT) with 12.8% of LMT repairs and 6.2% of MMT repairs performed on the posterior root. 70% of repairs were performed with all-inside technique, which was the predominant technique for all tear patterns in both MMT and LMT. Only 14.1% of repairs were performed with inside-out technique, but 70% of these cases were for displaced tears. The average number of implants/sutures for non-displaced tears was 4.0, compared with 5.9 for displaced tears. While a majority of repairs used meniscocapsular repair techniques, 11.1% of meniscus repairs were based on meniscal-based sutures including 20.8% of radial tear repairs. 14 different implants were used by study surgeons (Figures 1 and 2). Conclusions: Amongst tears selected for repair in children and adolescents, LMT is more common than MMT, and the majority of cases arise in conjunction with ACLR, compared to isolated tears. The predominant tear pattern is vertical in MMTs (80%). By percentage, radial tears are seven times more common and posterior root tears are twice as common in lateral meniscus tears. Given the high and increasing frequency of this injury and procedure, nationally, the variation detected in repair techniques and implants utilized represent potential opportunities for optimization of care and reduction in health care costs. Table 1. Medial and lateral mensicus tear types and fixation techniques used. () indicated percentage of repair technique type for each tear type [ABSTRACT FROM AUTHOR]

Objectives: The phenomenon of bony remodeling of healed displaced clavicle midshaft fractures in adolescents remains poorly understood. The purpose of the current study was to evaluate and quantify clavicle remodeling in a large population of adolescents with completely displaced fractures treated non-operatively to understand the factors that may influence this process. Methods: Patients were identified from the database(s) of a multi-center study group investigating the functional outcomes of adolescent clavicle fractures. Patients between the ages of 10 and 19 years with completely displaced mid-diaphyseal clavicle fractures that were treated non-operatively who had further imaging of the affected clavicle at a minimum of 9 months from initial injury were included. Radiographic measurements were performed on the injury and final follow-up films. Fracture remodeling was subjectively classified as 'complete/near-complete', 'moderate', or 'minimal' (Figure 1) and subsequently analyzed quantitively and qualitatively to determine factors associated with deformity correction. Results: Ninety-eight patients (mean age of 14.4±2.2 years) were analyzed at a mean radiographic follow-up of 3.4± 2.3 years. Fracture shortening, superior displacement, and angulation significantly improved during the follow-up period by 59%, 61%, and 30% respectively (p<0.001). Fracture remodeling was found to be associated with follow-up time; those with longer follow-up time demonstrate more remodeling (p<0.001). Ninety-two percent of patients <14 years and 79% of patients ³14 years-old at time of injury with a minimum follow-up of four years underwent complete/near-complete remodeling. Conclusions: Significant clavicle remodeling occurs in adolescent patients with displaced fractures, including older adolescents and particularly when followed for longer time intervals. This finding may help explain why symptomatic malunions are so infrequently observed in adolescent patients, even in severely displaced fractures. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to characterize distal clavicle fractures in a cohort of pediatric and adolescent athletes who underwent operative treatment at a single, tertiary-care pediatric center, including surgical techniques used and resultant clinical outcomes. Methods: A retrospective review was performed of all clavicle fractures extending to the level of the corococlavicular ligaments or more lateral, which were treated operatively at a single tertiary-care pediatric hospital between the years of 2005-2020. Patients >19 years-old or those with pathological fractures were excluded. Radiographic fracture characteristics, surgical techniques, time to radiographic healing, return to sports, and complications were analyzed. Results: Fifty-two patients were identified, with mean age 13.8 ± 2.2 years. The majority of fractures were classified as Nenopoulus type IIB (transverse, displaced; 42.3%) or type IIIB (oblique, displaced; 26.9%), though type IIA (transverse, minor displacement; 3.8%), IV (comminuted; 11.6%), and V (AC dislocation; 15.4%) patterns were also observed. Primary direction of displacement was posterior in 90% of cases and superior in 10%. Plate fixation was performed in 53.8% of surgeries, with locking plate (26.9%) and hook plate (17.3%) most frequent. Suture-based fixation was performed in 32.7% of cases (Figure 1). Rate of implant removal was 66% after plate fixation, the majority of which (72.2%) were planned at the time of primary fixation. Total complication rate, including unplanned removal of implant, was higher in the plate fixation group (25%) than in the suture-based fixation group (11.2%). Time to radiographic healing was not significantly different between plate and suture-based constructs (2.9 vs. 2.9 months, p = 0.96) though patients with suture-based constructs returned to sport faster (2.5 vs. 3.6 months, p = 0.014). Conclusions: Posteriorly displaced fractures comprised the vast majority of surgically-treated distal clavicle fractures in pediatric and adolescent athletes. When chosen in the appropriate patient, based on age and fracture pattern, suture-only constructs can lead to similar time to radiographic healing and faster return to sports compared to plate-based constructs, with significantly reduced need for removal of hardware. These data provide a foundation for future comparative research to further elucidate precise surgical indications and optimal treatment approaches in this population. Table 1. Fixation Methods for Distal Clavicle Fractures [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the safety and efficacy of performing a lateral extra-articular tenodesis (LET) with a modified Lemaire technique (MLT) in conjunction with anterior cruciate ligament reconstruction (ACLR) in children and adolescents at increased risk for failed ACLR. Methods: A consecutive series of patients ≤19 years who underwent simultaneous ACLR and LET with minimum two-year follow-up data were reviewed. Patients were indicated for LET when one or more of the following risk factors were present: participant in high-risk competitive sport such as football, lacrosse, soccer or basketball, grade 3 pivot shift, hyperlaxity (Beighton score > 6), recurvatum, revision ACLR, contralateral ACLR, or chronic ACL insufficiency. ACLR was performed using either full-thickness quadriceps tendon (QUAD) for skeletally immature patients or bone-patellar tendon-bone (BTB) autograft for skeletally mature patients. All-epiphyseal (AE) or complete transphyseal (CT)techniques were used depending on patients' skeletal maturity. At a minimum two-year follow-up, patient-reported outcome measures included Single Assessment Numeric Evaluation (SANE), Pediatric International Knee Documentation Committee (Pedi-IKDC), and the HSS Functional Activity Brief Scale (HSS Pedi-FABS) scores. Return-to-sport (RTS)data and second surgeries were also obtained. Results: Sixty-one consecutive patients (mean age 15.17 ±1.73 years, range 11-19 years, 62% female) were analyzed (Table 1). 59 patients (97%) participated in organized sports including soccer, basketball, football and lacrosse, with soccer being the most popular one. The average grade at the time of surgery was 9th grade. Ten patients (16%) were revision ACLR procedures. Seven (11%) patients underwent AE and 54 (89%) underwent CT ACLR. Forty-two (69%) cases employed a QUAD autograft, while 19 (31%) utilized a BTB autograft. All patients underwent a LET with a MLT and 2 patients underwent simultaneous implant mediated guided growth with a plate for structural genu valgum. At two-year follow-up, mean SANE score was 95, median Pedi-IKDC score was 91, and median HSS-Pedi Fabs score was 27. RTS rate was 91.8%. Ten patients had subsequent surgical procedures, including two hardware removal procedures for hemiepiphysiodesis, three contralateral ACLR, three meniscus surgeries, one lysis of adhesions, and one revision ACLR for BTB graft re-rupture. Two patients were lost to follow-up and excluded from the study. Conclusions: The findings suggest that concomitant LET and ACLR in adolescent patients with risk factors for failed ACLR is associated with favorable patient-reported outcomes, high return to sports participation, and low ACL re-rupture rate at two years follow-up. [ABSTRACT FROM AUTHOR]

