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Della Villa F, Buckthorpe M, Pellegrini A, Ranzini A, Esposito F, Crescenzo C, Nanni G, Zago M. A comparative video analysis of hamstring injuries mechanism and situational pattern in men's and women's football (soccer). Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38881374 DOI: 10.1002/ksa.12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/03/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE To describe the injury mechanism and situational patterns of severe (absence >28 days) hamstring muscle injuries in professional male and female football (soccer) players. METHODS The data for males were sourced from Serie A clubs participating in both national and international competitions from 2018 to 2021. For the female cohort, hamstring injuries were identified during matches of the top national/international competitions from 2017 to 2023. Video footage was obtained, and three raters categorised injury mechanisms and situational patterns. Injuries were also examined according to the month, minute and location. RESULTS A total of 129 severe hamstring injuries were identified, with 64 occurring in females and 65 in males. Video analysis was possible for 29 (45%) female cases and 61 (94%) male cases. Female injuries had longer lay-off times (97.8 ± 77.1 days) than males (39.6 ± 20.9 days). Females had a higher proportion of indirect contact injuries (34%) than males (13%) and a lower proportion of non-contact injuries (66% vs. 87%). Four situational patterns were identified: running was the most common for both sexes, representing 59% of female injuries and 41% of male injuries. Over-stretching injuries were split across open and CKC scenarios but collectively explained nearly half (48%) of male injuries but only one in five (21%) female injuries. Kicking injuries had a higher proportion in females (17%) than males (10%). Injuries were more common in the second half for females and the first half for males. CONCLUSION Females had a higher proportion of indirect contact, running and kicking injuries and a lower proportion of non-contact and stretch-type injuries than males. Understanding injury patterns can inform tailored prevention programs, considering sex-specific differences. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Matthew Buckthorpe
- Education and Research Department, Isokinetic Medical Group, Bologna, Italy
- Faculty of Sport, Technology and Health Sciences, St Mary's University, Twickenham, London, UK
| | - Alessandro Pellegrini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Alice Ranzini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | - Gianni Nanni
- Medical Area, Bologna Football Club 1909, Bologna, Italy
| | - Matteo Zago
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
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Akoto R, Mehl J, Diermeyer T, Achtnich A, Petersen W, Lambert C. Direct contact and very rapid valgus distortion characterise the injury mechanism of anterior cruciate ligament ruptures in judo. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38813883 DOI: 10.1002/ksa.12280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/30/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To analyse anterior cruciate ligament (ACL) rupture (ACLR) injury mechanisms in competitive judo using systematic video analysis, focusing on contact situations and biomechanics. METHODS Seventeen videos of judo competitions wherein athletes developed ACLRs were included and retrospectively evaluated by five analysts. In all videos, the moment of initial contact and the index frame were defined. The judo techniques leading to the injury; the occurrence of direct contact, indirect contact or noncontact mechanisms; the time interval between the initial contact and index frame; the positions of the hip, knee and foot in relation to the initial contact and index frame; and the balance status during the initial contact and index frame were recorded. RESULTS Eleven (65%) of ACLRs in judo involved direct contact. The mean time interval between initial contact and index frame was 15 ± 22 ms. Thirteen (77%) athletes were not balanced at initial contact. In the index frame, the hip was abducted in all cases and in combination with internal rotation in 12 (71%) cases. From initial contact to index frame, hip flexion increased in all cases; at index frame, the knee joint was internally rotated relative to the trunk in 12 (71%) cases, and the knee flexion angles increased from the initial contact. In the index frame, the foot was externally rotated relative to the knee in 12 (71%) cases, and severe valgus development of the knee with valgus collapse was observed in 14 (82%) cases. CONCLUSIONS A direct attack on the knee was the most common injury mechanism observed. Valgus distortion appears to be the most important component of the mechanism of injury. With this knowledge, 'modified defence reactions' for specific judo techniques can be developed to reduce the injury risk. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ralph Akoto
