Knee fractures in the athlete

Fractures and Dislocations on the Playing Field: Which Are Emergent and What to Do?

High-energy injuries, including fractures and dislocations, are occurring with increasing frequency in athletic competitions with the increasing size and speed of players. Common fractures and dislocations will be discussed in this article. We will evaluate emergent versus routine injuries and discuss appropriate treatment at the athletic venue. Fractures that can be seen with athletic activities include cervical spine; knee osteochondral fractures; tibia, ankle, and clavicle. Dislocations that will be considered include knee, patella, hip, shoulder, sternoclavicular joint, and proximal interphalangeal joint of the finger. These injuries vary significantly both in severity and in the emergent nature of the injury.

Patellar fracture among elite-level European soccer players: 4-year case-control cohort analysis of return to play, re-injury, and player performance

OBJECTIVES

There is a paucity of literature investigating the relationship between patellar fracture and player performance of professional soccer players following return to play (RTP). Our goal is to determine the rate of RTP, time to RTP, and effect on player performance following patellar fracture.

METHODS

Twenty-one elite-level European professional soccer players who sustained a patellar fracture between 1999 and 2018 were identified via a publicly accessible database. Athletes with patellar fracture were matched to controls by age, height, years played in the league, season of injury, and position. Change in performance metrics between one season prior to injury and the following four seasons after injury were compared.

RESULTS

Players with patellar fracture were absent for a mean 207.95 ± 135.55 days and 16.81 ± 31.79 games. Fifteen (71%) players returned to play after injury with 67% returning within 1 season after injury. Injured players did not demonstrate significant change in performance metrics at any of the follow-up timepoints compared to control. Subgroup analysis showed that attackers recorded approximately 1200 fewer minutes played per season than pre-injury levels 2 seasons following injury, significantly fewer (p < 0.05) than the control cohort recording similar minutes per season throughout the study period. Midfielders and defenders demonstrated similar fluctuations in performance to the control cohort for both field time and performance metrics (p > 0.05).

CONCLUSION

Seventy-one percent of players RTP after patellar fracture with an associated absence of 7 months and 17 missed games. Overall, injured players did not demonstrate a significant decline in performance as demonstrated by games played, total minutes played per season, minutes per game, assists, and goals 1 season after injury. Attackers played fewer minutes during the season of and 2 seasons after the initial injury.

Diagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta-analysis

INTRODUCTION

More evidence on diagnostic validity of physical examination tests for knee disorders is needed to lower frequently used and costly imaging tests.

OBJECTIVE

To conduct a systematic review of systematic reviews (SR) and meta-analyses (MA) evaluating the diagnostic validity of physical examination tests for knee disorders.

METHODS

A structured literature search was conducted in five databases until January 2016. Methodological quality was assessed using the AMSTAR.

RESULTS

Seventeen reviews were included with mean AMSTAR score of 5.5 ± 2.3. Based on six SR, only the Lachman test for ACL injuries is diagnostically valid when individually performed (Likelihood ratio (LR+):10.2, LR-:0.2). Based on two SR, the Ottawa Knee Rule is a valid screening tool for knee fractures (LR-:0.05). Based on one SR, the EULAR criteria had a post-test probability of 99% for the diagnosis of knee osteoarthritis. Based on two SR, a complete physical examination performed by a trained health provider was found to be diagnostically valid for ACL, PCL and meniscal injuries as well as for cartilage lesions.

CONCLUSION

When individually performed, common physical tests are rarely able to rule in or rule out a specific knee disorder, except the Lachman for ACL injuries. There is low-quality evidence concerning the validity of combining history elements and physical tests.

Sideline management of acute knee injuries

Sideline management of acute knee injuries requires medical personnel to have knowledge of injury patterns, mechanisms, physical findings, and treatment strategies. Fractures and multiple-ligament injured knees need to be rapidly diagnosed and stabilized to allow for timely transfer to a location where further evaluation and definitive treatment can be provided.