Introduction: The frequency of anterior cruciate ligament (ACL) injuries is increasing in pediatric and adolescent patients. Currently, there is no standardized skeletal maturity determination for pediatric and adolescent patients that present with an ACL tear. Hypothesis/Purpose: This study aims to evaluate physicians' preferences for obtaining bone age studies for pediatric and adolescent patients with an ACL injury. Methods: A survey link was sent to the members of Pediatric Research in Sports Medicine (PRiSM). Participation in the survey was voluntary. Consent was obtained by the participants taking part in the survey. Results: Forty-five physician responses were included in this analysis. Seven were female, thirty-six male, and one preferred not to answer. Twenty physicians had completed a pediatric orthopaedic fellowship, six had completed a sports medicine fellowship, and nineteen had completed both. Thirty-five respondents reported that greater than 75% of their patients were 18 years old or younger. When asked about the number of ACL reconstructions performed each year on skeletally immature patients, 15.6% (n=7) report less than 5, 11.1% (n=5) said 5-9, 44.4% (n=20) said 10-34, 20.0% (n=9) report 35-49, and 8.9% (n=4) said they perform 50 or more. A majority of the participants (n=32) said that they routinely obtain a skeletal age study. Of the participants that routinely order a skeletal age study, 100% (n=32) get a bone age for patients 11 and 12 years old. Seventeen (n=17) obtain a bone age study for patients 8-14 years of age. When asked about bone age determination method, 100% (n=45) said one method they use is hand bone age and twenty-four (n=24) only use hand bone age. Thirty-four (n=34) report they sometimes see a significant difference (2 or more years) between bone age radiographs and chronological age while eleven (n=11) report they almost never see a significant difference. Thirty-one report that a patient's skeletal age sometimes changes their technique or graft preference. Conclusion: Results of this survey suggest that bone age studies are used to treat pediatric and adolescent patients with ACL injuries. Hand bone age, in particular the Greulich-Pyle method, is the most widely used among the respondents. Obtaining bone age radiographs can help physicians to formulate a proper treatment plan for their patients. Further research is needed to identify the true impact of bone age studies on the treatment of ACL injuries in pediatric and adolescent patients. Table 1: Preferences for Obtaining Bone Age Studies for Pediatric and Adolescent Patients with ACL Injuries [ABSTRACT FROM AUTHOR]

