Jefferson fracture as sport injury in weight-lifting athlete: A rare case report and literature review

INTRODUCTION AND IMPORTANCE

Cervical spine fractures are rare in sports, but their potentially grave consequences mean that they must be given special attention. The aim of this study was to present the case of a recreational athlete with a fracture of C1 resulting from weightlifting.

CASE PRESENTATION

Young, recreational athlete came with severe neck pain right after weightlifting. There was no neurologic deficits occurred. X ray and CT scan examination showed complete fracture of the right posterior and anterior arch of C1 and disruptions of the right transverse foramen and ligament. MRI revealed no sign of impingement or compromised canal. Patient was then treated conservatively with sternal occipital mandibular immobilizer (SOMI) brace for 4 weeks. Thereafter, the neck pain resolved gradually. No neurologic deterioration occurred. At time of brace removal, patient was free of pain with normal motoric and sensory function.

CLINICAL DISCUSSION

Our case was the first report of a Jefferson fracture caused by a direct injury mechanism due to the weightlifting sport. The type III Jefferson fracture produced by this contrary injury mechanism showed that with adequate force, another spectrum of injury mechanisms may be created.

CONCLUSION

With adequate assessment and proper patient selection, Jefferson fracture can be treated effectively by SOMI brace with excellent functional outcomes.

Factors associated with persistent pain in college athletes with a history of lateral ankle sprain

OBJECTIVES

To determine the factors associated with and prevalence of persistent pain in college athletes with chronic ankle instability (CAI) and with previous lateral ankle sprain (LAS) without CAI.

DESIGN

Cross-Sectional Study.

SETTING

Online survey at one university.

PARTICIPANTS

Of the 385 respondents surveyed online, 140 were identified as having experienced at least one LAS (CAI group: 69, coper group: 24, LAS group not classified as either: 47).

MAIN OUTCOME MEASURES

Factors associated with the presence of pain during activities of daily living (ADL) and sports were identified using multivariate logistic regression analyses. Independent variables were demographics, injury characteristics, the Identification of Functional Ankle Instability (IdFAI) score, the Foot and Ankle Ability Measure Sports (FAAM-Sports) and ADL subscales, and the Tampa Scale for Kinesiophobia-11 score.

RESULTS

The prevalence of pain during ADL and sports in the three groups was 16.7%-42.0% and 33.3%-56.5%, respectively. FAAM-Sports and IdFAI score were significantly associated with pain during ADL and sports in the CAI group (odd ratio: 0.923 and 1.145), respectively. No significant pain-related factors were found in the coper and LAS groups.

CONCLUSIONS

Lower self-reported function and greater perceived ankle instability may be important factors in pain management in athletes with CAI.

The functional movement screen predicts sports injuries in Chinese college students at different levels of physical activity and sports performance

Background

Functional Movement Screen (FMS) is used to evaluate the movement quality of an individual. However, the FMS composite score used to predict sports injuries is currently ambiguous. Further refinement of the FMS scoring method may be required to more accurately predict sports injuries.

Objectives

To investigate whether FMS scores could accurately predict sports injuries in college students with different levels of physical activity (PA) and sports performance (SP).

Methods

One hundred eighty-seven college students aged 18 to 22 were prospectively screened by the FMS test and grouped by the levels of PA and SP. Sports injury occurrences were monitored and collected 12 months later. Spearman's rank coefficients and binary logistic regression were used to identify the risk factors for sports injuries. The receiver operating characteristic (ROC) curve and the total area under the curve (AUC) value were used to determine the optimal FMS cut-off point for sports injuries.

Results

The FMS composite score (sum of the seven FMS tests) exhibited a fair association with sports injuries (r = -0.434, P < 0.001). Those with an FMS cut-off point of 17.5 were more likely to acquire sports injuries. The AUC value of the ROC curves was 0.764 (95% CI: 0.618-0.909) in the low PA students, 0.781 (95% CI: 0.729-0.936) in the moderate PA students, and 0.721 (95% CI: 0.613-0.879) in the high PA students. Furthermore, students stratified by SP level showed an AUC value of 0.730 (95% CI 0.607-0.853) in the low SP group and 0.778 (95% CI 0.662-0.894) in the moderate SP group, while it declined to 0.705 (95% CI 0.511-0.800) in the high SP group. The FMS cut-off score successfully identified individuals who reported sports injuries at a higher rate in the low (PA, 84.62%; SP, 90.48%) and moderate (PA, 93.75%; SP, 77.78%) groups than in the high groups (PA, 65.52%; SP, 57.89%).

Conclusions

The FMS composite score could be used to predict sports injuries in college students with an FMS cut-off value of 17.5. Population stratification by the levels of PA and SP seems to influence the predictive accuracy of the FMS.

Are EPB41 and alpha-synuclein diagnostic biomarkers of sport-related concussion? Findings from the NCAA and Department of Defense CARE Consortium

BACKGROUND

Current protein biomarkers are only moderately predictive at identifying individuals with mild traumatic brain injury or concussion. Therefore, more accurate diagnostic markers are needed for sport-related concussion.

METHODS

This was a multicenter, prospective, case-control study of athletes who provided blood samples and were diagnosed with a concussion or were a matched non-concussed control within the National Collegiate Athletic Association-Department of Defense Concussion Assessment, Research, and Education Consortium conducted between 2015 and 2019. The blood was collected within 48 h of injury to identify protein abnormalities at the acute and subacute timepoints. Athletes with concussion were divided into 6 h post-injury (0-6 h post-injury) and after 6 h post-injury (7-48 h post-injury) groups. We applied a highly multiplexed proteomic technique that used a DNA aptamers assay to target 1305 proteins in plasma samples from athletes with and without sport-related concussion.

RESULTS

A total of 140 athletes with concussion (79.3% males; aged 18.71 ± 1.10 years, mean ± SD) and 21 non-concussed athletes (76.2% males; 19.14 ± 1.10 years) were included in this study. We identified 338 plasma proteins that significantly differed in abundance (319 upregulated and 19 downregulated) in concussed athletes compared to non-concussed athletes. The top 20 most differentially abundant proteins discriminated concussed athletes from non-concussed athletes with an area under the curve (AUC) of 0.954 (95% confidence interval: 0.922‒0.986). Specifically, after 6 h of injury, the individual AUC of plasma erythrocyte membrane protein band 4.1 (EPB41) and alpha-synuclein (SNCA) were 0.956 and 0.875, respectively. The combination of EPB41 and SNCA provided the best AUC (1.000), which suggests this combination of candidate plasma biomarkers is the best for diagnosing concussion in athletes after 6 h of injury.

