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Hyunjae Jeon, Melanie L. McGrath, Neal Grandgenett, and Adam B. Rosen

Context: Patellar tendinopathy (PT) is prevalent in physically active populations, and it affects their quality of living, performance of activity, and may contribute to the early cessation of their athletic careers. A number of previous studies have identified contributing factors for PT; however, their contributions to self-reported dysfunction remain unclear. Objective: The purpose of this investigation was to determine if strength, flexibility, and various lower-extremity static alignments contributed to self-reported function and influence the severity of PT. Design: Cross-sectional research design. Setting: University laboratory. Participants: A total of 30 participants with PT volunteered for this study (age: 23.4 [3.6] y, height: 1.8 [0.1] m, mass: 80.0 [20.3] kg, body mass index: 25.7 [4.3]). Main Outcome Measures: Participants completed 7 different patient-reported outcomes. Isometric knee extension and flexion strength, hamstring flexibility and alignment measures of rearfoot angle, navicular drop, tibial torsion, q-angle, genu recurvatum, pelvic tilt, and leg length differences were assessed. Pearson’s correlation coefficients were assessed to determine significantly correlated outcome variables with each of the patient-reported outcomes. The factors with the highest correlations were used to identify factors that contribute the most to pain and dysfunction using backward selection, linear regression models. Results: Correlation analysis found significant relationships between questionnaires and body mass index (r = −.35–.46), normalized knee extension (r = .38–.50) and flexion strength (r = −.34–.50), flexibility (r = .32–.38, q-angle (r = .38–.56), and pelvic tilt (r = −.40). Regression models (R 2 = .22–.54) identified thigh musculature strength and supine q-angle to have greatest predictability for severity in patient-reported outcomes. Conclusions: These findings put an emphasis of bodyweight management, improving knee extensor and flexor strength, and posterior flexibility in PT patients.

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Kelly M. Seevers, Hannah G. Stephenson, and Adam B. Rosen

The purpose of this case report is to present the case of a Division I collegiate female soccer player diagnosed with a blow-up fracture and a concussion. This athlete suffered from a blow-up fracture, a fracture of the superior orbital rim, which is less common than the inferior, blowout fracture. The uniqueness comes from a common mechanism, player-to-player contact, causing an uncommon fracture pattern and the athlete’s full, unrestricted, return to sport. Severity of these injuries can vary from very mild to very severe, and the treatment options are variable depending on the severity.

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Christine C. Center, Samuel J. Wilkins, Ross Mathiasen, and Adam B. Rosen

The purpose of this report is to present the case of a high school football player who sustained an injury during a game, resulting in an acute subdural hematoma (SDH). The patient underwent an emergent decompressive craniectomy. The uniqueness of the case is due to both rare pathology and treatment. The athlete had a positive outcome due to prompt on-field assessment and advanced surgical treatments. Athletic trainers should know how to recognize symptoms of emergent traumatic brain injuries and be prepared to implement an emergency action plan when necessary.

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Adam B. Rosen, Jupil Ko, Kathy J. Simpson, and Cathleen N. Brown

Patellar tendinopathy is often managed with a patellar tendon strap, however, their effectiveness is unsubstantiated. The purpose of this study was to determine if straps altered pain or lower extremity kinetics of individuals with patellar tendinopathy during landing. Thirty participants with patellar tendinopathy and 30 controls completed drop jumps with and without patellar tendon straps. Wearing the strap, tendinopathy participants demonstrated significantly decreased pain and reduced knee adductor moment; all participants displayed significantly decreased anterior ground reaction force while wearing a strap. Patellar tendon strapping may reduce pain due to alterations in direction and magnitude of loading.

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Takeaki Ando, Shannon Gehr, Melanie L. McGrath, and Adam B. Rosen

The purpose of this report is to present the case of a National Junior Collegiate Athletic Association football player diagnosed with Chiari malformation postconcussion. A Chiari malformation is characterized by the cerebellum presenting below the level of the foramen. The uniqueness of this case stems from the patient’s health history, length of symptoms, and diagnosis. The effectiveness of treatment options, and the primary means to reduce the risk of catastrophic head injury in those with Chiari malformations are debatable. Clinicians should be familiar with the potential for the presence of a Chiari malformation with persistent symptoms postconcussion.

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John P. Rech, J. Megan Irwin, Adam B. Rosen, Jessica Baldwin, and Michaela Schenkelberg

Lower levels of physical activity (PA) are often observed among children with autism spectrum disorder (ASD) compared to children without ASD; however, some studies have demonstrated few to no PA differences between the two groups. The purpose of this systematic review with meta-analysis was to compare the differences in PA between children (2–18 years) with and without ASD. An exhaustive search of five online databases was completed, and 31 studies met the inclusion criteria. A pooled random-effects Hedges’s g model was used to determine differences in PA between children with and without ASD. Children with ASD were found to be significantly less physically active than children without ASD (Δ = −0.62, p < .001). Subgroup analyses revealed significant moderate to large differences in PA by intensity level, age, setting, and measurement methods. Future studies are needed to further explore the underlying mechanisms associated with lower levels of PA among children with ASD.