Background: The uncommon nature of tibial spine fractures may result in delayed presentation, diagnosis, and treatment. Elucidation of the contributing factors to such delays may provide an opportunity to improve patient care. Additionally, the outcomes of delayed surgery are unknown. Hypothesis/Purpose: The purpose of this study is to evaluate risk factors for, and consequences of, delayed surgical treatment of pediatric tibial spine fractures. Methods: We performed a retrospective cohort study of tibial spine fractures treated surgically at 10 institutions between 2000 and 2019. Demographic and pre-operative data were collected, as was intra-operative information and post-operative complications. Attention was focused on delays in evaluation and treatment, which were treated as both continuous and categorical variables. Surgery ≥21 days after injury was considered "delayed". Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounding factors. Results: A total of 368 subjects (mean age 11.7±2.9 years) were included, 21.2% of which underwent surgery ≥21 days after injury. Patients who experienced delayed surgery had 3.8 times higher odds of being diagnosed with a TSF 1 or more weeks after injury [95% confidence interval (CI) 1.1-14.3, p=0.04], 2.3 times higher odds of having seen multiple clinicians prior to the treating surgeon (95% CI 1.1-4.8, p=0.02), 5.8 times higher odds of having magnetic resonance imaging 1 or more weeks after injury (MRI; 95% CI 1.6-20.8, p<0.007), and were 2.4 times more likely to have public insurance (95% CI 1.3-4.2, p=0.003). Meniscal injuries were encountered intra-operatively in 42.3% of those that had delayed surgery compared to 16.6% of patients that did not (p<0.001), resulting in 2.8 times higher odds in multivariate analysis (95% CI 1.6-5.0, p<0.001). Delayed surgery was also a risk factor for procedure duration longer than 2.5 hours (odds ratio 3.3, 95% CI 1.4-7.9; p=0.006). Patients who experienced delayed surgical management and an operation longer than 2.5 hours had 3.7 times higher odds of developing arthrofibrosis (95% CI 1.1-12.5, p=0.03). Conclusion: When surgery for a TSF was performed ≥21 days after injury, patients were at increased risk for concomitant meniscal pathology, longer case duration, and possibly post-operative arthrofibrosis. Those who experienced delays in diagnosis or MRI, saw multiple clinicians, and had public insurance were more likely to have a delay to surgery. These results provide an opportunity to optimize care for children that are at highest risk for delayed treatment. [ABSTRACT FROM AUTHOR]

Background: The relationship between physical therapy (PT) visit utilization and performance during single-legged hop testing after anterior cruciate ligament reconstruction (ACLR) in young patients is unclear. Purpose: To examine the effect of PT utilization on hop testing performance in pediatric and adolescent patients after ACLR. Methods: A retrospective review of patients who underwent primary ACLR between 2013 and 2019 at 5 institutions was conducted. All patients followed a structured rehabilitation protocol as directed by the treating institution and completed a return to sport (RTS) test which included single-legged hop testing. PT frequency was assessed both overall and by time period (first 6 weeks, week 7-month 3, 3-6 months, and 6-12 months). PT visits were recorded up until the time of hop testing. To account for variability, the average number of visits attended per week during the observed time was calculated for each patient. The effect of PT visit rate on the odds of passing a hop test was assessed using multivariable logistic regression controlling for time to test, age, sex, and insurance status. Passing was defined as achieving a limb symmetry index (LSI) ≥ 90% on all available tests (single hop, triple hop, crossover hop, and timed hop, if performed), as well as passing just the single hop test. The primary predictor of interest included the average rate of PT visits at the time of hop test (≥1 visit per week vs. <1 visit per week). Results: 289 patients were identified (mean age, 15.7 ± 1.9 years). The mean time from surgery to the first PT visit was 0.36 ± 0.24 months. RTS testing was performed at a mean of 8.0 ± 1.9 months. Patients averaged 0.98 ± 0.38 visits per week until the RTS test. Mean LSIs for the single hop, triple hop, crossover hop, and timed hop were 96.3 ± 8.2, 97.1 ± 6.5, 98.5 ± 7.8, and 98.2 ± 7.4, respectively. 68.9% of patients passed all performed test; 85.5% passed the single hop test. The weekly rate of PT visits had no statistically significant effect on the odds of passing all performed hop tests (OR, 0.98; 95% CI, 0.56-1.71) or the single hop test (OR, 1.05; 95% CI, 0.51-2.18). Furthermore, the distribution of PT visits did not affect hop testing performance (Table 1). Conclusion: The rate and distribution of PT visit utilization was not associated with hop testing performance in pediatric and adolescent patients after ACLR. Table 1. Adjusted Odds Ratios (95% CI) for Passing Hop Test (All Performed and Single Hop Only), by PT Weekly Visit Rate During 1st 6 weeks, 7 weeks to 3 months, After 3 Months [ABSTRACT FROM AUTHOR]

Background: Graft failure remains a challenging complication after anterior cruciate ligament reconstruction (ACLR) in children and adolescents. Anterolateral ligament reconstruction (ALLR) and lateral extra-articular tenodesis (LET) show promise in lowering the risk of ACL graft failure, but there is little data on surgeon practices and preferences in the pediatric population. An improved understanding can help determine the feasibility of future research, identify questions of interest, and ultimately design clinical studies. Hypothesis/Purpose: The purpose of this study is to quantify surgeon practices regarding ALLR and LET in children and adolescents. Methods: An electronic survey was administered to surgeons in the Pediatric Research in Sports Medicine (PRiSM) society. Surgeon and practice demographic information was collected. The survey then asked several questions about indications, preferences, and techniques for ALLR or LET in the context of primary and revision pediatric ACLR. Chi-square and Fisher exact tests were used to evaluate factors that impact surgical preferences. Results: A total of 63 surgeons completed the survey, of which 62% performed ≥50 pediatric ACLR annually. In the setting of primary ACLR, 35/63 (56%) sometimes perform ALLR or LET. The frequency increased to 50/63 (79%) with revision ACLR. The most common indications for ALLR/LET in the primary setting were high-grade pivot shift, knee hyperextension, generalized laxity, and type of sports participation. Surgeons whose practice was >75% sports medicine were more likely to perform ALLR/LET with both primary and revision ACLR (p=0.005 and <0.001, respectively). Those that completed a sports medicine fellowship were more likely to perform these procedures than those with only pediatric orthopaedic training in both primary (68% vs. 36%, p=0.01) and revision scenarios (92% vs. 60%, p=0.002). Of the 28 respondents that do not perform ALLR/LET with primary ACLR, 75% cited insufficient evidence as the reason. However, 95% of surgeons that do perform these procedures expressed interest in studying them prospectively and 86% were willing to randomize patients. Conclusion: In this study of pediatric sports surgeons, 56% sometimes perform ALLR or LET with primary ACLR and 79% with revision ACLR. Surgeons with sports medicine fellowship training or a mostly sports practice were more likely to perform these procedures. Insufficient evidence was the most common reason given by those that do not perform ALLR or LET. However, there was substantial willingness to prospectively study and even randomize pediatric patients to assess the impact of ALLR/LET in this population. [ABSTRACT FROM AUTHOR]

