Relationship between movement dysfunctions and sports injuries according to gender of youth soccer player

The purpose of this study is to investigate relationship between movement dysfunctions and sports injuries according to gender of youth soccer player. Thirty-eight middle school soccer players participated in this study and they were divided into male (n=19) and female (n=19) groups. The Functional Movement Screen (FMS) and the Quadriceps-angle (Q-angle) during single-leg squat were analyzed for identifying imbalance and asymmetry of the body, and sports injury questionnaire was examined for 6 months after FMS test. The number of sports injuries did not show significant difference between youth male and female soccer athletes. In FMS results, the scores of overhead squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, and rotary stability and the total scores were no significant differences between gender, but the score for the trunk stability push-up was significantly higher in male group than female group. There was no significant difference of Q-angle values between the left and right legs, but Q-angle value between youth male and female groups significantly showed interaction. Therefore, the present data suggested that FMS and Q-angle during single-leg squat might be indicators to predict and/or prevent sports injury in youth male and female soccer players.

Psychosocial interventions help facilitate recovery following musculoskeletal sports injuries: a systematic review

Context: Recent research demonstrates a connection between psychological factors and return to play following a musculoskeletal sports injury. Although it has been shown that psychological factors can influence when and if an athlete returns to play, it is unclear if the implementation of psychosocial interventions during the recovery process can address these factors and potentially increase the likelihood of return to play after physical recovery from injury. Objective: To examine the efficacy of interventions designed to address psychosocial factors that influence return to play after sports injuries. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Pubmed, Embase, and Google Scholar databases were searched from the earliest entry through May 2018. Search terms included 'psychology,' 'sports injury,' 'anterior cruciate ligament injury,' 'anterior cruciate ligament reconstruction,' 'intervention,' 'return to play,' and 'return to sport.' Studies were included and reviewed if they reported on the efficacy of a psychosocial intervention program in injured athletes. Results: Initial searches of Pubmed, Embase, and Google Scholar databases identified 560 articles, 329 articles, and 34,400 hits, respectively. After inclusion and exclusion criteria were applied, eight articles remained that met inclusion criteria. Interventions of relaxation/guided imagery, positive self-talk, goal setting, counseling, emotional/written disclosure, and modeling videos were found to be effective interventions for promoting recovery after a musculoskeletal sports injury. These interventions facilitated positive mood changes, pain management, exercise compliance, and rehabilitation adherence. No study examined the effect of psychosocial interventions on return to play. Conclusion: This systematic review demonstrates that psychosocial interventions can facilitate post-injury recovery in athletes by promoting a positive emotional state and rehabilitation adherence. Further research is necessary to determine the most effective psychosocial interventions for specific psychological factors, the ideal duration of interventions, the best method of implementation following a sports injury, and the impact of these interventions on return to play.

LOW BACK PAIN AND INJURY IN BALLET, MODERN, AND HIP-HOP DANCERS: A SYSTEMATIC REVIEW

Background

Low back pain is believed to be a common complaint among dancers; however, a comparison across recent research is needed to support or disprove this assertion across genres.

Purpose

To determine the prevalence of low back pain and low back injury in ballet, modern, and hip-hop dancers through a systematic literature review. A secondary goal was to identify trends amongst dance genres, level of mastery, gender, and age, if possible.

Study Design

Systematic Review of the Literature.

Methods

PRISMA search strategy of terms relating to dance and low back pain was conducted within the Pubmed, MEDLINE, SPORTDiscus, Web of Science, and the archives of the Journal of Dance Medicine and Science databases between November 2017 and March 2018. Inclusion criteria were published articles that addressed low back pain or injury in ballet, modern, or hip-hop dance population. Exclusion criteria included studies relating to specific pathologies or studies that did not report specific dance genre. All included articles were assessed for quality using a modified grading evaluation and a Modified Newcastle-Ottawa Risk of Bias assessment.

Results

Twenty-five ballet articles, five modern, and three hip-hop articles met the inclusion criteria, for a total of 33 articles. Twenty-five of the 33 studies relied on a questionnaire to gather data. Risk of bias results ranged from 3-7/10 and quality of studies ranged from Good I to Limited III. Prevalence of low back pain seems relatively high in ballet dance (range: 20.3%-79% of total dancers are affected). Little research exists on the prevalence of back pain in modern or hip-hop dancers, but hip-hop dancers also seem likely to have low back pain (range: 46.6%-85.7% of total dancers are affected). Low back injuries are also present in ballet (range: 2.1%-88% of total injuries), modern (range: 8.6%-21.6% of total injuries), and hip-hop (range: 26.3%-69.6%).

Conclusion

Ballet dancers seem to be at risk for low back pain or injury independent of gender, age or level of mastery; however, there is not enough evidence to draw any conclusions about modern dancers or hip-hop dancers and their risk for low back pain/injury currently. Future higher-level studies are needed with reduced risk of bias.

Level of Evidence

2a.

[Analysis of the mass skiers' injury in a large ski resort in Chongli, China]

OBJECTIVE

To make a retrospective analysis of the injuries of skiing population in a large ski resort in Chongli, China and provide a basis for predicting the rapidly increasing medical needs for ski injuries in the context of the 2022 Winter Olympic Games.

METHODS

The basic data of all injured skiers who were treated in a medical station of a large ski resort in Chongli during the snow season from November 2017 to March 2018 and from November 2018 to March 2019 were collected. The number of skiers, the number of injuries, the causes of injuries, the types of injuries and the locations of injuries were compared.

RESULTS

A total of 753 skiers were injured in two snow seasons, and the estimated average incidence of injury was 4.53 and 4.46 per 1 000 skier days at the resort respectively. The average daily injury rate per 1 000 skiers in November of the two snow seasons was relatively low, with 2.20 and 1.38 cases respectively. The difference of injury rate in different months might have little to do with snowfall and more to do with passenger flow. In both the snow seasons, men accounted for more injuries than women, and injured skiers aged between 21 and 30 accounted for the largest proportion, reaching 36.8%. The main causes of injuries were falls (76.6%). The highest rate of injury was in the head and neck (17.9%), followed by the knee (17.4%) and wrist and fingers (13.3%). The most common types of injuries were contusion and trauma (29.5%) and joint and/or ligament injuries (22.2%). Children (2-12 years old) accounted for 12.7% of all the injured skiers. The rate of moderate to severe injuries (including fractures, concussions, etc.) was 34.8% among the injured patients over 50 years of age.

CONCLUSION

The snow resort should focus on injuries to children and elderly skiers and carry out targeted guidance and rescue work. In order to better ensure the medical safety of skiers, the ski resort medical station and nearby treatment hospitals should be equipped with a corresponding number of medical personnel and equipment, and the ski resort should further improve its safety management and rescue system.

Adolescent physical activity-related injuries in school physical education and leisure-time sports

Objective

The aims of this study were to investigate the prevalence of sports injuries in school physical education (PE) and leisure-time sports among 1011 15- to 16-year-old adolescents in relation to physical activity, and to examine goal orientation.

Methods

A survey was used with additional narrative descriptions.

Results

There was a higher prevalence of injuries in leisure time (645/993 = 65%) than in PE (519/998 = 52%). Two groups with high PE injury rates were identified: a) highly active (258/998 = 26%) in both school PE and leisure-time sports and b) highly inactive (180/998 = 18%) in both contexts. There were no differences between girls and boys. Task-oriented adolescents were more prone to injury.

Conclusions

The high prevalence of injuries in PE appears to have two mechanisms: renewed inadequately recovered leisure-time injuries among highly active adolescents, and injuries among fragile inactive adolescents unfamiliar with exercise. PE educators of these two groups with different injury patterns have a considerable didactic challenge. Knowledge of inadequately recovered injuries and consideration of the high volume and intensity of early sport-specific training in children and adolescents are important parameters in the design of lesson plans for PE.

Traumatic and non-traumatic bone marrow edema in ankle MRI: a pictorial essay

Bone marrow edema (BME) is one of the most common findings on magnetic resonance imaging (MRI) after an ankle injury but can be present even without a history of trauma. This article will provide a systematic overview of the most common disorders in the ankle and foot associated with BME.

The presence of BME is an unspecific but sensitive sign of primary pathology and may act as a guide to correct and systematic interpretation of the MR examination. The distribution of BME allows for a determination of the trauma mechanism and a correct assessment of soft tissue injury. The BME pattern following an inversion injury involves the lateral malleolus, the medial part of the talar body, and the medial part of the distal tibia. In other cases, a consideration of the distribution of BME may indicate the mechanism of injury or impingement. Bone in direct contact with a tendon may lead to alterations in the bone marrow signal where BME may indicate tendinopathy or dynamic tendon dysfunction. Changed mechanical forces between bones in coalition may lead to BME. Degenerative changes or minor cartilage damage may lead to subchondral BME. Early avascular necrosis, inflammation, or stress fracture may lead to more diffuse BME; therefore, a detailed medical history is crucial for correct diagnosis.

