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Background: Impairments in balance or postural control are common following sport-related concussion (SRC). The Balance Error Scoring System (BESS) is widely utilized to assess static postural stability, but laboratory-based balance measures have been shown to more accurately detect changes in postural control. Hypothesis/Purpose: To determine whether postural control improved between presentation to the sports medicine clinic and return-to-sport (RTS) initiation, and whether this trend mirrored symptom scores and cognitive performance. A secondary aim was to assess whether changes in postural control were more accurately captured with center of pressure (COP) based measures compared to BESS. Methods: Patients diagnosed with a SRC were tested within 10 days of presentation (V0) and when cleared by a physician to begin a RTS protocol (V1). Clinical measures included Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and the King-Devick (K-D) test. The BESS was performed with eyes closed while standing barefoot on a force platform for 6 conditions: double-limb stance, single-limb stance, and tandem stance on both firm and foam surfaces. BESS scores and total balance time were recorded for each condition, and COP-based measures were computed for both double-limb stance conditions (Table 1). Sample entropy was computed to quantify COP regularity over time with increased values indicating improvement in postural control. Wilcoxon signed-rank tests were performed to determine significance between visits (α <0.05). Results: Forty patients (17 males, 13.8±2.0 years) were included for analysis. ImPACT verbal and visual memory scores improved by 10% and 12%, respectively, total symptom score decreased (V0 18.03±13.85, V1 0.97±2.08; p <0.01), and visual motor speed and reaction time were both 11% faster on the K-D test. For postural control, the BESS indicated significant improvement given the reduction in errors on both surfaces (Firm Total: V0 3.23±2.09, V1 2.25±2.11, p =0.01; Foam Total: V0 7.38±2.05, V1 6.08±1.76, p <0.01; Table 1). Similarly, COP-based measures exhibited better overall balance between visits (Figure 1), primarily in the medial-lateral direction on the firm and the anterior-posterior direction on the foam. Lastly, sample entropy improved between visits, indicating more effective postural control. Conclusion: Significant improvement in postural control was observed during the recovery period which mirrored improvement in symptom scores and cognitive performance. Additionally, while COP-based measures showed similar trends to the BESS, they provided more detailed information in regards to balance recovery. Specifically, findings from the double stance condition highlight the utility of a more advanced assessment of postural control for determining RTS readiness following a SRC. Table 1. COP-based measures of balance performance at diagnosis (V0) and clearance (V1) visits Figure 1. Representative stabilograms of double stance balance on firm and foam surfaces at diagnosis (V0) and clearance visits (V1) [ABSTRACT FROM AUTHOR]

Background: CDC and AAP guidelines discourage routine neuroimaging following concussion, as CT scans are only indicated if severe intracranial injury is suspected. Validated prediction rules such as Pediatric Emergency Care Applied Research Network (PECARN) criteria have decreased the number of unnecessary pediatric head CTs; however, are still commonly performed following pediatric sport-related concussion (SRC). Hypothesis/Purpose: To determine differences in injury characteristics and outcomes in athletes who did and did not undergo head CT following SRC. Methods: Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015-May 2021. Participants aged 5-18 diagnosed with SRC and presenting within 30 days were included. Participants were separated into 2 groups based on whether they had a CT scan following SRC: CT (negative scan) and no CT. Positive CTs were excluded. Groups were matched in age and time to presentation (≤14, >14-30 days). Demographics, concussion-related details, and 3-month outcome variables were analyzed including days to symptom resolution (≤30 vs >30 days) and return-to-play (RTP). Results: 324 participants were included: 162 in each group. There were no significant differences between the groups in sex, race, ethnicity, or previous concussion history. Differences in injury-related characteristics are reported in Table 1. Participants in the CT group were more likely to be participating in unorganized events (p=0.05), and less likely to continue playing following SRC (p=0.003) than the no CT group. The CT group more frequently reported head to surface mechanism of injury than the no CT group. Significantly higher rates of loss of consciousness (LOC), amnesia, and vomiting following SRC were reported in the CT group. At 3-months post-SRC, the no CT group reported RTP a week sooner than the CT group (28.8±22.3 vs 35.7±27.3 days, p=0.019). However, there was no difference in prolonged recovery (>30 days: 29.6 vs 40.5%, p=0.07) or overall RTP rates (91.9 vs 85.8%, p=0.09) between the no CT and CT groups. Conclusion: Pediatric athletes who underwent CT following SRC exhibited significantly different injury-related characteristics compared to those who did not, but the differences observed did not impact symptom resolution or return-to-play. While LOC and vomiting differences align with the PECARN prediction rules and likely contribute to decision to perform CT, the additional differences of participating in an unorganized event, head-to-surface impact, and amnesia are not part of PECARN criteria. Further research is needed to discover which variables may contribute to unnecessary head CTs following SRC. Table 1. Injury related characteristics between the CT and no CT scan groups [ABSTRACT FROM AUTHOR]

