Acut badminton injuries

Aetiology, epidemiology and treatment of musculoskeletal injuries in badminton players: a systematic review and meta-analysis

The present study has two main goals: to conduct a systematic review of musculoskeletal injuries experienced by badminton players, and to examine the management of such injuries. Searches were conducted of the PROSPERO, PubMed, Scopus, and SPORTDiscus databases, from their inception until March 2023. The papers analysed were all based on a study population consisting of individuals aged 18 years or more, diagnosed with badminton-related injuries. The methodological quality assessments was using the Newcastle-Ottawa Scale and REVMAN. A total of 28 studies were included in the systematic review. In total, the analysis included 2435 participants. Of these athletes, 35.6% (1012) were female and 64.4% (1503) were male. By type of injury, sprains were the most commonly studied and the most prevalent, accounting for 36.06% of the sample. These were followed by muscle injuries, representing 23.86% of the total. Injuries to the joints were the least prevalent, accounting for 4.97% of the sample. Lower limb injuries accounted for 52.15% of the total. Of these, ankle injuries were the most common. Despite the generally low quality of the studies considered, the evidence suggests that musculoskeletal injuries, especially to the lower limb, most commonly affect badminton players of all levels.

Influence of Torsional Stiffness in Badminton Footwear on Lower Limb Biomechanics

Torsional stiffness of athletic footwear plays a crucial role in preventing injury and improving sports performance. Yet, there is a lack of research focused on the biomechanical effect of torsional stiffness in badminton shoes. This study aimed to comprehensively investigate the influence of three different levels of torsional stiffness in badminton shoes on biomechanical characteristics, sports performance, and injury risk in badminton players. Fifteen male players, aged 22.8 ± 1.96 years, participated in the study, performing badminton-specific tasks, including forehand clear stroke [left foot (FCL) and right foot (FCR)], 45-degree sidestep cutting (45C), and consecutive vertical jumps (CVJ). The tasks were conducted wearing badminton shoes of torsional stiffness measured with Shore D hardness 50, 60, and 70 (referred to as 50D, 60D, and 70D, respectively). The primary biomechanical parameters included ankle, knee, and MTP joint kinematics, ankle and knee joint moments, peak ground reaction forces, joint range of motion (ROM), and stance time. A one-way repeated measures ANOVA was employed for normally distributed data and Friedman tests for non-normally distributed data. The 70D shoe exhibited the highest ankle dorsiflexion and lowest ankle inversion peak angles during 45C task. The 60D shoe showed significantly lower knee abduction angle and coronal motions compared to the 50D and 70D shoes. Increased torsional stiffness reduced stance time in the FCR task. No significant differences were observed in anterior-posterior and medial-lateral ground reaction forces (GRF). However, the 70D shoe demonstrated higher vertical GRF than the 50D shoe while performing the FCR task, particularly during 70% - 75% of stance. Findings from this study revealed the significant role of torsional stiffness in reducing injury risk and optimizing performance during badminton tasks, indicating that shoes with an intermediate level of stiffness (60D) could provide a beneficial balance between flexibility and stability. These findings may provide practical references in guiding future badminton shoe research and development. Further research is necessary to explore the long-term effects of altering stiffness, considering factors such as athletic levels and foot morphology, to understand of the influence of torsional stiffness on motion biomechanics and injury prevalence in badminton-specific tasks.

Intelligent prediction of lower extremity loadings during badminton lunge footwork in a lab-simulated court

Introduction: Playing badminton has been reported with extensive health benefits, while main injuries were documented in the lower extremity. This study was aimed to investigate and predict the knee- and ankle-joint loadings of athletes who play badminton, with "gold standard" facilities. The axial impact acceleration from wearables would be used to predict joint moments and contact forces during sub-maximal and maximal lunge footwork. Methods: A total of 25 badminton athletes participated in this study, following a previously established protocol of motion capture and musculoskeletal modelling techniques with the integration of a wearable inertial magnetic unit (IMU). We developed a principal component analysis (PCA) statistical model to extract features in the loading parameters and a multivariate partial least square regression (PLSR) machine learning model to correlate easily collected variables, such as the stance time, approaching velocity, and peak accelerations, with knee and ankle loading parameters (moments and contact forces). Results: The key variances of joint loadings were observed from statistical principal component analysis modelling. The promising accuracy of the partial least square regression model using input parameters was observed with a prediction accuracy of 94.52%, while further sensitivity analysis found a single variable from the ankle inertial magnetic unit that could predict an acceptable range (93%) of patterns and magnitudes of the knee and ankle loadings. Conclusion: The attachment of this single inertial magnetic unit sensor could be used to record and predict loading accumulation and distribution, and placement would exhibit less influence on the motions of the lower extremity. The intelligent prediction of loading patterns and accumulation could be integrated to design training and competition schemes in badminton or other court sports in a scientific manner, thus preventing fatigue, reducing loading-accumulation-related injury, and maximizing athletic performance.

