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Background: Previous studies have reported that spondylolysis occurs predominantly at the L5 and L4 levels, with defects at higher levels occurring in <5% of cases. However, computed tomography and radiography were the primary imaging modalities in these studies. Current evidence regarding diagnostic imaging for pediatric lumbar spondylolysis suggests that magnetic resonance imaging (MRI) is as accurate as computed tomography in detecting early stress reactions of the pars interarticularis or pedicles without fractures while avoiding radiation exposure. The early detection of spondylolysis results in a higher likelihood of bony union and a decreased likelihood of spondylolisthesis. Hypothesis: The increased use of MRI may reveal a larger proportion of spondylolysis in patients who experience an injury at a higher spinal level than previously reported. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The medical records of 902 pediatric and adolescent athletes (364 female, 538 male) diagnosed with symptomatic pars interarticularis and pedicle stress injuries at 2 academic medical centers between 2016 and 2021 were retrospectively reviewed. All patients had MRI scans taken at the time of diagnosis. Only patients with pars/pedicle edema on MRI were included. Data regarding spondylolysis stage, spinal level of injury, unilateral versus bilateral injury, sport participation, and MRI protocol over the 5-year study period were analyzed. Results: Male patients presented at older ages than female patients (P <.001). Soccer was the most common sport at symptom onset and the second most common single-sport activity among those who specialized (participating in 1 sport year-round at the exclusion of others), behind gymnastics. The mean symptom duration was 4.0 months. Although most patients (83.5%) had exclusively lower lumbar stress injuries, 9.1% of injuries occurred at or above the L3 level. Over half of the patients had active single-level pars/pedicle fractures on MRI, with a mean symptom duration before presentation in this subgroup of 4.0 months. Even when pars/pedicle stress reactions were excluded from analysis, 7.1% of patients were injured at or above the L3 level. Conclusion: Among male and female athletes aged 8 to 21 years presenting with symptomatic pars interarticularis and pedicle stress injuries evaluated by MRI at the time of initial diagnosis, there was a higher incidence of upper lumbar stress injuries than previously reported. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate yellow card policies' (YCPs) effectiveness in reducing competition contact injuries (CCIs). Design: Retrospective cohort. Setting: High schools. Participants: Soccer players from High School (HS) Reporting Information Online participating schools, 2005/06 to 2017/18. Independent Variables: Athlete exposure (AE), CCIs from HS competitions collected from states with/without YCPs. Main Outcome Measures: Rate and rate ratio (RR) of athlete-athlete CCIs recorded by athletic trainers were compared between states with/without YCPs and pre-YCPs/post-YCPs among the states with YCPs using Poisson regressions. Proportions of severe athlete-athlete CCIs were also described in states with/without YCPs. Results: Fifteen states implemented YCPs between 2005/06 and 2017/18; 901 athlete-athlete CCIs occurred during 352 775 competition AEs in states with YCPs, and 3525 injuries during 1 459 708 competition AEs in states without YCPs. There was no significant difference in injury rates between schools in states with/without YCPs (RR 1.07; 95% confidence interval [CI]: 0.97-1.17). Among state with YCPs, injury rates were not significantly different between pre-YCP and post-YCP implementation (RR 1.15; 95% CI: 0.98-1.34). Although a significantly lower proportion of injuries resulting in >3 weeks' time loss (TL) occurred in states with YCPs (injury proportion ratio 0.81; 95% CI: 0.66-0.997), no significant differences were observed in proportions of other severe athlete-athlete CCIs between states with/without YCPs. Conclusions: Yellow card policies were ineffective in lowering HS soccer athlete-athlete CCI rates, although injuries resulting in >3 weeks' TL were less prevalent in states with YCPs. Implementation of YCPs alone, without proper enforcement, may not be a sufficient injury prevention strategy. [ABSTRACT FROM AUTHOR]

Background: Recent efforts have focused on eliminating dangerous hits in ice hockey. Fair play rule changes have successfully reduced injury risk but have not been widely implemented. Purpose: To determine the effect of a penalty infraction minutes (PIM) rule change in high school boys' ice hockey on injuries and game disqualification penalties. Study Design: Cohort study; Level of evidence, 3. Methods: Injury data were collected from 2 Rhode Island hospital systems and game/penalty data through the Rhode Island Hockey Coaches Association website. Participants included high school boys' hockey varsity players aged 13 to 19 years presenting to 5 emergency departments for hockey injuries during 6 seasons (December 2012–April 2018). Rule change for the 2015-2016 season implemented varying suspensions for players accumulating ≥50 PIM and ≥70 PIM during regular season and playoffs. Injuries were classified as body checking or non–body checking related, and injury rates pre– versus post–rule change were compared via the Cochran-Mantel-Haenszel chi-square test with the odds ratio (OR) to measure risk reduction. Results: During the study period, 1762 boys' high school varsity hockey games were played. Of 134 game-related injuries, 82 (61.2%) were attributable to body checking. The PIM rule change was associated with a significant reduction in all injuries (OR, 0.55; 95% CI, 0.35-0.86; P = .008), concussion/closed head injury (OR, 0.44; 95% CI, 0.23-0.85; P = .012), and combined subgroups of concussion/closed head injury and upper body injury (OR, 0.50; 95% CI, 0.31-0.80; P = .003). Game disqualification penalties per season were not significantly reduced following the rule change, occurring in 5.2% of games before the rule change and 4.4% of games after (OR, 0.84; 95% CI, 0.54-1.31; P = .440). Conclusion: Implementation of a statewide PIM restriction rule change effectively reduced the mean number of game-related injuries per season among high school boys' hockey varsity players. [ABSTRACT FROM AUTHOR]