Background: Track & field has more participants compared to any other high school sport and continues to gain popularity among middle school aged kids. Among many events, hurdles is unique because there is continued running with repeated jumping over an apparatus. Although serious injury has been anecdotally reported, there are few studies describing pediatric hurdle injuries including sex and age differences. Purpose: To investigate hurdle-related injury types and body locations based on age and sex among children and adolescents. Methods: Hurdle related injury data was extracted from the National Electronic Injury Surveillance System (NEISS), which represents emergency room visits. The search period was a 10-years (2008-2017). The eligibility criteria was < 18 years of age. Injuries were then classified based upon injury type and body location(s) involved. A chi-square (x2) analysis was employed to assess proportional differences of top three hurdle related injury types and body locations by age (<14 years vs. >15 years) and sex (male vs. female). Statistical significance was set as p<0.05. Results: A total of 749 cases related to hurdle injuries were extracted. Among recorded 749 injuries, traumatic fractures (N=218, 29.1%), joint sprain (N=191, 25.5%), and contusion/hematoma/bruise (N=78, 10.4%) were found as the top three most commonly sustained injuries. Chi-square (x2)analysis found more traumatic fractures in <14 years (34.1%) compared to >15 years (21.5%, p=0.001) while more joint sprain was identified in >15 years (29.6%) than <14 years (22.8%, p=0.036). Regarding sex comparisons, males had more traumatic fractures (35.1%) than females (24.3%, p=0.001). Conversely, females sustained more joint sprains (29.1%) and contusion/hematoma/bruise (12.7%) than males (joint sprain, 21.0%, p=0.012; contusion/hematoma/bruise, 7.5%, p=0.020). The top 3 injured body locations were ankle (N=140, 18.7%), knee (N=120, 16.0%), and wrist (N=69, 9.2%). No differences were found between body locations and age; however, statistical differences were detected by sex comparisons. Ankle injury was more common in females (24.0%) than males (12.0%, p=0.001). Yet, injury at wrist was more prevalent in males (11.7%) compared to females (7.2%, p=0.034). Conclusion: Findings of this study suggest that hurdle injury types seen in the emergency room differ by sex and age: more fractures are seen in males and younger pediatric populations while more sprains are seen in females and older adolescents. These findings may be helpful in event planning and may also play a role in injury prevention. [ABSTRACT FROM AUTHOR]

Background: Avulsion fractures of the pelvis and hip are common injuries in adolescent patients. Avulsion sites include the rectus femoris at the anterior inferior iliac spine (AIIS), the sartorius at the anterior superior iliac spine (ASIS), the hamstrings at the ischial tuberosity, abdominal muscles on the iliac crest (IC), iliopsoas at the lesser trochanter (LT). Although these fractures are commonly treated conservatively, there is no consensus on the preferred treatment modality (conservative vs. surgical fixation) or thresholds for surgical treatment. The published literature is generally limited to small retrospective series, with in some cases conflicting results. Purpose: To summarize the available evidence on outcomes of pelvic and hip avulsion fractures in the pediatric and adolescent population using a systematic review of the literature. Study design: Systematic review. Methods: A systematic review of the literature was performed per PRISMA guidelines. Inclusion criteria included mean patient age of ≤18.0 years, ≥5 patients, avulsions treated with 3 months of injury, and publication in the English language. Patient characteristics, type of activity performed when injured, treatment modality, complications, and outcomes (rates of persistent symptoms, return to sport, subsequent surgery), were recorded by specific fracture type. Results: A total of 1034 patients with acute avulsion fractures from 23 studies were included. Of these, the outcomes were reported in 799 patients, including 693 (86.7%) who underwent conservative treatment and 106 (13.3%) who underwent surgical intervention. All types of acute avulsion fractures had good results with conservative treatment. Ischial tuberosity avulsions had the highest rate of persistent symptoms (25.4%) but only 10.2% underwent subsequent surgery. AIIS avulsions also had a high rate of persistent symptoms (19.3%) but very few underwent subsequent surgery (1.3%). Faster return to sport was noted in conservatively treated patients in ASIS and AIIS avulsions (both p<0.05). While good results have been reported with surgical treatment, conservative treatment of ASIS, AIIS, ischial tuberosity, IC, and LT avulsions appears to be nearly uniformly successful with low rates of persistent symptoms or subsequent surgery. Conclusions: Both conservative treatment and surgical treatment of pelvic avulsion injuries appear to be effective for the majority of patients. Ischial tuberosity and AIIS avulsions have the highest rates of persistent symptoms at 25% and 19%, respectively. Further prospective research into all fracture types is needed to better define indications for surgery in a subgroup of patients. Figure 1: Forest plot of the estimated prevalence of each avulsion type in relation to the other as a proportion in the study population (Avulsion / Total). The studies included were those that described at least four of the major five fracture types (anterior inferior iliac spine [AIIS], anterior superior iliac [ASIS], iliac crest [IC], ischial tuberosity [ISCH] and Lesser trochanter [LT]). [ABSTRACT FROM AUTHOR]