Case study: The influence of Achilles tendon rupture on knee joint stress during counter-movement jump - Combining musculoskeletal modeling and finite element analysis

BACKGROUND

Presently, the current research concerning Achilles tendon rupture repair (ATR) is predominantly centered on the ankle joint, with a paucity of evidence regarding its impact on the knee joint. ATR has the potential to significantly impede athletic performance and increase tibiofemoral contact forces in athletes. The purpose of this study was to prognosticate the distribution of stress within the knee joint during a countermovement jump through the use of a simulation method that amalgamated a musculoskeletal model of a patient who underwent Achilles tendon rupture repair with a finite element model of the knee joint.

METHODS

A male elite badminton player who had suffered an acute Achilles tendon rupture in his right leg one year prior was selected as our study subject. In order to analyze his biomechanical data, we employed both the OpenSim musculoskeletal model and finite element model to compute various parameters such as joint angles, joint moments, joint contact forces, and the distribution of knee joint stress.

RESULTS

During the jumping phase, a significantly lower knee extension angle (p < 0.001), ankle dorsiflexion angle (p = 0.002), peak vertical ground reaction force (p < 0.001), and peak tibiofemoral contact force (p = 0.009) were observed on the injured side than on the uninjured side. During the landing phase, the ankle range of motion (ROM) was significantly lower on the injured side than on the uninjured side (p = 0.009), and higher peak vertical ground reaction forces were observed (p = 0.012). Additionally, it is logical that an injured person will put higher load on the uninjured limb, but the finite element analysis indicated that the stresses on the injured side of medial meniscus and medial cartilage were significantly greater than the uninjured side.

CONCLUSIONS

An Achilles tendon rupture can limit ankle range of motion and lead to greater joint stress on the affected area during countermovement jumps, especially during the landing phase. This increased joint stress may also transfer more stress to the soft tissues of the medial knee, thereby increasing the risk of knee injury. It is worth noting that this study only involves the average knee flexion angle and load after ATR in one athlete. Caution should be exercised when applying the conclusions, and in the future, more participants should be recruited to establish personalized knee finite element models to validate the results.

Risk Factors for, and Prediction of, Shoulder Pain in Young Badminton Players: A Prospective Cohort Study

BACKGROUND

Shoulder pain (SP) caused by hitting the shuttlecock is common in young badminton players. The objectives of the present study were to predict the risk factors for SP in young badminton players, and to determine the optimal risk factor cut-off that best discriminates those players who are at higher risk of suffering from SP.

METHODS

A prospective cohort study was conducted with 45 under-17 badminton players who participated in the Spanish Championship. Data were collected on anthropometric age, sports history, sagittal spinal curves, range of motion (ROM) and maximum isometric strength of shoulder. After 12 months, players completed a SP history questionnaire. Bayesian Student's t-analysis, binary logistic regression analysis and ROC analysis were performed.

RESULTS

Overall, 18 (47.4%) players reported at least one episode of SP. The shoulder internal rotation (SIR) ROM showed the strongest association (OR = 1.122; p = 0.035) with SP. The SIR ROM has an excellent ability to discriminate players at increased risk for SP (p = 0.001). The optimal cut-off for SIR ROM, which predicts players with an 81% probability of developing SP, was set at 55° (sensitivity = 75.0%, specificity = 83.3%).

CONCLUSIONS

The young badminton players who had a shoulder internal rotation ROM of 55° or less have a higher risk of SP one year later.

Acute injuries in Badminton from 10 to 66 years of age: an epidemiological study of 140 cases among all types of practice

PURPOSE

The main objective of this retrospective study was to establish an epidemiological overview of patients admitted to an Emergency department specialized in musculo-skeletal trauma for acute lesions related to Badminton practice in the period from January 1st 2010 to January 1st 2015.

