logo logo
Sports injuries and illnesses in the Lillehammer 2016 Youth Olympic Winter Games. Steffen Kathrin,Moseid Christine Holm,Engebretsen Lars,Søberg Pia K,Amundsen Olav,Holm Kristian,Moger Thomas,Soligard Torbjørn British journal of sports medicine BACKGROUND:Injury and illness surveillance during high-level youth sports events is an important first step in health prevention and caretaking of the young elite athletes. AIM:To analyse injuries and illnesses that occurred during the 10 days 2nd Youth Olympic Winter Games (YOG), held in Lillehammer 2016. METHODS:We recorded the daily occurrence (or non-occurrence) of injuries and illnesses through the reporting of (1) all National Olympic Committee (NOC) medical teams and (2) the polyclinic and medical venues by the Lillehammer Organising Committee (LYOCOG) medical staff. RESULTS:In total, 1083 athletes (48 double-starters), 46% (n=502) of them females, from 70 NOCs were registered in the study. NOCs and LYOCOG reported 108 injuries and 81 illnesses, equalling to 9.5 injuries and 7.2 illnesses per 100 athletes. The percentage of injured athletes was highest in the snowboard and ski slopestyle and cross disciplines, alpine skiing and skeleton, and lowest in the Nordic skiing disciplines. Approximately, two-thirds of the injuries (n=71, 65.7%) prevented the athlete from training or competition, while 10 injuries (9.3%) were registered with an estimated absence from sport for >7 days. The rate of illness was highest in curling and the Nordic skiing disciplines with most of them being respiratory tract infections (81.5%). CONCLUSIONS:Overall, 9% of the athletes incurred at least one injury during the games, and 7% an illness, which is similar to the first YOG in Innsbruck 2012 and slightly lower compared with previous Winter Olympic Games. The incidence of injuries and illnesses varied substantially between sports. 10.1136/bjsports-2016-096977
Clinical and biomechanical outcomes following patellar tendon repair with suture tape augmentation. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie PURPOSE:Patellar tendon ruptures (PTR) occur predominantly in middle-aged patients following indirect trauma. The aim of this study was to quantify the short-term results using a suture tape augmentation technique for the repair of PTR. METHODS:All consecutive patients with acute (< 6 weeks) PTR who underwent suture tape augmentation between 03/2014 and 11/2019 at a single institution with a minimum follow-up of 12 months were retrospectively evaluated. Outcome measures included Visual Analog Scale (VAS) for pain, Tegner Activity Scale (TAS) and return to sport rates, Lysholm score, International Knee Documentation Committee subjective knee form (IKDC) as well as Knee Injury and Osteoarthritis Outcome Score (KOOS). Additionally, a standardized clinical examination and an isometric strength evaluation of knee extension and flexion were performed. It was hypothesized that high return to sport rates and good functional outcome would be observed and that the majority of patients would not present with a severe (> 20%) knee extension strength deficit when compared to the contralateral side. RESULTS:A total of 7 patients (mean age 37.0 ± SD 13.5 years; 6 male/1 female) were available for final assessment at a median follow-up of 17.0 (25-75% IQR 16.0-77.0) months. Three injuries occurred during ball sports, two injuries occurred during winter sports, and one injury each occurred during a motorcycling and skateboarding accident. The average time between trauma and surgery was 4.7 ± 2.6 days. At follow-up, patients reported little pain (VAS: 0 [0-0.4]). Return to sport was possible for all patients 8.9 ± 4.0 months postoperatively at a high level (TAS: 7.0 [6.0-7.0]). Five patients (71.4%) returned to the preinjury level of play, and 2 (28.6%) did not return to the preinjury level of play. Patient-reported outcome measures were moderate to good (Lysholm score: 80.4 ± 14.5; IKDC: 84.2 ± 10.6; KOOS subscales: pain 95.6 ± 6.0, symptoms 81.1 [64.9-89.1], activities of daily living 98.5 [94.1-100], sport and recreation function 82.9 ± 14.1 and knee-related quality of life 75.9 ± 16.3). All patients were very satisfied (57.1%) or satisfied (42.9%) with the postoperative result. No postoperative complications were reported. Strength measurements revealed a severe knee extension deficit in 3 patients (42.9%), but no significant deficit of isometric knee extension or flexion strength in comparison with the contralateral side was observed overall (p > 0.05). CONCLUSION:Suture tape augmentation in acute PTR repair leads to good functional outcome without major complications. Although a severe knee extension strength deficit may occur in some patients postoperatively, an excellent return to sports rate and high patient satisfaction can be expected nonetheless. LEVEL OF EVIDENCE:Retrospective cohort study; III. 10.1007/s00590-023-03572-4
Strategies for enhancing proprioception and neuromuscular control of the knee. Hewett Timothy E,Paterno Mark V,Myer Gregory D Clinical orthopaedics and related research Proprioception and neuromuscular control of the knee are compromised after ligament injury and must be regained if the athlete is to return to high level sports at a normal injury risk level. The anterior cruciate ligament deficient and reconstructed knee will be used as a model to describe differences in proprioception and neuromuscular control to those of an uninjured knee. The purpose of the current review is threefold. First, the basic science of proprioception and neuromuscular control specific to the knee will be summarized and reviewed. The review will include an overview of terminology, neurophysiology, and the effects of injury on the function of both lower limbs. Second, tools used for assessment and rehabilitation of proprioceptive deficits will be evaluated. Specific rehabilitation procedures that incorporate prophylactic conditioning that focus on transitioning the injured athlete back into sport will be presented. Finally, the literature with respect to gender variation in proprioception and neuromuscular control will be evaluated. The goal of the current review is to provide the clinician and the clinical scientist with sufficient background information for the development of quantitative methods to evaluate a patient's functional capacity and to assist in preventative, preoperative, and postoperative decision-making strategies. 10.1097/00003086-200209000-00008