CONCLUSION

Our data suggest that proteomic profiling may provide novel diagnostic protein markers and that a combination of EPB41 and SNCA is the most predictive biomarker of concussion after 6 h of injury.

Epidemiology of Football Injuries of the German Bundesliga: A Media-Based, Prospective Analysis over 7 Consecutive Seasons

BACKGROUND

This study describes the implementation of a standardised, prospective injury database covering the entire 1st male German football league ("Bundesliga") based on publicly available media data. For the first time, various media sources were used simultaneously as the external validity of media-generated data was low in the past compared to data obtained by way of the "gold standard", i.e. by the teams' medical staffs.

METHODS

The study covers 7 consecutive seasons (2014/15-2020/21). The primary data source was the online version of the sport-specific journal "kicker Sportmagazin™" complemented by further publicly available media data. Injury data collection followed the Fuller consensus statement on football injury studies.

RESULTS

During the 7 seasons, 6653 injuries occurred, thereof 3821 in training and 2832 in matches. The injury incidence rates (IRs) per 1000 football hours were 5.5 [95% CI 5.3-5.6], 25.9 [25.0-26.9] per 1000 match, and 3.4 [3.3-3.6] per 1000 training hours. Twenty-four per cent of the injuries (n = 1569, IR 1.3 [1.2-1.4]) affected the thigh, 15% (n = 1023, IR 0.8 [0.8-0.9]) the knee, and 13% (n = 856, IR 0.7 [0.7-0.8]) the ankle. Muscle/tendon injuries contributed 49% (n = 3288, IR 2.7 [2.6-2.8]), joint/ligament injuries 17% (n = 1152, IR 0.9 [0.9-1.0]), and contusions 13% (n = 855, IR 0.7 [0.7-0.8]). Compared to studies using injury reports from the clubs' medical staff, media data revealed similar proportional distributions of the injuries, but the IRs tended towards the lower end. Obtaining specific locations or diagnosis especially with regard to minor injuries is difficult.

CONCLUSIONS

Media data are convenient for investigating the quantity of injuries of an entire league, for identifying injuries for further subanalysis, and for analysing complex injuries. Future studies will focus on the identification of inter- and intraseasonal trends, players' individual injury histories, and risk factors for subsequent injuries. Furthermore, these data will be used in a complex system approach for developing a clinical decision support system, e.g. for return to play decisions.

Associations of time to return to performance following acute posterior thigh injuries with running biomechanics, hamstring function, and structure in collegiate sprinters: A prospective cohort design

BACKGROUND

The time to return to sport from acute hamstring strain injuries is associated with several functional and structural impairments. However, not all previous studies assessed the preinjury level before acute hamstring strain injuries directly. The purpose of this study was to examine the associations of the time to return to performance following acute hamstring strain injuries with deficits in running biomechanics, hamstring function and structure in collegiate sprinters by a prospective study.

METHODS

Using a prospective cohort design, 72 participants were recruited from a collegiate track and field team. At the preinjury assessment, a 60-m running-specific test, passive straight leg raise test and isometric knee flexion strength test were assessed at the beginning of the competitive season for three consecutive years (2017-2019). Afterwards, postinjury examinations were performed only in sprinters with acute hamstring strain injuries.

FINDINGS

Twelve sprinters strained their hamstring muscle (incidence rate of hamstring strain injuries: 16.7%); the majority (n = 10) were classified as grades 0-2. The running speed deficit of the running-specific test was associated with the time to return to performance as well as the passive straight leg raise test deficit. In the running-specific test, lower-limb kinetic deficits were more strongly associated with the time to return to performance compared to lower-limb kinematic deficits.

INTERPRETATION

A running-specific test may be considered one of the most convenient and valid tests for assessing rehabilitation progress after acute hamstring strain injuries.

Examining the effects of femoral anteversion and passive hip rotation on ACL injury and knee biomechanics: a systematic review and meta-analysis

Purpose

Greater femoral internal rotation (via anteversion or passive hip ROM) is associated with knee biomechanics thought to contribute to anterior cruciate ligament (ACL) injury, but it is unknown if femoral internal rotation contributes to actual ACL injury occurrence. The objective of this systematic review and meta-analysis was to quantify the extent to which femoral anteversion and hip range of motion (ROM) influence knee biomechanics consistent with ACL injury and actual ACL injury occurrence.

Methods

Using PRISMA guidelines, PubMed, CINAHL, SportDiscus, and Scopus databases were searched. Inclusion criteria were available passive hip ROM or femoral anteversion measure, ACL injury OR biomechanical analysis of functional task. Two reviewers independently reviewed titles, abstracts, and full texts when warranted. Included studies were submitted to Downs & Black Quality Assessment Tool. Meta-analyses were conducted for comparisons including at least two studies.

Results

Twenty-three studies were included (11 injury outcome, 12 biomechanical outcome). Decreased internal rotation ROM was significantly associated with history of ACL injury (MD -5.02°; 95% CI [-8.77°—-1.27°]; p = 0.01; n = 10). There was no significant effect between passive external rotation and ACL injury (MD -2.62°; 95% CI [-5.66°—- 0.41°]; p = 0.09; n = 9) Participants displaying greater frontal plane knee projection angle had greater passive external rotation (MD 4.77°; 95% CI [1.17° – 8.37°]; p = 0.01; n = 3). There was no significant effect between femoral anteversion and ACL injury (MD -0.46°; 95% CI [-2.23°—1.31°]; p = 0.61; n = 2). No within-sex differences were observed between injured and uninjured males and females (p range = 0.09 – 0.63).

Conclusion

Though individuals with injured ACLs have statistically less passive internal and external rotation, the observed heterogeneity precludes generalizability. There is no evidence that femoral anteversion influences biomechanics or ACL injury. Well-designed studies using reliable methods are needed to investigate biomechanical patterns associated with more extreme ROM values within each sex, and their prospective associations with ACL injury.

Level of evidence: IV.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40634-022-00479-7.

