Assessment of commercially available computerized neurocognitive testing in the adolescent concussed athlete: A retrospective analysis.

Background: Clinicians frequently use computer-based neurocognitive assessments to aid in the diagnosis and management of Sport Related Concussion (SRC). With practitioners using varied Neuro-Cognitive Assessment Tools (NCAT), questions arise concerning among NCAT and how these differences may affect patient care. The purpose of the current study is to offer a comparative analysis of two widely accepted, commercially available computer-based neurocognitive testing modalities in the adolescent concussed athlete. Hypothesis: There will be a difference between the C3 Logix® vs ImPACT® scoring in the IRPT and RTP Study Design: Retrospective chart review. Methods: In order to identify patients that were diagnosed with SRC, the records of patients reporting to a Sports Medicine practice were reviewed from a period of 18 months. All patients were assessed with either the ImPACT® or C3 Logix NCAT®. The date of the injury (DOI) as well as the patient’s symptom level (IVAL), time to initiation of the return to play protocol (IRTP), and time to the return to play (RTP) were recorded. Results: Two hundred and twenty-two records (222) were identified. There was no difference in the symptom score (P = 0.22) at the IEVAL between C3 Logix® (31.5±27.0) and ImPACT® (23.2±21.9), in the IRTP (P = 0.22) between the C3 Logix® (6.2±4.3 days) and ImPACT® (5.1±4.3 days) or RTP (P = 0.46) between C3 Logix (12.1±4.9 days) and ImPACT (15.6±19.8 days). Weak to moderate correlations were found between symptom scores, IRTP, and RTP. Conclusions: Clinicians made similar recommendations, independent of the NCAT used, as when to initiate the return to play protocol and when the patient could ultimately return to play. Clinical Relevance: The particular NCAT utilized by clinician was not a primary factor in the clinical judgement towards the management of the patient with SRC

ECG measurement parameters of athletes are reliable when made with a smartphone based ECG device

Pre-participation cardiac screening including electrocardiogram (ECG) is a subject of controversy among sports medicine practitioners. Opponents of pre-participation ECG screen site concerns regarding the cost and accuracy of the testing. Recently, a single lead ECG accessory has become available for use with smartphones. The purpose of this study was to evaluate the between and within rater validity and reliability of the Kardia device in recording the ECG parameters rate, rhythm, and PR, QRS, and QT intervals. The ECG parameter made with the smartphone were also compared to same measures made using a 12 lead electrocardiograph. This investigation used a repeated measures cross-sectional design. The investigation was conducted in 2 separate phases using separate participant samples. Phase 1 (N=10) was used to determine the within rater reliability with the Kardia device. Phase 2 (N=12) was used to determine the reliability between the Kardia device and the 12 lead electrocardiograph. The between rater and between device reliability for the rate, QT interval and QRS duration parameters ranged good to very good (ICC = 0.667 – 0.981). The current investigation showed that the reliability of the ECG parameters measured using the smartphone technology ranged from good to very good. This paper serves as support for a technological advancement that will help advance the debate on the utility of ECG testing as part of the athletic pre-participation physical

A Review of Mesenchymal Stem Cell Injections for Osteoarthritis

Mesenchymal stem cell (MSC) injections for osteoarthritis is reviewed. Methods- PubMed search identifying articles in English from 2003-2018 that used intra- articular injection (IA), cartilage repair, cartilage regeneration, chondral injury, adipose stem cells, bone marrow stem cells, mesenchymal stem cells, or autologous stem cells. Results – 388 patients receiving IA MSC injections are discussed with data obtained from 10 case reports or case series, 4 randomized clinical trials (RCT), 1 cohort study, and 3 case controlled therapeutic studies. Conclusions – MSC injections may be an effective adjunct in the management of osteoarthritis and a variety of cartilage related pathologies

ECG measurement parameters of athletes are reliable when made with a smartphone based ECG device

Pre-participation cardiac screening including electrocardiogram (ECG) is a subject of controversy among sports medicine practitioners. Opponents of pre-participation ECG screen site concerns regarding the cost and accuracy of the testing. Recently, a single lead ECG accessory has become available for use with smartphones. The purpose of this study was to evaluate the between and within rater validity and reliability of the Kardia device in recording the ECG parameters rate, rhythm, and PR, QRS, and QT intervals. The ECG parameter made with the smartphone were also compared to same measures made using a 12 lead electrocardiograph. This investigation used a repeated measures cross-sectional design. The investigation was conducted in 2 separate phases using separate participant samples. Phase 1 (N=10) was used to determine the within rater reliability with the Kardia device. Phase 2 (N=12) was used to determine the reliability between the Kardia device and the 12 lead electrocardiograph. The between rater and between device reliability for the rate, QT interval and QRS duration parameters ranged good to very good (ICC = 0.667 – 0.981). The current investigation showed that the reliability of the ECG parameters measured using the smartphone technology ranged from good to very good. This paper serves as support for a technological advancement that will help advance the debate on the utility of ECG testing as part of the athletic pre-participation physical

Current concepts in the treatment of gross patellofemoral instability

Patellofemoral instability is a painful and commonly recurring condition, which often must be managed surgically. Diagnosis can be aided by the use of a variety of physical exam signs, such as the Q angle, Beighton hypermobility score, glide test, J sign, patellar tilt test, and apprehension test. Imaging modalities including x-ray, CT, and MRI guide both diagnosis and management by revealing trochlear dysplasia, bony malalignment, and ligamentous injury that contribute to instability. Following an initial patellar dislocation, nonoperative management with bracing and physical therapy is an acceptable option, despite limited evidence that operative management may improve functional outcome and reduce recurrent dislocations. For recurrent dislocations, operative management is indicated, and the appropriate procedure depends on the patient’s anatomy and the cause of instability. Reconstruction of the medial patellofemoral ligament (MPFL) restores the primary soft tissue restraint to lateral patellar dislocations, and can be performed using a variety of techniques. In patients whose instability is related to bony malalignment, a tibial tubercle osteotomy is commonly performed to realign the extensor mechanism and establish proper patellar tracking. In patients with trochlear dysplasia, a trochleoplasty may be performed to create a sufficient groove for the patella to traverse. Often these procedures must be combined to address all causes of instability. The reported outcomes following all three of these procedures are generally very good, with the majority of patients experiencing functional improvements and a low rate of recurrent instability, although more large randomized controlled trials are needed to determine which techniques are most effective. The purpose of this clinical commentary is to provide an overview of the current methods employed by orthopedic surgeons to diagnose and manage patellar instability. Level of Evidence: