The current study has found that there is no statistical difference in measuring the cervical pedicle via radiography (CT) or directly. There are more significant differences comparing the cervical pedicles of males and females in the European/American population than exists in the Asian population (specifically in pedicle width and height). There are also significant differences at C3 and C4 cervical pedicle between the Asian and European/American population (specifically in the pedicle axis length and transverse angle).

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Pediatric Achilles tendon injuries requiring surgical treatment are considered rare and have not been well described. A retrospective chart review was conducted from 2010 to 2020 to identify cases of acute Achilles tendon rupture or laceration that required surgical repair in individuals 19 years or younger. A total of 24 individuals with acute Achilles tendon ruptures (n = 8) and lacerations (n = 16) were identified. All spontaneous ruptures occurred in skeletally mature individuals during sports. One subject was on minocycline at the time of injury, while two had a body mass index (BMI) ≥ 99% for age. Another had a history of clubfoot surgery on the injured side. Patients with lacerations were younger (9.9 ± 3.3 vs 16.3 ± 1.6 years) and had lower BMI (17.3 ± 3.8 vs. 28.0 ± 9.4) than those with spontaneous ruptures. The majority of cases had good outcomes with no postoperative complications.

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: The physical, psychological, and social benefits of sports participation in adolescents have been well reported in the able-bodied population. However, those with physical disabilities encounter many barriers to participating in sports, which limits access to these benefits. Additionally, due to their disabilities, these individuals are often not viewed as athletes by the general population and therefore may not identify as one themselves. : Our study seeks to use qualitative research techniques to identify the themes influencing adolescents’ participation in sled hockey and determine their identity as athletes. : Cross-sectional qualitative interview. Our IRB approved study recruited athletes at sled hockey practices and tournaments where interviews were moderated and transcribed. Transcriptions were coded according to common themes mapped in Figure 1. : We surveyed 19 youth sled hockey players (range 10-24 years old, mean 15.3) with multiple physical disabilities, the most common diagnosis being spina bifida (14) (Table 1). Our qualitative analysis identified the most prevalent themes that influence participation in adaptive sports to be: social factors, intrapersonal factors, motivators to start sport, access, physical and mental health, and athletic identity (Figure 1). Initial motivators to start involvement included encouragement from parents, role models, adapted sports organizations, healthcare providers or personal interest in the sport itself. Despite the perceived medical and financial barriers, support from teammates and funding assistance in purchasing equipment facilitated continued involvement. Our population also reported many perceived benefits to continued participation in adaptive sports, each reporting “having fun” while playing a sport they “love”. Other benefits were connecting with friends of similar disabilities and capabilities, who encourage them, serve as role models, and make them feel included. Furthermore, the mentorship the coaches provide, pushing the athletes to achieve, creates an atmosphere of competitiveness and a feeling of physical and mental wellbeing. Ultimately, this competitive environment allows for formation of an athletic identity, reported by 18 out of the 19 interviewees. : Despite encountering barriers to participating in a team sport that requires expensive equipment and travel and negotiating the limitations of physical disabilities requiring frequent medical procedures and time away from sport, the overpowering benefits of participation allow majority of our adolescent population to thrive and to identify as athletes. Among the main facilitators to continued involvement are mentorship and support from coaches and parents, comradery and competition, all which lead to physical and mental wellbeing and feeling of inclusiveness and accomplishment. [Figure: see text][Table: see text]

Background: Patellar tendinopathy is a common chronic condition caused by mechanical loading that leads to patellar tendon (PT) degeneration, with an estimated incidence of 13% across all sports in adolescents. Musculoskeletal ultrasound (MSK-US) evaluation is becoming more common in the diagnostic process, but normative data are extremely rare for the adolescent population. These normative data are needed to aid in proper interpretation of the MSK-US image. Purpose: The purpose of this study was to determine standard reference values for thickness, width, and cross-sectional area (CSA) of the PT using MSK-US in asymptomatic adolescent athletes. Methods: IRB approval, parental consent, and athlete assent were obtained prior to data collection. Bilateral PT were scanned using a portable US unit with a 12-4MHz linear array transducer. Long axis images were captured at the apex and 1cm distal to the patella, 1 cm proximal to the insertion and at the PT insertion (Figure 1a & 1b). Short axis images were captured 1 cm proximal and distal to the attachments. PT thickness, width, and CSA were measured using ImageJ by a single evaluator. Additional exploratory analyses were also conducted. Results: Seventy-one adolescent athletes (27 males, 44 females) between 11-18 years old (13.8 ±1.8 years) volunteered. Mean values for PT thickness, width, and CSA are found in Table 1. Significant differences in PT thickness and CSA between sex were identified at each measurement location (P<.05), with males ranging 4.0-9.9 mm thicker than females. PT width was not significantly different proximally or distally. The left proximal PT was significantly wider than right (P<.0001), but no other side differences were found. Lastly, significant weak positive correlations were present in distal tendon CSA with height (left PT: r(52)=.348, P=.014, right PT: r(49)=.369, P=.007) and weight (left PT: r(50 )=.290, P=.041). There was no correlation with age. Conclusion: These data represent one of the largest healthy cohorts of adolescent athletes from which normative data have been collected. This preliminary analysis reveals some interesting trends, such as the thickness of the PT is greatest at the insertion and origin, while thinner at mid-tendon, with the insertion the thicker of the two. Age was not correlated with PT size, but distal PT CSA was larger with taller and heavier individuals. These data will contribute to the paucity of adolescent PT MSK-US data, which should aid clinicians in interpretation, diagnostic accuracy, and management of active adolescent patients with patellar tendinopathy. [Figure: see text][Table: see text]

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