Faculty Bibliography

The participation of females in sports has increased significantly since the passage of Title IX. Sports participation may place young athletes at risk for knee injuries, including patellofemoral pain syndrome (PFPS), osteochondritis dissecans (OCD), and anterior cruciate ligament (ACL) rupture. Differences in anatomy, hormone production, and neuromuscular patterns between female and male athletes can contribute to disparities in knee injury rates with female athletes more vulnerable to PFPS and ACL injury. Biological differences between sexes alone cannot fully explain worldwide differences in musculoskeletal health outcomes. Social, cultural and societal attitudes toward gender and the participation of girls and women in sports may result in a lack of accessible training for both injury prevention and performance optimization; one must recognize the effects of gender disparities on injury risk. More nuanced approaches to assess the complex interplay among biological, physiologic, and social influences are needed to inform best practices for intervention and sports injury prevention.

Disparities persist in pediatric sports medicine along the lines of race, ethnicity, insurance status, and other demographic factors. In the context of knee injuries such as anterior cruciate ligament (ACL) ruptures, meniscus tears, and tibial spine fractures, these inequalities affect evaluation, treatment, and outcomes. The long-term effects can be far-reaching, including sports and physical activity participation, comorbid chronic disease, and socio-emotional health. Further research is needed to more concretely identify the etiology of these disparities so that effective, equitable care is provided for all children.

CONTEXT/UNASSIGNED:With the current Centers for Disease Control and Prevention recommendations for mask use to minimize transmission of coronavirus 2019 (COVID-19) coupled with concern for future pandemics that would require mask wearing, providing data-driven guidance with respect to athletic performance is essential. OBJECTIVE/UNASSIGNED:The purpose of this study was to perform a systematic review of existing literature on the use of face masks while exercising to assess the physiologic effects of face masks worn during athletic activities. DATA SOURCES/UNASSIGNED:A systematic review was conducted of studies on face mask use during exercise according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Potential studies were identified through searches of MEDLINE, Embase, Cochrane CENTRAL and CINAHL databases. STUDY SELECTION/UNASSIGNED:Screening was completed independently by 2 coauthors who sought to identify studies that described the effects of oronasal mask use, if any, on sports/exercise/physical activity, for any age, gender, or level of sport. Articles describing mask effects without exercise, articles published before 1980, and non-English language studies were excluded. STUDY DESIGN/UNASSIGNED:Systematic review. LEVEL OF EVIDENCE/UNASSIGNED:Level 3. DATA EXTRACTION/UNASSIGNED:Data extraction focused on physiologic parameters measured during physical activity performed while wearing a face mask. RESULTS/UNASSIGNED:Twenty-two articles met all inclusion criteria. Study analysis revealed that the use of masks in healthy volunteers during exercise had no significant effect on physiologic parameters measured including heart rate (HR), respiratory rate (RR), oxygen saturation, and perceived exertion. Of the studies that investigated N95 masks in the healthy adult population, 2 reported modest changes in RR and maximum power output indicative of decreased athletic performance when subjects were exercising at maximum effort. Similar findings were seen in studies of subpopulations including children and pregnant women. CONCLUSION/UNASSIGNED:Available data suggest that healthy individuals can perform moderate-to-vigorous exercise while wearing a face mask without experiencing changes in HR, RR, and oxygen saturation that would compromise individual safety or athletic performance. In the specific situation in which an N95 mask is worn, maximum power generated may be impaired. WHAT IS KNOWN ABOUT THE SUBJECT/UNASSIGNED:To date, there has been no systematic review of the existing literature to provide a clear consensus on whether face mask use significantly impacts athletic performance. Mask use has been demonstrated safe in the workplace; however, the use of face masks during exercise has not been examined on a large scale, particularly with respect to physiologic parameters. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE/UNASSIGNED:This analysis highlights that available data suggest that healthy individuals can perform heavy exercise in face masks with minimal physiologic changes. This is the first systematic review of studies analyzing exercise use wearing masks. With the evidence presented here commonly cited concerns about both safety and performance decrements with mask use during physical activities may be allayed.

