Background: The current coronavirus 2019 (COVID-19) pandemic has prompted a multitude of public health response measures including social distancing, school cancellations, and cessation of organized sports. Purpose: To examine the impact of COVID-19 and corresponding public health measures on the characteristics of common pediatric musculoskeletal injuries associated with sports. Study Design: Cohort study; Level of evidence, 3. Methods: This was a multicenter retrospective cohort study comparing patients with sports injuries presenting to 3 geographically diverse level I pediatric trauma hospitals and outpatient orthopaedic surgery clinics in the United States during the COVID-19 pandemic and a prepandemic period at the same institutions. Patients were included if they presented for care between February 15 and July 15 in 2020 (pandemic cohort) or between March 15 and April 15 in 2018 and 2019 (prepandemic cohort). Results: Included were 1455 patients with an average age of 12.1 ± 4.5 years. When comparing patients presenting in 2018 and 2019 with those presenting in 2020, we observed a decrease in mean age during the pandemic (12.6 ± 4.0 vs 11.0 ± 5.2 years; P = .048). Additionally, a decrease in the proportion of injuries attributed to sports (48.8% vs 33.3%; P < .001) and those occurring at school (11.9% vs 4.0%; P = .001) was observed. The proportion of injuries attributable to clavicle fractures increased during the early stages of the pandemic (13.2% vs 34.7%; P < .001). There was no statistically significant delay to care in injuries presenting during the pandemic (41.5 ± 141.2 vs 19.23 ± 79.1 days; P = .175). Conclusion: Across 3 tertiary care institutions, patients were seen without significant delay during the pandemic. We observed a significant decline in pediatric musculoskeletal injuries associated with sports during the COVID-19 pandemic. This decrease has been accompanied by a shift in both injury type and mechanism.

Background: Isolated pediatric lateral ankle injuries, including ankle sprain (AS) and nondisplaced Salter-Harris type 1 (SH-1) distal fibular fracture, are common orthopaedic sports-related injuries. Variability in treatment is suspected among pediatric orthopaedic surgeons. Complications from medical treatment or lack thereof have not been reported in this population. Purpose: The purpose of this study was to investigate treatment variability and associated complications after pediatric AS and SH-1 via a survey of members of the Pediatric Orthopaedic Society of North American (POSNA). Study Design: Cross-sectional study. Level of evidence, 5. Methods: A voluntary, anonymous survey was distributed to POSNA membership (approximately 1400 members) via email. Survey questions, specific to both grade 1 or 2 AS and nondisplaced or minimally displaced SH-1 injuries in skeletally immature patients, focused on initial evaluation, immobilization, return to sports, and complications. We analyzed variability both in treatment between AS and SH-1 injury and in respondent characteristics. For statistical analysis, chi-square or Fisher exact test was used for categorical variables, and analysis of variance was used for continuous variables. Results: The survey response rate was 16.4% (229/1400). Of the respondents, 27.7% used examination only to distinguish between AS and SH-1, whereas 18.7% performed serial radiography to aid with diagnosis. A controlled ankle motion boot or walking boot was the most common immobilization technique for both AS (46.3%) and SH-1 (55.6%); the second most common technique was bracing in AS (33.5%) and casting in SH-1 (34.7%). Approximately one-third of all respondents recommended either outpatient or home physical therapy for AS, whereas only 11.4% recommended physical therapy for SH-1 ( P < .01). Results showed that 81.2% of respondents reported no complications for SH-1 treatment and 87.8% reported no complications for AS treatment. Cast complications were reported by 9.6% for SH-1 and 5.2% for AS. Rare SH-1 complications included distal fibular growth arrest, infection, nonunion, late fracture displacement, and recurrent fracture. Conclusion: Significant variability was found in primary treatment of pediatric AS and SH-1 injuries. Rare complications from injury, treatment, and neglected treatment after SH-1 and AS were reported.

Background: Preservation of articular cartilage in the setting of acute or chronic injury in the adolescent and young adult knee is paramount for long-term joint health. Achieving osseous union, minimizing implant-related injury, and eliminating the need for reoperation for traumatic chondral and osteochondral lesions (OCLs) and osteochondritis dissecans (OCD) remain a challenge for the orthopaedic surgeon. Purpose: To evaluate radiographic healing, patient-reported outcomes, and short-term complications after suture-bridge fixation of chondral fragments, osteochondral fractures, and OCD lesions in the knee. Study Design: Case series; Level of evidence, 4. Methods: The study included consecutive patients (38 patients, 40 knees) treated within a single academic sports medicine institution who underwent suture-bridge fixation of an OCL or an OCD lesion of the knee from initiation of the technique in October 2019 through March 2021. The suture-bridge technique entailed bioabsorbable knotless anchors placed on the outside margins of the lesion with multiple strands of hand-tensioned absorbable (No. 0 or No. 1 Vicryl) or nonabsorbable (1.3-mm braided polyester tape) bridging suture. Healing was assessed by radiography and magnetic resonance imaging (MRI), with MRI scans obtained on all OCD lesions and any chondral-only lesions. MRI scans were available for 33 of 40 (82.5%) knees within 1 year of surgery and were evaluated for lesion healing. Complications and rates and timing of return to sport were evaluated. Patient-reported outcomes in the OCD cohort were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) to determine early pain and functional improvement. Results: In total, 33 (82.5%) lesions demonstrated full union, and no lesions failed treatment. MRI assessment of healing (mean, 5.8 months; range, 3-12 months) demonstrated 9 (64.3%) OCD lesions with full union, 5 (35.7%) OCD lesions with stable union, and no OCD lesions with nonunion. Of the OCLs, 17 (89.5%) had full union, 2 (10.5%) had stable union, and none had nonunion. The 7 bony OCLs without an MRI scan demonstrated complete radiographic union. In 30 (75.0%) lesions, patients returned to sports at a mean of 6.5 months (range, 3.8-10.2 months). KOOS Activities of Daily Living, Pain, Quality of Life, and Symptoms scores demonstrated significant improvement from baseline at 6 months and at 1 year. There were 2 (5%) complications, consisting of reoperation for marginal chondroplasty on an otherwise stable lesion, and re-operation for intial un-treated patellar instability, with no reoperations for failure or revision of the suture-bridge construct. Conclusion: In this series of OCLs and OCD lesions of the knee, suture-bridge fixation demonstrated excellent rates of MRI and radiographic union and good early outcomes with minimal short-term complications. This technique may be used for lesion salvage as an alternative to metallic and nonmetallic screw/tack constructs in the treatment of these challenging lesions. Longer term follow-up and investigation are warranted.