Proprioceptive Training for the Prevention of Ankle Sprains: An Evidence-Based Review. Journal of athletic training Reference:  Schiftan GS, Ross LA, Hahne AJ. The effectiveness of proprioceptive training in preventing ankle sprains in sporting populations: a systematic review and meta-analysis. J Sci Med Sport. 2015;18(3):238-244. CLINICAL QUESTION:  Does the use of proprioceptive training as a sole intervention decrease the incidence of initial or recurrent ankle sprains in the athletic population? DATA SOURCES:  The authors completed a comprehensive literature search of MEDLINE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (PEDro) from inception to October 2013. The reference lists of all identified articles were manually screened to obtain additional studies. The following key words were used. Phase 1 population terms were sport*, athlet*, and a combination of the two. Phase 2 intervention terms were propriocept*, balance, neuromusc* adj5 train*, and combinations thereof. Phase 3 condition terms were ankle adj5 sprain*, sprain* adj5 ankle, and combinations thereof. STUDY SELECTION:  Studies were included according to the following criteria: (1) the design was a moderate- to high-level randomized controlled trial (>4/10 on the PEDro scale), (2) the participants were physically active (regardless of previous ankle injury), (3) the intervention group received proprioceptive training only, compared with a control group that received no proprioceptive training, and (4) the rate of ankle sprains was reported as a main outcome. Search results were limited to the English language. No restrictions were placed on publication dates. DATA EXTRACTION:  Two authors independently reviewed the studies for eligibility. The quality of the pertinent articles was assessed using the PEDro scale, and data were extracted to calculate the relative risk. Data extracted were number of participants, intervention, frequency, duration, follow-up period, and injury rate. MAIN RESULTS:  Of the initial 345 studies screened, 7 were included in this review for a total of 3726 participants. Three analyses were conducted for proprioceptive training used (1) to prevent ankle sprains regardless of history (n = 3654), (2) to prevent recurrent ankle sprains (n = 1542), or (3) as the primary preventive measure for those without a history of ankle sprain (n = 946). Regardless of a history of ankle sprain, participants had a reduction in ankle-sprain rates (relative risk [RR] = 0.65, 95% confidence interval [CI] = 0.55, 0.77; numbers needed to treat [NNT] = 17, 95% CI = 11, 33). For individuals with a history of ankle sprains, proprioceptive training demonstrated a reduction in repeat ankle sprains (RR = 0.64, 95% CI = 0.51, 0.81; NNT = 13, 95% CI = 7, 100). Proprioceptive training as a primary preventive measure demonstrated significant results (RR = 0.57, 95% CI = 0.34, 0.97; NNT = 33, 95% CI = 16, 1000). CONCLUSIONS:  Proprioceptive training programs were effective in reducing the incidence rates of ankle sprains in the athletic population, including those with and those without a history of ankle sprains. 10.4085/1062-6050-52.11.16
Optimizing performance by improving core stability and core strength. Hibbs Angela E,Thompson Kevin G,French Duncan,Wrigley Allan,Spears Iain Sports medicine (Auckland, N.Z.) Core stability and core strength have been subject to research since the early 1980s. Research has highlighted benefits of training these processes for people with back pain and for carrying out everyday activities. However, less research has been performed on the benefits of core training for elite athletes and how this training should be carried out to optimize sporting performance. Many elite athletes undertake core stability and core strength training as part of their training programme, despite contradictory findings and conclusions as to their efficacy. This is mainly due to the lack of a gold standard method for measuring core stability and strength when performing everyday tasks and sporting movements. A further confounding factor is that because of the differing demands on the core musculature during everyday activities (low load, slow movements) and sporting activities (high load, resisted, dynamic movements), research performed in the rehabilitation sector cannot be applied to the sporting environment and, subsequently, data regarding core training programmes and their effectiveness on sporting performance are lacking. There are many articles in the literature that promote core training programmes and exercises for performance enhancement without providing a strong scientific rationale of their effectiveness, especially in the sporting sector. In the rehabilitation sector, improvements in lower back injuries have been reported by improving core stability. Few studies have observed any performance enhancement in sporting activities despite observing improvements in core stability and core strength following a core training programme. A clearer understanding of the roles that specific muscles have during core stability and core strength exercises would enable more functional training programmes to be implemented, which may result in a more effective transfer of these skills to actual sporting activities. 10.2165/00007256-200838120-00004
Closed kinetic chain rehabilitation for sports injuries. Kibler W B Physical medicine and rehabilitation clinics of North America Closed chain techniques can increase the effectiveness of rehabilitation protocols because they allow more normal physiologic activations and biomechanical motions, especially in the early rehabilitation phase. They have been shown to be effective in knee/leg rehabilitation, but are also useful in shoulder/scapula rehabilitation. Facilitation patterns allow muscles to be activated in normal sequences, but also allow them to be isolated to recover their normal strength. Closed chain exercises are an integral part of accelerated rehabilitation programs.