BACKGROUND/UNASSIGNED:In addition to the familiar sports-related injuries and conditions experienced by cisgender athletes, transgender athletes may also face unique challenges to maintaining their musculoskeletal health. Encouraging sports medicine professionals to become familiar with accepted nomenclature and terminology related to transgender athletes will enable open communication on the field, in the athletic training facility, and office. OBJECTIVE/UNASSIGNED:Understanding contemporary medical and surgical gender-affirming treatments and the unique ways in which the musculoskeletal system might be affected by each - such as impairments in bone health, changes in ligamentous function and the potential increased risk for deep venous thromboembolism - is essential for provision of optimal musculoskeletal care to transgender athletes. Knowledge of the existing participation policies for transgender athletes is also key for enabling sports medicine professionals to effectively counsel athletes about the need for specialized protective equipment. Additionally, this knowledge is important for appropriately managing therapeutic use exemptions in the competitive sports setting. CONCLUSION/UNASSIGNED:This article provides an overview of the current accepted nomenclature, common gender-affirming medical and surgical treatments, unique musculoskeletal health considerations, and participation policies for transgender athletes.

OBJECTIVE/UNASSIGNED:Studies have shown a high prevalence of femoroacetabular impingement (FAI) among elite athletes yet there is a paucity of data on FAI in Nordic skiers. The purpose of this study was to determine the prevalence of radiographic FAI in professional Nordic Combined Skiers and Ski jumpers compared to controls and assess functional outcomes including hip range of motion (ROM) and pain in patients with radiographic evidence of FAI compared to those without it. METHODS/UNASSIGNED:A cohort of elite Nordic Skiers underwent medical history, physical examination, and pelvic radiographs at their visit with a fellowship-trained sports medicine physician. On pelvis radiographs, Alpha angle>55 degrees was deemed cam-positive, and positive crossover signs, Tönnis<0, or LCEA>40 were deemed pincer positive. Further stratification was performed by sex, ski event type, hip pain, presence of cam lesions, and presence of pincer lesions. Spearman correlation matrix was performed to measure the association between radiographic measurements and ROM. RESULTS/UNASSIGNED:Nineteen Nordic skiers and nineteen age, sex, and BMI matched controls were included in the study. There were no significant differences in age, sex, BMI, and hip pain between groups. While Nordic skiers demonstrated decreased ROM bilaterally on external rotation compared to controls, skiers had larger ROM bilaterally on extension, abduction, adduction compared to controls. Skiers were significantly more likely to have bilateral crossover sign and alpha angles>55 compared to controls. Subgroup analysis showed that Cam positive patients had higher flexion and adduction ROM and pincer positive patients had significantly higher flexion and abduction ROM compared to patients without cam and pincer lesions respectively. Patients with hip pain had significantly lower right hip abduction ROM compared to patients without hip pain. No significant correlations were seen between radiographic measurements and ROM. CONCLUSION/UNASSIGNED:Similar to other elite 'hip heavy' sport athletes, Nordic skiers gave a notably higher prevalence of radiographic cam and pincer type morphology and significantly higher ROM compared to nonathletic controls. Clinicians evaluating Nordic skiers should be aware of these baseline findings with respect to a possible elevated long-term risk of symptomatic FAI in these athletes as well as other conditions related to radiographic FAI.