A systematic analysis of BME on MRI can help to determine the trauma mechanism and thus assess soft tissue injuries and help to differentiate between different etiologies of nontraumatic BME.

Arthroscopic correction of femoroacetabular impingement improves athletic performance in male athletes

PURPOSE

To measure the changes in athletic performance in athletes treated arthroscopically for femoroacetabular impingement and compare results to a matched controlled athletic cohort, over a 1-year period.

METHODS

Male athletes scheduled for arthroscopic correction of symptomatic FAI were recruited and tested (pre-operatively and 1-year postsurgery) for measures of athletic performance which included acceleration (10-m sprint), change of direction speed (CODS), squatting depth, and reactive strength index (RSI). The FAI group was compared to a matched, healthy, control group who were tested at baseline and 1 year later with no disruption to their regular training or competition status; the prevalence of anterior groin pain during testing in either group was recorded. Hip range of motion (ROM) was also measured for both groups at baseline and at 1 year in the FAI group to look for change following intervention.

RESULTS

Prior to surgery, the FAI group were slower than the control group (p < 0.001) for acceleration (3% slower) and CODS (10% slower). At 1 year, 91% of the FAI group returned to full competition at an average time of 17 weeks, while substantial reductions in pain were also noted during acceleration (51-6%, p = 0.004), CODS (62-8%, p = 0.001), and squat test (38-8%, p = 0.003). Significant improvements were seen in the FAI group for CODS (7%, p < 0.001) and squat depth measures (6%, p = 0.004) from baseline to 1 year (significant time × group interaction effects were noted for these also). The changes in performance in the control group over time were non-significant across all of the measures (n.s.). At 1-year postsurgery, there were no statistically significant differences between the groups for any of the athletic measures. There was a significant and clinically important improvement in range of hip motion in the FAI group at 1-year postsurgery (p < 0.05).

CONCLUSION

Symptomatic FAI causes substantial reductions in athletic performance compared to healthy competitors placing these athletes at a distinct performance disadvantage. The results from the current study demonstrate that arthroscopic correction (including labral repair) in athletes with symptomatic FAI, reduces pain and restores athletic performance to a level which is comparable to healthy athletes, at 1 year.

LEVEL OF EVIDENCE

II.

Posterior cruciate ligament lesions are mainly present as combined lesions even in sports injuries

PURPOSE

To analyse 1000 consecutive patients, treated with isolated or combined posterior cruciate ligament (PCL) reconstruction in a single centre according to the epidemiological factors and differences in injury patterns depending on the activity during trauma.

METHODS

Between 2004 and 2019, one thousand isolated and combined PCL reconstructions were performed. The medical charts and surgical reports of all patients were analysed regarding epidemiological factors. The PCL lesions were divided into isolated and combined lesions with at least one additional ligamentous injury. The influence of activity during accident and additional injury on the presence of isolated or combined lesions and injury patterns was calculated.

RESULTS

In 388 patients (38.8%), sporting activity was the main activity in PCL lesions, followed by traffic accidents in 350 patients (35.0%). Combined injuries were present in 227 patients (58.5%) with sports injuries and 251 patients (71.7%) with traffic accidents. Only during handball, an isolated PCL lesion (69.1%) was more common than a combined lesion. Highest rate of combined lesions was present in car accidents (91.7%). In all activities except skiing and biking, the most common additional peripheral injury was a tear of the posterolateral corner. In skiing and biking accidents, the most common additional peripheral lesion was a lesion of the medial collateral ligament. In patients with PCL lesion and additional fracture of the same lower extremity, a combined lesion was more common than an isolated lesion (p = 0.001).

CONCLUSION

Combined PCL lesions are more common than isolated lesions, even in sports injuries (except handball). Incidence and injury pattern vary depending on activity during trauma. Main additional peripheral lesion is a lesion of the posterolateral corner, except biking and skiing accidents where a medial lesion is more common.

LEVEL OF EVIDENCE

Level III.

Prevalence and characteristics of chronic ankle instability and copers identified by the criteria for research and clinical practice in collegiate athletes

OBJECTIVES

To investigate the prevalence and characteristics of chronic ankle instability (CAI) and copers among collegiate athletes as identified by criteria for research (CAI-R and copers-R) and for clinical practice (CAI-C and copers-C).

DESIGN

Cross-sectional study.

SETTING

University.

PARTICIPANTS

Collegiate athletes (n = 507).

MAIN OUTCOME MEASURES

Participants were assessed by questionnaires based on the International Ankle Consortium guidelines. The percentages of participants with CAI-R, CAI-C, copers-R and copers-C were calculated, respectively. Demographic and injury data were statistically compared between CAI-R and copers-R groups.

RESULTS

The data of 470 participants was retained after exclusions. Of these, the prevalence of CAI-R (10.0%) was only half of that of CAI-C (19.8%), and that of copers-R and copers-C was about 5%. Seventy percent of unclassifiable participants had recurrent ankle sprains. CAI was most common in basketball, while copers were less prevalent in basketball, judo, rugby and gymnastics. The age at the initial injury was significantly younger in the CAI-R participants than in the copers-R.

CONCLUSIONS

The type of sport and the age at the initial injury may be associated with developing CAI. The standard criteria may not capture the entire clinical CAI population, therefore, care should be taken when applying the research to clinical practice.

Current clinical practice and return-to-sport criteria after anterior cruciate ligament reconstruction: a survey of Brazilian physical therapists

BACKGROUND

Adherence to the use of recommended measures/criteria for return to sport clearance after anterior cruciate ligament reconstruction is crucial for successful rehabilitation.

OBJECTIVES

The purpose of this study was to describe the current clinical practice of Brazilian physical therapists that treat patients after anterior cruciate ligament reconstruction, including the measures/criteria used to support the decision-making process regarding return to sport. The secondary aim was to investigate factors associated with the use of the most recommended measures/criteria for return to sport.

METHODS

An electronic survey questionnaire was sent to Brazilian physical therapists. The survey consisted of questions about demographics and professional and clinical practice data related to anterior cruciate ligament reconstruction postoperative rehabilitation and return to sport criteria. Descriptive statistics and chi-square tests were used for analyses.

RESULTS

A sample of 439 professionals participated in the survey. Only 6.4% of the physical therapists use the most recommended measures/criteria for return to sport after anterior cruciate ligament reconstruction. Professional certification in Sports Physical Therapy was the only factor associated with the use of these recommended measures/criteria (p=0.02). The measures most used for return to sport clearance were related to physical factors (65.3% to 75.1%), such as range of motion and muscle strength. A small number of professionals use questionnaires to assess functional (16.6%) and psychological (19.1%) aspects of their patients to support the decision-making process.

CONCLUSION

In their clinical practice, most Brazilian physical therapists do not use the recommended measures/criteria for return to sport after anterior cruciate ligament reconstruction.

Injuries in Male and Female Elite Aquatic Sports Athletes: An 8-Year Prospective, Epidemiological Study

This study aimed to determine the injury patterns associated with training activities in elite South Korean aquatic sports athletes training for the Olympic Games. From 2012 to 2019, we prospectively collected data on elite aquatic sports athletes at the Korea National Training Center. The athletes were assessed by four sports medicine doctors, and data were stratified according to sex, aquatic style, injury body location, and injury severity. Chi-square tests were used to compare groups. Injury rates was expressed as rate ratios with 95% confidence intervals. Annually, the center hosts an average of 42 elite aquatic athletes spread over four aquatic styles. We recorded 797 injuries in total (annual average: 2.37 injuries/athlete), during training sessions, 57.1% of which were mild injuries. For all athletes, most injuries occurred in the upper limb (35.9%), followed by the lower limb (31.0%), the trunk (24.5%), and the head and neck (8.7%). Aquatic style significantly influenced injury body location and severity for both male and female athletes (injury body location: p < 0.001 and p < 0.010, respectively; injury severity: p = 0.027 and p < 0.001, respectively). In general, male and female athletes experienced a comparable risk of injury (rate ratio: 1.15; 95% confidence intervals: 0.53-2.46). Among the male and female South Korean elite aquatic athletes training for the Olympic Games, most injuries were mild and occurred in the upper limb, and aquatic style influenced injury body location and severity.

Achilles tendoscopy for non insertional Achilles tendinopathy. A case series study

BACKGROUND

Achilles non-insertional tendinopathy is usually treated with conservative means. If resistant to a rehabilitation protocol surgical treatment could be proposed. The aim of this research is to report the mid-term clinical results of endoscopic assisted surgery for patients suffering from recalcitrant painful non-insertional Achilles tendinopathy.

METHODS

A consecutive series of 11 patients (6 men and 5 women), median age of 54 (range 40-67) years, with chronic recalcitrant painful non-insertional Achilles tendinopathy were included. All patients completed at least 20 physical therapy sessions and 6 months of no sports activities before surgery. All underwent Achilles tendoscopy, without tendon excision or transfer with a median follow-up of 87 (27-105) months. We report the preoperative symptoms duration, treatment before surgery, complications and satisfaction after surgery, return to previous sport level, and postoperative VISA-A score.