Strength and Power Training in Rehabilitation: Underpinning Principles and Practical Strategies to Return Athletes to High Performance. Maestroni Luca,Read Paul,Bishop Chris,Turner Anthony Sports medicine (Auckland, N.Z.) Injuries have a detrimental impact on team and individual athletic performance. Deficits in maximal strength, rate of force development (RFD), and reactive strength are commonly reported following several musculoskeletal injuries. This article first examines the available literature to identify common deficits in fundamental physical qualities following injury, specifically strength, rate of force development and reactive strength. Secondly, evidence-based strategies to target a resolution of these residual deficits will be discussed to reduce the risk of future injury. Examples to enhance practical application and training programmes have also been provided to show how these can be addressed. 10.1007/s40279-019-01195-6
Diagnosis, prevention and treatment of common shoulder injuries in sport: grading the evidence - a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). British journal of sports medicine This statement paper summarises and appraises the evidence on diagnosis, prevention, and treatment of common shoulder injuries in sports. We systematically searched Medline and Embase. The Grading of Recommendations Assessment, Development and Evaluation tool was applied to evaluate the overall quality of evidence.For diagnosis, we included 19 clinical tests from mixed populations. Tests for anterior instability, biceps-labrum complex injuries and full subscapularis rupture had high diagnostic accuracy (low to moderate quality of evidence).For prevention, the Oslo Sports Trauma Research Center, the Shoulder Control, the FIFA 11+ shoulder injury prevention programmes, and a baseball-specific programme (range of motion, stretching, dynamic stability and strengthening exercises) showed moderate to large effect size in reducing the risk of shoulder injury compared with no intervention (very low to moderate quality of evidence).For treatment, a rehabilitation programme including stretching, ice packs, electrotherapy and compression, and strengthening exercises showed a large effect size in reducing pain and disability compared with no intervention in athletes with subacromial impingement syndrome (very low to moderate quality of evidence). For the treatment of supraspinatus tendinopathy, hyperthermia treatment (heating the skin to 38°C-40°C) resulted in large effect size in reducing pain and disability compared with ultrasound or pendular swinging and stretching exercises (moderate quality of evidence). Strengthening exercise alone or in combination with stretching exercises promoted a large effect in reducing shoulder pain (cohort studies, no comparators) (very low quality of evidence). The quality of evidence for most estimates was low to moderate, indicating that future high-quality research may alter our recommendations for clinical practice. 10.1136/bjsports-2022-105674
ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline. Sports health CONTEXT:Anterior cruciate ligament (ACL) reconstruction (ACLR) and postoperative rehabilitation continues to be a multidisciplinary focus in both research and clinical environments. Recent research on ACLR warrants a reexamination of clinicians' current rehabilitation practices to optimize the strikingly variable clinical outcomes after ACLR and return to sport. The purpose of the article and updated guidelines is to use contemporary evidence to systematically revisit our practice guidelines and validate our clinical milestones with data from our university-based practice. EVIDENCE ACQUISITION:Using the PubMed search engine, articles that reported on ACLR rehabilitation and protocols, guidelines, graft type, healing and strain, return to sport, psychological considerations, and secondary injury prevention published from 1979 to 2020 were identified using the search terms , , , , , , , and . STUDY DESIGN:Clinical review. LEVEL OF EVIDENCE:Level 5. RESULTS:Clinical milestones after ACLR were validated using clinical data collected from 2013 to 2017 at a university-based practice. Variables including knee joint range of motion, effusion, Knee Outcome Survey-Activities of Daily Living Scale, and quadriceps strength index were tracked throughout rehabilitation and analyzed to help inform an updated ACLR rehabilitation guideline. CONCLUSION:Incorporating the latest research, combined with direct clinical data, provides a current, realistic, and clinically benchmarked strategy for ACLR rehabilitation. Commonly held clinical beliefs regarding rehabilitation after ACL injury must be challenged by the latest research to improve patient outcomes and decrease the risk of reinjury. Key updates to the practice guidelines include the use of frequent and accurate quadriceps strength testing, delayed return-to-sport timeline, immediate use of open kinetic chain exercise, criterion-based progressions for running, sprinting, plyometrics, agility, cutting/pivoting, return to competition, and the inclusion of a secondary prevention program after return to sport. STRENGTH OF RECOMMENDATION TAXONOMY (SORT):B. 10.1177/19417381211056873