METHODS

There were 135 patients with 140 admissions and 146 total number of injuries. There were 67 females (48%) and 73 males (52%). The mean age was 28 ± 13.8 years, ranging 10-66 years. 91 patients (65%) could be contacted by telephone to fill a questionnaire aimed at completing the information provided by the medical records.

RESULTS

129 lesions (88.3%) were located to the lower limbs, 16 (11%) to the upper limbs, and one (0.7%) at the head. For the whole series, there were 89 sprains (60.9%), 32 tendino-muscular lesions (21.9%), 13 fractures (8.9%), 5 dislocations (3.4%), 3 painful contusions (2.1%), 3 meniscal injuries (2.1%) and one wound (0.7%). In the lower limbs, lateral ankle sprain was the most frequent diagnosis (43.4%), followed successively by rupture of the Achilles tendon (13.9%), tennis leg (8.5%), and mid-foot sprain (6.9%). Of the 146 lesions, 117 (80.1%) received non-operative treatment, 28 (19.1%) received surgical treatment in the operation room, and one simple wound (0.7%) was sutured in the emergency room.

CONCLUSIONS

Lateral ankle sprains followed by tendino-muscular lesions of the calf are by far the most frequent lesions of badminton. Modification of the shoes of badminton players should be considered to decrease the high incidence of ankle injuries.

Longitudinal study on locations of injury among junior high school, high school, and university badminton athletes at Japanese national-level competitions

[Purpose] The aim of study was to examine incidence of injury according to location of injury to develop an injury prevention program for elite badminton players of junior high school, high school, and university. [Participants and Methods] We conducted a prospective longitudinal study, between April 2012 and March 2013, on 133 national-level badminton players attending junior high school, high school, and university. Injury rates in athletes per 1,000 exposures were calculated based on gender and school age for the five most common injury locations, in addition, severity, type and circumstance were investigated. [Results] Injury rates in athletes per 1,000 exposures were the highest in the racket-side (RS) shoulder/clavicle among the female university students (4.35), RS thigh of high school females (2.21), and lumbar spine/lower back of males of all school ages and junior high school females (1.83–1.25). Significantly higher injury rates were noted for the overuse of the lumbar spine/lower back and RS shoulder/clavicle, trauma of the RS thigh and ankle, and injury, when compared with slight injury of the RS ankle. [Conclusion] Injury prevention programs should be developed for RS shoulder/clavicle overuse in university females, RS thigh trauma in high school females, and lumbar spine/lower back in males of all school ages and junior high school females.

Effects of badminton insole design on stress distribution, displacement and bone rotation of ankle joint during single-leg landing: a finite element analysis

Previous research has reported that up to 92% of injuries amongst badminton players consist of lower limb, whereby 35% of foot fractures occurred at the metatarsal bone. In sports, insoles are widely used to increase athletes' performance and prevent many injuries. However, there is still a lack of badminton insole analysis and improvements. Therefore, this study aimed to biomechanically analyse three different insole designs. A validated and converged three-dimensional (3D) finite element model of ankle-foot complex was developed, which consisted of the skin, talus, calcaneus, navicular, three cuneiform, cuboid, five metatarsals and five phalanges. Three existing insoles from the market, (1) Yonex Active Pro Truactive, (2) Victor VT-XD 8 and (3) Li-Ning L6200LA, were scanned using a 3D scanner. For the analysis, single-leg landing was simulated. On the superior surface of the skin, 2.57 times of the bodyweight was axially applied, and the inferior surface of the outsole was fixed. The results showed that Insole 3 was the most optimum design to reduce peak stress on the metatarsals (3.807 MPa). In conclusion, the optimum design of Insole 3, based on the finite element analysis, could be a justification of athletes' choices to prevent injury and other complications.

Risk Prediction of Injury Among Recreational Badminton Players in India

BACKGROUND/PURPOSE

Since badminton has emerged as a frequently played non-contact recreational sport in India, it is essential to document the injury patterns and incidence. However, there is no existing literature on this topic among Indian players.

MATERIALS AND METHODS

A web-based questionnaire was circulated among recreational badminton players across North India, enquiring about demographic details, injury characteristics, and factors associated with an injury like BMI, warm-up practice, and physical training.

