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Objectives: The public health opioid abuse epidemic has led to nationwide interest in judicious use and close monitoring of opioid pain medication. Knee arthroscopy(KA) and anterior cruciate ligament reconstruction(ACLR) are common procedures in adolescent patients for which narcotics have been historically utilized for post-operative pain management. The purpose of this study is to investigate pain management strategies following basic KA or ACLR by pediatric sports surgeons who contribute to a multi-center quality improvement initiative(SCORE). Methods: Surgeon participants in SCORE represent fifteen U.S. institutions from primarily academic teaching hospitals who specialize in pediatric sports medicine. Surgeons contribute all ACLR and other KA-related cases. A RedCap survey was distributed to all SCORE surgeon participants in December 2019. A KA (defined as a knee arthroscopy that does not include a ligament reconstruction or a cartilage procedure other than chondroplasty) represented a less invasive procedure, while the ACLR represented a more invasive procedure. Survey results were collected and analyzed for both practice patterns of regional anesthesia utilization and post-operative narcotic prescribing volumes. Results: Twenty-eight SCORE surgeon participants completed the survey, a 100% response rate. A planned prescription of a mean of 16.4 pain pills (range 0-40 pills) were reported for pain management following a KA, only 32.1% of surgeons reported adjunctive regional anesthesia techniques for this procedure in addition to general anesthesia. Following an ACLR, surgeons reported a planned prescription of a mean 23.8 pain pills (range 0-40 pills) and most (92.3%) reported utilization of regional anesthesia for their peri-operative analgesia strategy. Of those using adjunctive regional anesthesia, significant variability was reported: 30.7% reported indwelling catheter placement for peripheral nerve block following ACLR as opposed to a single shot injection method, and several block locations were reported to be utilized of which adductor canal (67.9%) block was the most common (see Figure 1). For both procedure types, variability in multi-modal pain management was noted, with incomplete adoption of the use of additional non-narcotic medication (acetaminophen, 64.2%; and NSAIDS, 75%). Cryotherapy devices were applied/prescribed in 75.0% of knee arthroscopy procedures and 92.8% of ACLR. Conclusions: Despite evidence for effective adjunctive pain management strategies, incomplete adoption of multi-modal techniques and reliance on narcotic medication remains a significant component of pediatric sports surgical practice; with on average > 15 pills prescribed following these procedures. Opportunities for reducing practice variability, adoption of multi-modal analgesia strategies, and decreasing post-operative narcotic use following common adolescent knee procedures exist for this subset of pediatric sports medicine specialists

Background: Pediatric physical inactivity is a major public health concern. According to the 2017 State of Play report, only 24% of youth meet the recommended physical activity (PA) dosage. Previous studies identified fundamental movement skill (FMS) proficiency as a predictor of physical literacy and PA. Mastery of FMS requires direct instruction and practice; however, it is unknown how well FMS are implemented in physical education (PE). Hypothesis/Purpose: To describe FMS practice patterns in the elementary PE curriculum. We had two hypotheses: 1) Fewer PE teachers provide comprehensive FMS instruction in later curriculum (grades 4-6) compared to early curriculum (grades 1-3) and 2) Fewer PE teachers teach FMS with direct instruction methods in later curriculum compared to early curriculum. Methods: A cross sectional survey design was used. PE teachers (grades 1-6) were recruited via electronic mail from various U.S. regions from January 2018 to March 2019. An electronic questionnaire was developed to ask about timing of FMS teaching and method of instruction. Additional questions were asked about methods used to evaluate FMS proficiency, including use of a standardized assessment of gross motor development, referrals and remediation recommended for children who appeared to be falling behind, and perceived barriers to FMS instruction. Chi-square tests (pResults: We collected 87 responses with approximately 9% from West, 42% from Midwest, and 49% from South regions. Among all responses, 54% of PE teachers taught all FMS and 40% taught all FMS with direct instruction. Approximately, 66 % taught all FMS for grades 1-3 compared to 42% for grades 4-6 (pConclusion: Results suggests that fewer PE teachers teach all FMS in late elementary PE curriculum compared to early curriculum. Additionally, fewer teachers utilize direct instruction methods to teach skills in late elementary curriculum. With time reported as the greatest barrier, a more efficient screening tool to evaluate FMS competency may be needed.

Background: Three dimensional (3D) motion analysis is considered the “gold standard” for evaluating human movements. However, its clinical utility is limited due to cost, operating expertise and lengthy post-processing time. Numerous qualitative scoring systems, using videos, have been introduced to assess trunk and lower extremity (LE) alignment in dynamic maneuvers. However, it is unknown if a qualitative scoring system is a reliable method to evaluate cutting movement. Hypothesis/Purpose: To assess the inter-rater and intra-rater reliability of a qualitative scoring system to evaluate trunk and LE alignment during a 45-degree side step cut. The sub-aim was to investigate the effect of interactive peer discussion on inter-rater reliability. Methods: A repeated measures study design was used. Six raters (2 MDs, 2 PTs, and 2 ATs) independently viewed 10 videos, consisting of a 45-degree side step cut performed by adolescent male and female athletes. A clinically established checklist (Figure 1) was given to examine quality of movements. After the 1st round, an interactive peer discussion was held to discuss videos, movement quality, and the checklist. Subsequently, after a 1-week wash out period, a 2nd round of evaluation (examining the same 10 videos) was performed. Following the 2nd round, and a 2-week wash out period, a 3rd round was performed to assess intra-rater reliability. In each round, video sequences were altered in random order to avoid memory bias. Intraclass correlation coefficient (ICC) and their 95% confident intervals (95% CIs) were calculated. Values less than 0.50, between 0.50 and 0.75, between 0.75 and 0.90, and greater than 0.90 were defined as poor, moderate, good and excellent reliability, respectively. Results: Inter-rater reliability for the 1st round was moderate (ICC: 0.565, 95%CIs: 0.074-0.866). Inter-rater reliability for the 2nd round was better, however, was still moderate (ICC: 0.632, 95%CIs: 0.100-0.895). Intra-rater reliability between the 2nd and 3rd round ranged from moderate to excellent (ICC: 0.589-0.910). Conclusion: The results of this study showed moderate inter-rater reliability and moderate to excellent intra-rater reliability of the qualitative checklist. Following the interactive peer discussion, slight improvements in inter-rater reliability were observed. The findings indicate that this checklist may allow clinicians to standardize their assessment of trunk and LE alignment during a cutting task, however, more objective methods to evaluate multiplane movements, such as genu valgum, may be warranted. [Figure: see text]