Background: Early sport specialization, involving intensive focus on a single sport for greater than 8 months per year at a prepubescent age, has become increasingly common in young athletes. While early sport specialization is often regarded as essential for success, there is growing concern that the potential risks to young athletes may outweigh the perceived benefits. Although numerous studies have explored early sport specialization, there has been no summative review on the topic in regard to the comprehensive impact on outcomes in these athletes. This study aims to systematically review the literature to determine the impacts of early specialization on injury, function, performance, sport success, and psychological outcomes. Methods: A review of Medline (PubMed) was conducted to search for studies relating to early sport specialization in pediatric patients (time of specialization < 18 years old) and outcomes. Extracted information included injury outcomes with a focus on overuse injuries, functional outcomes, performance outcomes, sport success, and psychological outcomes. For studies that reported relevant statistics, p < 0.05 was considered statistically significant. All studies were described qualitatively. Results: An initial search resulted in a total of 826 studies. After applying inclusion and exclusion criteria, 93 studies were included. A total of 62,327 athletes were included in the study. The average age of study participants was 15.9 years, with an average age at specialization of 11.6 years. Early sport specialization was associated with increased risk of injury, worse functional and physical performance, decreased or no benefit to sport success, and poor psychological outcomes. Conclusions: Early sport specialization was associated with increased risk of injury and negative impacts on functional and physical performance measures. There was also no clear advantage regarding sport success. Early sport specialization was linked to harmful effects on athlete psychological well-being. Late specialization, multisport participation, and following training volume guidelines can aid in mitigating these risks.

Background: Patellar dislocation in pediatric athletes often involve additional injuries not identified on plain films. Purpose: To identify the rate of medial patellofemoral ligament (MPFL) injury and adjunctive injury findings identified by magnetic resonance imaging (MRI) in first-time patellar dislocations in the pediatric population. Study Design: Systematic review; Level of evidence, 4. Methods: This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD: 42024559285). PubMed, EMBASE, and SPORTDiscus were searched for studies on MRI findings after first-time pediatric patellar dislocations. Abstracts and articles were screened using predefined inclusion and exclusion criteria. The inclusion criteria were (1) first-time patellar dislocation, (2) explicit documentation of MRI findings, (3) patients <18 years, and (4) written in English. The exclusion criteria were (1) abstract only, case reports, or review articles; (2) overlapping or repeated patient sets; in such cases, the article containing the more comprehensive variables was retained. Data were extracted regarding patient characteristics and MRI findings. Pooled rates were calculated using only the studies that reported the specific variable in question. Bias was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies, and the Joanna Briggs Institute Critical Appraisal tools for the cross-sectional studies and case series. Results: A total of 322 studies were initially identified. After screening by 2 independent reviewers, 12 articles were included in the data extraction. Findings include complete MPFL tears in 47% of cases, while partial MPFL tears were present in 41% of the time. Osteochondral (OC) injury was present in 50% of the MRIs. Among these, chondral lesions were reported in 75% of MRIs, OC lesions in 21%, and OC fractures in 37%. The location of these lesions was isolated to the medial patella facet 66% of the time, compared with the lateral femoral condyle, which was the location for 31% of the lesions. Additionally, loose bodies were found in 34% of MRIs. Conclusion: This study highlights the frequent occurrence of significant MRI findings in pediatric first-time acute patellar dislocations, showing that obtaining MRI after first-time patellofemoral instability events in the pediatric population should be standard of care.

Background: Pediatric acromioclavicular (AC) joint injuries are rarely reported, and data on return-to-sport rates (RTS) in this population are limited. This study aims to characterize management strategies and return-to-sport outcomes following AC joint injuries in pediatric athletes, addressing a gap in the current literature. Methods: Patients under 18 years of age who sustained an AC joint injury between March 1, 2014, and March 1, 2024, were identified using databases from a large tertiary referral hospital and a large children’s hospital. Extracted data included patient demographics, injury patterns, management approaches, and RTS status. Results: A total of 108 patients (110 shoulders) were included (74% male; mean age, 12.77±2.13 y; range 8 to 17 years). Low-grade injuries accounted for 95% of cases, and all injuries were managed nonoperatively. Sling immobilization was used in 40%, physical therapy (PT) in 29%, rest in 17%, and a combination of sling and PT in 15%. The most common mechanisms were football (29, 26%), motor vehicle collisions (11, 10%), and soccer (10, 9%). At least 48% (52) of patients had documented return-to-sport dates, with the median RTS time being 21 days (IQR 14 to 49.45 d). Concomitant injury was associated with a longer RTS time (HR 0.33, 95% CI 0.16-0.69, P =0.003). Conclusions: In this cohort of pediatric athletes, AC joint injuries were predominantly low-grade and managed nonoperatively. Of the patients with documented follow-up and RTS, the median RTS time was 3 weeks. These findings reinforce the favorable prognosis of nonoperative treatment for low-grade injuries in this population. Given the rarity of pediatric AC joint injuries and the limited published data, reporting these outcomes is essential to guide evidence-based management in pediatric sports medicine. Level of Evidence: IV: retrospective cohort study.

The aim of this study was to investigate the impact of musculoskeletal (MSK) health literacy on clinical outcomes and patient satisfaction following total shoulder arthroplasty (TSA). We hypothesized that low MSK health literacy score would be associated with inferior clinical outcomes and lower patient satisfaction rates. A retrospective cohort study was conducted at a tertiary care center. Patients between 6 months and 9 years post-operative following shoulder arthroplasty, both anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty were included. All patients were treated by one of 2 sports fellowship–trained surgeons. Patients were emailed a questionnaire that included basic demographics, American Shoulder and Elbow Surgeons (ASES) shoulder score, TSA satisfaction, and the Literacy in Musculoskeletal Problems survey. Patients were categorized as having low health literacy (LHL) if they answered fewer than 6 out of 9 questions correctly on the Literacy in Musculoskeletal Problems survey and as having normal health literacy (NHL) if they answered 6 or more questions correctly. Statistical analysis was performed to determine associations between LHL, patient characteristics, and outcomes of interest. This included multivariate logistic and linear regression models that assessed the relationship between MSK health literacy and ASES. Of 734 patients emailed the survey, 310 responded, and 230 met inclusion criteria and were included in the final analysis. One hundred and seventy-seven patients (77%) had NHL and 53 individuals (23%) had LHL. The mean ASES score was 74.2 ± 19.8 in the NHL group and 62.9 ± 23.9 in the LHL group. Patients with LHL had significantly lower ASES scores than those with NHL (P = .0007). Patient satisfaction rate (90.3% vs. 82.7%, P = .2101) and willingness to undergo surgery again (89.8% vs. 84.9%, P = .334) were similar between the NHL and LHL groups, respectively. Multivariate analysis showed that NHL was independently predictive of a significantly higher ASES score (P = .009, odds ratio: 1.025). Approximately one-quarter of patients undergoing TSA at our institution had LHL. Patients with LHL were found to have significantly lower patient-reported outcome scores, although rates of patient satisfaction and willingness to undergo surgery again were comparable to those with NHL. These findings highlight an association between health literacy and post-operative recovery that likely reflects the influence of broader educational and socioeconomic determinants of health. These findings should be interpreted as associative and hypothesis-generating.