Search

Background: The initial diagnosis of capitellum osteochondritis dissecans (OCD) is typically confirmed using standard anteroposterior (AP) and lateral elbow radiographs, despite low sensitivity, which is approximately 44-47%. An AP image of the elbow in 45° of flexion has been suggested to increase diagnostic accuracy. Purpose: To assess the diagnostic performance, inter- and intra-observer reliability, and confidence level for identifying capitellum OCD using plain radiographs (AP, lateral, and 45° flexion AP) in pediatric and adolescent patients. Methods: This was a retrospective study including pediatric and adolescent patients with capitellum OCD and a healthy control group. Independent clinicians were blinded to the official radiologists’ reports and reviewed images on a picture archiving and communication system on two separate occasions 1 week apart. A 5-point Likert scale was used to assess the clinicians’ level of confidence (1-not at all confident; 5-very confident). Inter- and intraobserver reliability was determined using kappa statistics. Results: The study included 28 elbows (24 patients) with a mean age of 12.5 ± 2.0 years. 64.3% were female. There were no differences in age ( P = 0.18), sex ( P = 0.62), or laterality ( P = 1.0) between the two groups. There were marked variations in the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for each of the following views: AP: Sensitivity 85.1; Specificity 89.3; PPV 88.8; NPV 85.7; accuracy 87.2. Lateral: Sensitivity 73.2; Specificity 91.7; PPV 89.8; NPV 77.4; accuracy 82.4. 45° flexion AP: Sensitivity 91.7; Specificity 91.1; PPV 91.1; NPV 91.6; accuracy 91.4. Standard radiographs (AP and lateral views) failed to diagnose capitellum OCD in 4.8% of cases. The sensitivity of the three combined views was 100%. Confidence levels in the clinicians’ diagnostic assessments were similar for each view (AP, 4.0; lateral, 4.0; and 45° flexion AP, 4.1). Interobserver reliability was substantial for AP and lateral views (k=0.65 and k=0.60, respectively) but highest for the 45° flexion AP radiographs (k=0.72). Intraobserver reliability for all views was moderate to perfect (k=0.52 to 0.93). Conclusion: The 45° flexion AP view can detect capitellum OCD with excellent accuracy, a high level of confidence, and substantial interobserver agreement. When added to standard AP and lateral radiographs, capitellum OCD can be diagnosed in 100% of cases.

Medical coverage of gymnastics competitions can be a challenging task for the sports medicine physician and other medical personnel because of the complexity and aerial nature of the sport. A broad understanding of the six gymnastics disciplines, along with the type of competitions, injury epidemiology, and the common acute gymnastics injuries will help sports medicine professionals in planning and delivering optimal care to the injured or ill gymnast. Language: en

Context: The Lystedt law requires high school athletes who have sustained a concussion to be removed from practice and play and not to be allowed to return until cleared by a medical professional. Objective: To determine the effect of the Lystedt law on injury and concussion documentation in the Seattle public high schools. Design: Cross-sectional study. Setting: Seattle public high schools. Patients or Other Participants: The numbers of students, aged 13 to 19 years in the 2008–2009, 2009–2010, and 2010–2011 school years, were 4348, 4925, and 4806, respectively. Main Outcome Measure(s): All injuries documented in SportsWare by athletic trainers in Seattle public high schools. We evaluated all injuries, including concussions recorded during the 2008–2009 school year, before the Lystedt law, and during the 2 school years after the law took effect (2009–2010 and 2010–2011). Incidence rates before and after the law were estimated and compared. Results: The concussion rate was −1.09% in 2008–2009, 2.26% in 2009–2010, and 2.26% in 2010–2011. A comparison of relative risks showed that the incidence rates of concussions were different before and 1 year after the Lystedt law (relative risk = 2.10; 95% confidence interval [CI] = 1.50, 2.93) and 2 years after the law (relative risk = 2.10; 95% CI = 1.49, 2.93). Overall, the mean number of days out of play after 2008–2009 was almost 7 days greater after the law took effect (difference = 6.9 days; 95% CI = 0.70, 13.1). For females, the mean number of days out of play after 2008–2009 was more than 17 days in 2009–2010 (difference = 17.2 days; 95% CI = 4.81, 29.5) and was more than 6 days in 2010–2011 (difference = 6.3 days; 95% CI = 1.62, 11.0). Conclusions: The number of documented concussions more than doubled after the institution of the Lystedt law, which may be attributed to heightened awareness and closer monitoring.