Background: Recent trends in youth sports demonstrate athletes specializing in a single sport at younger ages in an effort to increase athletic success. Research suggests that increased training volume and early sport specialization are associated with increased injury risk, overuse injury, and athlete burnout. Although the exact threshold to avoid injuries has not been elucidated, some pediatric studies have shown increased risk of overuse injury with training more hours per week than their age in years. Hypothesis/Purpose: To determine if athletes presenting to a pediatric sports medicine clinic are participating in more hours per week than their age in years and associated factors related to sport participation. Methods: Data were prospectively collected from participants who presented to a tertiary sports medicine clinic for injury evaluation between October 2016-May 2021. Participants aged 5-<19 years who reported playing sports and had hours per week in their primary sport documented were included. Demographic and sport-related variables were reviewed. Participants were separated into two groups based on whether number of hours per week in their primary sport exceeded their age: UNDER (chronologic age and under) and OVER. Results: 10,586 total participants: 8846 (83.6%) UNDER and 1740 (16.4%) OVER. There was no difference in age (13.7±2.6 vs 13.6±2.6 years, p=0.27) between the UNDER and OVER group. There were more males (49.7 vs 38.5%, p<0.0001) and more Hispanic or Latinos (20.2 vs 16.4%, p<0.0001) in the UNDER compared to the OVER group. Soccer (23.0%) was the most common primary sport for the UNDER group while gymnastics (27.1%) was for the OVER group. More participants considered themselves single-sport athletes (68.5 vs 54.1%, p<0.0001) and reported their highest level of competition as club/select/travel (52.0 vs 38.2%, p<0.0001) in the OVER group than the UNDER group. The OVER group reported a significantly higher number of sport participation hours per week than the UNDER group (20.5±8.2 vs 6.9±3.7 hours, p<0.0001, Figure 1), an additional year (6.8±3.2 vs 5.6±3.3 years, p<0.0001), and weeks per year participating in their primary sport (41.7±13.4 vs 32.0±15.5 weeks, p<0.0001). Conclusion: About 15% of athletes seen at the sports medicine clinic reported participating in more hours per week than their age. These athletes were more likely to report being single-sport athletes and participating in club-style teams. Understanding this information may aid providers in educating families in the OVER group about potential increased risk for injury due to high weekly participation volumes and sport specialization. Figure 1. Average number of participation hours per week in the OVER compared to the UNDER group [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) injuries are among the most common knee injuries in pediatric athletes. While much of the literature focuses on partial or complete tear of the ligament, there is little information on low-grade ACL sprains in either the adult or pediatric literature. Purpose: This study seeks to provide an analysis of grade 1 pediatric ACL sprains investigating injury characteristics, and report trends in management and outcomes. Methods: A retrospective review of patients, aged 8-19 years, presenting to a sports medicine clinic with a knee injury between January 2014-February 2021 was performed. Electronic medical records were queried for a diagnosis of low-grade ACL sprain based on radiology (MRI) reports that identified the injury. Charts were reviewed to collect data on demographics, sport history, injury details, clinical exam, return to play (RTP), and MRI findings. Descriptive statistics and comparisons within gender, age, and RTP were analyzed. Results: 67 patients were diagnosed with a grade 1 ACL sprain based upon clinical assessment and MRI findings and treated for such. Average age at injury was 14.51±2.46 years (56.72% male), with a mean RTP of 8.77±6.67 weeks from date of diagnosis and 12.57± 8.04 weeks from date of injury. Most frequent activities when injured were soccer (23.88%), football (16.42%), and basketball (14.93%).0 patients underwent ACL surgical treatment; 2 patients underwent surgery for concomitant injuries (both meniscus tears). 55 patients (82.09%) sustained one or more concomitant injuries: bone contusion (50.91%), non-ACL ligamentous injury (30.91%), meniscus injury (25.45%), soft tissue/muscular injury (12.73%), other (31.48%). 23 patients (37.7%) had non-negative Lachman on clinical exam. Successful conservative interventions included therapy (95.45%), bracing (87.88%), and activity restrictions (86.15%). Females were more likely to be injured in their primary sport than males (82.14% vs. 59.46%, p=0.05). Analysis of bone contusion location vs. RTP clearance date was performed. Patients who took longer to RTP (16+ vs <16 weeks) were more likely to also have a lateral femoral condylar (LFC) contusion (75% vs. 16.67%, p=0.05). Conclusion: Given limited literature on the topic, this review provides presentation characteristics and initial RTP correlates for pediatric low-grade ACL sprains. While longer term follow-up is needed as we continue to learn about the injury, the success rate of conservative treatment indicates that therapy, bracing, and activity restrictions may be considered over surgical management for low-grade ACL sprains. [ABSTRACT FROM AUTHOR]