1
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Chou YC, Hsu YH, Lee D, Yang JW, Yu YH, Chan EC, Liu SJ. Novel Bioresorbable Drug-Eluting Mesh Scaffold for Therapy of Muscle Injury. ACS Biomater Sci Eng 2024; 10:2595-2606. [PMID: 38480510 DOI: 10.1021/acsbiomaterials.3c01669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
A novel bioresorbable drug-eluting polycaprolactone (PCL) mesh scaffold was developed, utilizing a solvent-cast additive manufacturing technique, to promote therapy of muscle injury. The degradation rate and mechanical properties strength of the PCL mesh were characterized after immersion in a buffer solution for different times. The in vitro release characteristics of vancomycin, ceftazidime, and lidocaine from the prepared mesh were evaluated using a high-performance liquid chromatography (HPLC) assay. In addition, the in vivo efficacy of PCL meshes for the repair of muscle injury was investigated on a rat model with histological examinations. It was found that the additively manufactured PCL meshes degraded by 13% after submission in buffered solution for four months. All PCL meshes with different pore sizes exhibited greater strength than rat muscle and survived through 10,000 cyclic loadings. Furthermore, the meshes could offer a sustained release of antibiotics and analgesics for more than 3 days in vitro. The results of this study suggest that drug-loaded PCL mesh exhibits superior ability to pure PCL mesh in terms of effectively promoting muscle repair in rat models. The histological assay also showed adequate biocompatibility of the resorbable meshes. The additively manufactured biodegradable drug-eluting meshes may be adopted in the future in humans for the therapy of muscle injuries.
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Affiliation(s)
- Ying-Chao Chou
- Bone and Joint Research Center, Department of Orthopedics, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Yung-Heng Hsu
- Bone and Joint Research Center, Department of Orthopedics, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Demei Lee
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan
| | - Jheng-Wei Yang
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yi-Hsun Yu
- Bone and Joint Research Center, Department of Orthopedics, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
| | - Err-Cheng Chan
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shih-Jung Liu
- Bone and Joint Research Center, Department of Orthopedics, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan
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2
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Sarac DC, Kocak UZ, Bayraktar D, Gucenmez S, Kaya DÖ. The Effects of 2 Different Soft Tissue Mobilization Techniques on Delayed Onset Muscle Soreness in Male Recreational Athletes: A Single-Blinded Randomized Controlled Trial. J Sport Rehabil 2024; 33:63-72. [PMID: 38086367 DOI: 10.1123/jsr.2023-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 01/31/2024]
Abstract
CONTEXT Soft tissue mobilization is frequently employed for delayed onset muscle soreness (DOMS) management. Foam roller and percussive massage are 2 popular soft tissue mobilization methods preferred by various professionals. However, their effects on DOMS symptoms are controversial and there are no studies comparing these 2 methods. The aim of the present study was to compare the acute effects of soft tissue mobilization with a foam roller or a percussive massage device on DOMS in young male recreational athletes. DESIGN A parallel, single-blinded, randomized controlled trial. METHODS Thirty-six participants (median [interquartile range 25/75]; age: 20.0 [19.3/21.0] y) were randomly allocated to percussive massage group (n = 12), foam roller group (n = 12), and control group (n = 12). First, a fatigue protocol targeting quadriceps femoris was performed. Then, participants received soft tissue mobilization with foam roller/percussive massage or rested for 10 minutes according to their groups. Pain and fatigue were evaluated by a visual analog scale, and the skin surface temperature of over the quadriceps femoris was measured with thermal camera imaging. Evaluations were performed at baseline, following fatigue protocol, at 24th hour, and at 48th hour. Changes from the baseline at 24th and 48th hours were compared between groups. RESULTS No significant between-group differences were observed at the assessments performed at 24th or 48th hour regarding the changes from baseline in pain (P value for 24th hour = .905, P value for 48th hour = .733), fatigue (P value for 24th hour = .895, P value for 48th hour = .606), or skin surface temperature measurements (P values for 24th hour = between .300 and .925, P values for 48th hour = between .311 and .750). CONCLUSIONS Soft tissue mobilizations applied with foam roller or percussive massage device do not seem to be superior to passive resting in alleviating DOMS symptoms in recreational athletes.
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Affiliation(s)
- Devrim Can Sarac
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
- Izmir Katip Celebi University Physiotherapy and Rehabilitation Training and Research Center, Izmir, Turkey
| | - Umut Ziya Kocak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
- Izmir Katip Celebi University Physiotherapy and Rehabilitation Training and Research Center, Izmir, Turkey
| | - Deniz Bayraktar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
- Izmir Katip Celebi University Physiotherapy and Rehabilitation Training and Research Center, Izmir, Turkey
| | - Sercan Gucenmez
- Division of Rheumatology, Department of Internal Medicine, Ataturk Training and Research Hospital, Izmir, Turkey
| | - Derya Özer Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
- Izmir Katip Celebi University Physiotherapy and Rehabilitation Training and Research Center, Izmir, Turkey
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3
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Rhim HC, Crockett Z, Schowalter S, Robinson DM. Cramp and a Pop 61-Year-Old Man With Acute Thigh Pain. Am J Phys Med Rehabil 2024; 103:e1-e3. [PMID: 37405900 DOI: 10.1097/phm.0000000000002309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
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4
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Edouard P, Reurink G, Mackey AL, Lieber RL, Pizzari T, Järvinen TAH, Gronwald T, Hollander K. Traumatic muscle injury. Nat Rev Dis Primers 2023; 9:56. [PMID: 37857686 DOI: 10.1038/s41572-023-00469-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
Traumatic muscle injury represents a collection of skeletal muscle pathologies caused by trauma to the muscle tissue and is defined as damage to the muscle tissue that can result in a functional deficit. Traumatic muscle injury can affect people across the lifespan and can result from high stresses and strains to skeletal muscle tissue, often due to muscle activation while the muscle is lengthening, resulting in indirect and non-contact muscle injuries (strains or ruptures), or from external impact, resulting in direct muscle injuries (contusion or laceration). At a microscopic level, muscle fibres can repair focal damage but must be completely regenerated after full myofibre necrosis. The diagnosis of muscle injury is based on patient history and physical examination. Imaging may be indicated to eliminate differential diagnoses. The management of muscle injury has changed within the past 5 years from initial rest, immobilization and (over)protection to early activation and progressive loading using an active approach. One challenge of muscle injury management is that numerous medical treatment options, such as medications and injections, are often used or proposed to try to accelerate muscle recovery despite very limited efficacy evidence. Another challenge is the prevention of muscle injury owing to the multifactorial and complex nature of this injury.