Seasonal and monthly trends in elbow ulnar collateral ligament injuries and surgeries: a national epidemiological study

Background

Monthly incidence of elbow ulnar collateral ligament (UCL) injuries and surgeries is relatively unknown. Defining seasonal peaks of UCL injuries and surgeries may identify opportunities for injury-prevention strategies. The purpose of this study is to analyze seasonal and monthly variations in UCL injuries and surgeries across the United States with emphasis on the timing of baseball season.

Methods

The Truven Health MarketScan database (2013-2015) was queried for patients younger than 40 years with a diagnosis code of elbow UCL sprain and a procedural code for UCL repair or reconstruction. Differences in patient characteristics were evaluated using chi-square and Mann-Whitney U-tests. Negative binomial regression models were calculated for UCL injuries and surgeries to assess monthly trends.

Results

UCL injuries were sustained by 13,894 patients, with 1404 (10.1%) patients having undergone surgery. The median age at first diagnosis was 17 years, and the median age of patients requiring surgery decreased from 20 to 18 years from 2013 to 2015 (P = .75). Most UCL injuries (n = 3785) and surgeries (n = 438) occurred during the spring season (March 21-June 20), and spring injuries were most likely to result in surgical management (11.6%). During the baseball season (March to September), the number of UCL injuries peaked in April/May, then declined, except for a second peak in September/October (incidence rate ratio 0.97; confidence interval 0.95, 0.99; P = .01). The number of UCL surgeries steadily increased from March (n = 116) to June (n = 152), followed by a gradual decline (incidence rate ratio 1.00; confidence interval 0.96, 1.04; P = .99).

Conclusion

Athletes frequently experienced UCL injuries and surgeries in the early months (April-June) of the baseball season. More emphasis should be paid to rehabilitative strategies at the beginning of a baseball season to help mitigate injury risk.

Post traumatic medial instability of the MTP1 joint and ensuing surgical reconstruction: A case report

Sport injuries of the first metatarsophalangeal joint are well described, especially with traumatic hallux valgus and turf toe reports. However, there is no description of infraclinical medial laxity and following articular disorders. We report the case of a thirty-year-old runner who suffered a sprain initially treated with retentive dressing and local injection. He developed microinstability of the first ray and quickly a bone cyst, pushing us to suggest surgical treatment. After one year of follow up after surgery, he returned to previous high-performance sport. This case highlights the probable undervaluation of post traumatic stability of the first metatarsophalangeal joint, and its potential consequences for the return to sport. LEVEL OF CLINICAL EVIDENCE: Level 4.

[Intraosseous foreign body or osteoma : Challenging differential diagnosis after open radius fracture]

Vorstellung eines 16-jährigen Patienten nach Fahrradsturz beim Mountainbiken 14 Tage nach primärer Versorgung nach offener Epiphysenverletzung. Metaphysär intraossär liegende Steine wurden bei anatomischer Reposition der Fraktur als nebenbefundliches Osteom fehlinterpretiert.

Unusual combination of posterior cruciate ligament tibial avulsion fracture and Segond fracture: A case report

Introduction and importance

Posterior cruciate ligament (PCL) avulsion fracture is an uncommon entity, but it poses significant morbidity to patient's knee and activities. A combination of PCL avulsion fracture with Segond fracture is rare and has not been described much before in known literature. In this case report, we present a rare case of a combination of these two injuries.

Case presentation

A 16-year-old cyclist who sustained left knee injury after a high-velocity fall while cycling. He fell with his anteromedial side of his left knee hitting the ground in flexion. After the fall, he felt excruciating pain and unable to bear weight. Examination revealed severe joint effusion, tenderness on posterior and lateral side of the left knee, no vascular injury and neurological deficit present. Radiographic examination revealed PCL avulsion fracture and Segond fracture. Five days after the injury, the avulsed PCL fragment and the lateral tibial plateau fragment were reduced and fixed with 3.5 mm cortical screw and washers. On the follow up, the patient stated that there is no pain on weightbearing position and after evaluated with Knee injury and Osteoarthritis Outcome Score (KOOS), the result is 90%.

Clinical discussion

Although the combination of PCL avulsion fracture and Segond fracture is rare, this pattern of injury could happen and could be considered when evaluating knee injuries.

Conclusion

Both fractures need to be addressed and managed adequately to restore knee stability and prevent early joint degeneration.

•

A rare case of combination of PCL avulsion fracture with Segond fracture

•

Segond fracture only present in 1.25% of the ACL avulsion cases

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PCL avulsion fracture is rare compare to intrasubstance PCL tear.

•

No other identical case has been described or reported previously.

Trigger Finger Associated with Fencing in an Adolescent: A Case Report

Trigger digits in children are rare and the vast majority of cases are primary and involve the thumb. Although there are isolated reports of trigger digits in children after trauma, we were unable to find any report of a trigger digit in a child caused by repetitive forceful gripping. We report a 14-year-old fencer who developed a trigger of his middle finger to highlight this unusual association. This was initially managed with a splint and analgesics and eventually required two intrathecal steroid injections for resolution of symptoms.

[Quality in shoulder surgery: is return to play all that matters?]

Pathologies of the shoulder joint present a significant burden on not only the affected individual but also the healthcare system as a whole. This article serves to delineate the outcomes that patients expect from undergoing shoulder surgery and the results that occur following shoulder surgery.

Machine learning methods in sport injury prediction and prevention: a systematic review

PURPOSE

Injuries are common in sports and can have significant physical, psychological and financial consequences. Machine learning (ML) methods could be used to improve injury prediction and allow proper approaches to injury prevention. The aim of our study was therefore to perform a systematic review of ML methods in sport injury prediction and prevention.

METHODS

A search of the PubMed database was performed on March 24th 2020. Eligible articles included original studies investigating the role of ML for sport injury prediction and prevention. Two independent reviewers screened articles, assessed eligibility, risk of bias and extracted data. Methodological quality and risk of bias were determined by the Newcastle-Ottawa Scale. Study quality was evaluated using the GRADE working group methodology.