RESULTS

Data of 237 eligible participants revealed an injury incidence rate of 57.1%. The ankle and dominant-side shoulder were the most common anatomical regions affected. The most common injury types were ligament sprain and muscle/tendon strain. Factors like age, frequency, duration of play, type of footwear, BMI, prior warm-up, court surface, and physical training were significantly associated with injury incidence on univariate logistic regression analysis. On multivariate logistic regression analysis, we found male gender, a lack of prior warm-up, inadequate physical training, and age group between 26 and 30 years to be four independent risk factors for injury.

CONCLUSION

The recreational badminton player of India had a relatively higher incidence of injury compared with the limited published data from other countries. Modifiable factors like a proper warm-up before the game, regular physical fitness training, and injury awareness programs can reduce the injury rates.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-022-00663-y.

Adjusted Landing Technique Reduces the Load on the Achilles Tendon in Badminton Players

Achilles tendon (AT) rupture is common among recreational male badminton players. We hypothesize that a landing technique following forehand jump strokes with the landing foot in a neutral position often performed by recreational players and occasionally by elite players may expose the AT to higher loads than a scissor kick jump (SKJ) technique with the leg/foot externally rotated. The study aimed to investigate if recreational players could reduce the load in the AT when adopting the SKJ technique compared to their habitual landing technique with the foot in a neutral position and secondarily to compare the AT force between recreational players and elite players. Ten recreational male players performed simulated jump strokes in a biomechanical laboratory using both their original technique and the SKJ technique traditionally used by elite players. For comparison reasons ten elite players performed SKJs. Landing kinematics and AT forces were captured and calculated using 3D movement analysis. The landing leg was more externally rotated in the recreational players' adjusted technique (78 ± 10 degrees, p < 0.001) compared to 22 ± 21 degrees in recreational players' original technique. The peak AT force of the recreational players was significantly higher for the original technique compared to the adjusted technique (68 ± 19 N/kg vs. 50 ± 14 N/kg, p = 0.005). Additionally, the peak AT forces observed during the recreational players' original technique was higher, though not significantly, than those observed for elite players (55 ± 11 N/kg, p = 0.017). / = 0.016 due to a Bonferroni correction. These findings indicate that recreational badminton players that normally land with the foot in a neutral position, may reduce their AT load by 25% when adopting the SKJ technique of elite players and land with the leg/foot in an externally rotated position.

Influence of Ankle Injury on Subsequent Ankle, Knee, and Shoulder Injuries in Competitive Badminton Players Younger Than 13 Years

Background:

In recent years, there has been a trend in badminton toward more specialized training at an earlier age. Accompanying this trend is the increased frequency of injuries in young players. Ankle injury is the most common injury in pediatric sports; however, its influence on subsequent injuries is rarely considered.

Purposes:

To evaluate the incidence of ankle, knee, and shoulder injuries in youth badminton and to investigate the influence of ankle injuries on subsequent ankle, knee, and shoulder injuries.

Study Design:

Descriptive epidemiology study; Level of evidence, 3.

Methods:

A custom-designed questionnaire was used to survey Japanese players 7 to 12 years of age who attended national elementary school–level badminton tournaments between May and September 2019. Information including the players’ characteristics, training history, injuries in the previous 12 months, and ankle injury histories were collected. Logistic regression was used for analysis.

Results:

A total of 478 players were included in the study, with 71 ankle injuries, 74 knee injuries, and 48 shoulder injuries reported. The injury incidence rates (per 1000 hours of play) were 0.23 (95% CI, 0.18-0.29) for the ankle, 0.24 (95% CI, 0.19-0.30) for the knee, and 0.16 (95% CI, 0.11-0.20) for the shoulder; 90.1% of ankle injuries, 25.7% of knee injuries, and 33.3% of shoulder injuries were acute. Previous ankle injury was significantly associated with subsequent ankle injury (adjusted Odds Ratio (OR), 3.05; 95% CI, 1.54-6.07; P < .05), knee injury (adjusted OR, 2.03; 95% CI, 1.12-3.69; P < .05), and shoulder injury (adjusted OR, 2.46; 95% CI, 1.26-4.83; P < .05).

Conclusion:

The study results indicated that previous injury to the ankle significantly increased the occurrence of subsequent ankle, knee, and shoulder injuries. Emphasizing protection and prevention of ankle injuries may help lower future injury risk in young badminton players.