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Affiliation(s)
- Pascal Edouard
- Université Jean Monnet, Lyon 1, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, Saint-Etienne, France.
- Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France.
| | - Gustaaf Reurink
- Department of Orthopedic Surgery and Sports Medicine, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Academic Medical Center, Amsterdam, Netherlands
- The Sports Physicians Group, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Abigail L Mackey
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Departments of Physical Medicine and Rehabilitation and Biomedical Engineering, Northwestern University, Chicago, IL, USA
- Hines VA Medical Center, Maywood, IL, USA
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Tero A H Järvinen
- Tampere University and Tampere University Hospital, Tampere, Finland
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
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5
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Madry H. Shaping experimental orthopaedics. J Exp Orthop 2023; 10:95. [PMID: 37743440 PMCID: PMC10518299 DOI: 10.1186/s40634-023-00658-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Henning Madry
- Institute of Experimental Orthopaedics, Saarland University, Kirrberger Straße, Building 37, 66421, Homburg, Saar, Germany.
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6
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Paton BM, Read P, van Dyk N, Wilson MG, Pollock N, Court N, Giakoumis M, Head P, Kayani B, Kelly S, Kerkhoffs GMMJ, Moore J, Moriarty P, Murphy S, Plastow R, Stirling B, Tulloch L, Wood D, Haddad F. London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport. Br J Sports Med 2023; 57:278-291. [PMID: 36650032 DOI: 10.1136/bjsports-2021-105384] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/19/2023]
Abstract
Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.
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Affiliation(s)
- Bruce M Paton
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK .,Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK
| | - Paul Read
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew G Wilson
- Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK
| | - Noel Pollock
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,British Athletics, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Babar Kayani
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sam Kelly
- Salford City Football Club, Salford, UK.,Blackburn Rovers Football Club, Blackburn, UK
| | - Gino M M J Kerkhoffs
- Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - James Moore
- Sports & Exercise Medicine, Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Simon Murphy
- Medical Services, Arsenal Football Club, London, UK
| | - Ricci Plastow
- Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Fares Haddad
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK.,Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
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7
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Orthobiologic Interventions for Muscle Injuries. Phys Med Rehabil Clin N Am 2023; 34:181-198. [DOI: 10.1016/j.pmr.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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8
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Menezes MA, Menezes DA, Vasconcelos LL, DeSantana JM. Is Electrical Stimulation Effective in Preventing or Treating Delayed-onset Muscle Soreness (DOMS) in Athletes and Untrained Adults? A Systematic Review With Meta-Analysis. THE JOURNAL OF PAIN 2022; 23:2013-2035. [PMID: 35964921 DOI: 10.1016/j.jpain.2022.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 01/04/2023]
Abstract
The effectiveness of electrical stimulation (ES) in preventing or treating delayed-onset muscle soreness (DOMS) and its effects on muscle recovery is unclear. The systematic review investigated the benefits or harms of ES on DOMS and muscle recovery. Databases (PubMed, Medline, CENTRAL, EMBASE, CINAHL, PsycINFO, PEDro, LILACS, SPORTDiscus) were searched up to March, 31st 2021 for randomized controlled trials (RCTs) of athletes or untrained adults with DOMS treated with ES and compared to placebo/sham (simulation or without ES), or control (no intervention). Data were pooled in a meta-analysis. Risk of bias (Cochrane Collaboration tool) and quality of evidence (GRADE) were analyzed. Fourteen trials (n=435) were included in this review and 12 trials (n=389) were pooled in a meta-analysis. Evidence of very low to low quality indicates that ES does not prevent or treat DOMS as well as ES does not help to promote muscle recovery immediately, 24, 48, 72, 96 hours after the intervention. Only one study monitored adverse events. There are no recommendations that support the use of ES in DOMS and muscle recovery. PERSPECTIVES: No recommendations support the use of electrical stimulation in delayed-onset muscle soreness and muscle recovery in athletes and untrained adults. This means that electrical stimulation is not fruitful for this population according those protocols used. Therefore, unlikely that further randomized controlled trials with the same approach will yield promising results.
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Affiliation(s)
- Mayara Alves Menezes
- Health Sciences Graduate Program, Federal University of Sergipe. R. Cláudio Batista - Palestina, nº 676, zip code: 49060-025. Aracaju, SE, Brazil
| | - Danielle Alves Menezes
- Psychology Graduate Program, Federal University of Sergipe. Cidade Universitária Prof. José Aloísio de Campos, Avenida Marechal Rondon, s/n - Jardim Rosa Elze, zip code: 49100-000. São Cristóvão, SE, Brazil
| | - Lucas Lima Vasconcelos
- Department of Psychology, McGill University, 2001 Avenue McGill College, QC, H3A 1G1 Montreal, Canada
| | - Josimari Melo DeSantana
- Department of Physical Therapy, Federal University of Sergipe. Cidade Universitária Prof. José Aloísio de Campos, Avenida Marechal Rondon, s/n - Jardim Rosa Elze, zip code: 49100-000. São Cristóvão, SE, Brazil..
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9
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Al-Husseini A, Fazel Bakhsheshi M, Gard A, Tegner Y, Marklund N. Shorter recovery time in concussed elite ice hockey players by early head-and-neck cooling - a clinical trial. J Neurotrauma 2022. [PMID: 36222612 DOI: 10.1089/neu.2022.0248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A sports-related concussion (SRC) is most commonly sustained in contact sports, and is defined as a mild traumatic brain injury. An exercise-induced elevation of core body temperature is associated with increased brain temperature that may accelerate secondary injury processes following SRC, and exacerbate the brain injury. In a recent pilot study, acute head-neck cooling of 29 concussed ice hockey players resulted in shorter time to return-to-play. Here, we extended the clinical trial to include players of 19 male elite Swedish ice hockey teams over 5 seasons (2016-2021). In the intervention teams, acute head-neck cooling was implemented using a head cap for ≥45 minutes in addition to the standard SRC management used in controls. The primary endpoint was time from SRC until return-to-play (RTP). Sixty-one SRCs were included in the intervention group and 71 SRCs in the control group. The number of previous SRCs was 2 (median and interquartile range (IQR): 1.0 - 2.0) and 1 (IQR 1.0 - 2.0) in the intervention and control groups, respectively; p= 0.293. Median time to initiate head-neck cooling was 10 min (IQR 7-15; range 5-30 min) and median duration of cooling was 45 min (IQR 45-50; range 45-70 min). The median time to RTP was 9 days in the intervention group (IQR 7-13.5 days) and 13 days in the control group (IQR 9-30; p<0.001). The proportion of players out from play for more than the expected recovery time of 14 days was 24.7% in the intervention group, and 43.7% in controls (p<0.05). Study limitations include that a) allocation to cooling or control management was at the discretion of the medical staff of each teams, decided prior to each season, and not by strict randomization, b) no sham cap was used and evaluations could not be performed by blinded assessors and c) it could not be established with certainty that injury severity was similar between groups. While the results should thus be interpreted with caution, early head-neck cooling, with the aim of attenuating cerebral hyperthermia, may reduce post-SRC symptoms and lead to earlier return-to-play in elite ice hockey players.
