Leina'ala Song, MD

All Publications

• Pregame and Halftime Intravenous Hyperhydration Practices in National Collegiate Athletic Association Football Bowl Subdivision Teams. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Schultz, E. A., Song, L., Hwang, C. E. 2026

  Abstract

  To assess current pregame (PIVFH) and halftime intravenous fluid hyperhydration (HIVFH) practices, protocols, indications, complications, and perceived efficacy in National Collegiate Athletic Association Football Bowl Subdivision (NCAA-FBS) football players.Cross-sectional survey.NCAA-FBS.Head team physicians and athletic trainers from 71 unique NCAA-FBS Division 1 schools.Voluntary anonymous 28-question validated survey.Number of teams using PIVFH and HIVFH.73 (30.7%) institutions completed surveys, representing 71 of 238 (29.8%) unique NCAA-FBS institutions. Twenty eight of 71 (39.4%) of institutions reported using PIVFH, while 29 of 71 (40.8%) reported using HIVFH. For PIVFH (20/28, 71.4%) and HIVFH (18/21, 85.7%), most institutions reported 1 L of IV fluid was administered, typically normal saline. Most teams (20/29, 68.9%) reported that 1 to 3 players received HIVFH when the temperature was above 80°F, while 12 of 29 (41.4%) teams used HIVFH regardless of temperature. Complications related to IVFH were reported by 28 of 71 (39.4%) institutions. The most commonly cited complications were provider needlestick, pulmonary edema, and infection.The use of PIVFH at NCAA-FBS institutions has remained relatively stable compared with prior studies. HIVFH, which was not previously reported, was used slightly more frequently than PIVFH and with greater variability based on ambient temperature. Many institutions reported complications related to IVFH, emphasizing the importance of carefully considering potential risks and benefits when implementing IVFH protocols.

  View details for DOI 10.1097/JSM.0000000000001473

  View details for PubMedID 42234023

• Handheld Ultrasound for Personalized All-Soft-Tissue Quadriceps Tendon Anterior Cruciate Ligament Reconstruction. Video journal of sports medicine Chu, C. R., Song, L., He, J., Roh, E. 2026; 6 (3): 26350254251408068

  Abstract

  The use of quadriceps tendon autograft for anterior cruciate ligament (ACL) reconstruction (ACLR) has substantially increased in popularity. Advantages include similar clinical outcomes to other autografts and greater intra-articular tendon volume. However, injury to the quadriceps muscle during graft harvest may compromise quadriceps recovery, which reduces clinical outcomes. Females have been identified as being at higher risk of poor quadriceps recovery after all soft tissue quadriceps tendon ACLR, with 61% of females reported to be unable to achieve terminal extension 6 weeks after surgery.To allow for 15 to 20 mm of graft-to-bone tunnel healing, autografts 65 to 70 mm long and 10 mm wide have been recommended for adults. A 3-dimensional magnetic resonance imaging study showed that quadriceps tendon length correlates with height and that 90% of patients 5'6" or taller had a quadriceps tendon length >70 mm. However, the Centers for Disease Control and Prevention (CDC) data show that 80% of adult females and 18% of adult males are shorter than 5'6" tall. This means that, for about half of adults and the vast majority of females, the quadriceps tendon may not support the harvest of a 70 mm all-soft-tissue graft without potentially injuring muscle tissue.Quadriceps tendon length and morphology can be readily assessed by ultrasound. This video demonstrates an easy new method for measuring quadriceps tendon morphology using handheld ultrasound devices that takes <1 minute.This information provides surgeons with knowledge and tools to customize graft harvest to avoid quadriceps muscle injury.Avoiding the removal of the quadriceps muscle during graft harvest reduces the role that donor-site morbidity can play in compromising quadriceps recovery after ACLR.The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

  View details for DOI 10.1177/26350254251408068

  View details for PubMedID 42137049

  View details for PubMedCentralID PMC13167307

• Increased Prevalence of Concussion in Collegiate Water Polo Goalkeepers. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Lee, M. C., Pham, N. S., Song, L., Hwang, C. E. 2025

  Abstract

  OBJECTIVE: To investigate the epidemiology of sport-related concussion in collegiate water polo players and compare the risk of concussion between goalkeepers and field players.DESIGN: Retrospective chart review using injury surveillance data from July 2016 and June 2022. Descriptive statistics, chi2 and Fisher exact tests, and pairwise comparisons using false discovery rate-adjusted P-values were used for statistical analysis.SETTING: Pac-12 conference collegiate water polo teams.PARTICIPANTS: Ninety-six Pac-12 athletes from 4 men's and 5 women's water polo teams, with a total of 124 identified concussions.INDEPENDENT VARIABLE: Player position (goalkeeper vs field player) and location of injury (practice vs competition vs not sport related).MAIN OUTCOME MEASURES: Prevalence of sport-related concussion by player position and location of injury.RESULTS: Goalkeepers experienced a significantly higher proportion of sport-related concussions than field players (26.2% vs 16.0%, P = 0.005). Most concussions in goalkeepers occurred from ball-to-head contact while most field player concussions were because of contact with another player. There was no significant difference in the number of concussions suffered in practice compared with competition.CONCLUSIONS: Collegiate water polo goalkeepers face a higher risk of concussion than field players, particularly from ball-to-head contact. Current safety protocols may be inadequate for goalkeepers. Future research should examine the effectiveness of protective headgear and modified practice equipment in mitigating concussion risk, potentially leading to rule changes.

  View details for DOI 10.1097/JSM.0000000000001365

  View details for PubMedID 40227165

• Head Injuries and Emergencies in Sport On-the-Field Emergencies, An Issue of Clinics in Sports Medicine Song, L., Griffin, G., Rao, A. 2023
• Chronic Lymphocytic Leukemia With Leptomeningeal Involvement Presenting as an Acute Encephalopathy. The Permanente journal Bae, W. H., Yee, M., Song, L., Canonico, M. M., Verhoef, P. A., Shimabukuro, K. A. 2022; 26 (2): 126-131

  Abstract

  Introduction Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in Western countries. Extramedullary involvement in the central nervous system (CNS) is a rare complication of the disease, and less than 200 cases have been reported. We report a case of leptomeningeal involvement of CLL that presented as an acute encephalopathy. Case presentation A 76-year-old man with treatment-naïve, Rai stage 0 CLL presented with altered mental status. Cerebrospinal-fluid studies, including flow cytometry, confirmed the leptomeningeal involvement of the previously diagnosed CLL. Surveillance imaging and lab studies showed no evidence of disease progression or Richter's transformation. One-time intrathecal methotrexate resulted in transient improvement of his mental status. Conclusion CLL patients with new-onset neurologic manifestations should be evaluated for the CNS involvement of the neoplasm via brain imaging and cerebrospinal-fluid flow cytometry. This CNS involvement of CLL is associated with poor clinical outcomes. Intrathecal treatment with methotrexate, cytarabine, and steroid may improve neurologic symptoms.

  View details for DOI 10.7812/TPP/21.081

  View details for PubMedID 35933656

  View details for PubMedCentralID PMC9662259

• Wimbldonitis? Clinical Journal of Sport Medicine Song, L., Young, J. M., Yamazaki, M. 2018
• Acanthosis Nigricans in Hawaiian Children vs Non-Hawaiian Children Song, L., Edinger, C., Robbins, K. National Institutes of Health. 2008