RESULTS

Eleven out of 249 studies met inclusion/exclusion criteria. Different ML methods were used (tree-based ensemble methods (n = 9), Support Vector Machines (n = 4), Artificial Neural Networks (n = 2)). The classification methods were facilitated by preprocessing steps (n = 5) and optimized using over- and undersampling methods (n = 6), hyperparameter tuning (n = 4), feature selection (n = 3) and dimensionality reduction (n = 1). Injury predictive performance ranged from poor (Accuracy = 52%, AUC = 0.52) to strong (AUC = 0.87, f1-score = 85%).

CONCLUSIONS

Current ML methods can be used to identify athletes at high injury risk and be helpful to detect the most important injury risk factors. Methodological quality of the analyses was sufficient in general, but could be further improved. More effort should be put in the interpretation of the ML models.

Arabic translation and cross-cultural adaptation of the Sport Concussion Assessment Tool 5 (SCAT5)

The aim was to create a Modern Standard Arabic SCAT5 version for different Arabic dialects. This translation and cross-cultural adaptation was performed in eight stages: initial translations, reconciliation of translations and cultural adaptation, back translation, appraisal of back translations, validation of the translation, review and adjustment by reconciliation committee, pretesting in 12 football players and document finalisation. As an alternative to the problematic Months In Reverse Order Test (MIROT) in Arabic, the Serial 3s test (32 Arabic and 30 English participants), the Days of the Week Backwards test (DWBT), and the 'Adding Serial 3s' test were tested (30 English and 30 Arabic participants) for accuracy, difficulty and time of completion. The Arabic SCAT5 was similar and comparable to the original English version (7-point Likert scales =< 2). Testing of the pre-final version of the Arabic SCAT5 took 20.4 (SD 3.4) and 17.7 (SD 3.0) minutes respectively to complete and was found acceptable in terms of clarity, understandability, grammatical correctness and coherence. The Arabic Serial 3s test (subtraction version) was unsuitable due to high completion time, low pass rate and high difficulty perception [time = 47.2 (SD 28.0) s; accuracy = 55.2%; difficulty = 3.2 (SD 1.1)]. The Arabic DWBT was too fast and undemanding for concentration testing [time = 4.6 (SD 1.5) s; accuracy = 90%; difficulty = 1.1 (SD 0.3)]. The Adding Serial 3s tests produced similar completion times [18.4 (SD 6.8) vs. 21.1 (SD 5.3), p = 0.088], accuracy (100%) and self-rated difficulty [English = 2.0 (SD 0.7) vs. Arabic-speaking participants = 2.1 (SD 0.8), p = 0.512] and was therefore adopted to replace the MIROT. This culturally adapted Arabic-SCAT5 questionnaire is the first concussion assessment tool available for Arabic-speaking healthcare providers and athletes. Sport Concussion Assessment Tool 5 (SCAT5). Biol Sport. 2021;38(1):129-144.

Short and long versions of a 12-week netball specific neuromuscular warm-up improves landing technique in youth netballers

OBJECTIVE

To investigate the efficacy of two 'NetballSmart', netball specific warm-ups in improving landing technique measures in New Zealand secondary school netball players.

DESIGN

Multi-site cluster experimental trial.

PARTICIPANTS

77 youth participants, mean ± SD age = 15.8 ± 0.9 were recruited from secondary school netball teams.

SETTING

12 teams from 6 schools performed either the NetballSmart Dynamic Warm-up (NSDW) (n = 37); or Power warm-up (PWU) (n = 40), three times a week for 12 weeks. All players within a school (2 teams) were assigned the same warm-up, avoiding treatment contamination.

MAIN OUTCOME MEASURES

A series of unilateral and bilateral drop vertical jumps on to a portable force plate were completed by all participants. Measures included peak vertical ground reaction force (GRF) for single-leg and bilateral landings; frontal plane projection angle (FPPA) for right and left single-leg landings and Landing error scoring system (LESS) for bilateral landings. Paired t-tests were used to assess mean differences pre and post the warm-up. Generalised linear mixed effects models were developed to evaluate the effects between the NSDW and PWU groups.

RESULTS

Significant improvements were found in all the landing technique outcome measures for both warm-up groups (ES Range- GRF = -0.6 to -1.1; FPPA = 0.8 to 1.2; LESS = -1.6 to-3.2; p < 0.05). Results of mixed effects models revealed that there was only a significantly greater improvement in LESS for the PWU group (β = -0.30, p = 0.001).

CONCLUSION

Results show both warm-ups can improve landing technique measures in youth secondary school netball players. It is recommended that coaches should consider implementing one of the two warm-ups in their netball programmes. Their choice of warm-up will likely be dependent on their environment and time demands.

Association between lower extremity muscle strength and acute ankle injury in youth team-sports athletes

OBJECTIVES

To investigate lower extremity muscle strength as risk factor for an acute ankle injury in youth athletes.

DESIGN

Cohort study.

SETTING

Basketball and floorball clubs.

PARTICIPANTS

188 youth (≤21) male and 174 female athletes.

MAIN OUTCOME MEASURES

1RM leg press, maximal concentric isokinetic quadriceps and hamstrings as well as maximal isometric hip abductor strength were measured and athletes were followed for an acute ankle injury up to three years. Cox regression models were used in statistical analyses.

RESULTS

In males, greater 1RM leg press and maximal quadriceps strength increased the risk of any type of acute ankle injury (Hazard ratio [HR] for 1 SD increase, 1.63 [95% CI, 1.12-2.39] and 1.43 [95% CI, 1.01-2.01], respectively). In females, greater 1RM leg press and difference between legs in hip abduction strength increased the risk of acute non-contact ankle injury (HR for 1 SD increase, 1.44 [95% CI, 1.03-2.02] and 1.44 [95% CI, 1.03-2.00], respectively). However, ROC curve analyses showed AUC:s of 0.57-0.64 indicating "fail" to "poor" combined sensitivity and specifity of these tests.

CONCLUSION

Greater strength in both sexes along with asymmetry in hip abductor strength in females increased the risk of acute ankle injury.

Young men in sports are at highest risk of acromioclavicular joint injuries: a prospective cohort study

PURPOSE

To study the incidence of acromioclavicular joint injuries in a general population.

METHODS

All acute shoulder injuries admitted to an orthopaedic emergency department were registered prospectively, using electronic patient records and a patient-reported questionnaire. The regional area was the city of Oslo with 632,990 inhabitants. Patients with symptoms from the acromioclavicular joint without fracture were registered as a dislocation (type II-VI) if the radiologist described widening of the joint space or coracoclavicular distance on standard anteroposterior radiographs. Patients without such findings were diagnosed as sprains (type I).