Introduction: The frequency of anterior cruciate ligament (ACL) injuries is increasing in pediatric and adolescent patients. Most surgeons elect to reconstruct the ACL in young, active patients to facilitate the resumption of sports and restore stability to the knee. Surgical technique and graft type preferences depend on the surgeon and skeletal maturity of the patient, but there is no clear standard based on age. Hypothesis/Purpose: This study aims to evaluate physicians' preferences for choosing a surgical plan for pediatric and adolescent patients with an ACL injury. Methods: A voluntary survey link was sent to members of Pediatric Research in Sports Medicine (PRiSM). Consent was obtained by the participants taking part in the survey. Results: Forty-five (n=45) physician responses were included in this analysis. Seven were female, thirty-six male, and one preferred not to answer. Twenty completed pediatric orthopaedic fellowships, six completed sports medicine fellowships, and nineteen completed both pediatric orthopaedic and sports medicine fellowships. Thirty-five respondents reported that greater than 75% of their patients were 18 years old or younger. The majority prefer the over the top technique for 8 to 10-year-old males over the all epiphyseal, partial transphyseal, and transphyseal techniques. The technique preference is split for 11, 12, and 13-year-old males. Twenty-five respondents prefer the partial transphyseal technique for 14-year-old male patients. A majority (n=42, n=43) prefer the transphyseal technique for 16 year old males and skeletally mature males. The technique preferences for female patients 9 years or less is the over the top technique. The technique preference is split for 10, 11, 12, and 13-year-old females. The majority (n=37, n=44, n=44) prefer the transphyseal technique for 14-year-old, 16-year-old, and skeletally mature female patients. The graft preference for males 11 years old or younger is the iliotibial band (ITB). The graft preference for males 12-year-old and older was split among the hamstring, ITB, bone-tendon-bone (BTB) and quadriceps grafts. When looking at the preferred graft for female patients, a majority prefer ITB for patients 10-years-old and younger. The participants' graft preferences for female patients 11-years-old and older is split. Conclusion: Results of this survey suggest that graft type and surgical technique preferences for pediatric and adolescent patients with ACL tears change based on the patient's age, with more agreement among surgeons at the extremes of patient ages. Further research is needed to track the impact of each surgical technique and graft choice on pediatric and adolescent patients. Table 1. Surgical Technique and Graft Preferences for Pediatric and Adolescent Patients with ACL Injuries [ABSTRACT FROM AUTHOR]

Background: Anterior Cruciate Ligament reconstruction (ACLr) is commonly performed in pediatric and adolescent patients. The most common early complication associated with ACLr is stiffness, including motion loss and arthrofibrosis. There is minimal literature regarding risk factors for stiffness following ACLr in this age group. Hypothesis/Purpose: To evaluate the incidence and risk factors associated with stiffness following ACLr using a multi-center quality improvement registry. Methods: A multi-center quality improvement registry (16 institutions, 26 surgeons) monitoring the safety of ACLr was reviewed. Audit processes using CPT codes were designed to insure that all consecutive cases were prospectively entered on patients <19 years old into a HIPAA-compliant electronic platform. Stiffness was defined as motion loss that prompted any deviation from the normal post-operative course (Clavien Dindo grade II or greater), including additional clinical or physical therapy (PT) visits, serial/dynamic splinting, or secondary surgery for stiffness (Clavien Dindo grade III). Each case of stiffness and associated complication form was secondarily reviewed to insure consistency of identification and grading. Demographic and peri-operative data were reviewed. Chi-Square or Fisher's exact tests were used for categorical comparisons and a Kruskal-Wallis test for continuous comparisons. Results: 2,839 ACLr cases (mean age 15.1, 6-19; female 46.9%) were identified, with stiffness reported in 4.2% of patients (including isolated flexion or extension and combined stiffness) and secondary surgery for stiffness (manipulation under anesthesia and/or lysis of adhesions) performed in 1.1% of patients. Loss of extension occurred in 3.8% of patients (59.3% females), while loss of flexion occurred in 3.1% of patients (49.4% females). Overall stiffness occurred with longer tourniquet times (93.0 min vs. 78.8 min, p<0.001) when used. Anterior displacement of medial or lateral meniscus tear were associated with nearly twice the incidence of extension loss (7.1%) and three times the incidence of surgery for stiffness (3.7%). Conclusion: Post-operative stiffness following ACLr is rare but may be associated with certain demographic and perioperative factors, such as female sex, prolonged tourniquet time, and certain concomitant injuries such as anteriorly displaced meniscus tears. The degree to which altered practices and/or additional monitoring/vigilance in the setting of such factors warrants additional study. [ABSTRACT FROM AUTHOR]

This study investigated equivalence of autism symptom domains in males and females with autism. Symptom data were obtained from 2643 children and adolescents with autism spectrum disorder (352 females, 2291 males; age range = 4–17 years) included in the Simons Simplex Collection. Items from the Social Responsiveness Scale and Autism Diagnostic Interview–Revised were mapped to nine a priori symptom dimensions. Multi-group confirmatory factor models, including measurement equivalence and item response theory analyses, examined whether males and females showed measurement or structural differences in autism symptom constructs. Results indicated mean differences in restricted interests that were not due to measurement bias. No other symptom dimension showed evidence of measurement bias and autism symptom structure was highly similar between males and females. Future studies are needed to carefully estimate any sex differences in the content, frequency, or intensity/severity of restricted interests in females and males. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the evidence base for using computer-assisted instruction (CAI) to improve the reading comprehension of students with learning disabilities (LD). Twelve peer-reviewed studies (seven comparison group studies, five single-case studies) met selection criteria and were evaluated according to the relevant What Works Clearinghouse (WWC) procedures and standards. Results showed that seven studies (five comparison group and two single-case studies) met WWC standards with or without reservations. Key instructional features employed in CAI studies meeting the WWC standards without reservations included practice opportunities, self-correction and immediate corrective feedback, teacher-directed instruction, and contingencies for enhancing student motivation and engagement. Implications for future research and suggestions for using quality indicators to improve the rigor of future CAI investigations are discussed. [ABSTRACT FROM AUTHOR]