As of 2015, 98% of U.S. states require preparticipation exams (PPE) before participating in scholastic sports. Despite widespread availability of a PPE monograph endorsed by six medical societies, a lack of uniformity exists regarding implementation of the PPE among Rhode Island health care providers (HCPs). Consequently, significant variability exists regarding how comprehensive a history and physical exam screening is conducted for adolescent athletes looking for sports participation clearance. The purpose of this document is to: 1) establish a uniform screening process in Rhode Island for the PPE utilizing a peer-reviewed history and physical exam; 2) familiarize HCPs with the 2010 PPE monograph, with emphasis on the cardiovascular and musculoskeletal (MSK) systems; 3) encourage HCPs to treat the PPE as a separate entity from the annual wellness visit; 4) engage HCPs and sports medicine providers in Rhode Island to improve the quality and process of evaluating adolescent athletes for sports participation. [ABSTRACT FROM AUTHOR]

Concussions are common injuries with increasing diagnostic incidence. The 4th International Conference on Concussion in Sport, held in November 2012 in Zurich, revised consensus statements regarding the definition of a concussion, diagnostic criteria, and management. Return-to-play guidelines require a graded return to activity in which concussed athletes remain symptom-free. In order to improve awareness pertaining to concussion diagnosis and management, legislation has now been enacted in all fifty states. Rhode Island enacted into law the School and Youth Programs Concussion Act in 2010, which increases awareness of concussions for athletes, coaches, teachers, school nurses and parents/guardians through written information and mandatory training for coaches. Athletes must be removed from practice/competition and cannot return until a physician has evaluated and cleared them. [ABSTRACT FROM AUTHOR]

Shoulder and elbow injuries in the adolescent population can be generally divided into skeletally immature and skeletally mature. Skeletally immature injuries refer to damage to the open growth plate (physis) in the young athlete, which have distinct differences in longterm risks if not managed correctly due to the potential for growth disturbance. Skeletally mature injuries occur in athletes with closed growth plates and are less likely to limit growth potential. It is important to recognize these different types of injuries, as well as the patients most at risk for each type because treatment may vary significantly between the two groups. The main skeletally immature injuries covered by this review will include: medial epicondyle apophysitis (“Little Leaguer’s elbow), medial epicondyle fractures, olecranon stress fractures, capitellar osteochondritis dissecans (OCD), and proximal humeral apophysitis (“Little Leaguer’s shoulder”). The skeletally mature injuries discussed will include: valgus extension overload syndrome (VEOS), ulnar collateral ligament (UCL) tear, shoulder instability, and superior labral anterior-posterior (SLAP) tears. we will review the history and presentation of the injuries as well as different treatment strategies and return to play guidelines for both primary care sports physicians as well as orthopedic surgeons. [ABSTRACT FROM AUTHOR]

Shoulder and elbow injuries in the adolescent population can be generally divided into skeletally immature and skeletally mature. Skeletally immature injuries refer to damage to the open growth plate (physis) in the young athlete, which have distinct differences in long-term risks if not managed correctly due to the potential for growth disturbance. Skeletally mature injuries occur in athletes with closed growth plates and are less likely to limit growth potential. It is important to recognize these different types of injuries, as well as the patients most at risk for each type because treatment may vary significantly between the two groups. The main skeletally immature injuries covered by this review will include: medial epicondyle apophysitis ("Little Leaguer's elbow), medial epicondyle fractures, olecranon stress fractures, capitellar osteochondritis dissecans (OCD), and proximal humeral apophysitis ("Little Leaguer's shoulder"). The skeletally mature injuries discussed will include: valgus extension overload syndrome (VEOS), ulnar collateral ligament (UCL) tear, shoulder instability, and superior labral anterior-posterior (SLAP) tears. We will review the history and presentation of the injuries as well as different treatment strategies and return to play guidelines for both primary care sports physicians as well as orthopedic surgeons.

Bone stress injuries occur when forces applied to a bone for an extended period exceed the ability of the bone to adequately remodel. These injuries, which range from stress reactions to nondisplaced and even displaced fractures, most often affect people who experience high levels of repetitive stress and loading in the lower extremity or changes in physical activity level. For example, stress fractures are common in endurance athletes, in athletes engaged in preseason and early-season conditioning, and in military recruits. In the military, these injuries are most often encountered during basic training, when new recruits undergo the rigors of intense physical activity to which they may not be accustomed. Female athletes and athletes with poor nutritional status are at elevated risk for injury. Bone stress injuries are difficult to diagnose with radiographs alone. Making the correct diagnosis may require a combination of physical examination, advanced imaging, and an index of suspicion. Differences in injury location account for variations in risk for nonunion, displacement, and other complications. For low-risk injuries, treatment typically consists of reduced weight-bearing for several weeks with gradual return to activity. Higher-risk injuries need to be closely monitored for progression and may require operative intervention. Even after surgery, some types of stress fractures may take several months to achieve radiographic union. In addition, underlying nutritional or metabolic deficiencies may need to be treated to prevent future injuries. In this article, we review the diagnosis, management, and prevention of bone stress injuries with a focus on more serious manifestations, such as stress fracture., Competing Interests: Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.