RESULTS

Mean preoperative symptoms duration was 1 year, having all performed at least 20 physical therapy sessions. No postoperative complications were reported, achieving a complete satisfaction in 10 of 11 patients. All patients returned to their preoperative sports level with a median postoperative VISA-A functional score of 100 (30-100) points.

CONCLUSIONS

The mid-term results of Achilles tendoscopy in patients with chronic painful non-insertional Achilles tendinopathy are satisfactory with a rapid rehabilitation. This procedure is safe and has a low complication rate.

LEVEL OF EVIDENCE

IV. Retrospective case series.

Conditions and Injuries Affecting the Nerves Around the Elbow

Sports-related peripheral neuropathies account for 6% of all peripheral neuropathies and most commonly involve the upper extremity. The routes of the median, radial, and ulnar nerves are positioned in arrangements of pulleys and sheaths to glide smoothly around the elbow. However, this anatomic relationship exposes each nerve to risk of compression. The underlying mechanisms of the athletic nerve injury are compression, ischemia, traction, and friction. Chronic athletic nerve compression may cause damage with moderate or low pressure for long or intermittent periods of time.

Injury surveillance of an Australian community netball club

OBJECTIVES

To describe injuries associated with netball and risk factors for lower limb injuries.

DESIGN

Prospective study. In the preseason, risk factors were investigated using self-report questionnaires and physical measurements. During the season, injuries were reported using a standardised report, verified by follow-up phone calls. Player training and game hours were recorded.

SETTING

Australian community netball club.

PARTICIPANTS

269 players from 9 divisions, aged 7-42 years.

MAIN OUTCOME MEASURES

Injury incidence rates per 1000 exposure hours were calculated. The most common mechanism, nature and consequence of injury were determined from frequencies. Logistic regression was used to identify predictors of lower limb injury and determine adjusted odds ratios for each risk factor.

RESULTS

169 injuries occurred with a rate of 13.8/1000 exposure hours (95% CI 11.8-16.0), majority (60%) to the lower limb. The most frequent injury mechanisms were collisions (28%) and awkward landings (27%), nature was 'Inflammation/swelling' (32%) and consequence was 'unable to continue playing/training' (50%). Previous history of injury (OR 6.9, 95% CI 3.7-13.0) and age greater than 13.5 years (OR 3.1, 95% CI 1.6-5.9) were significant risk factors for a season lower limb injury.

CONCLUSION

Injury rates in this community netball club were high. Results suggest that further research regarding the implementation and effectiveness of injury prevention programs for community netballers is required.

Fact-finding survey regarding judo-related injuries of judokas in developing country

[Purpose] The purpose of this study was to investigate sports-related injuries among judokas in Mongolia which is classified in the lower-middle income country. This study may help prevent future sports-related injuries. [Participants and Methods] We studied 75 judokas affiliated to the judo club in Ulaanbaatar, Mongolia. The questionnaire survey included questions regarding current and past judo-related injuries. [Results] Out of 75 judokas, 39% judokas had current judo-related injuries, and 25% judokas had past injuries. The injuries were most commonly located in the shoulder/clavicular, followed by that in the ankle and knee. The most frequent injury was a sprain/ligament injury, followed by a fracture and a dislocation. Seventy-three percent of current injuries and 88% of the past injuries received medical attention. Self-management was carried out for 35% of the injuries. The time lost from judo matches and training was 0–1,095 days for current injuries and 0–545 days for past injuries. [Conclusion] In this study, the injury rate for judokas was higher than that reported in previous studies. In addition, numerous severe injuries were noted. It is observed that, despite medical attention and self-management, the recovery periods are prolonged. Additionally, we believe that the judokas are unable to return to competition without problems.

Prediction model for utilization of complementary and alternative medicine for sports injuries among Korean elite collegiate athletes

Background

The purpose of this study was to describe the use of complementary and alternative medicine (CAM) services by Korean elite collegiate athletes and to examine the factors influencing the utilization of CAM, or Korean Medicine (KM).

Methods

Students in Korea National Sport University (KNSU) enrolled and in training during August to December 2017 completed the survey. Data from the survey was analyzed through path analysis.

Results

Students who were training in the Department of Physical Education, KNSU (n = 624, 70% males, mean age 21.3 ± 1.2) participated in this study. 15% of the respondents chose KM clinics for sports injuries, a higher rate than that of the general population, and 44% of KM interventions involved acupuncture. In the path analysis, sports injuries were positive predictors for utilization of medical services and the perception of KM, and KM utilization and the perception of KM were positive predictors of the willingness to receive KM treatments.

Conclusions

The use of KM such as acupuncture was relatively high in elite collegiate athletes. The perception of KM and willingness to receive KM treatments were mediated by previous KM experiences. A higher accessibility towards KM treatments are necessary.

Musculoskeletal injuries in athletes from five modalities: a cross-sectional study

Background

Musculoskeletal injuries (MSK-I) are a serious problem in sports medicine. Modifiable and non-modifiable factors are associated with susceptibility to these injuries. Thus, the aim of this study was to describe the prevalence of and identify the factors associated with MSK-I, including tendinopathy and joint and muscle injuries, in athletes.

Methods

In this cross-sectional observational study, 627 athletes from rugby (n = 225), soccer (n = 172), combat sports (n = 86), handball (n = 82) and water polo (n = 62) were recruited at different sports training centres and competitions. Athlete profiles and the prevalence of MSK-I were assessed using a self-reported questionnaire. Only previous MSK-I with imaging confirmation and/or a positive physical exam by a specialized orthopaedist were considered. The association of the epidemiological, clinical and sports profiles of athletes with MSK-I was evaluated by a logistic regression model.

Results

The mean age was 25 ± 6 years, and 60% of the athletes were male. The epidemiological, clinical and sports profiles of the athletes were different for the five sport groups. The MSK-I prevalence among all athletes was 76%, with 55% of MSK-I occurring in a joint, 48% occurring in a muscle and 30% being tendinopathy, and 19% of athletes had three investigated injuries. The MSK-I prevalence and injury locations were significantly different among sport groups. There was a predominance of joint injury in combat sports athletes (77%), muscle injury in handball athletes (67%) and tendinopathy in water polo athletes (52%). Age (≥30 years) was positively associated with joint (OR = 5.2 and 95% CI = 2.6–10.7) and muscle (OR = 4.9 and 95% CI = 2.4–10.1) injuries and tendinopathy (OR = 4.1 and 95% CI = 1.9–9.3).

Conclusion

There is a high prevalence of tendinopathy and joint and muscle injuries among rugby, soccer, combat sports, handball and water polo athletes. The analysis of associated factors (epidemiological, clinical and sports profiles) and the presence of MSK-I in athletes suggests an approximately 4–5-fold increased risk for athletes ≥30 years of age. The identification of modifiable and non-modifiable factors can contribute to implementing surveillance programmes for MSK-I prevention.

Surgical treatment of an ischial tuberosity avulsion fracture with delayed presentation

Avulsion fractures of the ischial tuberosity usually occur in skeletally immature athletes following eccentric contraction of the hamstrings. When displaced fractures are left untreated, subsequent non-union and proximal hamstring fibrosis may lead to chronic pain and reduced activity. However, the indications for and outcomes of operative fixation when presentation is delayed remain unclear. We report the case of a 14 year old male athlete who presented to our institution 6 weeks after sustaining a displaced ischial tuberosity avulsion fracture. He underwent open reduction and internal fixation using a cannulated screw system via a posterior approach, with excellent results at 18 months follow-up. We report our surgical findings in detail as well as a novel method for post-operatively assessing functional screw head prominence-the seated radiograph.

Effect of deep transverse friction massage vs stretching on football players’ performance

BACKGROUND

Flexibility, agility and muscle strength are key factors to either win or lose a game. Recently the effect of a new technique, deep transverse friction massage (DTFM) on muscle extensibility as compared to traditional stretching techniques has been examined.

AIM

To compare the effect of DTFM vs static and dynamic stretching techniques on the hamstring’s extensibility, agility, and strength amongst Lebanese and Syrian football players. Recording the incidence of non-contact hamstring muscle injury was a secondary objective.

METHODS

This study is a single-blinded prospective longitudinal randomized controlled trial. The experiment took place over a period of four weeks. Football players were randomized into three intervention groups (static stretching; dynamic stretching; DTFM). Participants of each group were followed-up carefully by assessors during their intervention sessions three times per week, for a total of 12 sessions and during the data collection. Extensibility, agility, and strength were compared between intervention groups at (baseline; acute; and chronic) phases. Straight leg raise and 1 repetition maximum tests were used to measure the dominant leg hamstring muscle extensibility and maximal strength respectively. T-drill test was used to assess the lower extremities agility.

