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BackgroundSince its release in 2015, the hoverboard has been associated with injuries in children and adolescents. However, its public health implications have yet to be explored in the orthopedic literature across multiple centers.Purpose/questionsWe sought to assess the nature of orthopedic injuries and the use of clinical resources related to the hoverboard at four high-volume, regional pediatric hospitals.MethodsDepartmental databases of emergency department (ED) consultations and urgent orthopedic clinic (UC) visits were queried for hoverboard injuries. A retrospective medical record review was performed for patients presenting over a 3-month period at four institutions. Data on demographics, injuries, clinical course, and resource use were analyzed. The frequency of hoverboard-related consultations was compared to those for monkey bar-related injuries at the primary study institution.ResultsEighty-nine patients with orthopedic hoverboard injuries presented to the ED and/or UC in the study period. Hoverboard injuries represented 2.2% of orthopedic ED consultations at the primary institution, compared to 1.5% for monkey bar injuries. Sixty-nine out of 89 (77.5%) total injuries involved the upper extremity, including 47 (52.8%) distal radius fractures, the most common hoverboard-related diagnosis. All but one injury (97.8%) underwent radiography, and eight (9%) required surgery. No patients reported wearing protective gear at the time of their injury.ConclusionsHoverboards were associated with a variety of pediatric orthopedic injuries and required the use of significant resources in the ED, UC, and operating room. These data may represent a starting point for further prospective multi-center studies and public health efforts toward prevention of hoverboard injuries.

Background: After arthroscopic Bankart repair (ABR) for anterior glenohumeral instability (GHI), adolescent athletes have higher rates of subsequent recurrent GHI than any other subpopulation. Elucidating which adolescents are at highest risk of postoperative recurrent GHI may optimize surgical decision-making. Purpose: To identify prognostic factors associated with subsequent recurrent GHI requiring revision stabilization surgery (RSS) after ABR. Study Design: Case-control study; Level of evidence, 3. Methods: The study included patients 12 to 21 years old who had undergone ABR for anterior GHI at a pediatric tertiary care hospital by 1 of 5 sports medicine fellowship–trained surgeons between 2000 and 2020. A multivariate Cox proportional hazards model, with percentage of patients with recurrent GHI undergoing subsequent RSS, was used with a time-to-event outcome analysis. The Cox model effects were expressed as the hazard ratio (HR). All tests were 2-sided, with an alpha of.05. Results: Records of 488 adolescent patients with ABR (78% male; mean age, 16.9 ± 1.98 years) were analyzed. Of these, 86 patients (17.6%) underwent subsequent RSS for recurrent GHI, yielding a cumulative risk of 8.8% at 2 years, 16.5% at 5 years, and 20% at 15 years. RSS occurred at a mean of 2.6 ± 2.1 years after ABR. Risk factors for RSS included >1 preoperative dislocation (2 dislocations: HR = 7.4, P =.0003; ≥3 dislocations: HR = 10.9, P <.0001), presence of a Hill-Sachs lesion (small: HR = 2.5, P =.0114; medium-large: HR = 4.2, P =.0004), younger age (1-year decrease: HR = 1.2, P =.0015), and participation in contact sports (HR = 1.8, P =.01). Adolescents with only 1 preoperative dislocation had a cumulative incidence of RSS (3.2%), which was significantly lower than those with 2 (24.2%) or ≥3 preoperative dislocations (33.5%). Conclusion: The number of dislocations before index ABR was the strongest risk factor for recurrent GHI requiring RSS in adolescents with anterior GHI, with 2 dislocations conferring >7-fold increased risk compared with a single preoperative dislocation. Other significant risk factors included the presence of a Hill-Sachs lesion, younger age, and participation in contact sports. [ABSTRACT FROM AUTHOR]

Context: To treat anterior cruciate ligament (ACL) injury, ACL reconstruction (ACLR) is currently a standard of the care. However, effect of ACLR graft type including bone patellar tendon bone (BTB), hamstring tendon (HT), or iliotibial band (ITB) on thigh size, knee range of motion (ROM), and muscle strength are understudied. Objective: To compare post-operative thigh circumference, knee ROM, and hip and thigh muscle strength in adolescent males who underwent ACLR, based on the three different autograft types: bone-patellar tendon-bone (BTB), hamstring (HS), and iliotibial (ITB). Setting: Biomechanical laboratory. Participants: Male ACLR patients who are younger than 22 years old (Total N=164). Intervention: At 6-9 month post-operative visits, thigh circumference, knee ROM, and hip and thigh muscle strength were measured. Main outcome measures: Deficits of each variable between the uninvolved and ACLR limb were compared for pediatric and adolescent ACLR males in the BTB, HS, and ITB cohorts. Baseline characteristics including physical demographics and meniscus tear status were compared, and differences identified were treated as covariates and incorporated in analysis of covariance. Results: Data from 164 adolescent male ACLR patients (mean age: 15.7±1.2) at 6-9 months, there were no statistical differences in thigh circumference, knee ROM, hip abductor, and hip extensor strength among the three autografts. However, patients with BTB demonstrated 12.2% deficits in quadriceps strength compared to 0.5% surplus in HS patients (p=0.002) and 1.2 % deficits in ITB patients (p=0.034). Patients with HS showed 31.7% deficits in hamstring strength compared to 5.4% deficits in BTB (p=0.001) and 7.7% deficits in ITB (p=0.001) groups at 6-9 month post-operative visits. Conclusion: Adolescent male ACLR patients with BTB and HS autografts demonstrated significant deficits in quadriceps and hamstring strength, respectively, at 6-9 months post-operatively. Minimal lower extremity strength deficits were demonstrated in pediatric male ACLR patients undergoing ITB harvest. [ABSTRACT FROM AUTHOR]