Incidence of injuries among amateur badminton players: A cross-sectional study

The main aims of this study were, firstly, to investigate the frequency, location, and severity of injuries in amateur badminton players, and then to determine risk factors that may be associated with a higher incidence of injuries.A cross-sectional study, composed of 150 players drawn from the 2018 BWF European Senior Championships, was analyzed. The definitions and types of injury included in the study are based on those published in previous epidemiology studies.Among the 150 players analyzed, 221 injuries were observed, of which the highest proportion (40.3%, n = 89) affected the lower limb. Of these 22.44% were to the knee and 18.3% to the leg. In the upper limb, the shoulder was most frequently affected (11.8%). The mean rate of injuries per 1000 hours of play was 0.134 (standard deviation [SD]: 0.1), with 0.138 (SD: 0.1) among the male players and 0.131 (SD: 0.08) among the female players (P = .981: F = 0.001). The average duration of the injuries suffered exceeded 28 days in 34.5% of the cases.The incidence of injury varied according to sex and age. Most injuries affected the muscles, especially those of the knee (in the lower limbs) and the shoulder (in the upper limbs).

The effect of match fatigue in elite badminton players using plantar pressure measurements and the implications to injury mechanisms

The purpose of this study was to investigate the differences in plantar pressure under the lead and trail foot between two lunge tasks to the net in the dominant (LD) and non-dominant (LND) directions, and to explore how fatigue affects the plantar pressure patterns whilst performing movements before and after a competitive match. Peak and mean pressure were measured with the Biofoot-IBV in-shoe system from five repetitions of each task, with sensors positioned under the calcaneus, midfoot and phalanges on the lead and trail foot. Data were collected pre and immediately post-playing an official first national league competition match. The study was conducted with a sample of thirteen first league badminton players. A 2 × 2 repeated ANOVA found significant differences between the two tasks and between pre- and post-match (fatigued state). Players also had different foot pressure distributions for the LD and LND tasks, which indicated a difference in loading strategy. In a fatigued state, the plantar pressure shifted to the medial aspect of the midfoot in the trail limb, indicating a reduction in control and a higher injury risk during non-dominant lunge tasks.

Badminton Injuries in Elite Athletes: A Review of Epidemiology and Biomechanics

Badminton is a popular sport in India and with multiple medal prospects will be closely followed at the Tokyo 2020 Olympics. Considered the fastest of the racquet sports, players require aerobic stamina, agility, strength, speed, and precision, besides requiring good motor coordination and complex racquet movements. Injuries in badminton are common despite it not being a contact sport, and include overuse injuries, and acute traumatic events. The game is physically challenging and demands complex repetitive upper and lower extremity movements with constant postural variations and poses a high risk of overuse injuries to both the appendicular and axial musculoskeletal systems. Badminton also necessitates short bursts of movement with sudden sharp changes in direction, which places players at risk of non-contact traumatic injuries to joints and muscle-tendon units. Preventing injuries and decreasing time away from training and competition are critical in an elite badminton player's sporting career. This analytical review identifies the incidence, severity, and profile of badminton injuries in elite players, and discusses the biomechanical basis of these injuries.

Understanding the impact loading characteristics of a badminton lunge among badminton players

Background

The rapid and repetitive badminton lunges would produce strenuous impact loading on the lower extremities of players and these loading are thought to be the contributing factors of chronic knee injuries. This study examined the impact loading characteristics in various groups of badminton athletes performing extreme lunges.

Methods

Fifty-two participants classified into male skilled, female skilled, male unskilled, and female unskilled groups performed badminton lunge with their maximum-effort. Shoe-ground kinematics, ground reaction forces, and knee moments were measured by using synchronised force platform and motion analysis system. A 2 (gender) x 2 (skill-level) factorial ANOVA was performed to determine the effects of different gender and different playing levels, as well as the interaction of two factors on all variables.

Results

Male athletes had faster approaching speed (male 3.87 and female 1.08 m/s), longer maximum lunge distance (male 1.47 and female 1.16 m), larger maximum (male 215.7 and female 121.65 BW/s) and mean loading rate (male 178.43 and female 81.77 BW/s) and larger peak knee flexion moment (male 0.75 and female 0.69) compared with female athletes (P < 0.001). Unskilled athletes exhibited smaller footstrike angle (skilled 45.78 and unskilled 32.35°), longer contact time (skilled 0.69 and unskilled 0.75 s), larger peak horizontal GRF (skilled 1.61 and unskilled 2.40 BW), smaller mean loading rate (skilled 150.15 and unskilled 110.05 BW/s) and larger peak knee flexion moment (P < .05; skilled 0.69 and unskilled 0.75 Nm/BW) than the skilled athletes. In addition, the interaction indicated greater peak GRF impact in female unskilled athletes compared with female skilled athletes (P < 0.001; female skilled 2.01 and female unskilled 2.95 BW), while there was no difference between male participants (P > 0.05; male skilled 2.19 and male unskilled 2.49 BW).

