President's Message

Welcome to the PRiSM Fall 2016 Newsletter! The goal of the newsletters has been to keep the membership informed about PRiSM activities, provide updates on recently published scientific literature related to pediatric sports medicine, and to get everyone excited for the Annual Meeting. I would like to thank Jim MacDonald and Peter Fabricant for editing the newsletter and PRiSM staff member, Jesse Cunningham, for his hard work on the newsletter.

The Annual Meeting is shaping up to be a fantastic opportunity to learn, present research, network, and advance pediatric sports medicine. The scientific program looks great with a mix of original scientific research, relevant reviews and updates, and breakouts. In addition, we will have key guest talks by Jimmy Andrews and Tony Herring, legends in sports medicine and pediatric orthopedics respectively. I want to thank Phil Wilson and John Polousky with their committee for their hard work in organizing such a great conference. Also, special thanks to Texas Scottish Rite Hospital for Children and Andrews Institute for hosting us. If you haven't already, please register for the meeting and book your hotel room today!

My major goal as PRiSM president was to build on the foundation started by the incredible effort of past president, Hank Chambers, by organizing and populating the PRiSM committees, fundraising from industry for financial solvency and eventual research funding, establishing a newsletter, planning for future Annual Meetings, and starting the Research Interest Groups (RIG's).

Of all these goals, the RIG's are particularly important to me. I think they allow an opportunity for PRiSM members to get involved in grassroot research efforts that will lead to advancing the field of pediatric sports medicine. The specific goals of the individual RIG's have been left intentionally open ended. Some may simply allow an opportunity to network and discuss topics of interest, others may lead to surveys or evidence-based medicine quantitative reviews, some may lead to multi-center case series or prospective cohort studies, and some may even lead to grant funding. Thanks to the RIG members, RIG leaders, and the research committee for their efforts. Most RIG's have had conference calls and their activities are summarized in this newsletter. I look forward to hearing their updates in person at the Annual Meeting where we have reserved time for their presentations. If you are not involved in a RIG but are interested, please let me know!

Finally, thanks to our board of directors and our executive director, Tracy Burr, for their hard work on regular calls to keep PRiSM moving forward. It is very exciting to see the momentum building.

I look forward to seeing y'all in Dallas in January,

Mininder Kocher, MD MPH
President, PRiSM

4^th Annual Meeting
January 26-28, 2017

Sponsored by:

The PRiSM Annual Meeting is designed to provide high-quality dissemination of information in the basic sciences, prevention, diagnosis, treatment, and technical advances in the multi-disciplinary areas of sports medicine for children and adolescents. The Scientific Program Committee has worked hard to provide a diverse, innovative and well-rounded program while incorporating feedback from last year’s meeting. As a result, we offer you two full days filled with learning opportunities, engaging top experts and collaboration opportunities.

OBJECTIVES

• Discuss the diagnosis & multidisciplinary management of common pediatric and adolescent sports related injuries.
• Establish treatment guidelines and algorithms for working with childhood athletes and their families.
• Examine multiple evidence based approaches to treating pediatric sports concerns.
• Explore clinical approaches to the injured athlete throughout their continuum of care.
• Evaluate effective ways to improve patient care and reduce lifelong sequelae of sports injuries.

WHO SHOULD ATTEND

Includes developmental and other pediatricians, orthopedic and neuro-surgeons, family physicians, physical and occupational therapists, orthotists, rehab engineers, athletic trainers, coaches, kinesiologists, nutritionists, educators, administrators, researchers, and all others concerned with pediatric and adolescent sports medicine.

REGISTRATION

Check out the Preliminary Program and register today. Early bird discounts are available through December 16^th, and PRiSM member discounts are available, through January 5^th

BOOK YOUR HOTEL TODAY!