Analysis of sex-specific injury patterns and risk factors in young high-level athletes. Frisch A,Seil R,Urhausen A,Croisier J L,Lair M L,Theisen D Scandinavian journal of medicine & science in sports This study analyzed sex-specific injury patterns and risk factors in young athletes (n=256) from 12 sport disciplines practicing at the national or the international level in the Grand-Duchy of Luxembourg. Injury occurrence as a result of sport practice was analyzed retrospectively over the year 2006 using a standardized self-administered questionnaire. Overall incidence was not different between girls and boys (1.20 and 1.21 injuries/1000 athlete-hours, respectively), but in the context of team sport competition girls tended to be at a greater risk (rate ratio 2.05, P=0.053). Girls had a higher proportion of injuries in the ankle/foot region compared with boys (34.8% vs 16.8%). No sex-related differences were found regarding injury severity. Multivariate logistic regression (controlling for age and practice volume) revealed that girls' team sports were associated with a greater injury risk compared with individual sports [odds ratio (OR) of 4.76], while in boys this was observed for racket sports (OR=3.31). Furthermore, physical or emotional stress tended to be a specific risk factor in girls. There was a tendency for injury outside sports to be coupled to a higher injury risk in girls and boys. Consideration of sex-specific injury patterns and risk factors could be of importance for effective injury prevention. 10.1111/j.1600-0838.2008.00860.x
Epidemiology of imaging-detected bone stress injuries in athletes participating in the Rio de Janeiro 2016 Summer Olympics. Hayashi Daichi,Jarraya Mohamed,Engebretsen Lars,D Crema Michel,W Roemer Frank,Skaf Abdalla,Guermazi Ali British journal of sports medicine BACKGROUND:Bone stress injuries are common in high-level athletics. AIM:To describe the demographics, frequency and anatomical location of stress injuries (ie, stress reaction and stress fractures) in athletes at the Rio de Janeiro 2016 Summer Olympic Games. METHODS:We recorded all sports injuries at the Rio de Janeiro 2016 Summer Olympics reported by the National Olympic Committee (NOC) medical teams and in the polyclinic and medical venues. Imaging was performed through the official IOC clinic within the Olympic Village, using digital X-ray cameras and 3T and 1.5T magnetic resonance (MR) scanners. Images were read centrally and retrospectively by musculoskeletal radiologists with expertise in sports injuries. RESULTS:11 274 athletes (5089 women (45%), 6185 men (55%)) from 207 NOCs participated in the study. 1101 injuries were reported. Imaging revealed 9 stress fractures (36%) and 16 stress reactions (64%) in 18 female and 7 male athletes (median age 25 years, age range 18-32). Stress injuries were mostly in the lower extremities (84%), particularly tibia (44%) and metatarsals (12%), with two in the lumbar spine (8%). Stress injuries were most common in track and field athletes (44%) followed by volleyball players (16%), gymnastics (artistic) (12%) and other type of sports. CONCLUSIONS:Twenty-five bone stress injuries were reported, more commonly in women, mostly in the lower extremities and most commonly in track and field athletes. Our study demonstrates the importance of early imaging with MRI to detect stress reactions before they can progress to stress fractures. 10.1136/bjsports-2017-098189
Low-Energy Lisfranc Injuries: When to Fix and When to Fuse. Patel Milap S,Mutawakkil Muhammad Y,Kadakia Anish R Clinics in sports medicine Lisfranc injuries can be devastating to the athlete and nonathlete. In the athletic population, minor loss of midfoot stability compromises the high level of function demanded of the lower extremity. The most critical aspect of treatment is identifying the injury and severity of the ligamentous/articular damage. Not all athletes are able to return to their previous level of function. With appropriate treatment, a Lisfranc injury does not mandate the cessation of an athletic career. We focus on the diagnosis and an algorithmic approach to treatment in the athlete discussion the controversy of open reduction and internal fixation versus arthrodesis. 10.1016/j.csm.2020.07.001
Rehabilitation and Return to Work and Sport After Rotator Cuff. Clinics in sports medicine This review covers a systematic approach to rehabilitation following rotator cuff repair. Rates of return to work and return to a prior level of sports activity in patients that have undergone rotator cuff repair will be reviewed. Risk factors and predictors of a patient's inability to return to work or prior level of sports participation will be discussed. Overall, there is a high level of return to work and sports following rotator cuff repair. Heavy manual laborers are at higher risk of not returning to a prior level of work, whereas professional overhead athletes are at higher risk of not returning to their prior level of play following rotator cuff repair. 10.1016/j.csm.2022.08.008
Sports-related testing protocols are required to reveal trunk stability adaptations in high-level athletes. Barbado David,Barbado Luis C,Elvira Jose L L,Dieën Jaap H van,Vera-Garcia Francisco J Gait & posture Trunk/core stability is considered a key component of training programs, because it could contribute to prevention of low-back and lower-limb injuries and to sports performance. Based on the specificity principle, sports-related trunk stability tests would be required in elite sports performance. However, there may be some generic qualities underlying trunk stability that can be assessed with nonspecific protocols, which are broadly used in sport and rehabilitation. To assess whether specific tests are needed in a high-performance context, we analyzed the influence of specialization in sports with large but qualitatively different balance control demands (judo and kayaking) on trunk stability and compared high-performance athletes with recreational athletes without a specific training history. Twenty-five judokas, sixteen kayakers and thirty-seven recreational athletes performed two trunk stability protocols: sudden loading, to assess trunk responses to external and unexpected perturbations; stable and unstable sitting, to assess the participant's ability to control trunk while sitting. Within-session test-retest reliability analyses were performed to support the between-groups comparison. Judokas showed lower angular displacement (0.199rad) against posterior loading than kayakers (0.221rad) probably because they are frequently challenged by higher sudden loads while they are pushed or pulled. Kayakers showed lower error (<6.12mm) of center of pressure displacements than judokas especially during dynamic task while sitting on an unstable seat (>7.33mm), probably because they train and compete seated on unstable surfaces. Importantly, judokas and kayakers obtained better results than recreational athletes only in those tests designed according to the specific demands of each sport (p<0.050). In conclusion, specific-sport training induces specific trunk stability adaptations, which are not revealed through nonspecific tests. 10.1016/j.gaitpost.2016.06.027