Collagen organization of the anterior cruciate ligament (ACL) can be evaluated using T2* relaxometry. However, T2* mapping requires manual image segmentation, which is a time‐consuming process and prone to inter‐ and intra‐ segmenter variability. Automating segmentation would address these challenges. A model previously trained using Constructive Interference in Steady State (CISS) scans was applied to T2* segmentation via transfer learning. It was hypothesized that there would be no significant differences in the model's segmentation performance between T2* and CISS, structural measures versus ground truth manual segmentation, and reliability versus independent and retest manual segmentation. Transfer learning was conducted using 54 T2* scans of the ACL. Segmentation performance was assessed with Dice coefficient, precision, and sensitivity, and structurally with T2* value, volume, subvolume proportions, and cross‐sectional area. Model performance relative to independent manual segmentation and repeated segmentation by the ground truth segmenter (retest) were evaluated on a random subset. Segmentation performance was analyzed with Mann–Whitney U tests, structural measures with Wilcoxon signed‐rank tests, and performance relative to manual segmentation with repeated‐measures analysis of variance/Tukey tests (α = 0.05). T2* segmentation performance was not significantly different from CISS on all measures (p > 0.35). No significant differences were detected in structural measures (p > 0.50). Automatic segmentation performed as well as the retest on all segmentation measures, whereas independent segmentations were lower than retest and/or automatic segmentation (p < 0.023). Structural measures were not significantly different between segmenters. The automatic segmentation model performed as well on the T2* sequence as on CISS and outperformed independent manual segmentation while performing as well as retest segmentation. [ABSTRACT FROM AUTHOR]

Non-invasive methods to document healing anterior cruciate ligament (ACL) structural properties could potentially identify patients at risk for revision surgery. The objective was to evaluate machine learning models to predict ACL failure load from magnetic resonance images (MRI) and to determine if those predictions were related to revision surgery incidence. It was hypothesized that the optimal model would demonstrate a lower mean absolute error (MAE) than the benchmark linear regression model, and that patients with a lower estimated failure load would have higher revision incidence 2 years post-surgery. Support vector machine, random forest, AdaBoost, XGBoost, and linear regression models were trained using MRI T2* relaxometry and ACL tensile testing data from minipigs (n = 65). The lowest MAE model was used to estimate ACL failure load for surgical patients at 9 months post-surgery (n = 46) and dichotomized into low and high score groups via Youden's J statistic to compare revision incidence. Significance was set at alpha = 0.05. The random forest model decreased the failure load MAE by 55% (Wilcoxon signed-rank test: p = 0.01) versus the benchmark. The low score group had a higher revision incidence (21% vs. 5%; Chi-square test: p = 0.09). ACL structural property estimates via MRI may provide a biomarker for clinical decision making. [ABSTRACT FROM AUTHOR]