PRiSM has rooms available now at the following hotels in Dallas. To book a room, please contact the hotel of your choice and mention the PRiSM Annual Meeting room block. Free shuttles will be available between Texas Scottish Rite Hospital for Children and all three hotels listed below:

Le Meridien, The Stoneleigh - $189/night
2927 Maple Ave
Dallas, TX 75201
Phone: (214) 871-7111
Make a reservation online
(Block closes December 27, 2016)

Omni Hotel - $179/night
555 S Lamar
Dallas, Texas 75202
Phone: (214) 744-6664
(Block closes January 2, 2017)

Warwick Melrose Hotel - $179/night
3015 Oak Lawn Avenue
Dallas, Texas 75219
Phone: (214) 521-5151
Make a reservation online
(Block closes January 4, 2017)

Research Interest Group Updates

PRiSM currently has 16 Research Interest Groups (RIGs), which began meeting in Summer 2016. Each RIG is planning research activities in their area of interest; please see the details below. If you would like to get involved or if you're already in one group and want to join another please contact the PRiSM Office at info@prismsports.org to express your interest.

Concussion
The Concussion RIG is working to standardize data collection across sites. The group is planning a survey on current measures in use and will then look at methods of ensuring the same data is collected at different locations.

Female Athlete
The Female Athlete RIG is considering several project topics, including: how clinicians diagnosis triad and what are they using for screening, stress fractures in athletes on the cusp of puberty, non-op measures for anterior snapping hip, Talar dome OCD’s, and Vitamin D levels. The group is considering which sports will be most feasible to survey, including dancers, gymnasts, and softball players.

Hip Disorders
The Hip Disorders RIG discussed identifying gaps in the knowledge: sense of treatment variability, case discussion for further thoughts, review the literature – systematic reviews, retrospective outcomes, prospective studies. Possible topics of focus include how to manage the capsule, pelvic evulsion fracture outcomes, femoral version, and obesity/BMI levels.

Injury Prevention
The Injury Prevention RIG has elected to survey athletes, parents and coaches/athletic trainers to determine current attitudes toward and participation in injury prevention programs. The group is working to compile potential survey questions and looking at methods of survey distribution.

Knee Multialignment Injury
The Knee Multialignment RIG established a one year goal of producing a review article on one of the following: case series reports, retro PCL avulsion, collateral ligament avulsion, or injury patterns. A longer-term goal of standardizing surgery exam form & MRI data form to allow for somewhat prospective view is also targeted for future work.

Medial Epicondyle
The Medial Epicondyle RIG selected two topics to explore: (1) rate of treatment plan agreement based on x-rays and (2) optimal/alternative fixtures for fractures in younger children. The group is gathering x-rays to be rated by the full group and is working on design studies for both topics.

Meniscus
The Meniscus RIG is focusing on classification of discoid meniscus, including delineation of what discoid meniscus looks like on MRI. The group is looking at a recent study’s IRB to determine potential overlap/differences in focus within the topic.

Outcome Measures
The Outcome Measures RIG is considering several projects. The first is a possible joint project with the Rehabilitation RIG, looking at what measures are practitioners using and/or measures they wish they had. The second is SR of pediatric outcomes and a list of which pertain to active youth/athletes. The third is the creation of a repository of scales that are validated in pediatrics, for PRiSM members to access.

Patellofemoral Instability
The Patellofemoral RIG chose as their primary project the creation of a survey to look at variability of diagnosis and treatment methods. The group is currently working on review and development of the survey. Potential secondary or future projects include implant mediated guided growth and patella instability,  safety of patella tendon medialization, and trochlea sulcus growth & remodeling after surgery for instability.

Rehabilitation
The Rehabilitation RIG is exploring partnerships with other RIGs on the topics of what outcome measures are being used at rehab centers (with Outcome Measures RIG), non-surgical interventions for patellofemoral pain (Patellofemoral Instability RIG), and variation in spondylolysis treatments (Spine/Spondylolysis RIG). Group members have been in contact with other RIGs, and have attended the other groups’ calls to explore whether there is common interest.

Shoulder Instability
The Shoulder Instability RIG is planning to document failure rates (re-operation or persistent subjective instability) after first time shoulder stabilization in patients < 18 years old. The group is reviewing the IRB of a similar study for use as potential template, as well as discussing study considerations and practical questions for the project.