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Affiliation(s)
- Ali Al-Husseini
- Lund University, 5193, Department of Clinical Sciences, Neurosurgery, Lund, Sweden;
| | | | - Anna Gard
- Lund University, 5193, Department of Clinical Sciences Lund, Entregatan 7, Hisshall EA, plan 4, Lund, Lund, Skane, Sweden, 22242;
| | - Yelverton Tegner
- Luleå University of Technology, Division of Medical Sciences, Department of Health Sciences, Department of Health Sciences, Luleå, Sweden, SE 971 87;
| | - Niklas Marklund
- Lund University, 5193, Clinical Sciences, Neurosurgery, Klinikgatan 17B, Lund, Sweden, 221 85.,Skåne University Hospital Lund, 59564, Neurosurgery, Lund, Sweden, 221 85;
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10
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Shukla M, Agrawal SS. A novel synergistic device for joint inflammation - efficacy on ankle sprain cases. J Med Eng Technol 2022; 46:265-269. [PMID: 35212582 DOI: 10.1080/03091902.2022.2039312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Joint inflammation results from soft-tissue injuries and cartilage damage. PRICE is the standard treatment approach for acute soft tissue injuries like ankle sprain. Electrical stimulation, application of orthotic braces, etc. is also effective for this. In a synergistic device all these components are combined and applied simultaneously. This device was developed for joint inflammation and tested for grade I & II acute ankle joint sprain. To test a synergistic - semirigid device, combining PRICE & electrical stimulation for acute ankle sprains of grades I & II for pain, range of motion and swelling is a case series was the objective. Device was developed using novel concept of synergistic applications of PRICE with electrical stimulation. The joint contour of ankle and specific biomechanical bony surface landmarks were considered. Ethical approval was taken from NTCC committee, AIPT. Recordings were taken from eight patients of acute ankle sprain with - in two days of injury, after getting ethical approval. Elevation to the ankle was provided by keeping the part over the pillow and data was recorded with the help of: 1.VAS scale for pain; 2. Measuring tape; 3. Goniometry. t-test was used to find out the significant difference pre and post the application of device. There was a significant reduction in pain (p = 0.006), edema (p = 0.011), dorsi-flexion (p = 0.015), and plantar flexion (p =0.008). The synegistic device has been effective for acute ankle inflammation - grade I & II ankle sprains in 5 sessions; sufficient for the return of function.
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Affiliation(s)
- Mayank Shukla
- Amity Institute of Physiotherapy, Amity University, Noida, India
| | - S S Agrawal
- Faculty of Health & Allied Sciences Amity University, Noida, India
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11
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Lempainen L, Mechó S, Valle X, Mazzoni S, Villalon J, Freschi M, Stefanini L, García-Romero-Pérez A, Burova M, Pleshkov P, Pruna R, Pasta G, Kosola J. Management of anterior thigh injuries in soccer players: practical guide. BMC Sports Sci Med Rehabil 2022; 14:41. [PMID: 35303927 PMCID: PMC8932115 DOI: 10.1186/s13102-022-00428-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022]
Abstract
Most of the anterior thigh injuries are contusions or strains, however, some of these injuries can be career ending. Early diagnosis and correct treatment are key to successful outcome. Analyzing injury mechanism and adding both clinical and imaging findings, clinicians can make the right treatment decisions already often in the acute phase of the injury. Low grade contusions and muscle strains are treated well with planned rehabilitation, but complete tendon injuries or avulsions can require operative treatment. Also, neglected minor injuries could lead to chronic disabilities and time lost from play. Typical clinical presentation of anterior thigh injury is swelling and pain during hip flexion or knee extension. In more severe cases a clear gap can be palpated. Imaging methods used are ultrasound and magnetic resonance imaging (MRI) which are helpful for clinicians to determine more exact the extent of injury. MRI can identify possible tendon retractions which may need surgery. Clinicians should also be aware of other traumatic lesions affecting anterior thigh area such as myositis ossificans formation. Optimal treatment should be coordinated including acute phase treatment with rest, ice, and compression together with designed return-to-play protocol. The anatomical structure involved lines the treatment pathway. This narrative review describes these more common reasons for outpatient clinical visits for anterior thigh pain and injuries among soccer players.
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Affiliation(s)
- Lasse Lempainen
- Sports Trauma Research Unit, FinnOrthopaedics, Joukahaisenkatu 6, 20520, Turku, Finland. .,Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland.
| | - Sandra Mechó
- Radiology Department, SCIAS-Hospital de Barcelona, Barcelona, Spain
| | - Xavier Valle
- FC Barcelona, Medical Services, FIFA Center of Excellence, Barcelona, Spain
| | | | | | | | | | - Alvaro García-Romero-Pérez
- Injury Prevention and Rehabilitation Department, Watford FC, Watford, England.,Physiotherapy Department, Universidad Camilo José Cela, Madrid, Spain
| | | | | | - Ricard Pruna
- FC Barcelona, Medical Services, FIFA Center of Excellence, Barcelona, Spain
| | - Giulio Pasta
- Medical Department, Parma Calcio 1913, Parma, Italy
| | - Jussi Kosola
- Department of Physical Activity and Health, Paavo Nurmi Centre, University of Turku, Turku, Finland.,Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland
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12
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Eliason A, Werner S, Engström B, Harringe M. Home training with or without joint mobilization compared to no treatment: a randomized controlled trial. J Phys Ther Sci 2022; 34:153-160. [PMID: 35221520 PMCID: PMC8860700 DOI: 10.1589/jpts.34.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate if joint mobilization in patients with subacromial pain
syndrome has additional benefits to a home training program on shoulder function and pain,
and to compare home training to no physical therapy. [Participants and Methods]
Eighty-nine primary care patients (mean age 45 years) with subacromial pain syndrome
during an average of 23 weeks. Home training was performed twice a day during a 12 week
period. One of the intervention groups received add-on shoulder joint mobilization to the
home training. A third group did not receive any physical therapy. Constant-Murley score,
pain and active range of motion was evaluated at baseline, 6 weeks, 12 weeks and 6 months.
[Results] The total Constant-Murley score revealed no significant differences between
groups at any time point. All groups improved over time. The add-on joint mobilization
group reached clinical important change at 12 weeks. The subscale pain showed that both
intervention groups reported less pain after 12 weeks compared to the reference group.
