Three-Dimensional Morphometric Characterization of Femoral Cam Lesions: Quantifying the Radial and Lateral Extents.

OBJECTIVE: To quantify the radial and lateral extents of femoral cam lesions in FAI patients relative to the alpha angle and correlate with clinical data. METHODS: Retrospective study of 81 hips with femoral cam morphology that underwent arthroscopic surgery between 2017 and 2019. At each hour over the clockface, the alpha angle (α) (abnormal defined as > 55°), radial extent, and lateral extent of cam lesions were measured on CT. These measurements were correlated with clinical and arthroscopic data. Statistics included independent samples t-test and chi-squared test with Bonferroni correction and multivariate logistic regression. RESULTS: Larger α at 12:00-4:00 in males vs females (56.6-63.4° vs 44.3-58.5°, P < 0.001) and at 2:00-4:00 with elite sports participation vs without (56.7-70.9° vs 49.6-61.1°, P ≤ 0.004). Independent risk factors for radial extent beyond 12:00-3:00 were: male sex (OR 4.82, 95% CI [1.46, 15.85], P = 0.010), BMI > 25 (OR 4.74, 95% CI [1.61, 14.00], P = 0.005), and elite sports participation (OR 3.28, 95% CI [1.09, 9.82], P = 0.034). Lateral extent increased at 1:00-4:00 in males vs females (7.8-18.6 mm vs 1.6-9.1 mm, P < 0.0001). A 16% prevalence of distal cam lesions was found at locations with normal α, resulting in underestimation of radial extent by an average of 1.7 hours. CONCLUSION: There is a positive correlation between the alpha angle, lateral extent, and radial extent of cam lesions. FAI patients who were male, participated in elite level sports, and had a BMI > 25 had larger cam lesions. A larger alpha angle is a risk factor for cartilage damage. Patients may have distal cam lesions at locations with normal alpha angles, though their significance is unknown.

An Analysis of Sports Specialization in NCAA Division I Collegiate Athletics.

BACKGROUND: Youth sports specialization has become more prevalent despite consequences such as increased injury rates and burnout. Young athletes, coaches, and parents continue to have misconceptions about the necessity of sports specialization, giving athletes the encouragement to focus on a single sport at a younger age. PURPOSE: To characterize the motivations for specialization and determine when elite athletes in various individual and team sports made the decision to specialize. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A Likert-style survey was developed and distributed to athletes from two National Collegiate Athletic Association (NCAA) Division I institutions. The survey's Flesch-Kincaid grade level was 6.3. Statistical analysis was performed via the Student t test, where a P value less than .05 was considered significant. RESULTS: A total of 303 athletes with a mean ± SD age of 19.9 ± 1.52 years across 19 sports were surveyed; 94.7% of specialized athletes had previously played another organized sport prior to college, and 45% of athletes had played multiple sports up to age 16 years. The mean age of specialization was 14.9 years, with a significant difference between athletes competing in team (15.5 years) and individual (14.0 years) sports (P = .008). Males in individual sports specialized earlier than those in team sports (P ≤ .001). Nearly one-fifth (17.4%) of athletes reported specializing at age 12 years or earlier. Personal interest, skill level, time constraints, and potential scholarships were the most important reasons for specialization overall. For individual sports, the motivations for specialization were similar, but collegiate (P < .001) or professional (P < .001) ambitions were significantly larger contributing factors. CONCLUSION: Early sports specialization is uncommon among NCAA Division I athletes for most team sports, whereas individual sports tend to have athletes who specialize earlier and are more motivated by professional and collegiate goals. This study characterized the timing of specialization among elite athletes, providing a basis for understanding the motivations behind youth sports specialization. Physicians should be prepared to discuss the misconception that early sports specialization is necessary or common among most team-focused collegiate-level athletes. Knowing the motivations for sports specialization will guide clinicians in their discussions with youth athletes.

Epidemiology and Detrimental Impact of Opioid Use in Patients Undergoing Arthroscopic Treatment of Femoroacetabular Impingement Syndrome.

PURPOSE: To determine the prevalence of preoperative opioid use in patients with femoroacetabular impingement (FAI) syndrome and to define how opioid use influences preoperative hip pain and function at a single center. METHODS: Between February 2015 and September 2016, patients undergoing hip arthroscopy at a single Midwest institution for FAI syndrome were retrospectively reviewed. Patients undergoing arthroscopy for non-FAI conditions and those with undocumented preoperative opioid use were excluded. Baseline validated measures (Hip Disability and Osteoarthritis Outcome Score [HOOS] pain and physical function; University of California, Los Angeles, activity scores; Veterans RAND 12 Item Health Survey) of health were collected at the time of surgery. Articular cartilage status was documented at the time of surgery. Opioid use was extracted from the electronic medical record retrospectively, and patients were designated current users, past users, or nonusers. Analysis of variance and 2-tailed Student's t-tests were used to detect differences between groups according to preoperative opioid use, and significance was set to P < .05. RESULTS: During the study period 321 patients underwent arthroscopic hip surgery for FAI and met the inclusion criteria (75 were excluded). Preoperatively, 55 patients (17%) were current opioid users, 89 (28%) were past users (not within 3 months of surgery), and 177 (55%) were opioid naive. Current opioid use was associated with significantly worse measures of joint and general health including HOOS-Pain (15.3 point difference, P < .001), HOOS-Physical Function (13.6 point difference, P < .001), University of California, Los Angeles, activity score (1.7 point difference, P < .001), and Veterans RAND 12 Item Health Survey mental component score (5.5 point difference, P < .001). Outerbridge cartilage grading and presence or length of labral tears were not worse in opioid users (P = .2-.61). CONCLUSIONS: Preoperative opioid use is common prior to arthroscopy for FAI and has detrimental impacts on hip pain and function. The present data also suggest cessation of opioid medication for 3 months prior to surgery may have meaningful impacts on baseline measures of hip and general health. LEVEL OF EVIDENCE: Level III, prognostic.