RESULTS

Of 103 Lebanese and Syrian male football players aged between 18 and 35 were sampled from Damascus-Syria and South of Lebanon to participate in this study. Between-groups measures of acute strength (P = 0.011) and chronic extensibility (P = 0.000) solely showed a significant difference, and the static group showed to be superior as compared to the other groups. No loss to follow-up or protocol violation was recorded.

CONCLUSION

Static stretching is showing to be superior to the other techniques used, regarding gaining long-term extensibility and short-term maximal muscle strength. In addition, DTFM showed improvements but did not outweigh the effects on footballers’ performance when comparing it to static and dynamic techniques. Finally, no difference between the interventions is recorded regarding the rate of muscle injuries incidence.

Prevalence of MRI-Detected Ankle Injuries in Athletes in the Rio de Janeiro 2016 Summer Olympics

OBJECTIVE

To describe the prevalence, severity, and location of ankle injuries as assessed on magnetic resonance imaging (MRI) in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games.

METHODS

We analyzed all ankle MRIs that were acquired for suspected injury as reported by the National Olympic Committee medical teams and the Organizing Committee medical staff during the Rio 2016 Summer Olympics. Diagnostic imaging was performed through the Olympic Village Polyclinic. Images were interpreted retrospectively according to standardized criteria.

RESULTS

A total of 11,274 athletes participated in the Games, of which 89 (8.8%) were referred for an ankle MRI. Eighty-eight of the 89 (99%) had at least 1 abnormal finding, and some had as many as 27, for an average of 6.2 abnormalities per examination. Around one-fifth of all abnormal findings were considered pre-existing (21%) and 79% were assumed to be the result of an acute or subacute injury. The highest proportion of acute/subacute injuries per athlete occurred in ball sports (7.0 injuries per examination) and in the age group >30. Most pre-existing findings per athlete were identified in the group of others (no track and field or ball sports athletes) with 2.5 findings per examination and respectively in the age group >30 (1.7).

CONCLUSION

Our study demonstrated a high prevalence of acute and subacute, but also pre-existing injuries in Olympic athletes undergoing ankle MRI. Tendon injuries were the most common acute injuries, found mainly in ball sports athletes. Most pre-existing ankle injuries were identified at the ligaments.

A biomechanical analysis of the stand-up paddle board stroke: a comparative study

Background

Stand-up paddle boarding (SUP) is a rapidly growing global aquatic sport, with increasing popularity among participants within recreation, competition and rehabilitation. To date, few scientific studies have focused on SUP. Further, there is no research examining the biomechanics of the SUP paddle stroke. The purpose of this study was to investigate whether variations in kinematics existed among experienced and inexperienced SUP participants using three-dimensional motion analysis. This data could be of significance to participants, researchers, coaches and health practitioners to improve performance and inform injury minimization strategies.

Methods

A cross-sectional observational design study was performed with seven experienced and 19 inexperienced paddlers whereby whole-body kinematic data were acquired using a six-camera Vicon motion capture system. Participants paddled on a SUP ergometer while three-dimensional range of motion (ROM) and peak joint angles were calculated for the shoulders, elbows, hips and trunk. Mann–Whitney U tests were conducted on the non-normally distributed data to evaluate differences between level of expertise.

Results

Significant differences in joint kinematics were found between experienced and inexperienced participants, with inexperienced participants using greater overall shoulder ROM (78.9° ± 24.9° vs 56.6° ± 17.3°, p = 0.010) and less hip ROM than the experienced participants (50.0° ± 18.5° vs 66.4° ± 11.8°, p = 0.035). Experienced participants demonstrated increased shoulder motion at the end of the paddle stoke compared to the inexperienced participants (74.9° ± 16.3° vs 35.2° ± 28.5°, p = 0.001 minimum shoulder flexion) and more extension at the elbow (6.0° ± 9.2° minimum elbow flexion vs 24.8° ± 13.5°, p = 0.000) than the inexperienced participants.

Discussion

The results of this study indicate several significant kinematic differences between the experienced and inexperienced SUP participants. These variations in technique were noted in the shoulder, elbow and hip and are evident in other aquatic paddling sports where injury rates are higher in these joints. These finding may be valuable for coaches, therapists and participants needing to maximize performance and minimize injury risk during participation in SUP.

Traumatic Isolated Myotendinous Rupture of the Teres Minor in a Young Athlete - A Unique Case Report

Introduction:

Functional role of teres minor (TM) is well known. To date, an isolated myotendinous rupture of the TM, without any lesion of the other cuff tendons, has never been reported in literature.

Case Report:

The patient was a 22-year-old soccer player who has presented with a direct shoulder traumatism that is causing persistent pain and impairment. Early appropriate imaging was done (magnetic resonance imaging [MRI] and arthro-computed tomography scan); it revealed an isolated tear of the TM at the myotendinous junction. Open surgical repair was performed through a posterior approach, within the 1st month after the injury. The patient was immobilized for 1 month in neutral rotation and then was allowed to begin the rehabilitation process. At the 2-year follow-up point, the patient had a pain-free and functional shoulder, allowing a return to full activities, including sport at the pre-injury level. MRI confirmed that the muscle had healed, without atrophy or fatty infiltration.

Conclusion:

A TM myotendinous tear is very rare but might be under diagnosed. Early appropriate imaging is necessary. Surgical repair may be the preferable option in young and active patients and should be performed at the acute phase before muscular atrophy and fatty infiltration occur.

Sport injury prevalence and risk by level of play and sports played among a representative population of French adolescents. A school-based study

BACKGROUND

Sports practice has both benefits and physical risks. In France, data related to adolescent sports injury are rare. The main purpose of this article is to study the prevalence and risk of injuries by level of play and sports in the southeast of France.

METHODS

Data collection was conducted in French schools among adolescents in 2015 and 2017 (n=1849; aged 14-19). Only sports players were included (n=1366). Two level of play were created. The low-level group included adolescents playing sport either outside or within a club, at the local level of competition or below. The high-level group included adolescents playing sport within a club at the state (regional) level of competition or higher. Odds-ratios and their 95% confidence intervals adjusted for variables selected using stepwise regression procedures were calculated to determine the injury risk of high-level athletes compared with those at low-level, in each sport. We also calculated the injury risk of each sport compared to all the other sports, by level of play.

RESULTS

In almost all sports activities, the prevalence of injured athletes was higher in the high-level of play than in the low-level of play. The increase in injury risk was the highest in tennis, basketball, dance, athletics and volleyball. When comparing sports, at the lowest level, handball, boxing, soccer and gymnastics practitioners were more at risk than the rest of the sample. At the highest level of play, only basketball players were more at-risk. Dancing is the less dangerous sport in terms of injury outcome, regardless the level.

CONCLUSION

From the state level of competition, injury risk increases significantly across most of the sports. Meanwhile, differences appeared regarding the prevalence, severity and nature of the sustained injuries. It would be useful to perform such analysis on a greater sample size, ideally representative of the national population of adolescents.

Pain perception and coping strategies influence early outcomes following knee surgery in athletes

OBJECTIVES

To determine whether pain perceptions and coping strategies are predictive of the following outcomes after knee surgery in athletes: (1) return to similar level of sport, (2) improvement in symptoms, and (3) improvement in kinesiophobia.

DESIGN

Prospective cohort study.

METHODS

101 athletes (52 men, 49 women; mean age 32.7years) at mean 12.1months follow-up were included. Independent relationships between patient outcomes and pre-operative measures were determined: short form McGill Pain questionnaire (SF-MPQ), Pain Catastrophizing Scale (PCS), Pain Coping Measure (PCM), and the brief COPE subscales of acceptance, denial, positive reframing, and use of instrumental support. Adjustment was performed for length of follow-up, symptom duration, surgical history, age, activity level, and surgical procedure.

RESULTS

Rate of return to similar level of sport was 73%; severe pain catastrophizers (PCS >36 points) had increased odds of not returning to similar level of sport (OR 11.3 CI 1.51, 236; p=0.02) whereas COPE-use of instrumental support was protective (per point increase: 0.72 CI 0.54, 0.94; p=0.02). Problem-focused coping positively correlated with improvement in IKDC-S scores (beta 0.032 SE 0.010; p=0.001). Improvement in kinesiophobia after surgery was less likely with higher pre-operative perceived pain frequency (OR 0.23 CI 0.06, 0.71; p=0.009) and higher COPE-denial scores (OR 0.43 CI 0.21, 0.88; p=0.02).

CONCLUSIONS

Among athletes undergoing knee surgery, severe pain catastrophizing is negatively associated with return to similar level of sport. Instrumental support and problem-focused coping strategies are associated with improved outcomes. High preoperative pain scores are negatively associated with improvement in kinesiophobia after rehabilitation.