[Conclusion] Home training is not superior to no treatment evaluated with the total
Constant-Murley score. However, home training with or without add-on joint mobilization
may decrease pain compared to no treatment.
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Affiliation(s)
- Anna Eliason
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet: SE-171 76 Stockholm, Sweden.,Health Care Services Stockholm County (SLSO), Region Stockholm, Sweden
| | - Suzanne Werner
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet: SE-171 76 Stockholm, Sweden
| | - Björn Engström
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet: SE-171 76 Stockholm, Sweden.,Capio Artro Clinic, Sweden
| | - Marita Harringe
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet: SE-171 76 Stockholm, Sweden
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Meek WM, Kucharik MP, Eberlin CT, Naessig SA, Rudisill SS, Martin SD. Calf Strain in Athletes. JBJS Rev 2022; 10:01874474-202203000-00015. [PMID: 35316243 DOI: 10.2106/jbjs.rvw.21.00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Calf strain is a common condition. In high-performance athletes, calf strain contributes to a substantial absence from competition. » Player age and history of a calf strain or other leg injury are the strongest risk factors for calf strain injury and reinjury. » Although the diagnosis is often clinical, magnetic resonance imaging and ultrasound are valuable to confirm the location of the strain and the grade of injury. » Nonoperative treatment is effective for most calf strain injuries. Operative management, although rarely indicated, may be appropriate for severe cases with grade-III rupture or complications. » Further investigation is necessary to elucidate the benefits of blood flow restriction therapy, deep water running, lower-body positive pressure therapy, platelet-rich plasma, and stem cell therapy for calf strain rehabilitation.
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Trunz LM, Landy JE, Dodson CC, Cohen SB, Zoga AC, Roedl JB. Effectiveness of Hematoma Aspiration and Platelet-rich Plasma Muscle Injections for the Treatment of Hamstring Strains in Athletes. Med Sci Sports Exerc 2022; 54:12-17. [PMID: 34310495 DOI: 10.1249/mss.0000000000002758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The effect of platelet-rich plasma (PRP) treatment on recovery in acute hamstring injuries is controversial. Previous study results are inconsistent, and a standardized therapeutic approach has not been established yet. PURPOSE To assess the treatment effect using a combination of hematoma aspiration and muscle strain PRP injection in partial hamstring muscle tears (grade 2 strains) in athletes. METHODS Magnetic resonance imaging of athletes with grade 2 hamstring strains were reviewed from 2013 to 2018. From 2013 to 2015, athletes were treated conservatively, and from 2016 to 2018, with a combination of ultrasound-guided hematoma aspiration and PRP muscle strain injection. The outcome, including return-to-play (in days) and recurrence rate, was compared retrospectively between both groups (conservative vs aspiration/PRP) using ANOVA and Fisher's exact test. There was no significant difference in age, type of sport, and muscle involvement (including injury grade/location, hamstring muscle type, and length/cross-sectional area of the strain). RESULTS Fifty-five athletes (28 treated conservatively, 27 with hematoma aspiration/PRP injection) were included. Average return-to-play time (mean) was 32.4 d in the conservative group and 23.5 d in the aspiration/PRP group (P < 0.001). Recurrence rate of the hamstring strain was 28.6% (8/28) in the conservative treatment group and less than 4% (1/27) in the aspiration/PRP group (P = 0.025). CONCLUSIONS Athletes with grade 2 hamstring strains treated with a combination of hematoma aspiration and PRP injection had a significantly shorter return-to-play and a lower recurrence rate compared with athletes receiving conservative treatment.
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Affiliation(s)
- Lukas M Trunz
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Jeffrey E Landy
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Christopher C Dodson
- Divison of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Orthopaedic Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Steven B Cohen
- Divison of Sports Medicine, Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Rothman Orthopaedic Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Adam C Zoga
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Johannes B Roedl
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Indirect Structural Muscle Injuries of Lower Limb: Rehabilitation and Therapeutic Exercise. J Funct Morphol Kinesiol 2021; 6:jfmk6030075. [PMID: 34564194 PMCID: PMC8482242 DOI: 10.3390/jfmk6030075] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022] Open
Abstract
Muscle injuries are the most common trauma in team and individual sports. The muscles most frequently affected are those of the lower limb, and in particular hamstrings, adductors, rectus femoris and calf muscles. Although several scientific studies have tried to propose different rehabilitation protocols, still too often the real rehabilitation process is not based on scientific knowledge, especially in non-elite athletes. Moreover, the growing use of physical and instrumental therapies has made it increasingly difficult to understand what can be truly effective. Therefore, the aim of the present paper is to review proposed therapeutic algorithms for muscle injuries, proposing a concise and practical summary. Following a three-phase rehabilitation protocol, this review aims to describe the conservative treatment of indirect structural muscle injuries, which are the more routinely found and more challenging type. For each phase, until return to training and return to sport are completed, the functional goal, the most appropriate practitioner, and the best possible treatment according to current evidence are expressed. Finally, the last section is focused on the specific exercise rehabilitation for the four main muscle groups with a structured explanatory timetable.
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da Cruz CBL, Sousa Filho LF, Lima DA, de Gois JI, de Oliveira ED. Effect of Phonophoresis and Copaiba Oil on Oxidative Stress Biomarkers after Skeletal Muscle Injury in Rats. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2657-2663. [PMID: 34243989 DOI: 10.1016/j.ultrasmedbio.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 04/03/2021] [Accepted: 04/11/2021] [Indexed: 06/13/2023]
Abstract
The objective of this study was to analyze the effectiveness of phonophoresis with copaiba oil gel, in comparison to therapeutic pulsed ultrasound alone or topical application of copaiba oil gel, on oxidative stress after a traumatic muscle injury. Forty male Wistar rats were divided into five groups: control, muscle injury, therapeutic pulsed ultrasound (TPU), copaiba oil gel (CO) and TPU plus CO. TPU and CO application occurred at 2, 12, 24, 48, 72 and 96 h after injury. The gastrocnemius muscle was injured by mechanical trauma. Malondialdehyde (a lipoperoxidation marker) and superoxide dismutase and catalase (antioxidant enzymes) were assessed 98 h after muscle injury. All were elevated in the muscle injury group. There was a significant difference among treatment groups favoring TPU plus CO for reducing malondialdehyde levels, but all treatments reduced superoxide dismutase and catalase activity, with no between-groups difference. In conclusion, phonophoresis-the application of TPU plus CO-was superior to TPU or CO alone for reducing lipoperoxidation. Phonophoresis, TPU alone and CO were all effective in decreasing antioxidant enzyme activity after a traumatic skeletal muscle injury.