Protective factors against the victimization of children and young people within the school and community environments (extrafamilial victimization) have received less attention than risk factors. To date, there has been no systematic review on protective factors. This systematic review therefore aimed to synthesize the prospective longitudinal research findings on the protective factors against extrafamilial victimization. A systematic search of multiple sources led to the identification of 19,053 studies. Following application of a predefined inclusion and quality assessment criteria, 13 studies exploring protective factors against peer victimization and exposure to violence were included in this review. Across these studies, 19 protective factors were explored: 9 individual factors and 10 contextual factors. Four studies also explored the impact of mediating and moderating variables on the relationship between predictors and extrafamilial victimization. Findings highlight inconsistencies in the definition and measurement of victimization, along with bias in a number of areas. Nevertheless, a small number of variables (perceptions of social competence, physical strength, and aggression) were identified as potential protective factors against extrafamilial victimization. Additionally, mediating and moderating variables were identified, and the interaction between individual and contextual protective and risk factors were highlighted. These findings are explored under the theoretical framework of the ecological systems theory and their practical and research-based implications are discussed. [ABSTRACT FROM AUTHOR]

This study examined parental mediation of children’s video game play in an Internet survey of 433 parents of children aged 5 to 18 years. We assessed the valence of active mediation (i.e., positive, negative, neutral) and the relationship between parental involvement and mediation techniques. Furthermore, we explored whether parental mediation was associated with child delinquency. Our results demonstrate that active mediation is generally negative or neutral in nature. Involved parents were more likely to use each mediation strategy than less involved parents; however, parental involvement did not predict negative mediation. Restrictive and negative mediation were significantly related to child delinquency. In sum, the findings show that parents are involved in monitoring their children’s use of this medium, just as they are with television. [ABSTRACT FROM AUTHOR]

The crisis of public spaces implies a closure to the private sphere and, as a consequence, the inanity of the education processes. Space privatization involves the supremacy of the “οίκος” (house) on the “αγορα” (public space), so that the house assumes the role of an enclosed community. The effect of this closure is a weakening of the spatial identification and socialization of preadolescents and the exclusion of differences and relationships with their peers. This break prevents and reduces the autonomous exploration of the space as a place of free expression, the communicative acting, the conflict. This article analyzes the efficacy of the educative role of the quarter and its incidence on the preadolescent development from a sheltered to an open space both through a deep relationship with the environment and an aptitude to explore the external world. The validity of these hypotheses has been proved through a study carried out in three cities. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) injuries in skeletally immature athletes are increasing. Purpose: To evaluate the 2-year clinical outcomes of all-inside, all-epiphyseal ACL reconstruction in skeletally immature athletes with 3 to 6 years of remaining growth, with a focus on return to sport and the incidence of second surgery. Study Design: Case series; Level of evidence, 4. Methods: Twenty-three skeletally immature athletes were prospectively evaluated after all-epiphyseal ACL reconstruction utilizing a hamstring autograft. The athletes’ age, sex, sport, mechanism of injury, radiographs, and magnetic resonance imaging (MRI) findings were noted. The evaluation included a physical examination, KT-1000 arthrometer measurements, isokinetic testing, and validated outcome scores. Standing radiographs and spoiled gradient recalled echo MRI scans were obtained at 6, 12, and 24 months postoperatively. A quality of movement assessment and return-to-sport performance analysis were also performed. Results: Of the 23 athletes, 6 were female (mean age, 11.3 years), and 17 were male (mean age, 12.6 years). At a minimum follow-up of 2 years (range, 24-45 months), the mean International Knee Documentation Committee score was 94.6 ± 4.9, the mean Lysholm score was 97.9 ± 4.0, the mean Marx activity rating scale score was 13.4 ± 3.6, and the mean Hospital for Special Surgery Pediatric Functional Activity Brief Scale score was 23.9 ± 7.0. Lachman and pivot-shift test results were negative in all patients. The mean side-to-side difference on the KT-1000 arthrometer was 0.9 ± 0.5 mm and less tight on the operated side. No significant growth disturbances were noted; however, 6 athletes had a leg-length discrepancy of more than 5 mm (range, 6-18 mm). Two patients had overgrowth in the femur of more than 15 mm (16 mm and 18 mm). Two athletes (8.7%) required second surgery. The mean time to return to unrestricted activity was 13.5 months (range, 8-22 months). Conclusion: The all-inside, all-epiphyseal ACL reconstruction technique using a hamstring autograft demonstrates excellent subjective and objective clinical outcomes in skeletally immature athletes without physeal arrest. [ABSTRACT FROM AUTHOR]