For many females, sports bras are an essential piece of equipment for participation in sports and physical activity. Breast pain or discomfort from lack of support may be a contributing factor to the noted gender disparity in physical activity of females compared to males. Our objective was to evaluate sports bra usage and characterize sports bra preferences of an active female cohort. This multicenter cross-sectional survey study was conducted at five geographically distinct academic centers. Our measure was administered during outpatient sports medicine clinic visits to females aged 11-64 years old. Chi-square tests were used to compare characteristics across subgroups. Our analysis consisted of 438 respondents, with a mean age of 22 ± 12.2 years. More than a quarter (27.4%) reported lack of breast support prevented them from being active or exercising. Age (p = 0.03), breast size (p < 0.0001), and household income (p = 0.01) were significantly associated with greater frequency of physical activity being limited by lack of breast support. Lack of breast support may be an important barrier for young females of specific populations to meeting physical activity recommendations. Further research is needed to improve the understanding of this important piece of sporting equipment for women.

The widespread shutdown in response to the coronavirus disease 2019 (COVID-19) pandemic, although varied across state and county levels, has undoubtedly impacted everyone to some degree. Within the pediatric population, the closure of schools and organized youth athletic programs has resulted in a unique situation that has made athletes physically deconditioned and at risk for injury. As sports and competition gradually restart, there are considerable risks to the skeletally immature athlete. The anatomic and physiologic changes that occur to bone and cartilage during growth make the young athlete particularly susceptible to both acute and overuse injuries. In the context of the pandemic, deconditioning, obesity, lack of variety, and the resultant mental health burden pose unique challenges in ensuring that young athletes safely return to the field. This review aims to identify risk factors for sport-related injuries and to outline strategies for minimizing these injuries as pediatric patients return-to-play after COVID-19. [Pediatr Ann. 2021;50(11):e465-e469.].

The increase in athletic participation of girls and women over the last half-century has brought into focus the need to better understand the psychology of female athletes. This review explores various non-physical factors that contribute to athletic success, such as resilience, mindfulness and sleep. The role of anxiety and depression in sport-related injury is another key issue that those invested in an athlete"™s training must be able to recognize and manage. Additionally, disordered eating and the harmful effects of social media affect females differently and at a higher rate than their male counterparts. Lastly, understanding how the female athlete views injury and recovery may allow us to successfully return injured athletes to sport. The goal of this article is to provide an overview of how a female athlete"™s mental and emotional well-being affect her athletic performance, injury risk and recovery following sports-related injury.

There is little written in the orthopaedic literature regarding common musculoskeletal problems that women encounter in relation to pregnancy and their clinical and surgical management. Exercise and other physical activity are generally recommended for most women before, during, and after pregnancy. Unfortunately, a variety of musculoskeletal issues may keep women from starting, continuing, or resuming a healthy exercise regimen throughout a notable portion of their reproductive years. Untreated and undertreated orthopaedic conditions in female athletes may therefore have further unintended negative effects on maternal and fetal health. This article reviews the existing literature on musculoskeletal health considerations before, during, and after pregnancy to provide practical information to orthopaedic surgeons who treat women of all ages and athletic abilities.

BACKGROUND:Early year-round training in a single sport has been associated with high rates of overuse injuries. Despite this increasingly well-known risk of early sport specialization, many young athletes elect to specialize in a single sport due to the perception that this practice gives them the best chance of attaining elite athletic status. However, early specialization in women's ice hockey has not previously been shown to be reliably associated with attainment of elite levels of performance. We hypothesized that professional women's ice hockey players specialize in mid-adolescence, at an age comparable to their male counterparts. METHODS:An anonymous survey was given to members of two National Women's Hockey League teams. The athletes were asked how many years they have been playing hockey, at what age they began playing only hockey on a year-round basis, how many sports they played in addition to hockey, and if they felt that playing multiple sports while growing up positively affected their hockey careers. RESULTS:Fifty-four players completed the survey. The players reported playing hockey for an average of 19.4 ± 3.4 years. They began specializing in ice hockey at an average of 16.1 ± 3.3 years of age, 2 years later than previously reported in male NHL and NCAA athletes. Before specializing in hockey, players played an average of 3.5 ± 1.4 other sports. Ninetyone percent of players reported feeling as though playing other sports positively affected their hockey career.