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinik Hamburg, Hamburg, Germany
| | - Julian Mehl
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Theresa Diermeyer
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus, Berlin, Germany
| | - Andrea Achtnich
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Wolf Petersen
- Sportsclinic Berlin, Department of Orthopedics, Martin Luther Hospital, Berlin-Grunewald, Berlin, Germany
| | - Christophe Lambert
- Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
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Sohn S, AlShammari SM, Lee JH, Kim MS. Bone Bruises and Concomitant Meniscus and Cartilage Damage in Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-Analysis. Bioengineering (Basel) 2024; 11:515. [PMID: 38790382 PMCID: PMC11118087 DOI: 10.3390/bioengineering11050515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: Bone bruises in acute anterior cruciate ligament (ACL) injuries are closely linked to the occurrence of simultaneous meniscal and cartilage damage. Despite the frequent occurrence of associated injuries including bone bruises, meniscus, and cartilage damage in patients with ACL injuries, a systematic review of the relationships between the presence of bone bruises and the extent of meniscus and cartilage injuries has yet to be conducted. (2) Methods: Multiple comprehensive databases, including MEDLINE, EMBASE, and the Cochrane Library, were searched for studies that evaluated the relationship between bone bruises and meniscus or cartilage injuries following ACL injuries. Study selection, data extraction, and meta-analysis were performed. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessments, and Review Manager 5.3 was used for data analysis. (3) Results: Data were extracted from 22 studies encompassing a total of 2891 patients with ACL injuries. Among the included studies, six studies investigated the relationships between bone bruises and medial meniscus (MM) or lateral meniscus (LM) injuries, while three studies investigated the relationships between bone bruises and cartilage injuries. There were no significant correlations between the presence of bone bruises and MM injuries (relative risk (RR) = 1.32; p = 0.61). A quantitative analysis indicated that individuals with bone bruises had a 2.71-fold higher likelihood of sustaining LM injuries than those without bone bruises (RR = 2.71; p = 0.0003). The analysis confirmed a significant relationship between bone bruises and cartilage injuries (RR = 6.18; p = 0.003). (4) Conclusions: Bone bruises occur most frequently in the lateral compartment. Bone bruises resulting from ACL injuries are related to accompanying LM injuries and cartilage injuries. Knowing these associations and the frequency of injuries may allow orthopedic surgeons to promptly address ACL-related meniscus and cartilage injuries on MRI results and in future clinical practice.
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Affiliation(s)
- Sueen Sohn
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Republic of Korea;
| | | | - Jeong Han Lee
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
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Sohn S, AlShammari SM, Hwang BJ, Kim MS. A Systematic Review of Bone Bruise Patterns following Acute Anterior Cruciate Ligament Tears: Insights into the Mechanism of Injury. Bioengineering (Basel) 2024; 11:396. [PMID: 38671817 PMCID: PMC11048204 DOI: 10.3390/bioengineering11040396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: The purpose of this systematic review was to determine the prevalence of bone bruises in patients with anterior cruciate ligament (ACL) injuries and the location of the bruises relative to the tibia and femur. Understanding the relative positions of these bone bruises could enhance our comprehension of the knee loading patterns that occur during an ACL injury. (2) Methods: The MEDLINE, EMBASE, and the Cochrane Library databases were searched for studies that evaluated the presence of bone bruises following ACL injuries. Study selection, data extraction, and a systematic review were performed. (3) Results: Bone bruises were observed in 3207 cases (82.8%) at the lateral tibia plateau (LTP), 1608 cases (41.5%) at the medial tibia plateau (MTP), 2765 cases (71.4%) at the lateral femoral condyle (LFC), and 1257 cases (32.4%) at the medial femoral condyle (MFC). Of the 30 studies, 11 were able to assess the anterior to posterior direction. The posterior LTP and center LFC were the most common areas of bone bruises. Among the 30 studies, 14 documented bone bruises across all four sites (LTP, MTP, LFC, and MFC). The most common pattern was bone bruises appearing at the LTP and LFC. (4) Conclusions: The most frequently observed pattern of bone bruises was restricted to the lateral aspects of both the tibia and femur. In cases where bone bruises were present on both the lateral and medial sides, those on the lateral side exhibited greater severity. The positioning of bone bruises along the front-back axis indicated a forward shift of the tibia in relation to the femur during ACL injuries.