Athletes' perception of the causes of injury in gymnastics. Kolar Edvard,Pavletič Mitija S,Smrdu Maja,Atiković Almir The Journal of sports medicine and physical fitness BACKGROUND:Gymnastics requires a high level of flexibility, conditioning and complete body recruitment that is infrequently matched by other sports. Artistic gymnastics has a relatively high incidence of injuries, which are generally of minor or medium severity. With all its complexity, it poses a unique diagnostic and treatment challenge to medical practitioners. The present study examined athletes' perception of the causes of injury and of the possible ways to reduce their incidence. METHODS:The research involved 63 quality athletes, of whom 20 were in men's artistic gymnastics, 21 in women's artistic gymnastics, and 22 in rhythmic gymnastics. We used the self-assessment method. Factors inducing injury were grouped into three different categories: training, the athlete himself, and the environment. We used the χ2 test to test the association between a risk factor and injuries. The association between injuries and risk factors was also tested using a multivariate logistic regression analysis. RESULTS:Overall, an incidence of 184 injuries was found, of which 67 (36.4%) were acute and 117 (63.5%) were chronic injuries. According to binary logistic regression analyses, psychological factors significantly associated with the prevalence of acute and chronic injury in both sexes for all disciplines were: a poor technique, improper methods of teaching, and an inadequate load. In our study, higher rates of acute and chronic injury were observed among male gymnasts, who reported their occurrence during training by overload, and among female gymnasts, who reported a poor technique, improper methods of teaching, and an inadequate load as main causes of their occurrence. CONCLUSIONS:Improving the communication between athletes and coaches, taking the opinion of an athlete into account, and the athlete's active involvement in preparation of the program include the most crucial points for reducing the incidence of injuries. 10.23736/S0022-4707.16.06228-9
Arthroscopic restoration of terminal elbow extension in high-level athletes. Blonna Davide,Lee Gwo-Chin,O'Driscoll Shawn W The American journal of sports medicine BACKGROUND:Although most people can lead near-normal lives with a limited but functional arc of elbow motion, athletes may find loss of terminal extension severely impairing. HYPOTHESIS:Arthroscopic contracture release is effective in restoring full elbow extension in athletes whose loss of terminal extension impairs their intensities and/or levels of performance in sport. STUDY DESIGN:Case series; Level of evidence, 4. METHODS:Between 1997 and 2007, 24 athletes (26 elbows; mean age, 38 years [range, 12-58]) whose chief complaint was limited elbow extension (≤35°) underwent arthroscopic release of contractures (average follow-up, 33 months [range, 12-88]). All the patients were classified according to a sport-specific scoring system using the subjective patient outcome for return to sports score and the summary outcome determination score. RESULTS:All 26 elbows improved subjectively and objectively with surgery. Of the 26 elbows, 25 were rated by the patients as normal (n = 15) or near-normal (n = 10) at final follow-up. Pain during intense sporting activities was absent in 17, mild and occasional without affecting performance in 6, and severe enough to affect performance in 1. Of the 24 patients (26 elbows), 22 patients (23 elbows) returned to the same sport at the same level of intensity and performance as before injury. Two patients (3 elbows) returned to the same sport but failed to reach their preinjury levels of performance. Extension improved in all patients, with the average flexion contracture decreasing from 27° ± 7° (range, 10°-35°) to 6° ± 9° (range, 10° of hyperextension to 25°; P < .001). Lack of extension was not a residual impairment factor in any patients. Three patients developed delayed-onset ulnar neuropathy after surgery, 2 of which were treated by subcutaneous transposition. All 3 resolved completely, 2 within the first 6 weeks; the other took longer than a year. CONCLUSION:The arthroscopic release of contractures is a predictable technique to achieve a highly functional elbow in athletes. 10.1177/0363546510376727
Diagnosis and Management of Acute Concussion. McCrea Michael A,Nelson Lindsay D,Guskiewicz Kevin Physical medicine and rehabilitation clinics of North America Over the past 2 decades, there have been major advances in the basic and clinical science of concussion and mild traumatic brain injury. These advances now provide a more evidence-informed approach to the definition, diagnosis, assessment, and management of acute concussion. Standardized clinical tools have been developed and validated for assessment of acute concussion across injury settings (eg, civilian, sport, military). Consensus guidelines now provide guidance regarding injury management and approaches to ensure safe return to activity after acute concussion. This article provides a brief, high-level overview of approaches to best practice in diagnosis, assessment, and management of acute concussion. 10.1016/j.pmr.2016.12.005