Factors That Drive Youth Specialization.

BACKGROUND: Specialization in young athletes has been linked to overuse injuries, burnout, and decreased satisfaction. Despite continued opposition from the medical community, epidemiological studies suggest the frequency is increasing. HYPOTHESIS: Extrinsic pressures in addition to individual aspirations drive this national trend in sports specialization. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. METHODS: A novel instrument assessing the driving factors behind youth specialization was generated by an interdisciplinary team of medical professionals. Surveys were administered to patients and athletes in the department's sports medicine clinic. RESULTS: The survey was completed by 235 athletes between 7 and 18 years of age, with a mean age of 13.8 ± 3.0 years. Athletes specialized at a mean age of 8.1 years, and 31% of athletes played a single sport while 58% played multiple sports but had a preferred sport. More than 70% of athletes had collegiate or professional ambitions, and 60% played their primary sport for 9 or more months per year, with players who had an injury history more likely to play year-round ( P < 0.01). Approximately one-third of players reported being told by a coach not to participate in other sports, with specialized athletes reporting this significantly more often ( P = 0.04). Half of the athletes reported that sports interfered with their academic performance, with older players stating this more frequently ( P < 0.01). CONCLUSION: Young athletes are increasingly specializing in a single sport before starting high school. While intrinsic drive may identify healthy aspirations, extrinsic influences are prevalent in specialized athletes. CLINICAL RELEVANCE: Extrinsic factors contributing to youth specialization were identified and compounded the deleterious sequelae of youth athlete specialization.

Quantifying Parental Influence on Youth Athlete Specialization: A Survey of Athletes' Parents.

BACKGROUND: Youth athlete specialization has been linked to decreased enjoyment, burnout, and increased injury risk, although the impact of specialization on athletic success is unknown. The extent to which parents exert extrinsic influence on this phenomenon remains unclear. PURPOSE/HYPOTHESIS: The goal of this study was to assess parental influences placed on young athletes to specialize. It was hypothesized that parents generate both direct and indirect pressures on specialized athletes. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A survey tool was designed by an interdisciplinary medical team to evaluate parental influence on youth specialization. Surveys were administered to parents of the senior author's orthopaedic pediatric patients. RESULTS: Of the 211 parents approached, 201 (95.3%) completed the assessment tool. One-third of parents stated that their children played a single sport only, 53.2% had children who played multiple sports but had a favorite sport, and 13.4% had children who balanced their multiple sports equally. Overall, 115 (57.2%) parents hoped for their children to play collegiately or professionally, and 100 (49.7%) parents encouraged their children to specialize in a single sport. Parents of highly specialized and moderately specialized athletes were more likely to report directly influencing their children's specialization (P = .038) and to expect their children to play collegiately or professionally (P = .014). Finally, parents who hired personal trainers for their children were more likely to believe that their children held collegiate or professional aspirations (P = .009). CONCLUSION: Parents influence youth athlete specialization both directly and by investment in elite coaching and personal instruction. Parents of more specialized athletes exert more influence than parents of unspecialized athletes.

Hot Topics in the Multicenter Orthopedics Outcomes Network: Anterior Cruciate Ligament.

Since 2015, the Multicenter Orthopedic Outcomes Network (MOON) has addressed several factors associated with patient outcome after anterior cruciate ligament (ACL) injury. These factors include predictors of high grade knee laxity, the impact of meniscus treatment on joint space narrowing after surgery, graft selection, treating diabetic patients, predictors of clinically significant pain, and outcomes of patients where meniscus tears were left in situ without treatment. The presence of meniscus tears and generalized laxity predict a lax examination under anesthesia prior to surgery. Allograft reconstructions carry a 5.2 times increased risk of re-tear compared to autograft. Patients with diabetes should be counseled they may be at increased risk (odds ratio 18.8) for infection after surgery. Subsequent ipsilateral knee surgery is the strongest predictor of postoperative pain after ACLR. Stable, partial thickness meniscus tears measuring less than 1 cm can be left alone without treatment with low re-operation rates at 6-years.