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Affiliation(s)
| | - Luis Fernando Sousa Filho
- Department of Physiotherapy, Federal University of Sergipe, São Cristovão, Brazil; Graduate Program in Physical Education, Federal University of Sergipe, São Cristovão, Brazil
| | - Diego Alves Lima
- Department of Physiotherapy, Federal University of Sergipe, São Cristovão, Brazil
| | - Joyce Izabel de Gois
- Department of Physiotherapy, Federal University of Sergipe, São Cristovão, Brazil
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Baumgart C, Grim C, Heiss R, Ehrenstein P, Freiwald J, Hoppe MW. Rehabilitation after a Complete Avulsion of the Proximal Rectus Femoris Muscle: Considerations from a Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168727. [PMID: 34444475 PMCID: PMC8392792 DOI: 10.3390/ijerph18168727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND A complete avulsion of the proximal rectus femoris muscle is a rare but severity injury. There is a lack of substantial information for its operative treatment and rehabilitation; in particular there is a lack of biomechanical data to evaluate long-term outcomes. CASE PRESENTATION The case report presents the injury mechanism and surgical treatment of a complete avulsion of the proximal rectus femoris muscle in a 41-year-old recreational endurance athlete. Moreover, within a one-year follow-up period, different biomechanical tests were performed to get more functional insights into changes in neuromuscular control, structural muscle characteristics, and endurance performance. Within the first month post-surgery, an almost total neuromuscular inhibition of the rectus femoris muscle was present. A stepwise reduction in inter-limb compensations was observable (e.g., in crank torque during cycling) during the rehabilitation. Muscular intra-limb compensations were shown at six months post-surgery and even one year after surgery, which were also represented in the long-term adaption of the muscle characteristics and leg volumes. A changed motor control strategy was shown by asymmetric muscle activation patterns during ergometer cycling, while the power output was almost symmetric. During rehabilitation, there might be a benefit to normalizing neuromuscular muscle activation in ergometer cycling using higher loads. CONCLUSIONS While the endurance performance recovered after six months, asymmetries in neuromuscular control and structural muscle characteristics indicate the long-term presence of inter- and intra-limb compensation strategies.
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Affiliation(s)
- Christian Baumgart
- Department of Movement and Training Science, University of Wuppertal, Fuhlrottstraße 10, 42119 Wuppertal, Germany;
- Correspondence: ; Tel.: +49-202-4393758
| | - Casper Grim
- Department of Orthopedic and Trauma Surgery, Klinikum Osnabrück, Am Finkenhuegel 1, 49076 Osnabrueck, Germany;
- Department of Human Science, University of Osnabrueck, Barbarastrasse 22c, 49076 Osnabrueck, Germany
| | - Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Maximiliansplatz 3, 91054 Erlangen, Germany;
| | - Philipp Ehrenstein
- Practice OrthoPro Duesseldorf, Breitestr 69, 40213 Duesseldorf, Germany;
| | - Jürgen Freiwald
- Department of Movement and Training Science, University of Wuppertal, Fuhlrottstraße 10, 42119 Wuppertal, Germany;
| | - Matthias Wilhelm Hoppe
- Institute of Movement and Training Science, University of Leipzig, Jahnallee 59, 04109 Leipzig, Germany;
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Hotfiel T, Hoppe MW, Heiss R, Lutter C, Tischer T, Forst R, Hammer CM, Freiwald J, Engelhardt M, Grim C. Quantifiable Contrast-Enhanced Ultrasound Explores the Role of Protection, Rest, Ice (Cryotherapy), Compression and Elevation (PRICE) Therapy on Microvascular Blood Flow. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1269-1278. [PMID: 33549381 DOI: 10.1016/j.ultrasmedbio.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/25/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
The aim of this randomized controlled laboratory study was to evaluate the role of standardized protection, rest, ice (cryotherapy), compression and elevation (PRICE) therapy on microvascular blood flow in human skeletal muscle. Quantifiable contrast-enhanced ultrasound was used to analyze intramuscular tissue perfusion (ITP) of the rectus femoris (RF) and vastus intermedius (VI) muscles in 20 healthy athletes who were randomly assigned to PRICE or control groups. Baseline perfusion measurements (resting conditions, T0) were compared with cycling exercise (T1), intervention (PRICE or control, T2) and follow-up at 60 min post-intervention (T3). The 20 min PRICE intervention included rest, cryotherapy (3°C), compression (35 mm Hg) and elevation. After intervention, PRICE demonstrated a decrease of ITP in VI (-47%, p = 0.01) and RF (-50%, p = 0.037) muscles. At T3, an ongoing decreased ITP for the RF (p = 0.003) and no significant changes for the VI were observed. In contrast, the control group showed an increased ITP at T2 and no significant differences at T3. PRICE applied after exercise led to a down-regulation of ITP, and the termination of PRICE does not appear to be associated with a reactive hyperemia for at least 60 min after treatment.
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Affiliation(s)
- Thilo Hotfiel
- Department of Orthopedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany; Center for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany.
| | | | - Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Erlangen Germany
| | - Christoph Lutter
- Department of Orthopedics, University Medical Center Rostock, Rostock, Germany
| | - Thomas Tischer
- Department of Orthopedics, University Medical Center Rostock, Rostock, Germany
| | - Raimund Forst
- Department of Orthopedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Christian Manfred Hammer
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Jürgen Freiwald
- Department of Movement and Training Science, University of Wuppertal, Wuppertal, Germany
| | - Martin Engelhardt
- Center for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
| | - Casper Grim
- Center for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
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Topical Corticosteroid Use Associated With Increased Degree of Ptosis and Rate of Ptosis Repair Failure. Ophthalmic Plast Reconstr Surg 2021; 37:33-37. [PMID: 32282642 DOI: 10.1097/iop.0000000000001671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the degree of ptosis and the risk of ptosis repair failure among patients with and without a history of topical corticosteroid use. METHODS Retrospective, case-controlled study examining topical corticosteroid use among adults with ptosis who underwent external levator advancement/resection (ELR) or Müller muscle conjunctival resection with at least 3 months postoperative follow-up. Comparative statistical analyses of surgical outcomes were performed amongst patients with and without history of topical corticosteroid use. RESULTS A total of 240 patients (406 eyelids) met study criteria, of which 36 patients (44 eyelids) had history of topical corticosteroid use. Mean preoperative margin reflex distance was 0.20 mm and 0.58 mm for topical corticosteroid and non-corticosteroids users (p = 0.01). Mean preoperative levator function was 9.78 mm and 10.38 mm for topical corticosteroid and non-corticosteroid users (p = 0.02). The rate of ptosis repair failure was 30% and 16% in patients with and without a history of topical corticosteroid use (odds ratio 2.25, 95% confidence interval 1.10-4.55; p = 0.03). The rate of recurrence per surgical type in eyelids with and without history of topical corticosteroid use was: external levator advancement/resection 11/27 (41%) and 48/266 (18%) (odds ratio = 3.12, confidence interval 1.36-7.15 0; p = 0.01); Müller muscle conjunctival resection 2/17 (12%) and 9/96 (9%) (odds ratio 1.29, confidence interval 0.25-6.56; p = 0.76). CONCLUSIONS Topical corticosteroid use is associated with more severe presenting ptosis and increased rates of ptosis repair failure. Compared to Müller muscle conjunctival resection, there is a significantly higher rate of ptosis repair failure in patients undergoing external levator advancement/resection.