RESULTS

Acromioclavicular joint injuries constituted 11% of all shoulder injuries (287 of 2650). The incidence was 45 per 10⁵ person-years (95% confidence interval [CI] 40-51). 196 (68%) were diagnosed as sprains and 91 (32%) as dislocations. Median age of all acromioclavicular joint injuries was 32 years (interquartile range 24-44), and 82% were men. Thirty percent of all acromioclavicular joint injuries were registered in men in their twenties. Sports injuries accounted for 53%, compared to 27% in other shoulder injuries [OR 3.1 (95% CI 2.4-4.0; p < 0.001)]. The most common sports associated with acromioclavicular joint injuries were football (24%), cycling (16%), martial arts (11%), alpine skiing and snowboarding (both 9%), and ice hockey (6%).

CONCLUSION

Our study suggests that in the general population, one in ten shoulder injuries involves the acromioclavicular joint and young men in sports are at highest risk. A prognostic level II cohort study.

Acute ankle sprain in athletes: Clinical aspects and algorithmic approach

Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40% of all sports-related injuries. It is especially common in basketball, American football, and soccer. The majority of sprains affect the lateral ligaments, particularly the anterior talofibular ligament. Despite its high prevalence, a high proportion of patients experience persistent residual symptoms and injury recurrence. A detailed history and proper physical examination are diagnostic cornerstones. Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules. Several interventions have been recommended in the management of acute ankle sprains including rest, ice, compression, and elevation, analgesic and anti-inflammatory medications, bracing and immobilization, early weight-bearing and walking aids, foot orthoses, manual therapy, exercise therapy, electrophysical modalities and surgery (only in selected refractory cases). Among these interventions, exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process. An exercise program should be comprehensive and progressive including the range of motion, stretching, strengthening, neuromuscular, proprioceptive, and sport-specific exercises. Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables, manual tests for stability, and functional performance testing. There are some common myths and mistakes in the management of ankle sprains, which all clinicians should be aware of and avoid. These include excessive imaging, unwarranted non-weight-bearing, unjustified immobilization, delay in functional movements, and inadequate rehabilitation. The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.

Association of the matrix metalloproteinase 3 (MMP3) single nucleotide polymorphisms with tendinopathies: case-control study in high-level athletes

BACKGROUND

Matrix metalloproteinases (MMPs) play an important role in matrix remodelling, as well as in tendon integrity. Due to overuse, athletes often develop chronic tendinopathies. If not treated, they lead to severe impairment, even complete tendon ruptures.

AIM

The main purpose of this study was to investigate whether three functional polymorphisms within the MMP3 gene are associated with increased risk of developing tendinopathies in high-level Croatian athletes.

METHODS

We have recruited one hundred fifty-five (63 high-level athletes with diagnosed tendinopathies and 92 asymptomatic controls) unrelated Caucasians for this case-control genetic study. All participants were genotyped for three single nucleotide polymorphisms (SNP) within the MMP3 gene: rs591058 C/T, rs650108 A/G and rs679620 G/A using the pyrosequencing method.

RESULTS

The MMP3 rs650108 GG (P = 0.0074) and rs679620 AA (P = 0.0119) genotypes were significantly over-represented in cases compared with controls, while rs591058 TT (P = 0.0759), as well as haplotype variant T - G - A (P = 0.06), implicated that there is an indication of predisposition for tendinopathies.

CONCLUSION

These results support association between functional variants within the MMP3 gene and the risk of tendinopathies in high-level athletes. Further research is needed to replicate these results in a larger population.

Rupture of the long head of the biceps brachii tendon near the musculotendinous junction in a young patient: A case report

We report an unusual case of the long head of the biceps brachii tendon rupture near the musculotendinous junction in a young patient. The injury occurred in a young athlete during sports competition. The clinical presentation, surgical treatment, and technique with tenodesis using a unicortical button of the ruptured tendon were presented. The post-surgical recovery was uneventful, and the patient returned to sports in 6 mo. The treatment approach and surgical technique of the long head of biceps brachii rupture was reviewed and discussed. In conclusion, surgical treatment of the long head of the biceps brachii tendon rupture with unicortical button tenodesis resulted in a favorable outcome in a young athlete.

Ibuprofen inhibited migration of skeletal muscle cells in association with downregulation of p130cas and CrkII expressions

Background

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat sports-related muscle injuries. However, NSAIDs were recently shown to impede the muscle healing process after acute injury. Migration of skeletal muscle cells is a crucial step during the muscle healing process. The present study was performed to investigate the effect and molecular mechanisms of action of ibuprofen, a commonly used NSAID, on the migration of skeletal muscle cells.

Methods

Skeletal muscle cells isolated from the gastrocnemius muscle of Sprague-Dawley rats were treated with ibuprofen. MTT assay (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) was used to evaluate cell viability, and cell apoptosis was evaluated by TUNEL assay, after ibuprofen treatment. Skeletal muscle cell migration and spreading were evaluated using the transwell filter migration assay and F-actin staining, respectively. The protein expression of p130cas and CrkII, which are cell migration facilitating genes, was determined by western blot analysis. The overexpression of p130cas of muscle cells was achieved by p130cas vector transfection.

Results

The results demonstrated that ibuprofen did not have a significant negative effect on cell viability and apoptosis. Ibuprofen inhibited the migration and spreading of skeletal muscle cells in a dose-dependent manner. Ibuprofen also dose-dependently decreased the protein expression of p130cas and CrkII. Furthermore, overexpression of p130cas resulted in the promotion of cell migration and spreading and counteracted ibuprofen-mediated inhibition.

Conclusion

This study suggested that ibuprofen exerts a potentially adverse effect on the migration of skeletal muscle cells by downregulating protein expression of p130cas and CrkII. These results indicate a possible mechanism underlying the possible negative effect of NSAIDs on muscle regeneration.