Background: Quantitative magnetic resonance imaging (qMRI) methods were developed to establish the integrity of healing anterior cruciate ligaments (ACLs) and grafts. Whether qMRI variables predict risk of reinjury is unknown. Purpose: To determine if qMRI measures at 6 to 9 months after bridge-enhanced ACL restoration (BEAR) can predict the risk of revision surgery within 2 years of the index procedure. Study Design: Cohort study; Level of evidence, 2. Methods: Originally, 124 patients underwent ACL restoration as part of the BEAR I, BEAR II, and BEAR III prospective trials and had consented to undergo an MRI of the surgical knee 6 to 9 months after surgery. Only 1 participant was lost to follow-up, and 4 did not undergo MRI, leaving a total of 119 patients for this study. qMRI techniques were used to determine the mean cross-sectional area; normalized signal intensity; and a qMRI-based predicted failure load, which was calculated using a prespecified equation based on cross-sectional area and normalized signal intensity. Patient-reported outcomes (International Knee Documentation Committee subjective score), clinical measures (hamstring strength, quadriceps strength, and side-to-side knee laxity), and functional outcomes (single-leg hop) were also measured at 6 to 9 months after surgery. Univariate and multivariable analyses were performed to determine the odds ratios (ORs) for revision surgery based on the qMRI and non-imaging variables. Patient age and medial posterior tibial slope values were included as covariates. Results: In total, 119 patients (97%), with a median age of 17.6 years, underwent MRI between 6 and 9 months postoperatively. Sixteen of 119 patients (13%) required revision ACL surgery. In univariate analyses, higher International Knee Documentation Committee subjective score at 6 to 9 months postoperatively (OR = 1.66 per 10-point increase; P =.035) and lower qMRI-based predicted failure load (OR = 0.66 per 100-N increase; P =.014) were associated with increased risk of revision surgery. In the multivariable model, when adjusted for age and posterior tibial slope, the qMRI-based predicted failure load was the only significant predictor of revision surgery (OR = 0.71 per 100 N; P =.044). Conclusion: Quantitative MRI-based predicted failure load of the healing ACL was a significant predictor of the risk of revision within 2 years after BEAR surgery. The current findings highlight the potential utility of early qMRI in the postoperative management of patients undergoing the BEAR procedure. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) revision surgery is challenging for both patients and surgeons. Understanding the risk factors for failure after bridge-enhanced ACL restoration (BEAR) may help with patient selection for ACL restoration versus ACL reconstruction. Purpose: To identify the preoperative risk factors for ACL revision surgery within the first 2 years after BEAR. Study Design: Case-control study; Level of evidence, 3. Methods: Data from the prospective BEAR I, II, and III trials were used to determine the preoperative risk factors for ACL revision surgery. All patients with a complete ACL tear (aged 13-47 years, depending on the trial), who met all other inclusion/exclusion criteria and underwent a primary BEAR procedure within 30 to 50 days from the injury (dependent on the trial), were included. Demographic data (age, sex, body mass index), baseline patient-reported outcomes (International Knee Documentation Committee [IKDC] subjective score, Marx activity score), preoperative imaging results (ACL stump length, notch size, tibial slope), and intraoperative findings (knee hyperextension, meniscal status) were evaluated to determine their contribution to the risk of ipsilateral ACL revision surgery. Results: A total of 123 patients, with a median age of 17.6 years (interquartile range, 16-23 years), including 67 (54%) female patients, met study criteria. Overall, 18 (15%) patients required ACL revision surgery in the first 2 years after the BEAR procedure. On bivariate analyses, younger age (P =.011), having a contact injury at the time of the initial tear (P =.048), and increased medial tibial slope (MTS; P =.029) were associated with a higher risk of ipsilateral revision surgery. Multivariable logistic regression analyses identified 2 independent predictors of revision: patient age and MTS. The odds of ipsilateral revision surgery were decreased by 32% for each 1-year increase in age (odds ratio, 0.684 [95% CI, 0.517-0.905]; P =.008) and increased by 28% for each 1° increase in MTS (odds ratio, 1.280 [95% CI, 1.024-1.601]; P =.030). Sex, baseline IKDC or Marx score, knee hyperextension, and meniscal status were not significant predictors of revision. Conclusion: Younger age and higher MTS were predictors of ipsilateral ACL revision surgery after the BEAR procedure. Younger patients with higher tibial slopes should be aware of the increased risk for revision surgery when deciding to undergo ACL restoration. [ABSTRACT FROM AUTHOR]

Context: Recent epidemiology studies indicated a steady increase of anterior cruciate ligament (ACL) injury in young athletes. ACL reconstruction (ACLR) is currently a standard of care, but the effect of ACLR graft including bone patellar tendon bone (BTB), hamstring tendon (HT), or iliotibial band (ITB) on balance and hop performance is understudied. Objective: To compare balance and hop deficits between uninvolved and reconstructed limbs in each autograft type (aim 1) and among the 3 autograft groups (aim 2). Setting: Biomechanical laboratory. Participants: Male ACLR patients who are younger than 22 years (total N = 160; BTB: N = 19, HT: N = 108, ITB: N = 33). Intervention: Approximately 6 to 9 months following ACLR, Y-balance and 4 types of hop tests were measured bilaterally. Main Outcome Measures: Limb symmetry index of balance and hop tests within each graft type and between the 3 graft types. Results: In the BTB group, significant anterior reach, single hop, triple hops, and cross-over hops deficits were observed on the ACLR limb compared with the uninvolved limb. The HT group showed significant deficits in single hop, triple hops, and cross-over hops on the ACLR limb relative to the uninvolved limb. Compared with the uninvolved limb, significantly decreased triple hops and 6-m timed hop deficits in the ACLR limb were recorded in the ITB group. When controlling for confounders and comparing among the 3 autograft types, the only significant difference was anterior reach, in which the BTB group showed significant deficits. Conclusion: Compared with the uninvolved limb, significant hop deficits in ACLR limb were prevalent among adolescent ACLR at ∼6 to 9 months postoperatively. After controlling covariates, significantly reduced anterior reach balance was found in the BTB group compared with the HT and ITB groups. [ABSTRACT FROM AUTHOR]