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Christopher J. Burcal, Sunghoon Chung, Madison L. Johnston, and Adam B. Rosen

Background: Region-specific patient-reported outcomes (PROs) are commonly used in rehabilitation medicine. Digital versions of PROs may be implemented into electronic medical records and are also commonly used in research, but the validity of this method of administration (MOA) must be established. Purpose: To determine the agreement between and compare the test–retest reliability of a paper version (FAAM-P) and digital version (FAAM-D) of the Foot and Ankle Ability Measure (FAAM). Study Design: Randomized, nonblinded, crossover observational study. Methods: A total of 90 adults were randomized to complete the FAAM-P or FAAM-D first, and then completed the second MOA (first day [D1]). The FAAM-D was a digital adaptation of both FAAM-P subscales on Qualtrics. Identical test procedures were completed 1 week later (D2). Data were removed if a participant scored 100% on both MOA, reported injury between D1 and D2, or did not complete both MOA. Agreement was assessed on 46 participants between the 2 MOA using intraclass correlation coefficients (ICC) at D1. There was good-to-excellent test–retest reliability for the FAAM activities of daily living. Results: The authors observed good agreement between the FAAM-P and FAAM-D for the activities of daily living (ICC = .88) and sport scales (ICC = .87). Test–retest reliability was good-to-excellent for the FAAM activities of daily living (FAAM-P: ICC = .87; FAAM-D: ICC = .89) and sport (FAAM-P: ICC = .71; FAAM-D: ICC = .91). Conclusions: The MOA does not appear to affect the responses on the FAAM; however, the authors observed slightly higher reliability on the FAAM-D. The FAAM-D is sufficient to be used for generating practice-based evidence in rehabilitation medicine.

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Cameron J. Powden, Rachel M. Koldenhoven, Janet E. Simon, John J. Fraser, Adam B. Rosen, Abbis Jaffri, Andrew B. Mitchell, and Christopher J. Burcal

Context: Intervention studies for chronic ankle instability (CAI) often focus on improving physical impairments of the ankle complex. However, using an impairments-focused approach may miss psychological factors that may mediate function and recovery. Patient-reported outcome (PRO) measures can be used to assess several dimensions of the health-related quality of life (HRQoL) and deliver enhanced patient-centered care. Therefore, the purpose of this investigation was to evaluate group-level improvements in HRQoL and treatment response rates following various interventions in patients with CAI. Design: Cross-sectional. Methods: Data from 7 previous studies were pooled by the chronic ankle instability outcomes network for participant-level analysis, resulting in 136 patients with CAI. Several interventions were assessed including balance training, gait biofeedback, joint mobilizations, stretching, and strengthening, with treatment volume ranging from 1 to 4 weeks. Outcome measures were PROs that assessed ankle-specific function (Foot and Ankle Ability Measure), injury-related fear (Tampa Scale of Kinesiophobia and Fear Avoidance Belief Questionnaire), and global well-being (Disablement in the Physically Active); the PROs assessed varied between studies. Preintervention to postintervention changes were evaluated using separate Wilcoxon signed-rank tests and effect sizes, and a responder analysis was conducted for each PRO. Results: Significant, moderate to large improvements were observed in PROs that assessed ankle-specific function, injury-related fear, and global well-being following intervention (P < .001). Responder rates ranged from 39.0% to 53.3%, 12.8% to 51.4%, and 37.8% for ankle specific function, injury-related fear, and global well-being, respectively. Conclusions: Various interventions can lead to positive improvements in HRQoL in patients with CAI. Treatment response rates at improving HRQoL are similar to response rates at improving impairments such as balance, further reinforcing the need for individualized treatment approaches when treating a patient with CAI.

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Hiromichi Usuki, Nealy Grandgenett, Sofia Jawed-Wessel, Adam B. Rosen, and Melanie L. McGrath

While Brazilian jiu-jitsu (BJJ) has a rate of injury similar to other combat sports, there is little information on the types of injuries sustained by BJJ athletes. The purpose of this study was to assess demographic information, participation rates, injuries, and medical care in BJJ athletes over a 12-month period. Seventy-eight athletes (75.0%) reported 136 injuries in the past year; however, medical attention was only sought for 59 (43.4%) of those injuries. No significant association was found between each demographic variable and injury prevalence. Despite the fact that a majority of BJJ athletes reported suffering an injury within the past year, slightly less than half of these injured athletes sought medical care. There was no difference in injury prevalence between belt ranks.

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Adam B. Rosen, Abbis Jaffri, Andrew Mitchell, Rachel M. Koldenhoven, Cameron J. Powden, John J. Fraser, Janet E. Simon, Matthew Hoch, and Christopher J. Burcal

Context: Ankle sprains result in pain and disability. While factors such as body mass and prior injury contribute to subsequent injury, the association of the number of ankle sprains on body anthropometrics and self-reported function are unclear in this population. Therefore, the purpose of this investigation was to assess differences in anthropometric measurements and self-reported function between the number of ankle sprains utilizing a large, pooled data set. Design: Cross-sectional. Methods: Data were pooled from 14 studies (total N = 412) collected by the Chronic Ankle Instability Outcomes Network. Participants were categorized by the number of self-reported sprains. Anthropometric data and self-reported function were compared between those who reported a single versus >1 ankle sprain as well as among groups of those who had 1, 2, 3, 4, and ≥5 ankle sprains, respectively. Results: Those who had >1 ankle sprain had higher mass (P = .001, d = 0.33) and body mass index (P = .002, d = 0.32) and lower Foot and Ankle Ability Measure-Activities of Daily Living (P < .001, r = .22), Foot and Ankle Ability Measure-Sport (P < .001, r = .33), and Cumberland Ankle Instability Tool (P < .001, r = .34) scores compared to the single ankle sprain group. Those who had a single ankle sprain weighed less than those who reported ≥5 sprains (P = .008, d = 0.42) and had a lower body mass index than those who reported 2 sprains (P = .031, d = 0.45). Conclusions: Some individuals with a history of multiple ankle sprains had higher body mass and self-reported disability compared to those with a single sprain, factors that are likely interrelated. Due to the potential for long-term health concerns associated with ankle sprains, clinicians should incorporate patient education and interventions that promote physical activity, healthy dietary intake, and optimize function as part of comprehensive patient-centered care.