The prevalence and risk factors of vitamin D inadequacy among male athletes in Kuwait: A cross-sectional study

The aim of this study was to determine the prevalence of vitamin D inadequacy in male athletes living in Kuwait, and to assess its relationship with possible risk factors including body composition, lifestyle and fasting Ramadan. A Cross- sectional study was conducted on a total of 250 male athletes registered in official sports clubs in Kuwait were included. Blood tests, anthropometric measurements and a lifestyle questionnaire were performed. Serum 25(OH)D level was used as a measure of vitamin D status. Vitamin D inadequacy was defined as serum 25(OH)D < 75 nmol/L, inadequate levels were further classified as vitamin D insufficiency (50-75 nmol/L), vitamin D deficiency (<50 nmol/L) and severe deficiency (<25 nmol/L). Thirty-six percent of the sample were football players, 13% were futsal players and the rest were players of 15 different outdoor and indoor sports. A prevalence of 83% of vitamin D inadequacy (< 75 nmol/L) was observed in male athletes in Kuwait, of which 23% had severe deficiency (< 25 nmol/L). The prevalence increased from 80% (n = 130) before Ramadan to 90% (n = 79) after Ramadan. There was a significant positive association between serum 25(OH)D concentrations and vitamin D intake (p < 0.001). Serum 25(OH)D concentrations were significantly inversely associated with risk of injuries (p = 0.008) and with the concentrations of parathyroid hormone (PTH) (p = 0.029). No statistically significant associations between 25(OH)D concentrations and sun exposure, physical activity or anthropometric levels were found. Similar to other studies in the Middle East, we found that healthy male athletes in Kuwait have a high prevalence of vitamin D inadequacy. The results of this study suggest the need for regular supplement intake and vitamin D awareness campaigns for athletes in Kuwait. More research is needed to assess the effect of Ramadan.

Exercise addiction is associated with emotional distress in injured and non-injured regular exercisers

INTRODUCTION

Exercise addiction is characterized by the use of physical activity to cope with emotions and mood, while sports injuries can lead to psychological distress such as depression and anxiety. The aim of the present study was to investigate the association between risk of exercise addiction and psychological distress, and whether this association was modified by injury status.

METHODS

A cross-sectional study with injured and non-injured recreational exercisers (n = 1083). Using the Exercise Addiction Inventory participants were classified into the following groups: High risk of exercise addiction (HREA) with musculoskeletal injury (n = 44); HREA without musculoskeletal injury (n = 31); Low risk of addiction (LREA) with injury (n = 563); LREA without injury (n = 445). The outcomes were depression using the Major Depression Inventory, and emotional stress using the Perceived Stress Scale. Data were analyzed using binomial regression analysis with prevalence proportion difference (PPD) as measure of association.

RESULTS

Compared with LREA-exercisers, more HREA exercisers were depressed (PPD = 13% points [95%CI 3.6; 22.4]) or experienced emotional stress (PPD = 26.2% points [95%CI 14.5; 37.8]). Amongst injured exercisers, more HREA exercisers had depression (PPDHREA-injured = 15.9% points [95%CI 2.5; 29.3]) compared with LREA-exercisers.

CONCLUSIONS

Recreational exercisers with high risk of exercise addiction reported more symptoms of depression and emotional stress, and this relationship seemed exacerbated in the presence of musculoskeletal injury. Psychological assessment and counseling may be useful supplements to somatic injury interventions for addressing emotional distress.

The biological respect of the posterolateral bundle in ACL partial injuries. Retrospective analysis of 2 different surgical management of ACL partial tear in a population of high-demanding sport patients

INTRODUCTION

Most of the techniques described in the literature for the repair of chronic partial ACL tears do not spare the intact portion of the ligament. Aim of this study was to perform a retrospective analysis of the results obtained from the same ACL reconstructive surgical technique applicated by sparing or not AM bundle in a population of 42 sports patients.

MATERIALS AND METHODS

From 2010 to 2012, 42 patients who suffered ACL partial tear injury with rupture of posterolateral bundle were randomly divided in two groups homogenous for sex, age and sport-level activities. The first group with 22 patients performed ACL reconstruction with ST-GR over-the-top technique sacrificing the anteromedial (Removing AMT Group) remaining bundle intact; otherwise, the second group with 20 patients performed the same ACL reconstruction using only ST and maintaining AM bundle (Sparing AMT Group). All the patients were followed up by MRI evaluation at 12 months and clinical evaluation with IKDC score, Tegner score at 6, 12, 24, 36, 48 and 60 months. KT-1000 instrument was performed at 12 months. The results were analyzed statistically to evaluate differences between the two groups in terms of subjective outcome, and stability and for all the tests P < 0.05 was considered significant.

RESULTS

We did not observe any failure at final follow-up. IKDC subjective score at final follow-up in Removing AMT Group was 91.2 ± 2.3 in Sparing AMT Group was 92.4 ± 2.7. Tegner score at final follow-up was 7.2 ± 2.1 for Removing AMT Group and 7.8 ± 1.8 for Sparing AMT Group. Arthrometric evaluation performed with KT-1000 at final follow-up showed a side-to-side difference of 0.9 ± 1.3 mm in the Removing AMT Group against 0.8 ± 1.0 mm in the Sparing AMT Group. Return time to the sport was 7.1 months for Removing AMT Group otherwise 6.1 months for the Sparing AMT Group.

CONCLUSIONS

Both the described techniques in this study demonstrated to be able to guarantee a successful outcome. However, although no statistically significant differences were evident in terms of subjective and objective outcome between these techniques some evident benefits were evident using the sparing bundle technique in Sparing AMT Group such as better clinical scores at the final follow-up and an earlier return to sport activity.

Initial symptom presentation after high school football-related concussion varies by time point in a season: an initial investigation

Background

Schedule-based and in-season factors (e.g., competition type) have been shown to be associated with symptom reporting patterns and injury severity in sport-related concussion (SRC). To determine if acute neurocognitive and symptom presentation following SRC differ by time point within a high school football season.

Methods

Multicenter ambispective cohort of high school football players who sustained a SRC (N = 2594). Timing (early, mid, and late season) of SRC was based on median dates for the start of the pre-season, regular season, and playoffs of each states’ football schedules. Analysis of covariance (ANCOVA) investigated differences across season period groups for: (1) neurocognitive test scores, (2) total symptom scores (TSS), and (3) individual symptom increases from baseline within 1-week post-injury.