Spine/Spondylolysis
The Spine/Spondylolysis RIG selected to focus on the question of what treatment methods are being used instead of bracing, and what imaging methods are in use?  The group is drafting questions to ask in a survey, as well as brainstorming distribution methods and funding sources.

Sports Specialization
The Sports Specialization RIG has defined their research question as “Does the prevalence of sport specialization in youth soccer athletes, versus healthy controls, differ based on geographic location?” A secondary question will also be studied: “Do highly specialized athletes have worse ABQ, fatigue, and PROMIS psychological scores compared to athletes with low levels of specialization?”. The group is reviewing already-validated surveys, exploring whether IRB approval is needed for an anonymous survey, and looking at distribution methods.

Stress Fractures/Overuse
The Stress Fractures/Overuse RIG is considering what topics are of the most interest to group members by compiling titles of papers that the group should write. From there, potential projects will be narrowed by group voting.

Tibial Spine
The Tibial Spine RIG is exploring project topics including: prospective comparative studies (open/scope, early vs. late treatment, suture vs. screw, early mobilization vs. late); functional outcomes and metrics with Tibial Spine Treatment; retrospective analysis of chronic displaced - non-unions/malunions; and what outcome measures are appropriate for tibial spine. Group members are gathering more information to present to the full group for narrowing their initial topic.

Ulnar Collateral Ligament Injuries
The Ulnar Collateral Ligament (UCL) Injuries RIG is investigating the feasibility of studies on two topics. The first is ligament changes in non-pitching throwing athletes using dynamic stress ultrasound, and the second is methods to improve care for PRP and partial tears. The group is composing exploratory proposals for each topic that include reasoning, objectives, and basic methodology.

Social Media

PRiSM has a Facebook group! Join us at http://www.facebook.com/groups/prismsports

Follow PRiSM on Twitter: https://twitter.com/prism_society.

Follow PRiSM Board Member Dr. Christina Master on Twitter at https://twitter.com/drtinamaster.

Member in the News

Dr. Gregory Myer will be giving an oral presentation on the study referenced in this article at the PRiSM 4^th Annual Meeting.

Device to protect brain from concussions inspired by birds
(CBS News, April 2016)

Reading List

1. The Anterolateral Ligament of the Knee: An Inconsistent Finding in Pediatric Cadaveric Specimens.
Shea KG, Polousky JD, Jacobs JC Jr, Yen YM, Ganley TJ.  J Pediatr Orthop. 2016 Jul-Aug;36(5):e51-4.

Dissection study of 8 skeletally immature cadaveric specimens in which only 1/8 (12.5%) had a discernable anterolateral ligament (ALL). The ALL may be an inconsistent structure in pediatric knees or may develop during childhood/adolescence.

2. Novel Arthroscopic Classification of Osteochondritis Dissecans of the Knee: A Multicenter Reliability Study.
Carey JL, Wall EJ, Grimm NL, et.al. Am J Sports Med. 2016 Jul;44(7):1694-8.

ROCK group arthroscopic classification of knee OCD, which showed high reliability and guides treatment of OCD lesions

3. American Academy of Orthopaedic Surgeons: Appropriate Use Criteria for Management of Osteochondritis Dissecans of the Femoral Condyle.
http:// www.aaos.org/ocdauc. Accessed June 30, 2016.

Full listing of the appropriate use criteria (AUC) for management of knee OCD.

4. Delayed Anterior Cruciate Ligament Reconstruction in Young Patients With Previous Anterior Tibial Spine Fractures.
Mitchell JJ, Mayo MH, Axibal DP, et.al. Am J Sports Med. 2016 Aug;44(8):2047-56.

Case series of 101 patients who underwent fixatino of anterior tibial spine fractures. Rate of subsequent (delayed) ACL reconstruction was 19%.

5. Arthroscopic Retrograde Drilling in Juvenile Osteochondritis Dissecans of the Talus.
Masquijo JJ, Ferreyra A, Baroni E. J Pediatr Orthop. 2016 Sep;36(6):589-93

Case series of 6 cases of retroarticular drilling of stable talus OCD lesions. All patients had high satisfaction despite 3 of 6 (50%) with persistent radiographic abnormalities at mean 37 month follow-up.