In-person sport participation was suspended across the United States in the spring of 2020 to slow the spread of the novel coronavirus (COVID-19). The purpose of this study was to survey the impact of COVID-19 on young athletes during a period of social and organized sports restrictions. An anonymous cross-sectional survey study was conducted of youth athletes in the midst of social distancing mandates and consisted of six components: demographics, sport participation, changes in sport-related goals/aspirations, sleep habits, and measures of anxiety and depression. 711 individuals who accessed the survey link yielded 575 (81%) participants with responses available for analysis. All respondents (aged 13.0 years) played organized sports, 62% were single-sport athletes, and 74% considered high-level. Participants were training ∼3.3 h less per week, spending more time outside, and 86% of participants continued to train while social distancing. Sleep duration increased (∼1.2 h/night) and sleep quality improved in 29% of young athletes. Additionally, 22% and 28% reported PROMIS® anxiety and depression scores characterized as ‘mild’, ‘moderate’, or ‘severe’. Older single-sport participants reported higher depression scores, while higher anxiety scores were seen in female participants with fewer years played. 10% of young athletes and 20% of teenagers changed their sports-related goals. Training style modifications, decreased training, and increased sleep quantity and quality were positive effects of COVID-19 restrictions, while athletic aspirational changes were undesirable effects. Single-sport athletes may be at greater risk for psychological symptoms when their routine is altered.

Objectives: Preservation of articular cartilage in the setting of acute or chronic injury in the knee is paramount for long-term joint health. Achieving osseous union, minimizing implant related injury, and eliminating the need for reoperation for osteochondral fracture lesions (OCL) and osteochondritis dissecans (OCD) remain a challenge for the orthopedic surgeon. To evaluate osseous and chondral integration following a suture and non-metallic anchor (suture-bridge) construct utilizing magnetic resonance imaging (MRI). A secondary purpose was to assess the outcomes and short-term complications of suture bridge fixation of OCL and OCD in the knee. Methods: Consecutive patients (n=39, 41 knees) treated within a single academic sports medicine institution who underwent suture-bridge fixation of an OCL or OCD of the knee from initiation of the technique in 10/2019 through 03/2021 were reviewed with IRB approval. The suture-bridge technique employed 1.5 or2.9mm bioabsorbable knotless anchors (avg n= 3.93; 3-6) placed on the outside margins of the lesion with multiple strands (2-8) of hand-tensioned absorbable (87.5%; #0 or #1Vicryl) or non-absorbable (2-0 braided polyester) bridging suture. A minimum of six months follow up to assess bony union was required for inclusion, resulting in 40 knees in 38 patients available for study. Demographics, pre-operative MRI lesion characteristics, including lesion type (OCL vs OCD), presence of bone in within the fragment, size, and location, were documented. Healing was assessed by radiographs and MRI, with MRI obtained on all OCDs and any chondral-only OCL lesions. MRI was available on 33/40 (82.5%) knees within one year of surgery and was rated for lesion healing: Full Union = 100% cancellous or cancellous-chondral lesion continuity, Stable Union = >50% continuity with some fibrous tissue present, Un-united = < 50% continuity and extensive fibrous signal or fluid below the lesion. Complications, and rates and timing of return to sport (RTS) were evaluated. For assessment of early pain and functional improvement in the setting of isolated osteochondral treatment (without confounding concurrent patellar instability, or other treatment in conjunction with OCL), KOOS patient reported outcomes were analyzed in the OCD cohort at 6 and 12 months. Results: 33 (82.5%) of all lesions demonstrated Full Union and no lesions failed treatment. MRI assessment of healing (5.8 months; 3-12 months) demonstrated 9 (64.3%) OCDs with Full union, 5 (35.7%) OCDs with Stable union, and none un-united (Figure 1); while OCLs demonstrated 17 (89.5%) with Full union, 2 (10.5%) with Stable union, and none un-united. (Figure 2) All 7 bony OCL without an MRI demonstrated radiographic union. 30 (75%) lesions returned to sports at an average of 6.5 months (3.8-10.2). KOOS Daily Living, Pain, Quality of Life, and Symptom scores all demonstrated significant improvement from baseline at 6months and 1 year. (Table 2). There were 2 (5%) complications consisting of re-operation for marginal chondroplasty on otherwise stable lesions, and no re-operations for failure or revision of the suture-bridge construct. Conclusions: In this series of OCL and OCD of the knee, suture-bridge fixation demonstrates excellent rates of MRI and radiographic union and good early outcomes with minimal short-term complications. This technique may be utilized for lesion salvage as preferred over loose body removal and marrow-stimulation and may have significant benefits in comparison to metallic and non-metallic screw/tack constructs in the treatment of these challenging lesions. Longer term follow-up and investigation is warranted. UPLOAD- https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/96288f30-99be-431a-9937-0218d3245043/1/Suture_Bridge_AbstractAOSSMFinalfigures.docx