Elite Athletes Successfully Return to the Preinjury Level of Sport Following Ankle Syndesmosis Injuries: A Systematic Review and Meta-Analysis. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine OBJECTIVE:To comprehensively review and report the outcomes of ankle syndesmotic injury management in elite athletes. DATA SOURCES:Three databases were searched for articles reporting the rate of return to sport following treatment of ankle syndesmotic injuries in elite athletes (collegiate or professional level). Ten articles and 440 athletes were included. Articles reporting the rate of return to sport following high ankle sprain injury in elite athletes. Data collected included demographics, type of treatment received, and return to sport (RTS) information. A random effects model was used. MAIN RESULTS:The estimated overall rate of RTS was 99% (95% CI, 95.5-99.9). The mean time to RTS was 38 ± 18 (range, 14-137) days. Of the 440 athletes, 269 (269/440%, 61%) were treated nonoperatively (nonoperative group); the rate of RTS was 99.6%, and the athletes returned at a mean time of 29 ± 14 (range, 13-45) days. A total of 171 athletes (171 of 440%, 39%) underwent surgical treatment (operative group). All (171 of 171%, 100%) athletes returned at a mean time of 50.3 ± 13 (range, 41-137) days. Almost all athletes who underwent surgery had suture button fixation (164 of 171 athletes, 96%), and the mean time to RTS was 7 weeks with 9.1% complication rate. CONCLUSIONS:Elite athletes with ankle syndesmosis injury return to sport at an extremely high rates, following operative or nonoperative treatment. Return to the preinjury level of competition should be expected at 4 weeks and 7 weeks in high-level athletes who undergo nonoperative and operative management, respectively. Suture button fixation was used by the majority of studies reporting surgical management of ankle syndesmosis injuries in athletes. 10.1097/JSM.0000000000001019
Sports-related wrist and hand injuries: a review. Avery Daniel M,Rodner Craig M,Edgar Cory M Journal of orthopaedic surgery and research BACKGROUND:Hand and wrist injuries are common during athletics and can have a significant impact especially if initially disregarded. Due to their high level of physical demand, athletes represent a unique subset of the population. MAIN BODY:The following is an overview of hand and wrist injuries commonly seen in athletics. Information regarding evaluation, diagnosis, conservative measures, and surgical treatment are provided. CONCLUSION:Knowledge of these entities and special consideration for the athlete can help the team physician effectively treat these players and help them achieve their goals. 10.1186/s13018-016-0432-8
Extensor tendon injuries in athletes. Chauhan Aakash,Jacobs Bruce,Andoga Alexandra,Baratz Mark E Sports medicine and arthroscopy review Extensor tendon injuries of the hand and wrist in high-level athletes can cause a delay in return to play and permanently affect their performance. Given the inherent demand for a speedy and complete recovery, orthopedic surgeons must have an understanding of how to best direct an athlete's treatment for these injuries. The extensor anatomy is very intricate and a thorough understanding of the anatomy can help with both diagnosis and treatment. However, untreated or poorly managed injuries are at risk of leading to chronic deformities. We will discuss the diagnosis and management of the most common extensor tendon injuries and tendinopathies of the hand found in athletes: mallet fingers, swan-neck deformities, boutonniere deformities, central slip ruptures, sagittal band ruptures, intersection syndrome, extensor carpi ulnaris tendinitis, and extensor carpi ulnaris subluxation. 10.1097/JSA.0000000000000011
The Postinjury Psychological Sequelae of High-Level Jamaican Athletes: Exploration of a Posttraumatic Stress Disorder-Self-Efficacy Conceptualization. Bateman André,Morgan Kai A D Journal of sport rehabilitation CONTEXT:Athletes at the highest levels appear to be most affected by sport-related injuries and suffer both physiologically and psychologically. Established models of psychological responses to injury, however, do not offer a comprehensive explanation based on posttraumatic stress disorder (PTSD), although some studies suggest that injuries may be interpreted as traumatic. Studies also suggest that perceived self-efficacy may be a mediator of PTSD development. OBJECTIVE:This study examines the psychological sequelae experienced by high-level athletes as a result of sport-related injuries based on a PTSD-self-efficacy framework. DESIGN:A cross-sectional survey design was used. PARTICIPANTS:Forty-six athletes (30 males and 16 females) from 4 different sports were conveniently sampled and completed a questionnaire battery assessing injury characteristics, trauma sequelae, and self-efficacy. MAIN OUTCOME MEASURES:Present injury status, PTSD symptomatology, and general self-efficacy. RESULTS:Injury was found to be associated with elevated levels of PTSD symptomatology. The presence of injury was a significant predictor of general PTSD and, specifically, hyperarousal symptoms; however, general self-efficacy was not found to predict trauma-related symptoms. There were indications, however, that self-efficacy beliefs may affect injury-related factors. CONCLUSIONS:This research highlights the presence of PTSD-related psychological dysfunction associated with sport injury, and further uncovers the possible impacts of self-efficacy beliefs in managing the stress of injury. These findings highlight the need for psychological support as injured athletes undergo rehabilitation. 10.1123/jsr.2017-0140