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Affiliation(s)
- Sueen Sohn
- Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul 01757, Republic of Korea;
| | | | - Byung Jun Hwang
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
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Dai R, Wu Y, Jiang Y, Huang H, Yan W, Shi H, Meng Q, Ren S, Ao Y. Comparison of Bone Bruise Pattern Epidemiology between Anterior Cruciate Ligament Rupture and Patellar Dislocation Patients-Implications of Injury Mechanism. Bioengineering (Basel) 2023; 10:1366. [PMID: 38135957 PMCID: PMC10740614 DOI: 10.3390/bioengineering10121366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Different bone bruise patterns observed using magnetic resonance imaging (MRI) after non-contact anterior cruciate ligament (ACL) rupture and lateral patellar dislocation may indicate different knee injury mechanisms. In this study, 77 ACL ruptures and 77 patellar dislocations in knee MR images taken from patients with bone bruises at our institution between August 2020 and March 2022 were selected and analyzed. In order to determine typical bone bruising patterns following by ACL rupture and patellar dislocation, sagittal- and transverse-plane images were used to determine bone bruise locations in the directions of medial-lateral and superior-inferior with MR images. The presence, intensity, and location of the bone bruises in specific areas of the femur and tibial after ACL rupture and patellar dislocation were recorded. Relative bone bruise patterns after ACL rupture and patellar dislocation were classified. The results showed that there were four kinds of bone bruise patterns (1-, 2-, 3-, and 4- bone bruises) after ACL rupture. The most common two patterns after ACL rupture were 3- bone bruises (including the lateral femoral condyle and both the lateral-medial tibial plateau, LF + BT; both the lateral-medial femoral condyle and the lateral tibial plateau, BF + LT; and the medial femoral condyle and both the medial and lateral tibial plateau, MF + BT) followed by 4- bone bruises (both the lateral-medial femoral condyle and the tibial plateau, BF + BT), 2- bone bruises (the lateral femoral condyle and tibial plateau, LF + LT; the medial femoral condyle and the lateral tibial plateau, MF + LT; the lateral femoral condyle and the medial tibial plateau, LF + MT; the medial femoral condyle and the tibial plateau, MF + MT; both the lateral-medial tibial plateau, 0 + BT), and 1- bone bruise (only the lateral tibial plateau, 0 + LT). There was only a 1- bone bruise (the latera femoral condyle and medial patella bone bruise) for patellar dislocation, and the most common pattern of patellar dislocation was in the inferior medial patella and the lateral anterior inferior femur. The results suggested that bone bruise patterns after ACL rupture and patellar dislocation are completely different. There were four kinds of bone bruise patterns after non-contact ACL rupture, while there was only one kind of bone bruise pattern after patellar dislocation in patients, which was in the inferior medial patella and lateral anterior inferior femur.
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Affiliation(s)
- Ruilan Dai
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin 300170, China
| | - Yue Wu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin 300170, China
| | - Yanfang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
| | - Hongshi Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
| | - Wenqiang Yan
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
| | - Huijuan Shi
- Biomechanics Laboratory, College of Human Movement Science, Beijing Sport University, Beijing 100080, China;
| | - Qingyang Meng
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
| | - Shuang Ren
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
| | - Yingfang Ao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing 100080, China; (R.D.); (Y.W.); (Y.J.); (H.H.); (W.Y.); (Q.M.)
- Beijing Key Laboratory of Sports Injuries, Beijing 100080, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing 100080, China
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin 300170, China
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Orringer M, Lau J, Feeley B, Pandya N. Bone Bruise Patterns Associated With Pediatric and Adult Anterior Cruciate Ligament Tears Are Different. Arthrosc Sports Med Rehabil 2022; 5:e151-e157. [PMID: 36866294 PMCID: PMC9971902 DOI: 10.1016/j.asmr.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/08/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose To describe differences in radiographic and magnetic resonance imaging (MRI) findings between adult and pediatric patients with known primary anterior cruciate ligament (ACL) injuries. Methods We performed a retrospective analysis of surgical patients with a history of ACL tears treated at our institution over a 7-year period. Patients were divided into 2 cohorts based on age (≤15 years and ≥21 years). Patients' radiographs and MRI studies were used to compare features including fracture incidence, bone bruise pattern, associated ligamentous injuries, and meniscal injuries between the 2 groups. Proportions of associated findings were analyzed using the 2-proportion z test. Results Within our cohorts of 52 sex-matched pediatric and adult patients, we found that pediatric patients were more likely to have radiographic evidence of fracture (P = .001) and MRI evidence of lateral femoral condylar bone bruising (P = .012). Adult patients had higher rates of medial femoral condylar bruising (P = .016) and medial proximal tibial bruising (P = .005), as well as popliteal fibular ligament injuries (P = .037), identified on MRI. Conclusions In this study, we identified differences in bone bruise patterns between pediatric and adult patients with primary ACL tears. Pediatric patients were more likely to have radiographic evidence of fracture and MRI evidence of lateral femoral condylar bone bruising. Adult patients were more likely to show medial femoral condylar and medial proximal tibial bone bruising, as well as popliteal fibular ligament injuries. Level of Evidence Level IV, prognostic case series.
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Affiliation(s)
- Matthew Orringer
- School of Medicine, University of California, San Francisco, San Francisco, California, U.S.A.,Address correspondence to Matthew Orringer, UCSF School of Medicine, 500 Parnassus Ave, San Francisco, CA 94143, U.S.A.
| | - Justin Lau
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Brian Feeley
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Nirav Pandya
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A
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