Collaborative care model for treatment of persistent symptoms after concussion among youth (CARE4PCS-II): Study protocol for a randomized, controlled trial

Background

Currently, there is limited evidence to guide intervention and service delivery coordination for youth who suffer a concussion and subsequently experience persistent post-concussive symptoms (PCS) (Lumba-Brown et al. JAMA Pediatr 172(11):e182853, 2018; Lumba-Brown A et al. JAMA Pediatr 172(11):e182847, 2018). We have developed a collaborative care intervention with embedded cognitive-behavioral therapy, care management, and stepped-up psychotropic medication consultation to address persistent PCS and related psychological comorbidities. The CARE4PCS-II study was designed to assess whether adolescents with persistent symptoms after sports-related concussion will demonstrate better outcomes when receiving this collaborative care intervention compared to a usual care (control) condition.

Methods/design

This investigation is a randomized comparative effectiveness trial to receive intervention (collaborative care) or control (usual care). Two hundred sports-injured male and female adolescents aged 11–18 years with three or more post-concussive symptoms that persist for at least 1 month but less than 9 months after injury will be recruited and randomized into the study. The trial focuses on the effects of the intervention on post-concussive, depressive, and anxiety symptoms measured 3, 6, and 12 months after baseline.

Discussion

The CARE4PCS II study is a large comparative effectiveness trial targeting symptomatic improvements in sports injured adolescents after concussion. The study is unique in its adaptation of the collaborative care model to a broad spectrum of primary care, sports medicine, and school settings. The investigation incorporates novel elements such as the delivery of CBT through HIPAA complaint video conferenceing technology and has excellent widespread dissemination potential should effectiveness be demonstrated.

Trial registration

ClinicalTrials.gov, NCT03034720. Registered on January 27, 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3662-3) contains supplementary material, which is available to authorized users.

Maximizing Return to Sports After Achilles Tendon Rupture in Athletes

Achilles tendon ruptures are devastating injuries to athletes, with return-to-sports rates around 70% and some risk for diminished performance post-injury. Surgical management in athletes is often favored for a number of reasons, although evidence guiding the optimal treatment is limited. Functional rehabilitation has been supported as a key component of operative and nonoperative treatment plans. Return-to-play protocols in the literature are sparse and varied due to often ambiguous definitions of what it means to return to sport and a lack of explicit criteria. Optimal sport-specific return-to-play milestones should be defined to guide the rehabilitation of injured athletes.

The pre-signing medical examination: The radiologists' role

PURPOSE

to review the role of the radiologist in reporting pre-signing medical imaging prior to athlete transfer between clubs.

METHOD

When a professional athlete transfers from one club to another they may undergo a transfer or "pre-signing" medical examination, of which imaging forms a major component. The purpose of imaging is to enable the overseeing sports physician to make a risk assessment on the athlete that may influence decisions such as the duration of contract offered. Imaging studies have to be performed and reported often within limited time constraints, usually by MSK radiologists specialised in sports imaging. This article describes the role of the sports radiologist in reporting pre-signing medical imaging studies, and discusses some of the common pathology identified, as well as some of the ethical and medicolegal issues encountered.

RESULTS

Not applicable. This is a review article.

CONCLUSION

the sports radiologists report of the pre-signing medical is an important component of the decision making process to sign an athlete, and is closely linked to the physical examination.

Partial thickness rotator cuff tears: Patient demographics and surgical trends within a large insurance database

Introduction

Partial thickness rotator cuff tears (PTRCT) are a common injury reported in 13-32% of the population, yet most of the current literature focuses on full thickness rotator cuff tears. Therefore, the purpose of this study was to analyze trends among patients with PTRCT including: (1) demographics; (2) comorbidities; (3) cost of care; (4) setting of initial diagnosis; and (5) change in incidence of PTRCT or surgical approach over time.

Methods

A Medicare patient-population consisting of 44 million lives was retrospectively analyzed from 2007 to 2017 using International Classification of Disease, 9th Revision (ICD-9) codes. Patients were identified for PTRCT using ICD-9 code: 726.13. The query yielded a total of 44,978 patients all of which had been previously diagnosed with PTRCT. Primary trends analyzed included: demographics, comorbidities, cost of care, initial setting of diagnosis, and change in incidence of PTRCT or surgical approach over time.

Results

PTRCTs and surgical repair of PTRCTs were most common in patients ages 65 to 69 and least common in patients who were 85 and older. Incidence of PTRCT was greater in females (54.12%) than males (45.88%). Comorbidities found within the population included hypertension, hyperlipidemia, diabetes mellitus, tobacco use, obesity, rheumatoid arthritis, and osteoarthritis of the shoulder. The average cost per episode of care totaled $9,923.26. PTRCTs were most commonly diagnosed in patients who resided in assisted living facilities (n = 27,106), making up 60% of the patient population. Reported incidence of PTRCT has increased substantially along with the surgical repair of PTRCT.

Conclusion

Reported cases of PTRCT and its surgical repair have both increased substantially over time. Approximately 11.70% of patients with PTRCT undergo either open or arthroscopic procedure as a means of surgical repair. With the growing popularity of arthroscopic procedures for rotator cuff repair, further investigation should be performed to analyze trends and risk factors for PTRCT, a seemingly underrepresented orthopedic condition.

Contact sport related head and neck injuries in pediatric athletes

OBJECTIVES

To describe the type and frequency of sports related pediatric head and neck trauma.

METHODS

The National Electronic Injury Surveillance System (NEISS) was searched for football, basketball, soccer, lacrosse and ice hockey related facial injuries. Cross-sectional analysis of incidence, age, and sex and specific injury diagnoses, mechanisms, and facial locations were performed. We focused on craniofacial and soft tissue injuries and excluded patients with concussion or other neurological injuries.

RESULTS

A total of 24,905 cases were identified in the NEISS database, corresponding to an estimated, 764,293 emergency department visits. The most hazardous sports were basketball, accounting for 356,188 visits (46.6%), football with 249,633 visits (32.6%), and soccer with 128,113 (14.7%) visits. Lacrosse and ice hockey accounted for 16,869 (1.9%) and 13,490 (1.5%) visits, respectively. There has been a decrease in injuries over the past 10 years, particularly for football (53%), ice hockey (46%), and lacrosse (41%). Soccer (13%) and basketball (9%) noticed the smallest decreases.

CONCLUSION

Children who play basketball, football and soccer are especially prone to emergency department visits related to the head and neck. Overall, there has been an improvement in number of injuries across the five sports investigated. Sports amenable to head and neck protective equipment saw the largest improvement (football, ice hockey, lacrosse), whereas only small decreases were noted in basketball and soccer. Changes in regulations for sports not amenable to more protective equipment may help decrease adverse events.

Trends of ED visits, admissions, and deaths for pediatric traumatic brain injury comparing sport and non-sport mechanisms

Background

Traumatic brain injuries (TBI) in children result in significant morbidity and mortality. There are many mechanisms, both sport and non-sport related, which cause these injuries. Studies have reported that Emergency Department (ED) visits for pediatric TBI caused by sports are increasing; however, no subsequent study has evaluated the trend in non-sport TBI. The objective of this study was to evaluate ED visits, admissions, and deaths for non-sport TBI compared to those caused by sports.

Methods

A retrospective study of children 5-19 years of age was performed at a pediatric, level 1 trauma center from 2002 to 2012. Subjects with a primary or secondary diagnosis of TBI were identified from the hospital's trauma registry, and mechanism of injury, disposition, injury severity score, and length of stay were recorded. Frequencies were used to characterize the population, Chi-square analysis was performed to determine differences between groups, and linear trend lines were calculated for sport-related and non-sport TBI by year.

Results

Thirteen thousand two hundred ninty one subjects were seen in the ED between 2002 and 2012 for a TBI; 9527 (72%) were from a non-sport mechanism, and 3764 (28%) were from a sport mechanism. Subjects with a non-sport TBI were more likely to be younger (p < 0.001), African American (p < 0.001), and have Medicare/Medicaid (p < 0.001). Subjects with a non-sport TBI were admitted to the hospital 15% of the time, and subjects with a sport-related TBI were admitted 10% of the time (p < 0.001). When evaluating all TBI by mechanism of injury, sport had the lowest injury severity score (mean 4.4) and the shortest length of stay (mean 1.6 days) of any mechanism. There were six deaths reported from non-sport TBI and none from sport-related TBI. ED visits for sport-related TBI increased 92%, and non-sport TBI increased 22% over 10 years. There was a peak in TBI, in both groups, seen in 2009.

Conclusions

ED visits for both sport and non-sport TBI have increased over the past 10 years. TBI from a non-sport mechanism was more likely to result in hospitalization or death. Prevention efforts should be expanded to include all high-risk TBI mechanisms, not just sports.

A hidden mismatch between experiences of young athletes with overuse injuries of the wrist and sports physicians' perceptions: a focus group study

BACKGROUND

Although overuse wrist injuries can have serious consequences, young athletes often do not immediately report their injury to a physician. This qualitative study aimed to identify symptoms and limitations related to overuse wrist injuries that young athletes consider important and to compare those with sports physicians' opinions, in order to improve the diagnostic process for early identification of overuse wrist injuries.

