Background Initial protocols for return to play cardiac testing in young competitive athletes following SARS‐CoV‐2 infection recommended cardiac troponin (cTn) to screen for cardiac involvement. This study aimed to define the diagnostic yield of cTn in athletes undergoing cardiovascular testing following SARS‐CoV‐2 infection. Methods and Results This prospective, observational cohort study from ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) included collegiate athletes who underwent cTn testing as a component of return to play protocols following SARS‐CoV‐2 infection. The cTn values were stratified as undetectable, detectable but within normal limits, and abnormal (>99% percentile). The presence of probable or definite SARS‐CoV‐2 myocardial involvement was compared between those with normal versus abnormal cTn levels. A total of 3184/3685 (86%) athletes in the ORCCA database met the inclusion criteria for this study (age 20±1 years, 32% female athletes, 28% Black race). The median time from SARS‐CoV‐2 diagnosis to cTn testing was 13 days (interquartile range, 11, 18 days). The cTn levels were undetectable in 2942 athletes (92%), detectable but within normal limits in 210 athletes (7%), and abnormal in 32 athletes (1%). Of the 32 athletes with abnormal cTn testing, 19/32 (59%) underwent cardiac magnetic resonance imaging, 30/32 (94%) underwent transthoracic echocardiography, and 1/32 (3%) did not have cardiac imaging. One athlete with abnormal troponin met the criteria for definite or probable SARS‐CoV‐2 myocardial involvement. In the total cohort, 21/3184 (0.7%) had SARS‐CoV‐2 myocardial involvement, among whom 20/21 (95%) had normal troponin testing. Conclusions Abnormal cTn during routine return to play cardiac screening among competitive athletes following SARS‐CoV‐2 infection appears to have limited diagnostic utility.

Musculoskeletal issues account for 8% of chief complaints in the pediatric outpatient setting, making the subject of particular interest to pediatricians. This chapter reviews the spectrum of musculoskeletal issues seen in the pediatric population. The spectrum of pediatric pathology ranges from congenital issues such as clubfoot, acquired pathology such as scoliosis, and activity-related complaints such as patellofemoral pain syndrome. Sports medicine is a concurrently rapidly evolving field, investigating numerous pathologies unique to active individuals. With 69% of youth participating in team or individual sports on a regular basis, a thorough understanding of the medical care of active youth is essential. The chapter reviews key sports-related topics, including preparticipation screening examinations, sport-related concussion, exercise-induced bronchospasm, and much more.

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HISTORY:A 49 yo active female ICU nurse who enjoys hiking presented with right achy knee pain that hadstarted 6 months prior, but worsened 3 months ago when she twisted her knee playing with her nephewin the pool. The pain was worse with prolonged time on her feet preventing her from exercising andimpacting her ability to work, particularly running to code blues. She also noted pain in her distal thighand intermittent swelling with increase in venous distension. PHYSICAL EXAMINATION: Right Knee examAppearance: No skin abnormalities. Mild varum deformity. Small effusion. Gait: Antalgic Palpation: Lateral joint line tenderness to palpation Range of motion: Normal range of motion, pain with flexion. Meniscal testing: Positive McMurray's, Thessaly, and bounce test. Ligament testing: Negative Lachman's, anterior drawer, posterior drawer. Pain but no laxity with varusstress at 30 degrees. Patellar testing: Positive inhibition Strength/Function: 5-/5 quadriceps strength DIFFERENTIAL DIAGNOSIS: 1. Meniscal tear 2. Venous thromboembolism 3. Malignancy 4. Osteoarthritis TESTS/RESULTS: XR 3V Right Knee:There are small spurs along the lateral and patellofemoral compartment. The joint spaces are normal.There is a small right effusion. There is a 2.4 cm focus of ill-defined sclerosis in the distal femoral shaft.This was not evident on the comparison study. MRI Right Knee without Contrast:There is a distal femoral metaphyseal lesion with chondroid matrix measuring 28 mm. There is a 2 mmextraosseous component anteriorly at the prefemoral fat pad.There is a T2 hyperintense focus in the proximal fibula which may represent a intraosseous ganglionversus an additional small cartilaginous lesion. FINAL DIAGNOSIS: Chondrosarcoma of the femur TREATMENT/OUTCOMES:The patient was referred to Orthopedic Oncology. Follow-up CT scan of the femur and chest showed nometastasis. The patient's case was reviewed with the medical tumor board and she was scheduled fordistal femur replacement.

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