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Kumar S, Shah B, Johari A, Anjum R, Garg D, Salhotra R, Tyagi A, Khan AM, Jain AK. Covid-19 Pandemic: Resumption of Orthopedic Care and Medical Education. Indian J Orthop 2021; 55:506-515. [PMID: 33840819 PMCID: PMC8019346 DOI: 10.1007/s43465-021-00379-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 02/04/2023]
Abstract
Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China (December 2019). The disease rapidly crossed the barrier of countries, continents and spread globally. Non-pharmaceutical measures such as social distancing, face mask, frequent hand washing and use of sanitizer remained the best available option to prevent the spread of disease. OPD, IPD admissions, elective O. Ts were curtailed. Orthopedic care was only limited to emergency and semi-urgent procedures like necrotizing fasciitis, open fracture, and compartment syndrome. These measures were taken to preserve infrastructure and manpower to manage covid-19 pandemic. The children were thought to have a low susceptibility to covid-19 as compared to an adult. Deferring the patient during pandemic has led to high orthopedic disease burden, morbidity and disease-related sequelae, hence elective care must be resumed with modified hospital infrastructure. Resumption of elective/emergent orthopedic care should be slow, phasic and strategic, much similar to unlocking. Cases must be stratified depending on covid status and severity. Dedicated O.Ts with neutral/negative pressure and HEPA filter for covid positive and suspected patients are to be used. All symptomatic and suspected patients should be investigated for covid-19 by RT-PCR, blood counts and CT scan. Regional anaesthesia should be preferred to General anaesthesia. Power drill/saw/burr/pulse lavage should be minimized to avoid aerosol generation. Postoperatively continuous surveillance and monitoring to be done for covid related symptoms. Medical institutes rapidly shifted to the online mode of education. Blended learning (virtual & physical) and imparting skills have to be continued in post covid phase with equitable distribution of teaching hours to students of different years.
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Affiliation(s)
- Saurabh Kumar
- University College of Medical Sciences (University of Delhi), New Delhi, India
| | - Bhushan Shah
- G.B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ashok Johari
- Children Orthopedic Hospital, Mumbai, Maharashtra India
| | - Rashid Anjum
- Acharya Shri Chander College of Medical Sciences Hospital, Jammu, Jammu and Kashmir India
| | - Devansh Garg
- University College of Medical Sciences (University of Delhi), New Delhi, India
| | - Rashmi Salhotra
- University College of Medical Sciences (University of Delhi), New Delhi, India
| | - Asha Tyagi
- University College of Medical Sciences (University of Delhi), New Delhi, India
| | - Amir Maroof Khan
- University College of Medical Sciences (University of Delhi), New Delhi, India
| | - Anil Kumar Jain
- University College of Medical Sciences (University of Delhi), New Delhi, India
- Orthopaedics Department, University College of Medical Sciences (University of Delhi), New Delhi, 110095 India
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Abstract
Patellofemoral pain (PFP) is among the most common injuries in recreational runners. Current evidence does not identify alignment, muscle weakness, and patellar maltracking or a combination of these as causes of PFP. Rather than solely investigating biomechanics, we suggest a holistic approach to address the causes of PFP. Both external loads, such as changes in training parameters and biomechanics, and internal loads, such as sleep and psychological stress, should be considered. As for the management of runners with PFP, recent research suggested that various interventions can be considered to help symptoms, even if these interventions target biomechanical factors that may not have caused the injury in the first place. In this Current Concepts article, we describe how the latest evidence on education about training modifications, strengthening exercises, gait and footwear modifications, and psychosocial factors can be applied when treating runners with PFP. The importance of maintaining relative homeostasis between load and capacity will be emphasized. Recommendations for temporary or longer-term interventions will be discussed. A holistic, evidence-based approach should consist of a graded exposure to load, including movement, exercise, and running, while considering the capacity of the individual, including sleep and psychosocial factors. Cost, accessibility, and the personal preferences of patients should also be considered.
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Affiliation(s)
- Jean-Francois Esculier
- The Running Clinic, Lac Beauport, QC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- MoveMed Physiotherapy, Kelowna, BC, Canada
| | - Kevin Maggs
- The Running Clinic, Lac Beauport, QC, Canada
- Lively Health Clinic, Gainesville, VA
| | - Ellora Maggs
- The Running Clinic, Lac Beauport, QC, Canada
- Peak Performance Care Physical Therapy, Sonora, CA
| | - Blaise Dubois
- The Running Clinic, Lac Beauport, QC, Canada
- Physiothérapie et médecine du sport PCN, Quebec City, QC, Canada
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Beggs I. Biological Basis of Treatments of Acute Muscle Injuries: A Short Review. Semin Musculoskelet Radiol 2020; 24:256-261. [PMID: 32987424 DOI: 10.1055/s-0040-1708087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Muscle strains occur frequently in recreational and professional sports. This article considers various treatment options in a biological context and reviews evidence of their efficacy. Treatments reviewed include the PRICE principle (P: rotection, R: est, I: ce, C: ompression, E: levation), early mobilization, physical therapy, hematoma aspiration, platelet-rich plasma injections, use of nonsteroidal anti-inflammatory drugs, corticosteroids, and local anesthetics, cellular therapies, and surgery.