METHODS

Twenty-one athletes aged 13-25 years in wrist-loading sports (gymnastics, tennis, judo, field hockey, volleyball and rowing) with a (previous) overuse wrist injury were included. In five focus groups, participants discussed important signals and limitations of their injury, as well as a list of relevant items previously composed by sports physicians. Data were grouped into themes and (sub)categories and subsequently coded.

RESULTS

Of the resulting 224 signals and 80 limitations, respectively 81 and 20 were labelled important. Athletes considered both pain and limitations during daily life activities important indicators of overuse wrist injury, as well as long pain duration, acute onset of pain, and accompanying symptoms like swelling, cracking and discoloration. All of the sports physicians' items were also considered important by the athletes, but sport-related pain and limitations were regarded by many athletes as a natural part of their sport.

CONCLUSIONS

Discrepancies exist between the opinions of young athletes and sports physicians on sport-related pain reporting and competing regardless of pain or limitations. Although clinicians may be inclined to focus on these aspects, they are advised to also inquire specifically about limitations and pain during daily life activities in young athletes with overuse wrist injuries.

Comparison of subsequent injury categorisation (SIC) models and their application in a sporting population

Background

The original subsequent injury categorisation (SIC-1.0) model aimed to classify relationships between chronological injury sequences to provide insight into the complexity and causation of subsequent injury occurrence. An updated model has recently been published. Comparison of the data coded according to the original and revised subsequent injury categorisation (SIC-1.0 and SIC-2.0) models has yet been formally compared.

Methods

Medical attention injury data was prospectively collected for 42 elite water polo players over an 8 month surveillance period. The SIC-1.0 and SIC-2.0 models were retrospectively applied to the injury data. The injury categorisation from the two models was compared using descriptive statistics.

Results

Seventy-four injuries were sustained by the 42 players (median = 2, range = 0–5), of which 32 injuries (43.2%) occurred subsequent to a previous injury. The majority of subsequent injuries were coded as occurring at a different site and being of a different nature, while also being considered clinically unrelated to the previous injury (SIC-1.0 category 10 = 57.9%; SIC-2.0 clinical category 16 = 54.4%). Application of the SIC-2.0 model resulted in a greater distribution of category allocation compared to the SIC-1.0 model that reflects a greater precision in the SIC-2.0 model.

Conclusions

Subsequent injury categorisation of sport injury data can be undertaken using either the original (SIC-1.0) or the revised (SIC-2.0) model to obtain similar results. However, the SIC-2.0 model offers the ability to identify a larger number of mutually exclusive categories, while not relying on clinical adjudication for category allocation. The increased precision of SIC-2.0 is advantageous for clinical application and consideration of injury relationships.

Electronic supplementary material

The online version of this article (10.1186/s40621-019-0183-1) contains supplementary material, which is available to authorized users.

An assessment of the utility and functionality of wearable head impact sensors in Australian Football

OBJECTIVES

To assess the utility and functionality of the X-Patch^® as a measurement tool to study head impact exposure in Australian Football. Accuracy, precision, reliability and validity were examined.

DESIGNS

Laboratory tests and prospective observational study.

METHODS

Laboratory tests on X-Patch^® were undertaken using an instrumented Hybrid III head and neck and linear impactor. Differences between X-Patch^® and reference data were analysed. Australian Football players wore the X-Patch^® devices and games were video-recorded. Video recordings were analysed qualitatively for head impact events and these were correlated with X-Patch^® head acceleration events. Wearability of the X-Patch^® was assessed using the Comfort Rating Scale for Wearable Computers.

RESULTS

Laboratory head impacts, performed at multiple impact sites and velocities, identified significant correlations between headform-measured and device-measured kinematic parameters (p<0.05 for all). On average, the X-Patch^®-recorded peak linear acceleration (PLA) was 17% greater than the reference PLA, 28% less for peak rotational acceleration (PRA) and 101% greater for the Head Injury Criterion (HIC). For video analysis, 118 head acceleration events (HAE) were included with PLA ≥30g across 53 players. Video recordings of X-Patch^®-measured HAEs (PLA ≥30g) determined that 31.4% were direct head impacts, 9.3% were indirect impacts, 44.1% were unknown or unclear and 15.3% were neither direct nor indirect head impacts. The X-Patch^® system was deemed wearable by 95-100% of respondents.

CONCLUSIONS

This study reinforces evidence that use of the current X-Patch^® devices should be limited to research only and in conjunction with video analysis.

Vestibulo-ocular dysfunction in adolescent rugby union players with and without a history of concussion

OBJECTIVES

Sport-related concussions are common in adolescent contact sports. Vestibulo-ocular dysfunction has been reported in athletes post-concussion. There is a lack of research on vestibulo-ocular function in sporting adolescents, and the influence of previous concussions on the vestibular system in this population. The aim of this study was to investigate vestibulo-ocular function in a cohort of adolescent rugby players with and without a history of concussion during pre-season assessment.

DESIGN

Cross-sectional cohort.

METHODS

213 male adolescent (13-18 years old) rugby players were recruited from six schools in Queensland, Australia. Vestibulo-ocular assessments were conducted during the preseason and included clinical assessment of oculomotor function and the vestibulo-ocular reflex (VOR) using the clinical and video-Head Impulse Test (HIT). Players were allocated into two groups: no history of concussion in the last 12 months (n = 165); and concussion in the last 12 months (n = 48).

RESULTS

There were no between group differences in vestibulo-ocular function for players with and without a history of concussion (p = 0.65). However, vestibulo-ocular dysfunction was reported in 69 (32.7%) of the players tested, who had either abnormal oculomotor control or VOR function.

CONCLUSIONS

The high prevalence of vestibulo-ocular dysfunction in adolescent rugby players suggests that positive clinical findings post-concussion need to be interpreted carefully in the absence of baseline or pre-concussion assessments.

Bilateral simultaneous anterior cruciate ligament reconstruction: A case series and review of the literature

Bilateral ACL rupture is a relatively uncommon injury with an incidence of 2-4%. Most bilateral ACL rupture occurs at two different times, but few cases of single-staged bilateral ACL ruptures have also been reported. There have been reports of both single-staged, and two-staged reconstruction of bilateral ACL ruptures in the literature but without a clear consensus. We present a series of five bilateral ACL rupture cases managed by single-staged arthroscopic ACL reconstruction, using quadrupled hamstring grafts. All of them were young males, with an average age of 26.8 years (Range: 19-39 years). Three out of five of these cases (60%) had sustained the injury to both the knees simultaneously while playing sports. All the five patients had generalized joint laxity with significant hyperextension of their knees. All the ten knees (in five patients) were clinically stable, at their last follow-ups. None of the knees had any early or late complications. A single-staged bilateral ACL reconstruction is a safe, reproducible, and cost-effective procedure for patients with a bilateral ACL deficient knee, in experienced hands.

Recent Advances in Pediatric Concussion and Mild Traumatic Brain Injury

Concussions after a head injury among children continues to be a substantial public health concern. An increasing number of concussions are being managed initially by primary care physicians. The diagnosis of concussion remains a clinical diagnosis despite the availability of ancillary tests such as computerized neuropsychological testing, advanced imaging, and blood biomarkers. Clinically, overlooking other injuries and comorbidities may lead to prolonged recovery for the patient. Addressing concussions in a multidisciplinary approach may help in reducing recovery time for patients. Retirement from sport in the pediatric population remains a controversial issue lacking evidenced-based studies.

Surgical fenestration and rehabilitation of a sports traumatic non-union ischial tuberosity fracture - Case report

INTRODUCTION

Ischial tuberosity fractures and complications may be an under recognized diagnosis in adolescent athletes. Operative interventions differ and may include anchor re-fixations, resections and osteostimulating drilling and partial hamstring releases. This case report illustrates a novel and less invasive management of a non-union following a proximal ischial tuberosity avulsion. This approach has to our knowledge not previously been described.

PRESENTATION OF CASE

The patient, a 14 years old female athlete, was complaining of sharp pain in the right side of the groin region, after an acute injury during a handball game. The pain was concentrated at the insertion of the adductor muscle group to the superior pubic ramus and the pubic symphysis. She was referred to our orthopaedic sports clinic after 6 months of unsuccessful conservative treatment. An MRI scan showed an ischial tuberosity non-union with a displacement less than 10 mm. Nine months after injury a surgical procedure was performed with the patient under general anaesthesia. An ultrasound guided fenestration of the non-union of the ischial tuberosity with a 1.6 mm Kirshner wire was performed. The enthesis was fenestrated 10 times, using a 1.2 mm syringe. Finally, a 5 ml local anaesthetic was injected in the area. 17 months after the trauma and 8 months postoperatively the patient had a full return to normal day activities including pain free squats and lunges. Radiologically the non-union was healed.

CONCLUSION

This novel and less invasive surgical procedure may therefore be seen as a possible treatment option to non-union of the ischial tuberosity with minimal displacement.