Functional Outcomes and Return to Sport After Cartilage Restoration of the Knee in High-level Athletes. The Journal of the American Academy of Orthopaedic Surgeons Articular cartilage injuries of the knee are being observed with increasing frequency in athletes and have proven to be difficult to treat given the limited regenerative ability of cartilage and the potential for progressive joint degeneration. A wide range of surgical treatments such as microfracture, autologous chondrocyte implantation, and osteochondral autograft and allograft have demonstrated promising results in these high-demand individuals. These procedures permit healing of cartilage defects while decreasing pain and restoring function with patient-reported outcomes demonstrating significant improvement at short-, mid-, and long-term follow-up. Most athletes are able to return to play after cartilage restoration of the knee, regardless of the surgical technique used. Although there is a large degree of heterogeneity across the literature and no consensus as to the optimal technique, osteochondral autograft transfer seems to offer the highest rate of return to sport and return to play at preinjury level. However, autologous chondrocyte implantation and osteochondral allograft transplantation are often used for larger defects or salvage after previous procedures, so results may be confounded. In addition, a multitude of factors including patient history, characteristics of the chondral lesion, and postoperative management may affect functional outcomes in athletes. 10.5435/JAAOS-D-21-00242
Evaluation and treatment of jersey finger and pulley injuries in athletes. Freilich Aaron M Clinics in sports medicine The flexor tendon system in the finger is complex and can be difficult to treat. Closed injuries to the flexor tendon or pulley system are not uncommon in high-level athletes. Their treatment can be complicated by in-season play, position, and the number of people involved in the patient's care. Injuries can be misdiagnosed as "sprains" or unreported by some athletes at the time of injury. Some of these injuries, especially flexor tendon avulsions, require prompt recognition and appropriate treatment to prevent permanent disability to the hand and finger. 10.1016/j.csm.2014.09.001
Paramagnetic contrast medium in high-level athletes with lower limb muscle injuries: can it make the return to sport safer reducing the recurrence rate? La Radiologia medica PURPOSE:The aim is to investigate whether contrast medium can improve accuracy in the assessment of healing muscle injury in high-level professional athletes. MATERIALS AND METHODS:Our series is a retrospective study including the records of 22 players (mean age 28 ± 5 SD) with lower limbs muscle injuries type 3a (Mueller-Wohlfarth). All athletes received two MRIs: the day after the injury and before resuming heavy effort activities. Contrast medium uptake was measured in the second MRI by comparing the mean enhancement at the lesion site (ME) with that of the healthy contralateral muscle (HM). The result is a percentage referred to as muscular contrast index (MC index). The difference between the mean MC index value between athletes with and without re-injury was assessed with both the Mann-Whitney and the Kruskal-Wallis test. RESULTS:Twenty-nine muscle injuries matched the inclusion criteria. The mean MC index values, adjusted for the variable of time elapsed between the last contrast examination and return to the field, were significantly different in the two study groups (p < .001). CONCLUSION:The contrast medium in the follow-up of muscle injuries may be useful in determining the degree of scar stability in a healing injury. Injuries with a high MC index were found to be 'unstable', with a higher rate of recurrence than those with a low MC index. Resumption of competitive activity after achieving not only clinical resolution but also a satisfactory MC index value may increase the safety of return to the field and reduce the recurrence rate. 10.1007/s11547-022-01472-x
The Effect of Acupuncture on Elbow Joint Sports Injuries Based on Magnetic Resonance Imaging. Computational and mathematical methods in medicine Purpose:Elbow joint injuries are extremely common in most athletes. Athletes' chronic elbow injuries can involve multiple complex anatomical structures related to orthopedics. Therefore, it is of great significance to explore the characteristics of magnetic resonance (MR) images of chronic sports injuries of the elbow joint and the influence of acupuncture treatment on MR images and clinical symptoms. Methods:A total of 60 elbow joints of 39 athletes from 15-25 years old were selected for coronal, sagittal, and axial MR scans to observe the image characteristics; 60 elbow joints were randomly divided into acupuncture group and control group and observed changes in MR images and clinical symptoms after acupuncture treatment. Results:After acupuncture treatment, the clinical symptoms were significantly improved. MR images showed that the elbow joint effusion was reduced, and the bone marrow edema was reduced. The effective rate of acupuncture treatment is as high as 100%, while the effective rate of the control group is only 40%. Acupuncture treatment has significantly improved the range of motion of the elbow joint. Conclusion:Acupuncture treatment can significantly relieve athletes' elbow joint pain and locking symptoms, improve joint range of motion, and is beneficial to recovery of special training and high-level competitive competitions. It is a sensitive, effective, and noninvasive method. 10.1155/2022/9005792
Peroneal Pathology in the Athlete. Clinics in podiatric medicine and surgery The peroneal tendons play a critical role in stabilizing the foot and ankle especially in athletes with high demands on lateral ankle strength. A complete understanding of the anatomy of the lateral ankle as well as a careful physical examination is imperative to diagnosing peroneal pathology, which is commonly misdiagnosed and can lead to chronic pain and inability to perform high level sport. Although low-demand patients do well with a conservative approach, most high-demand athletes will benefit from surgical intervention. 10.1016/j.cpm.2022.07.009