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Affiliation(s)
- Ian Beggs
- Analytic Imaging, Edinburgh, United Kingdom
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Tischer T, Bode G, Buhs M, Marquass B, Nehrer S, Vogt S, Zinser W, Angele P, Spahn G, Welsch GH, Niemeyer P, Madry H. Platelet-rich plasma (PRP) as therapy for cartilage, tendon and muscle damage - German working group position statement. J Exp Orthop 2020; 7:64. [PMID: 32885339 PMCID: PMC7471237 DOI: 10.1186/s40634-020-00282-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/25/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Platelet rich plasma (PRP) is widely used in orthopaedics, but is still heavily debated. Therefore, a survey among the German “Working Group for Clinical Tissue Regeneration” of the German Society of Orthopaedics and Traumatology was conducted to achieve a consensus about the current therapeutical potential of PRP. Methods A first survey (n = 65 experts, all orthopaedic/trauma surgeons) was conducted (n = 13 questions). Following, a second round (n = 40 experts) was conducted with 31 questions to achieve consensus in 5 categories: three most common indications, PRP application, future research areas. Results Therapeutic PRP application was regarded as useful (89%), possibly even more important in the future (90%). Most common indications were tendon pathologies (77%), osteoarthritis (OA) (68%), muscle injuries (57%) and cartilage damage (51%). Consensus was reached in 16/31 statements. The application of PRP for early knee OA (Kellgren-Lawrence grade II) was regarded as potentially useful, as well as for acute and chronic tendinopathies. For chronic lesions (cartilage, tendons), multiple injections (2–4) were seen preferable to singular injections. However, no sufficient data exists on the time interval between the injections. Standardization of PRP preparation, application, frequency, as well as determining the range of indication is strongly recommended. Conclusions There is a need of further standardization of the PRP preparation methods, indication and application protocols for knee OA and other indications, which must be further evaluated in basic science studies and randomized controlled clinical trials. Level of evidence Consensus of expert opinion, Level V.
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Affiliation(s)
- T Tischer
- Department of Orthopaedic Surgery, University medicine Rostock, Doberanerstr. 142, 18057, Rostock, Germany.
| | - G Bode
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Freiburg, Germany
| | - M Buhs
- Norddeutsches Knorpelcentrum, COVZ Quickborn, Quickborn, Germany
| | - B Marquass
- Klinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Universität Leipzig, Leipzig, Germany
| | - S Nehrer
- Donau University Krems, Krems, Austria
| | - S Vogt
- Klinik für Sportorthopädie und arthroskopische Chirurgie, Hessing Stiftung, Augsburg, Germany
| | - W Zinser
- Klinik für Orthopädie und Unfallchirurgie, St. Vinzenz-Hospital, Dinslaken, Germany
| | - P Angele
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - G Spahn
- Center of Trauma and Orthopaedic Surgery Eisenach and Jena University Hospital, Jena, Germany
| | - G H Welsch
- UKE Athleticum, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - P Niemeyer
- OCM Gemeinschaftspraxis, Munich, Germany
| | - H Madry
- Center of Experimental Orthopaedics, Saarland University, Homburg, Germany
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26
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Phillips MR, Chang Y, Zura RD, Mehta S, Giannoudis PV, Nolte PA, Bhandari M. Impact of COVID-19 on orthopaedic care: a call for nonoperative management. Ther Adv Musculoskelet Dis 2020; 12:1759720X20934276. [PMID: 32612712 PMCID: PMC7307278 DOI: 10.1177/1759720x20934276] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgical specialties face unique challenges caused by SARS-COV-2 (COVID-19). These disruptions will call on clinicians to have greater consideration for non-operative treatment options to help manage patient symptoms and provide therapeutic care in lieu of the traditional surgical management course of action. This study aimed to summarize the current guidance on elective surgery during the COVID-19 pandemic, assess how this guidance may impact orthopaedic care, and review any recommendations for non-operative management in light of elective surgery disruptions. METHODS A systematic search was conducted, and included guidance were categorized as either "Selective Postponement" or "Complete Postponement" of elective surgery. Selective postponement was considered as guidance that suggested elective cases should be evaluated on a case-by-case basis, whereas complete postponement suggested that all elective procedures be postponed until after the pandemic, with no case-by-case consideration. In addition, any statements regarding conservative/non-operative management were summarized when provided by included reports. RESULTS A total of 11 reports from nine different health organizations were included in this review. There were seven (63.6%) guidance reports that suggested a complete postponement of non-elective surgical procedures, whereas four (36.4%) reports suggested the use of selective postponement of these procedures. The guidance trends shifted from selective to complete elective surgery postponement occurred throughout the month of March. The general guidance provided by these reports was to have an increased consideration for non-operative treatment options whenever possible and safe. As elective surgery begins to re-open, non-operative management will play a key role in managing the surgical backlog caused by the elective surgery shutdown. CONCLUSION Global guidance from major medical associations are in agreement that elective surgical procedures require postponement in order to minimize the risk of COVID-19 spread, as well as increase available hospital resources for managing the influx of COVID-19 patients. It is imperative that clinicians and patients consider non-operative, conservative treatment options in order to manage conditions and symptoms until surgical management options become available again, and to manage the increased surgical waitlists caused by the elective surgery shutdowns.
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Affiliation(s)
- Mark R. Phillips
- Department of Health Research Methods, Evidence,
and Impact, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8,
Canada
| | | | - Robert D. Zura
- Department of Orthopaedic Surgery, Louisiana
State University Health Sciences Center, New Orleans, LA, USA
| | - Samir Mehta
- Department of Orthopaedic Surgery, University of
Pennsylvania, Philadelphia, PA, USA
| | | | - Peter A. Nolte
- Department of Orthopaedic Surgery, Spaarne
Gasthuis, Hoofddorp, the Netherlands
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, McMaster
University, Hamilton, ON, Canada
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Hotfiel T, Grim C, Heiss R, Weisskopf L, Bloch W, Engelhardt M. Ausgewählte klinische und physiologische Aspekte zur Behandlung von Muskelverletzungen – Update 2020. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.orthtr.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Reichl FX, Högg C, Liu F, Schwarz M, Teupser D, Hickel R, Bloch W, Schweikl H, Thomas P, Summer B. Actovegin® reduces PMA-induced inflammation on human cells. Eur J Appl Physiol 2020; 120:1671-1680. [PMID: 32447451 PMCID: PMC8497287 DOI: 10.1007/s00421-020-04398-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/16/2020] [Indexed: 01/06/2023]
Abstract
Purpose The effect of Actovegin® was investigated on PMA- and LPS-induced human peripheral blood mononuclear cells (PBMCs). Methods PBMCs (1 × 106 cells/ml) from five blood donors (2 f, 3 m; 45–55 years) were grown in medium and exposed to Actovegin® in the presence or absence of PMA or LPS. Supernatants were collected to assess the concentration of cytokines (TNF-α, IL-1beta, IL-6 and IL-10). The reactive oxygen species (ROS) were assessed by a ROS-GloTM H2O2 assay. Results Stimulation of cells by PMA or LPS (without Actovegin®) significantly increased the secretion of IL-1beta, IL-6, IL-10 and TNF-α from PBMCs, compared to controls. Pre-treatment of cells with Actovegin® (1, 5, 25, 125 µg/ml) plus PMA significantly decreased the secretion of IL-1beta from PBMCs, compared to controls (PMA without Actovegin®). In contrast, addition of Actovegin® (1, 5, 25, 125 and 250 µg/ml) plus LPS did not alter the IL-1beta production, compared to controls (LPS without Actovegin®). TNF-α, IL-6 and IL-10 do not contribute to the reduction of inflammatory reactions with Actovegin®. Conclusions Actovegin® can reduce the PMA-induced IL-1beta release and the ROS production from PBMCs. These findings may help to explain the clinically known positive effects of Actovegin® on athletic injuries with inflammatory responses (e.g., muscle injuries, tendinopathies).