[Ankle dislocation without osseous lesions]

Approximately 7-10% of all emergency department patients are diagnosed with distortion of the upper ankle joint. A dislocation of the upper ankle joint without fracture is described in the literature as being very rare. In 33-50% the ankle dislocations are at least first-degree open and associated with a fracture of the tibia, the fibula or the talus. We report the course, treatment and results 12 months after trauma of a posteromedial first-degree open dislocation of the upper ankle joint without fracture. To our knowledge, there is no record of this pathology mentioned in the German language literature.

Are oral health and fixed orthodontic appliances associated with sports injuries and postural stability in elite junior male soccer players?

Background

Dental caries and periodontitis are associated with elevated levels of pro-inflammatory cytokines which may trigger muscle fatigue during exercise, a strong risk factor for sports injuries. Fixed orthodontic appliances (FOA) may cause poor oral health and may disturb proprioceptive inputs of the stomatognathic system. This study aims to explore associations of poor oral health and of use of a FOA with injury frequency and postural stability.

Methods

One hundred eighty seven Belgian elite junior male soccer players, aged 12-17 years, completed a self-report questionnaire asking about injuries in the past year, oral health problems, use of a FOA, demographics and sports data, and stood in unipedal stance with eyes closed on a force plate to assess postural stability.

Results

Ordinal logistic regression with number of injuries in the past year as ordinal dependent variable and dental caries and/or gum problems, age and player position as covariates, showed that participants who reported dental caries and/or gum problems and never had had a FOA reported significant more injuries in the past year compared to the reference group of participants who reported no oral health problems and never had had a FOA (adjusted OR = 2.45; 95% CI, 1.19-5.05; p = 0.015). A 2 (temporomandibular joint problems) × 2 (FOA) × 2 (age) ANOVA with postural stabilities as dependent variables, showed a significant FOA x age interaction for the non-dominant (standing) leg. Post-hoc t-tests showed a significant better postural stability for the non-dominant leg (and a trend for the dominant leg) for the older compared with the younger participants in the non-FOA group (p = .002, ES = 0.61), while no age differences were found in the FOA-group.

Conclusions

These results indicate that poor oral health may be an injury risk factor and that a FOA may hinder the development of body postural stability.

Incidence, costs, and temporal trends of sports injury-related hospitalisations in Australian children over a 10-year period: A nationwide population-based cohort study

OBJECTIVES

To quantify and describe the incidence, cost, and temporal trends of sports injury-related hospitalisations in Australian children over a 10-year period.

DESIGN

Retrospective population-based cohort study.

METHODS

This study used linked hospitalisation and mortality data of children aged ≤16 years who were hospitalised for sports-related injury in Australia from 1 July 2002 to 30 June 2012. Age-standardised incidence rates were calculated with 95% confidence intervals (CI). Negative binomial regression was used to examine change in temporal trends in incidence rates.

RESULTS

There were 130,167 sports injury-related hospitalisations during the 10-year study period. The overall annual incidence rate was 281.0 (95%CI: 279.5, 282.6) per 100,000 population. Males and older children were more frequently hospitalised than their female and younger counterparts. The most common sports activities resulting in hospitalisation were team ball sports (43.1%) and wheeled non-motor sport (22.3%). There was no significant annual decline in the overall incidence rate during the 10-year study period (-1.0% [95%CI: -3.0%, 1.0%]). The estimated total hospital treatment cost was $396 million, with an estimated mean cost per injured child of $3058.

CONCLUSIONS

There has been no significant decline in sports injury-related hospitalisation rates among Australian children during 2002-03 to 2011-12. This may suggest that sports injury prevention initiatives in Australia to date have been inadequate to produce population-level reduction in sports injury-related hospitalisations. It is recommended that a national injury prevention strategy to reduce the burden of sports injuries among Australian children is developed and implemented.

Estimating Concussion Incidence Using Sports Injury Surveillance Systems: Complexities and Potential Pitfalls

Numerous sports injury surveillance systems exist with the capability of tracking concussion incidence data. It is important for the consumers of sport-related concussion data, be they researchers or the public, to have a comprehensive understanding of the strengths and limitations of sports injury surveillance systems. This article discusses issues of system design and analysis that affect the interpretation and understanding of sport-related concussion incidence data from sports injury surveillance systems. Such understanding will help inform the design of sports injury surveillance systems and research studies that aim to identify risk factors, develop prevention strategies, and evaluate prevention mechanisms.

The epidemiology of MRI-detected pelvic injuries in athletes in the Rio de Janeiro 2016 Summer Olympics

OBJECTIVE

To describe the prevalence, severity and location of pelvic injuries, including hip, muscle and tendon pathologies, as assessed on MRI in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games.

METHODS

We analyzed all pelvic MRIs that were acquired for suspected injury as reported by the National Olympic Committee (NOC) medical teams and the Organizing Committee medical staff during the Rio 2016 Summer Olympics. Diagnostic imaging was performed through the Olympic Village Polyclinic, using 3 T and 1.5 T MR scanners. Images were interpreted retrospectively according to standardized criteria.

RESULTS

A total of 11,274 athletes participated in the Games, of which 40 (0,4%) were referred for a pelvic MRI. Thirty-seven of the 40 (92%) had at least one abnormal finding, and some had as many as 17, for an average of 4.1 pathologies per examination. Almost half of all abnormal findings were assessed as pre-existing (46%). The majority of acute/subacute injuries were observed in track and field athletes (44%), whereas the highest number of pre-existing findings was seen in ball-sports athletes (39%). Forty-seven per cent of all acute/subacute injuries were muscle injuries with the gluteus maximus muscle the most commonly affected. In contrast, most pre-existing findings were detected at the symphysis (59%).

CONCLUSION

Our study demonstrated a high prevalence of both acute/subacute injuries and chronic changes in Olympic athletes undergoing pelvic MRI. Muscle injuries were the most common acute injuries, found mainly in track and field athletes. Most chronic changes were identified at the symphysis region in ball-sports athletes.

[Biomechanical screening for injury prevention : The importance of 3D-motion analysis in high performance sports]

Standardized clinical diagnostic procedures cannot assess the functionality of the anatomical structures in sport-specific movement. Biomechanical screening is able to detect deficits but is not sufficiently and objectively precise with the current clinical examination tools including conventional imaging techniques. The fields of use of functional testing methods are versatile and range from injury prevention analysis, screening during rehabilitation phases up to the return-to-play decision. Using simple musculoskeletal function analysis it is difficult to assess the risk of injuries. The main advantage of instrumented 3D-motion analysis is its potential to generate objective, reliable and reproducible data with exact joint angles, muscle activity, as well as loading inside the joints during movement. These marker-based motion analysis procedures are more time-consuming and more cost intensive and necessitate in particular biomechanical and medical knowledge to assess the analytical data in terms of clinical relevance. In the absence of scientific studies on biomechanical analyses in professional sports, this study shows preliminary approaches to this topic.

[Injury prevention in amateur football with FIFA 11+ : What is implemented on the football pitch?]

BACKGROUND

The warm-up and injury prevention program FIFA 11+ was developed to reduce injuries in recreational and amateur level football. Despite systematic education it is uncertain what amount of knowledge is passed down to the lower recreational level football players and what exercises are implemented in the daily routine. This study presents the summarized experiences of German coaches about the implementation of exercises on the football pitch.

MATERIAL AND METHODS

In this study 142 coaches who participated in 1 (of 5) of the 2‑day courses between 2013 and 2017 were sent a questionnaire. The questionnaire consisted of 24 questions, which were developed by the football union of Lower Saxony. Incomplete questionnaires were excluded from the study.

RESULTS

A total of 121 questionnaires could be analyzed, which is a response rate of 85.2%. The mean time period between the 2‑day training and answering the questionnaire was 29 months. Of the participating coaches 82.6% indicated that they use the program regularly (22% of the coaches use it twice a week or more frequently, 34% use it only once a week) and 6% of the coaches use additional programs to prevent injuries. A total of 86% of the participants believed in a reduction in the incidence of injuries induced by the FIFA 11+ concept, 89% of the participants rated the FIFA 11+ program as good ors very good, 91% rated the teaching concept as good or very good and 94% of the participants would recommend the 2‑day advanced course to others.

DISCUSSION

The prevention program as well as the advanced training concept were evaluated very positively. Most coaches use the program regularly. Nevertheless, many coaches use the FIFA 11+ exercises less than the recommended twice a week. Most coaches praised the good structure of the program, but also wished for the possibility of variations.

CONCLUSION

The prevention program FIFA 11+ is seen by coaches in recreational and amateur football as an effective tool to prevent injury. Implementation on the football pitch is regular but not as frequent as the evidence-based recommendations in the training concept.

A prospective injury surveillance study in canyoning

INTRODUCTION

Little is known about injuries in canyoning. It was the purpose of this study to determine injury rates, patterns, causes and risk factors in canyoning; and to identify targets for future injury prevention strategies.

METHODS

From May to October 2015, 109 participants from 17 different countries were prospectively followed via a monthly e-mail-based questionnaire.