Results

Significant group differences were observed in TSS, F(2, 2589) = 15.40, p <  0.001, η_p² = 0.01, and individual symptom increases from baseline, F(2, 2591) = 16.40, p <  0.001, η_p² = 0.01. Significant increases were seen from baseline to both midseason and late season in both TSS, χ² = 24.40, p <  0.001, Φ = 0.10 and individual symptoms, χ² = 10.32, p = 0.006, Φ = 0.10. Post hoc tests indicated a linear trend, with late-season injured athletes reporting approximately twice the TSS (13.10 vs. 6.77) and new symptoms (5.70 vs. 2.68) as those with early-season injuries.

Conclusion

In a cohort of American high school football student-athletes, those suffering SRC in the late-season time period had increased acute symptom burden. SRC sustained later in-season may require more conservative management.

Knee injury and osteoarthritis outcome score of Korean national ice hockey players

[Purpose] To investigate sports injuries in Korean national ice hockey players by surveying parts, times, types, frequency, cure, and prevention types of sports injuries and provide basic data for injury prevention and performance improvement of ice hockey players. Another purpose of this study was to evaluate the incidence of ice hockey injuries according to age and the relationship between etiological factors and injuries in high school students. [Subjects and Methods] This was a cross-sectional study. Eighteen female ice hockey players in Korean elite athletes were recruited for this study. This study was conducted by a self-administered questionnaire survey using Knee Injury and Osteoarthritis Outcome Score (KOOS) of national ice hockey players. [Results] Participants were injured mainly during training. Injuries were caused by skate, puck-contact, and body check. Five subscales of KOOS were significantly correlated with each other except that the correlation between activities of daily living and quality of life was insignificant. [Conclusion] For injury prevention in national team ice hockey players, full gear is recommended. In addition, therapist in the field needs to conduct injury prevention through consistent observations and counseling in order to prevent injury and improve performance. Ice hockey players also need sufficient rest with systematic and scientific training for injury prevention and performance improvement.

Anterior cruciate ligament reconstruction: MR imaging findings

More than two million people tear their anterior cruciate ligament (ACL) each year, and ACL reconstruction occupies a significant proportion of everyday orthopedic practice, being one of the most commonly performed sports medicine surgical procedures. Patients with postoperative symptoms are frequently imaged to monitor ligament grafts and to identify complications. Given the number of patients undergoing ACL reconstruction, knowledge of the potential complications of this surgery is essential for radiologists. This article provides a review of imaging of ACL reconstruction procedures and the potential complications specific to this surgery.

Arthroscopic anterior cruciate ligament repair for proximal anterior cruciate ligament tears in skeletally immature patients: Surgical technique and preliminary results

BACKGROUND

Anterior cruciate ligament (ACL) tears in children are increasingly common and present difficult treatment decisions due to the risk of growth disturbance. Although open primary ACL repair was abandoned in the historical literature, recent studies have suggested that there is a role for arthroscopic primary repair in patients with proximal tears.

METHODS

This is a retrospective review of five consecutive patients aged 9.2years (range 8 to 10) who underwent suture anchor ACL reinsertion. Patients were included if they were Tanner stages 1-2 and proximal ACL tears with adequate tissue quality confirmed arthroscopically. The time frame was 81days. Arthroscopic ACL reinsertion was performed with bioabsorbable suture anchor. Clinical evaluation, KT-1000™, and MRI were re-evaluated. Clinical outcomes were measured using International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score.

RESULTS

At a mean follow-up of 43.4months (range 25 to 56), no re-injury and leg length discrepancies were observed. Four patients had negative Lachman tests. The remainder had a grade 1 Lachman test. The mean side-to-side difference was 3 (2-4mm). In MRI obtained at the last follow-up, no articular lesions or growth arrest were observed and the reinserted ACL was recognized in every exam. All patients returned to previous level of activity and presented normal and nearly normal IKDC score. The mean Lysholm score was 93.6.

CONCLUSION

Arthroscopic ACL repair can achieve good short-term results with joint stability and recovery of sport activity in skeletally immature patients, with proximal ACL avulsion tear.

Spinal alignment, mobility of the hip and thoracic spine and prevalence of low back pain in young elite cross-country skiers

This study investigated the association between spinal alignment, mobility of the hips and the thoracic spine and low back pain in adolescent cross-country skiers. Cohort of 51 elite cross-country skiers from a cross-country skiing high school in Sweden participated in the study. Sagittal spinal alignment, active range of motion in flexion, extension and rotation of the thoracic spine as well as passive and active extension of the hips were measured. The participants also completed a questionnaire regarding training, competition, skiing technique and occurrence of low back pain. A simple linear regression was calculated to predict pain score based on thoraco-lumbar relation, with a significant (P<0.05) regression equation of y=-0.069x+2.280 (standard error of estimate, 0.034). Participants with greater lordosis than kyphosis were more likely to suffer from low back pain than subjects without this offset. Thoracic mobility and passive or active hip extension showed no correlation with low back pain. Sagittal spinal alignment seems to be related with low back pain among young elite cross-country skiers. This study shows that range of motion of the thoracic spine and hips do not have an effect on the prevalence of low back pain in this population.

Experiences of returning to elite beach volleyball after shoulder injury

The purpose of this study was to examine beach volleyball players’ experience regarding shoulder injury and how it affects their return to play. To achieve the research aims a qualitative design with semi-structured interviews had been conducted, five elite beach volleyball players, four men and one woman aged 27–42 participated in the study. All participants had suffered a severe shoulder injury, with absence from training and competing for at least 28 days. The findings of this study indicate that it is the individual’s inner motivation, together with a clear goal and support from the community, family, teammate and coach that are the most important factors when going through rehabilitation and getting back to playing beach volleyball after a shoulder injury. All participants had been affected by their injury in some way; some of the participants had been affected in a positive way since they had become mentally stronger and had developed better volleyball technique after rehabilitation. The conclusions of this study indicate that there are three distinct factors that increase the chances of getting back to playing beach volleyball after shoulder injury; it is the players’ self motivation, together with a clear goal and support from the community.

Restrained tibial rotation may prevent ACL injury during landing at different flexion angles

BACKGROUND

Internal tibial rotation is a risk factor for anterior cruciate ligament (ACL) injury. The effect of restraining tibial rotation (RTR) to prevent ACL injury during single-leg landing is not well understood. We aimed to investigate the effect of impact load and RTR on ACL injury with respect to flexion angle. We hypothesized that RTR could protect the knee from ACL injury compared to free tibial rotation (FTR) regardless of flexion angle and create a safety zone to protect the ACL.