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Affiliation(s)
- Franz-Xaver Reichl
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany.
| | - Christof Högg
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany
| | - Fangfang Liu
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany
| | - Markus Schwarz
- Institute for Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Teupser
- Institute for Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Goethestr. 70, 80336, Munich, Germany
| | - Wilhelm Bloch
- Molecular and Cellular Sport Medicine, German Sport University, Cologne, Germany
| | - Helmut Schweikl
- Department of Conservative Dentistry and Periodontology, University Hospital, Regensburg, Germany
| | - Peter Thomas
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Burkhard Summer
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
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Intramuscular Injection of Combined Calf Blood Compound (CFC) and Homeopathic Drug Tr14 Accelerates Muscle Regeneration In Vivo. Int J Mol Sci 2020; 21:ijms21062112. [PMID: 32204424 PMCID: PMC7139694 DOI: 10.3390/ijms21062112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022] Open
Abstract
Skeletal muscle injuries in competitive sports cause lengthy absences of athletes from tournaments. This is of tremendous competitive and economic relevance for both the athletes and their respective clubs. Therapy for structural muscle lesions aims to promote regeneration and fast-track return-to-play. A common clinical treatment strategy for muscle injuries is the intramuscular injection of calf blood compound and the homeopathic drug, Tr14. Although the combination of these two agents was reported to reduce recovery time, the regulatory mechanism whereby this occurs remains unknown. In this in vivo study, we selected a rat model of mechanical muscle injury to investigate the effect of this combination therapy on muscle regeneration. Gene expression analysis and histological images revealed that this combined intramuscular injection for muscle lesions can enhance the expression of pro-myogenic genes and proteins and accelerate muscle regeneration. These findings are novel and depict the positive effects of calf blood compound and the homeopathic drug, Tr14, which are utilized in the field of Sports medicine.
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Hotfiel T, Mayer I, Huettel M, Hoppe MW, Engelhardt M, Lutter C, Pöttgen K, Heiss R, Kastner T, Grim C. Accelerating Recovery from Exercise-Induced Muscle Injuries in Triathletes: Considerations for Olympic Distance Races. Sports (Basel) 2019; 7:sports7060143. [PMID: 31200464 PMCID: PMC6628249 DOI: 10.3390/sports7060143] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/14/2019] [Accepted: 06/04/2019] [Indexed: 12/15/2022] Open
Abstract
The triathlon is one of the fastest developing sports in the world due to expanding participation and media attention. The fundamental change in Olympic triathlon races from a single to a multistart event is highly demanding in terms of recovery from and prevention of exercise-induced muscle injures. In elite and competitive sports, ultrastructural muscle injuries, including delayed onset muscle soreness (DOMS), are responsible for impaired muscle performance capacities. Prevention and treatment of these conditions have become key in regaining muscular performance levels and to guarantee performance and economy of motion in swimming, cycling and running. The aim of this review is to provide an overview of the current findings on the pathophysiology, as well as treatment and prevention of, these conditions in compliance with clinical implications for elite triathletes. In the context of DOMS, the majority of recovery interventions have focused on different protocols of compression, cold or heat therapy, active regeneration, nutritional interventions, or sleep. The authors agree that there is a compelling need for further studies, including high-quality randomized trials, to completely evaluate the effectiveness of existing therapeutic approaches, particularly in triathletes. The given recommendations must be updated and adjusted, as further evidence emerges.
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Affiliation(s)
- Thilo Hotfiel
- Department of Orthopedic, Trauma, Hand and Neuro Surgery, Klinikum Osnabrück GmbH, Osnabrück 49076, Germany.
- Deutsche Triathlon Union (DTU), Frankfurt 60528, Germany.
- Department of Orthopedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen 91054, Germany.
| | - Isabel Mayer
- Department of Orthopedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen 91054, Germany.
| | - Moritz Huettel
- Department of Orthopedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen 91054, Germany.
| | - Matthias Wilhelm Hoppe
- Department of Orthopedic, Trauma, Hand and Neuro Surgery, Klinikum Osnabrück GmbH, Osnabrück 49076, Germany.
- Department of Movement and Training Science, University of Wuppertal, Wuppertal 42119, Germany.
| | - Martin Engelhardt
- Department of Orthopedic, Trauma, Hand and Neuro Surgery, Klinikum Osnabrück GmbH, Osnabrück 49076, Germany.
- Deutsche Triathlon Union (DTU), Frankfurt 60528, Germany.
| | - Christoph Lutter
- Department of Orthopedics, Rostock University Medical Center, Rostock 18057, Germany.
- Department of Sports Orthopedics, Sports Medicine, Sports Traumatology, Klinikum Bamberg, Bamberg 96049, Germany.
| | | | - Rafael Heiss
- Department of Radiology, University Hospital Erlangen, Erlangen 91054, Germany.
| | - Tom Kastner
- Deutsche Triathlon Union (DTU), Frankfurt 60528, Germany.
- Department of Sport Medicine Humboldt University and Charité University Medicine, Berlin 10117, Germany.
- Institute for Applied Training Science Leipzig (IAT), Leipzig 04109, Germany.
| | - Casper Grim
- Department of Orthopedic, Trauma, Hand and Neuro Surgery, Klinikum Osnabrück GmbH, Osnabrück 49076, Germany.
- Deutsche Triathlon Union (DTU), Frankfurt 60528, Germany.
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Image guided injection therapies in athletes-Do they work and what should we be using? Eur J Radiol 2018; 110:193-202. [PMID: 30599860 DOI: 10.1016/j.ejrad.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 12/01/2018] [Indexed: 12/18/2022]
Abstract
In the modern management of the injured elite athlete, the goals of guided injection therapies have extended beyond simple reduction of pain to enhancement of tissue healing and accelerated return to competition, faster than natural healing can allow. This article will review the injection therapies which are frequently used in elite sports injury management and describe other less commonly used injection therapies that are available to the treating clinician and athlete. The evidence base, where available, for each treatment option will be summarised.
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