RESULTS

During 13,690 h of canyoning, 57 injury-events occurred. The overall injury-rate was 4.2 injuries/1000 h of canyoning. The hand (23%) and lower leg and foot (25%) were most frequently involved. Most of the injuries were mild (n = 27, 49%) and limited to the soft-tissue. There were seven severe injuries (12%) with two lateral malleolar fractures, both necessitating surgery. The majority of injuries were due to material failure (44%) and significantly more injury-events were reported when the tour included rappelling (p = 0.037). Canyoning guides suffered from significantly less injuries compared to beginners and advanced canyoneers (p < 0.001).

CONCLUSIONS

The majority of canyoning injuries are mild. On the other side, roughly one-tenth suffered from severe injury. Canyoning guides are less prone to injury-events and beginners should consider performing tours with experienced guides. Notwithstanding, rappelling was the most common activity associated with an injury and the material used was deemed causative for an injury-event in almost half of all cases. Further improvement in canyoning equipment, frequent equipment service, and instructional courses to ensure adequate employment of equipment might minimize the risk of getting injured.

Sport Concussion Assessment Tool: Interpreting day-of-injury scores in professional ice hockey players

OBJECTIVES

To characterize the clinical utility of Sport Concussion Assessment Tool 3 (SCAT3) baseline and normative reference values for the assessment of acute concussion; and to identify the sensitivity of each SCAT3 subcomponent to the acute effects of concussion.

DESIGN

Prospective cohort.

METHODS

The day-of-concussion SCAT3 results (n=27) of professional male ice hockey players (mean age=27, SD=4) were compared to athlete's individual baseline and to the league's normative reference values. Normative cutoffs corresponding to 10th percentile and natural distribution change cutoffs corresponding to 90th percentile cumulative frequency were considered uncommon.

RESULTS

The percentages of the players with uncommon day-of-injury performance, when post-injury scores were compared to individual baseline versus (vs.) normative values, were as follows: symptoms: 96% vs. 100% (post-injury score: M=12, Md=12, SD=4; severity M=26, Md=23, SD=13); Standardized Assessment of Concussion (SAC): 33% vs. 27% (post-injury M=25, Md=26, SD=3); modified-BESS (M-BESS): 46% vs. 46% (post-injury M=7, Md=5, SD=7); Tandem Gait: 18% vs. 31% (post-injury M=11, Md=12, SD=4); coordination: both 8%. The number and severity of post-injury symptoms were significantly greater, with extremely large effect sizes (Cohen's d=2.44-3.92), than normative values and individual baseline scores. The post-injury SAC score was significantly lower relative to both baseline (d=0.68) and normative values (d=0.88). The post-injury M-BESS performance was significantly worse when compared to both individual baseline (d=1.06) and league normative values (d=1.46). No significant day-of-injury Tandem Gait deficits were observed using either comparison method.

CONCLUSIONS

SCAT3 league normative values were as sensitive as individual baseline scores during day-of-injury assessments. Symptoms were the most sensitive post-concussion component of the SCAT3.

Operative treatment of pelvic apophyseal avulsions in adolescent and young adult athletes: a follow-up study

INTRODUCTION

Pelvic apophyseal avulsion can limit young athletes' performance for months and may result in permanent disability. Nonoperative treatment is most commonly preferred, while surgical management with reduction and fixation is reserved for selected cases. Our aim was to evaluate outcomes of operative management of pelvic apophyseal avulsions in a series of adolescents and young adult athletes.

MATERIALS AND METHODS

Operative room registries and medical records were reviewed to identify patients who received surgical treatment for pelvic apophyseal avulsions who were younger than 24 years and with a minimum of 12 month follow-up.

RESULTS

Thirty-two patients (16.8 years ± 2.6) were identified. The most common avulsion sites were anterior inferior iliac spine (34.4%, N = 11) and ischial tuberosity (34.4%, N = 11). Other avulsions were five cases (15.6%) of the pubic apophysis, four cases (12.5%) of the anterior superior iliac spine apophysis and one case of the iliac crest apophysis. Seventeen cases (53.1%) underwent surgery early, i.e., during the first 3 months after the acute injury. Twenty-two cases (68.8%) involved reduction with internal fixation, and six cases (18.8%) involved resection of the fragment. Twenty-six athletes (81.3%, N = 26) reported good outcomes and were able to return to preinjury sports level. Six patients (18.8%) had moderate outcome and reported activity limitations during high-level sports. Large displacement (> 20 mm) or delayed (> 3 months) surgery was not associated with inferior outcomes (P = 0.690 and P = 0.392, respectively). Injury side (P = 0.61) or gender (P = 0.345) did not affect outcomes.

CONCLUSIONS

Operative management of pelvic apophyseal avulsion results in return to the preinjury sports level in more than 80% of the cases. However, while both acute surgery for large displacement and delayed intervention for failed nonoperative treatment are generally successful in improving sports function in these cases, comparative studies are required to refine criteria for surgery.

LEVEL OF EVIDENCE

Case series, IV.

A prospective analysis of injury rates, patterns and causes in Cliff and Splash Diving

INTRODUCTION

Information about injuries and its differences in Cliff Diving (CD) and Splash Diving (SD) are unknown. It was the aim to analyse (1) injury rates, patterns and causes; (2) differences (in injuries) between both disciplines; and to (3) identify targets for future injury prevention interventions.

METHODS

From April to November 2013, 81 cliff and 51 splash divers were prospectively surveyed with an encrypted, monthly e-mail-based questionnaire.

RESULTS

During a total of 7857h diving with an average diving height of 13 (±7)m, an overall injury rate of 7.9 injuries/1000h of sport exposure was reported. Cliff divers most commonly suffered from injuries of the foot and ankle (18%; n=24) and neck and cervical spine (14%; n=19). In SD, the lower limb (52%; n=43) and lower back (23%; n=19) were most frequently involved. In 79% (n=49) of the cases, the injury happened while entering the water. Cliff divers were in 52% (n=15) of the injuries in a feet-first and in 14% (n=4) in a head-first position. Splash divers were in 45% (n=9) of the injuries in a back- or buttocks-first position. Most of the injuries were bruises (47%; n=104) and muscle strains (13%; n=28). The injury risk during practice was significantly higher than in competition (11.3 vs. 4.5 injuries/1000h; OR 2.5; p=0.001). The injury risk of experts (15.4/1000h exposure) was significantly higher than in professionals (6.3/1000h exposure; OR 2.4; 95% CI, 3.3-1.9; p<0.001), although the average diving height was significantly higher in professionals (19m±8 vs. 12m±6; p<0.001). Significantly more professionals performed dryland training compared to experts (p=0.006).

CONCLUSION

Most of the injuries are related to the water entry. The entry position plays a key role in injury patterns with pursuant differences comparing CD with SD. Although most of the injuries involved soft-tissue only, severe injuries have been reported. Targets for future injury prevention strategies include protection for the increased impaction at entry; adaption of the diving conditions in practice to those in competition; dryland training courses; and instruction of non-professional divers to teach appropriate diving techniques.

Long Term Changes in Muscles around the Knee Joint after ACL Resection in Rats: Comparisons of ACL-Resected, Contralateral and Normal Limb

The purpose of this study was to investigate the long-term effects of anterior cruciate ligament (ACL) resection on the morphological and contractile characteristics of rectus femoris (RF) and semimembranosus (SM) muscles in both injured and contralateral hindlimbs in rats. Wistar male rats (8-week old) were used. Rats were divided into two groups; ACL-resected and (sham-operated) control groups. Furthermore, right and left limbs of rats in the ACL-resected group were assigned as ACL-resected and contralateral groups, respectively, at 1 day, 1, 4, and 48 weeks after ACL resection. No ACL-resection-associated changes in the mass of both muscles were observed 1 week after ACL resection. On the other hand, ACL-resection-associated reduction on mean fiber cross-sectional area (fiber CSA) in RF muscle lasted 48 weeks after ACL resection. Furthermore, ACL-resection associated increase in fiber composition of type I fiber in RF muscle in contralateral limbs. In addition, long-term effects of ACL resection were observed in both ACL-resected and contralateral limbs. Evidences from this study suggested that ACL resection may cause to change in the morphological (fiber CSA) and contractile (distribution of fiber types) properties of skeletal muscles around the knee joint in not only injured but also contralateral limb. Rehabilitation for quantitative and qualitative muscle changes by ACL resection may be required a special care for a long-term period.

Review: Medial collateral ligament injuries

The medial collateral ligament (MCL) is a major stabilizer of the knee joint. It is the most common ligament injured in the knee, particularly in athletes, and has been reported to be torn in 7.9% of all knee injuries.² The MCL has a complex, layered anatomy with multiple insertions and functions. Minor trauma can cause tearing of the superficial portion whereas higher energy mechanisms can disrupt both the deep and superficial layers. History and physical are often adequate, but the gold standard for diagnosis is MRI. Lesser injuries to the MCL can often be treated conservatively with early rehabilitation, but more significant tears often necessitate surgery. A thorough understanding of the MCL and associated injuries is essential for proper diagnosis and treatment.