METHODS

Thirty porcine specimens were potted in a rig manufactured to replicate single-leg landing maneuvers. A mechanical testing machine was used to apply external forces in the direction of the tibial long axis. A 3D displacement sensor measured anterior tibial translation (ATT). The specimens were divided into 3 groups of 10 specimens and tested at flexion angles of 22 ± 1°, 37 ± 1° and 52 ± 1° (five RTR and five FTR) through a consecutive range of actuator displacements until ACL failure. After dissection, damage to the joint was visually recorded. Two-way ANOVA were utilized in order to compare compressive forces, torques and A/P displacements with respect to flexion angle.

RESULTS

The largest difference between peak axial compressive forces (~3.4 kN) causing ACL injury between RTR and FTR was reported at a flexion angle of 22°. Tibial torques with RTR was in the same range and < 20 Nm at the instance and just before ACL failure, compared to a significant reduction when cartilage/bone damage (no ACL failure) was reported. Isolated ACL injuries were observed in ten of the 15 FTR specimens. Injuries to bone and cartilage were more common with RTR.

CONCLUSIONS

RTR increases the threshold for ACL injury by elevating the compressive impact load required at lower flexion angles. These findings may contribute to neuromuscular training programs or brace designs used to avoid excessive internal/external tibial rotation. Caution must be exercised as bone/cartilage damage may result.

Isolated inferior peroneal retinculum tear in professional soccer players

INTRODUCTION

Peroneal tendon dislocations are rare injuries that can easily be misdiagnosed. Up to date literature mostly describes proximal peroneal tendon dislocations due to superior peroneal retinaculum (SPR) tear. In this article, we present the assessment, diagnostic algorithm and a new therapeutic option for the distal dislocation of the long peroneal tendon due to isolated inferior peroneal retinaculum (IPR) tear.

PATIENTS AND METHODS

Between 2001 and 2011 three patients with distal peroneal tendon dislocation were operated. All of them were competitive athletes in the national soccer league. They presented with an ankle sprain and prolonged problems on the lateral side of the foot with no improvement after conservative therapy measures. Coleman block test was performed; ultrasound and MRI showed a tendon dislocation under the IPR. The patients underwent surgical repair that consisted of peroneal tubercle excision, a new lateral calcanear groove formation for both peroneal tendons and IPR plasty.

RESULTS

At the two year follow up the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score showed a significant increase. The decrease of painful stimuli assessed by a Visual Analogue Scale (VAS) was significant as well. At an average of 12 weeks after the surgery, the patients returned to their level of sport activity before injury and didn't report similar problems later.

CONCLUSION

Description of distal peroneal tendon dislocations is limited in the literature. This topic should be considered in differential diagnostics of an acute and chronic ankle sprain which leads to chronic ankle pain and instability. The authors recommend surgical treatment as a method of choice especially in professional athletes.

Injury rates in Iranian taekwondo athletes; a prospective study

Purpose

Taekwondo, as the most popular martial art among Iranian sportsmen, might lead to injury for the athletes of this sport during competitions. We decided to report the incidence rate of injuries sustained by the athletes of this sport during national competitions.

Methods

All competitions of Iran national championship taekwondo league in 2006-2007 with 204 athletes were observed prospectively to detect the occurrence of injuries. The severity of injuries was classified into four groups (mild, moderate, severe, and critical) according to the involvement of medical care team in the contest, ability of the athletes to resume and duration of probable absence of injured athletes from future competitions and training sessions. Athlete-Exposure (A-E) was defined as the number of competitions multiplied by two. On this base, the rate of injury incidence per 1000 A-Es, the rate of injuries per time unit and the rate of injury occurred for each 100 athletes were considered as the major outcomes of this study.

Results

Of totally 1,338 A-Es, 93 injuries were recorded during the competitions. The rate of injury incidence was found to be 69.5 injuries per 1000 A-Es and the rate of injuries per minute of competitions was 0.023 which corresponded to 23.3 injuries per 1000 minutes of competitions. 45.6 injuries were occurred for each 100 athletes during the course of competitions. The most frequent injuries were mild (68.8%) and critical injuries (24.7%), followed by moderate and severe injuries; 4.3% and 2.1%, respectively.

Conclusion

The rate of injury we found was lower than that of western countries. In spite of finding the lower limbs as the most frequent place of injuries in other studies, we found the upper limbs as the most predisposed place of injuries which might be due to difference in the method of combat of Iranian athletes with other athletes.

K-wire Arthrodesis and Coracoclavicular Augmentation of Complete Acromioclavicular Separations: Functional and Subjective Results

BACKGROUND

In recent years, there has been a trend from operative to conservative management of complete acromioclavicular separations. Despite this, surgical treatment is still recommended to manual workers and athletes, who account for a large part of the patients. The objective of this study was to evaluate the functional outcome of type III separations according to Tossy managed by temporary arthrodesis of the acromioclavicular joint combined with coracoclavicular augmentation. Special attention was paid to sport exercising patients.

PATIENTS AND METHODS

In this study, 32 patients (mean age 39 years) with a complete acromioclavicular separation were investigated. All of them underwent a surgical treatment managed by temporary acromioclavicular arthrodesis with two parallel k-wires and augmentation of the coracoclavicular ligaments with a biodegradable cord (PDS). Functional outcome was assessed after an average follow-up of 36 months by using the Constant-Murley-, Neer- and DASH-score. Additionally, incidence of complications and subjective results were observed.

RESULTS

Evaluation of the data, obtained from the scores, revealed an excellent result for the Constant-Murley- and DASH-score for 84% of the patients. Regarding the Neer-score, 78% had an excellent outcome. Eighty-four percent of the patients assessed revealed an excellent to fair subjective result. Cosmetic reasons were most frequently the cause for discontentedness. Minor complications occurred in three patients without severe sequelae. All patients returned back to former working and sport activity level.

CONCLUSION

Surgical treatment of complete acromioclavicular separations by temporary arthrodesis with two k-wires and coracoclavicualar PDS-augmentation results in good to excellent function. It is associated with a low complication rate and a high patient contentedness. Particularly for athletes in non-contact sports this surgical technique can still be recommended.