In adolescence, the complexity of human ontogenesis embraces biological growth and maturation as well as mental, affective, and cognitive progress, and adaptation to the requirements of society. To accept our morphological constellation as part of our gender may prove a problem even to a child of average rate of maturation. The main purposes of the present study were to compare selected body shape factors of early adolescents belonging to different physical self-concept subgroups, and to identify those somatic factors that have the strongest influence on the physical self-concept. A randomly selected subsample of the 2nd Hungarian National Growth Study formed the sample of the analysis. Besides the anthropometric investigations, the Tennessee Self-Concept Scale was administered to altogether 2,140 adolescents (aged 11-14). The multinominal logistic regression was used to reveal the relationship between absolute body dimensions, relative body dimensions, nutritional status, body mass components, body shape, and physical self-concept. The better the physical self-concept, the less the fatness was found in both sexes. In early adolescents, having negative physical self-concept endomorphy was significantly larger than in their age-peers with good self-concept. The presumed fact that obesity is not popular in adolescence has been confirmed by this study. However, the underweight nutritional status was attractive in the girls. These results informed us about the considerable influence of the pubertal-not-normal nutritional status on the discrepancy between the ideal and actual self-concepts. [ABSTRACT FROM AUTHOR]

This study’s purpose was to examine the relations among future orientation, self-esteem, and later adolescent risk behaviors, and to compare two mediational models involving self-esteem versus future orientation as mediators. An ethnically diverse sample of 12- to 14-year-olds (N = 862, 54% female, 53% ethnic minority) was assessed longitudinally. Correlations supported the hypotheses that future orientation and self-esteem are (a) positively correlated with each other (r > .40) and (b) negatively related to various risky behaviors that were composited into a measure of risk orientation. Controlling for social desirability, self-esteem partially mediated the relation between future orientation and later risk orientation, and future orientation partially mediated the relation between self-esteem and risk orientation. The results shed light on how the concept of possible selves might factor into adolescents’ risk avoidance. In particular, both future orientation and healthy self-esteem may serve as protective factors against engaging in risky behavior. [ABSTRACT FROM AUTHOR]

Past research has demonstrated the particularly damaging effects of exposure to multiple forms of victimization, or "poly-victimization," on youth mental health. The primary objective of the present study is to begin to identify the mechanisms that help explain its powerful impact. Analyses are based on two waves of longitudinal data from the National Survey of Children's Exposure to Violence (NatSCEV), conducted in 2008 and 2010, that comprised a telephone sample of 1,186 youth ages 10 to 17. Using structural equation modeling, we examine direct and indirect effects on distress symptoms of increased, decreased, and stable high poly-victimization between Waves 1 and 2 compared to no or low victimization in both waves. Specifically, we consider the extent to which reductions in core psychosocial resources, including family support, peer support, self-esteem, and mastery, mediate the relationship between these poly-victimization conditions and distress. Relative to stable low victimization, both increased poly-victimization and stable high poly-victimization were associated with declines in all four resources. However, only self-esteem and mastery significantly mediated the association between poly-victimization and distress, with mastery showing the strongest effect. Although significant indirect effects were evident, poly-victimization still had a strong direct effect on distress with resource factors controlled. Findings support the hypothesis that the potent effect of poly-victimization on youth mental health is, in part, due to its damaging influence on core psychosocial resources. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is beneficial, enhancing healthy development. However, one-third of school-age children practicing sports regularly suffer from an injury. These injuries are associated with sex, chronological age, and PA level.Purpose: To identify the importance of age, PA level, and maturity as predictors of injury in Portuguese youth.Study Design: Descriptive epidemiological study.Level Of Evidence: Level 3.Methods: Information about injury and PA level was assessed via 2 questionnaires (LESADO RAPIL II) from 647 subjects aged 10 to 17 years. Maturity offset according to Mirwald (time before or after peak height velocity) and Tanner-Whitehouse III bone age estimates were used to evaluate maturation. Binary logistic regression and gamma regression were used to determine significant predictors of injury and injury rate.Results: Injury occurrence was higher for both sexes in recreational, school, and federated athletes (athletes engaged in sports that are regulated by their respective federations, with formal competition). These injuries also increased with age in boys and in the higher maturity offset group in girls. Injury rate was higher for both sexes in the no sports participation group. Early-maturing girls, with higher bone age and lower maturity offset, showed higher injury rate.Conclusion: Injuries in Portuguese youth were related to PA level, age, and biological maturation. Recreational, school, and federated athletes had more injury ocurrences while subjects with no sports participation had higher injury risk. Older subjects had more injuries. Early-maturing girls that had just passed peak height velocity may be particularly vulnerable to risk of sports injury because of the growing process.Clinical Relevance: Increased knowledge about injury with specific PA exposure data is important to an overall risk management strategy. This study has deepened the association between injury and biological maturation variables. [ABSTRACT FROM AUTHOR]