Hamstring Injuries: A Current Concepts Review: Evaluation, Nonoperative Treatment, and Surgical Decision Making. The American journal of sports medicine The purpose of this current concepts review is to highlight the evaluation and workup of hamstring injuries, nonoperative treatment options, and surgical decision-making based on patient presentation and injury patterns. Hamstring injuries, which are becoming increasingly recognized, affect professional and recreational athletes alike, commonly occurring after forceful eccentric contraction mechanisms. Injuries occur in the proximal tendon at the ischial tuberosity, in the muscle belly substance, or in the distal tendon insertion on the tibia or fibula. Patients may present with ecchymoses, pain, and weakness. Magnetic resonance imaging remains the gold standard for diagnosis and may help guide treatment. Treatment is dictated by the specific tendon(s) injured, tear location, severity, and chronicity. Many hamstring injuries can be successfully managed with nonoperative measures such as activity modification and physical therapy; adjuncts such as platelet-rich plasma injections are currently being investigated. Operative treatment of proximal hamstring injuries, including endoscopic or open approaches, is traditionally reserved for 2-tendon injuries with >2 cm of retraction, 3-tendon injuries, or injuries that do not improve with 6 months of nonoperative management. Acute surgical treatment of proximal hamstring injuries tends to be favorable. Distal hamstring injuries may initially be managed nonoperatively, although biceps femoris injuries are frequently managed surgically, and return to sport may be faster for semitendinosus injuries treated acutely with excision or tendon stripping in high-level athletes. 10.1177/03635465231164931
Athletic Hip Injuries. Lynch T Sean,Bedi Asheesh,Larson Christopher M The Journal of the American Academy of Orthopaedic Surgeons Historically, athletic hip injuries have garnered little attention; however, these injuries account for approximately 6% of all sports injuries and their prevalence is increasing. At times, the diagnosis and management of hip injuries can be challenging and elusive for the team physician. Hip injuries are seen in high-level athletes who participate in cutting and pivoting sports that require rapid acceleration and deceleration. Described previously as the "sports hip triad," these injuries consist of adductor strains, osteitis pubis, athletic pubalgia, or core muscle injury, often with underlying range-of-motion limitations secondary to femoroacetabular impingement. These disorders can happen in isolation but frequently occur in combination. To add to the diagnostic challenge, numerous intra-articular disorders and extra-articular soft-tissue restraints about the hip can serve as pain generators, in addition to referred pain from the lumbar spine, bowel, bladder, and reproductive organs. Athletic hip conditions can be debilitating and often require a timely diagnosis to provide appropriate intervention. 10.5435/JAAOS-D-16-00171
Injuries in extreme sports. Laver Lior,Pengas Ioannis P,Mei-Dan Omer Journal of orthopaedic surgery and research Extreme sports (ES) are usually pursued in remote locations with little or no access to medical care with the athlete competing against oneself or the forces of nature. They involve high speed, height, real or perceived danger, a high level of physical exertion, spectacular stunts, and heightened risk element or death.Popularity for such sports has increased exponentially over the past two decades with dedicated TV channels, Internet sites, high-rating competitions, and high-profile sponsors drawing more participants.Recent data suggest that the risk and severity of injury in some ES is unexpectedly high. Medical personnel treating the ES athlete need to be aware there are numerous differences which must be appreciated between the common traditional sports and this newly developing area. These relate to the temperament of the athletes themselves, the particular epidemiology of injury, the initial management following injury, treatment decisions, and rehabilitation.The management of the injured extreme sports athlete is a challenge to surgeons and sports physicians. Appropriate safety gear is essential for protection from severe or fatal injuries as the margins for error in these sports are small.The purpose of this review is to provide an epidemiologic overview of common injuries affecting the extreme athletes through a focus on a few of the most popular and exciting extreme sports. 10.1186/s13018-017-0560-9
Sports Injuries of the Hand, Wrist, and Elbow. Goldfarb Charles,Dy Christopher,Brogan David,Osei Daniel Instructional course lectures Sports injuries of the upper extremity are a common problem seen by those who care for athletes and those who manage upper extremity injuries. The term "high-level athlete" may include adolescents and high school students, collegiate athletes, and of course, the professional athlete. However, the "weekend warrior" can sustain similar injuries and can have a similar desire to return to play as quickly as possible. The challenge in management of these injuries to the elbow, wrist, and hand is identifying those injuries that will benefit from early surgery compared with those that may be safely treated nonsurgically. A rapid return to play may be possible with some injuries with cast or splint immobilization based on the sport and position played. Management of common sports injuries of the hand, wrist, and medial elbow should be reviewed with consideration of return to play.
Magnetic Resonance Imaging Findings of Core Muscle Injuries in High Level Athletes. Current sports medicine reports ABSTRACT:Core muscle injuries are common injuries in athletes involved in high speed side-to-side acceleration movements. The term core muscle injury encapsulates several different injuries that occur in the pelvic region that have similar presentations. Along with a good history and physical examination, magnetic resonance imaging (MRI) can be a helpful tool in the diagnostic process. Correct orientation and protocols are needed to show the correct anatomy with an MRI. Furthermore, to determine the exact etiology of the core muscle injury, it is important to know which structures are likely to be involved and be able to recognize the patterns of injury on imaging. 10.1249/JSR.0000000000000820