Self-concept research in early adolescence typically measures young people’s self-perceptions of competence in specific, adult-defined domains. However, studies have rarely explored young people’s own views of valued self-concept factors and their meanings. For two major self domains, the active and the social self, this mixed-methods study identified factors valued most by 526 young people from socioeconomically diverse backgrounds in Ireland (10-12 years), and explored the meanings associated with these in a stratified subsample (n = 99). Findings indicate that self-concept scales for early adolescence omit active and social self factors and meanings valued by young people, raising questions about content validity of scales in these domains. Findings also suggest scales may under-represent girls’ active and social selves; focus too much on some school-based competencies; and, in omitting intrinsically salient self domains and meanings, may focus more on contingent (extrinsic) rather than true (intrinsic) self-esteem. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess sedentary behavior during school recess in Brazilian boys and girls. The study included 455 students (233 boys and 222 girls), aged 8 to 17 years, enrolled in a public school in the city of Londrina, Brazil. All data was collected using questionnaires. Logistic regression with odds ratio and confidence interval (95%) was used to measure the relationship between sedentary behavior and sex, age, weight, screen time, and economic status. There was a high prevalence (40.7%) of sedentary behavior in this sample, with girls (aged 8 to 17 years) more likely than boys (54.5% vs. 27.5%, respectively) and older students (13-17 years) more likely than younger students (8-12 years) to engage in sedentary behavior (49.6% vs. 30.1%, respectively). These findings, and their broad implications for health and for interventions to increase physical activity, are discussed in light of past literature. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament reconstruction is becoming more common in skeletally immature individuals, and it may be performed with transphyseal or physeal-sparing techniques. A number of studies have assessed the outcomes of these techniques, but there is a need to systematically evaluate the pooled data from these studies. Purpose: To compare the differences in demographics and outcomes of transphyseal and physeal-sparing techniques by assessing (1) demographics, (2) incidence of growth disturbances, and (3) graft survivorship in the pediatric population. Study Design: Systematic review. Methods: A thorough review of 3 databases was performed to identify all studies that evaluated outcomes after pediatric reconstruction based on transphyseal or physeal-sparing techniques. After completing our search and cross-referencing for additional sources, 43 reports were identified for this review. Reports were analyzed for differences in demographics as well as incidence of leg-length discrepancies, angular deformities, and graft survivorship. After review of manuscripts, 27 studies were included for review (21 transphyseal and 6 physeal-sparing studies). Results: Those who had transphyseal reconstruction were more likely to be female (39% vs 20%; P = .0001), while those with the physeal-sparing surgery were younger (12 vs 13.5 years of age; P = .0001). The transphyseal and physeal-sparing cohorts demonstrated similar incidence rates of leg-length discrepancies (0.81% vs 1.2%, respectively; P = .64) and angular deformities (0.61% vs 0%, respectively; P = .36). The transphyseal and physeal-sparing cohorts also showed similar rates of rerupture (6.2% vs 3.1%, respectively; P = .11). Conclusion: Although the study groups were not well matched with regard to age and sex, our results show that these surgical techniques have no differences in incidence of growth disturbances or graft survivorship. Younger males tend to undergo physeal-sparing reconstruction. Future research should focus on long-term outcome metrics with the physeal-sparing techniques, as there remains a paucity of studies regarding them. [ABSTRACT FROM AUTHOR]

This grounded theory study explores conceptualisations of chronic fatigue syndrome/myalgic encephalomyelitis from semi-structured interviews with 10 health-care professionals working with children and adolescents. The findings suggest that a lack of a clear empirical understanding of chronic fatigue syndrome/myalgic encephalomyelitis leads to ‘working with uncertainty’, whereby health-care professionals utilise previous experiences to make sense of the condition and inform their clinical practice. How health-care professionals make sense of chronic fatigue syndrome/myalgic encephalomyelitis may influence the labels given to young people and the interventions they receive. The findings provide insight into a currently understudied area, and highlight potential avenues for further research and clinical practice. [ABSTRACT FROM AUTHOR]

Currently, there is no established measure to assess prolonged grief in adolescents. A new measure was designed based on the Extended Grief Inventory, the Inventory of Complicated Grief—Revised for Children, and the Inventory of Prolonged Grief for Children/Adolescents. We investigated the psychometric properties of the Prolonged Grief Questionnaire for Adolescents in a sample of 69 14- to 18-year-old parentally bereaved adolescents living in rural Rwanda. Additionally, we obtained sociodemographic information and assessed loss experiences and depressive symptoms. A principal component analysis revealed item loadings on two factors, which we named separation distress and secondary emotions. Internal consistency in this first evaluation was high (α = .94), and the criterion validity was satisfying. A sensitivity of 85.3% and a specificity of 85.9% were found. The small sample size is a major limitation. However, the Prolonged Grief Questionnaire for Adolescents may be a promising tool for assessing prolonged grief symptoms in adolescents. [ABSTRACT FROM AUTHOR]

This longitudinal study investigated the timing effect of bullying on developmental trajectories of externalizing behaviors from middle childhood to adolescence. We focused on the relation of (a) only an early experience of bullying (i.e., desisters) to subsequent externalizing behaviors in adolescence and (b) only a late experience of bullying (i.e., late-onsetters) to the concurrent externalizing behaviors in adolescence. Their trajectories of externalizing behaviors were compared with the persisters and to the non-experience group. Individual growth curve modeling was conducted using 440 child–mother dyads from the Springfield Child Development Project, a community-representative, longitudinal study over a 6-year period that included four time interviews. We modeled the changes in child aggression and delinquency from 7 to 19 years of age as a function of bully status group. Results indicated that the levels of aggression and delinquency for the desisters decreased over time (with the cessation of bullying in adolescence) and were significantly lower than those of the persisters and similar to those of the non-involved group at the end of the trajectory (cessation effect). For the late-onsetters, the level of delinquency increased over time (with the onset of bullying behaviors in adolescence) and were significantly higher than those of the non-involved group and similar to those of the persisters at the end of the trajectory (onset effect). The aggression for the late-onsetters, however, did not support the onset effect. This study implies that we need to pay more attention to intervening for late-onset. [ABSTRACT FROM AUTHOR]

This investigation explored the association between anxiety sensitivity and attentional bias for threatening information in children and adolescents (N = 40). Participants completed a pictorial version of the visual-probe task, featuring pain-related, health-threat and general-threat images presented for 500 and 1250 ms. Regression analyses revealed significant associations between anxiety sensitivity and attentional bias towards pain-related images presented for 500 ms and between state anxiety and attentional bias towards general-threat images presented for 1250 ms. These results suggest that in children and adolescents, anxiety sensitivity is associated with attentional bias for negative information of personal relevance. [ABSTRACT FROM AUTHOR]