Conclusions

These data suggested that male athletes and/or unskilled athletes experience greater impact loading rates and peak knee flexion moment during lunge compared with female and skilled athletes, respectively. This may expose them to higher risk of overuse injuries. Furthermore, female unskilled athletes seemed to be more vulnerable to lower extremity injuries.

Epidemiological Patterns of Alternative Racquet-Sport Injuries in the United States, 1997-2016

Background

Racquet sports have increased in popularity over the past decade. Although research is available regarding the epidemiological characteristics of tennis injuries, little is known about the frequency and characteristics of injuries in other racquet sports.

Hypothesis

Given the increase in all racquet sport participation in the United States (US), it is hypothesized that injuries have accordingly become more frequent.

Study Design

Descriptive epidemiology study.

Methods

Using the National Electronic Injury Surveillance System database, we reviewed the numbers of badminton and squash/racquetball injuries presenting to a representative sample of US emergency departments (EDs). We used weighted estimates to extrapolate the data to the US population. Incidence estimates were compared with national participation data and stratified.

Results

A total of 4330 injuries were reported, representing an estimated 173,000 injuries presenting to US EDs from 1997 through 2016. Despite the increase in the number of players from 2006 through 2016, the annual injury rate for squash/racquetball declined significantly, including the rates for each body region assessed. No similar trend was found for badminton injuries. Within our extrapolated ED cohort, the lower extremities were the most common body region injured (37%). Strains/sprains were the most common injury type in the trunk (73%), lower extremities (65%), and upper extremities (32%), whereas lacerations were most common in the head/neck (49%). In badminton, the youngest players (age range, 5-18 years) sustained twice as many fractures (relative risk [RR], 1.96; 95% CI, 1.14-3.38) and almost 3 times as many lacerations as patients in any other age group. Similarly, the youngest squash/racquetball players were at highest risk for lacerations (RR, 1.45; 95% CI, 1.22-1.73) and head and neck injuries (RR, 1.52; 95% CI, 1.26-1.83).

Conclusion

Although declines in rates of squash/racquetball injuries were observed, the increasing popularity of badminton, squash, and racquetball necessitates further preventive measures to improve player safety, with an emphasis on the youngest players.

Increasing age in Achilles rupture patients over time

BACKGROUND

The changing demographics of Achilles tendon rupture (ATR) patients have not fully been investigated. However, there has been a general suspicion that this injury is occurring in an increasingly older population, in terms of mean age. The aim of this study was to objectively show an increase in age in Achilles tendon rupture patients over time.

METHODS

Published literature on Achilles tendon ruptures was searched for descriptive statistics on the demographics of patients in the studies, specifically mean and median age of Achilles tendon rupture patients, gender ratio, percentage of athletics-related injuries, percentage of smokers, and BMI. Linear regression analyses were performed to determine the trend of patient demographics over time. A Welch one-way ANOVA was carried out to identify any possible differences in data obtained from different types of studies.

RESULTS

The patient demographics from 142 studies were recorded, with all ATR injuries occurring between the years 1953 and 2014. There was no significant difference in the mean age data reported by varying study types, i.e. randomized controlled trial, cohort study, case series, etc. (P=0.182). There was a statistically significant rise in mean age of ATR patients over time (P<0.0005). There was also a statistically significant drop in percentage of male ATR patients (P=0.02). There is no significant trend for percentage of athletics-related injuries, smoking or BMI.

CONCLUSION

Since 1953 to present day, the mean age at which ATR occurs has been increasing by at least 0.721 years every five years. In the same time period, the percentage of female study patients with ATR injuries has also been increasing by at least 0.6% every five years.

LEVEL OF EVIDENCE

Level III; Retrospective cohort study.

Residual substance P levels after capsaicin treatment correlate with tendon repair

The aim of the study was to assess healing after capsaicin-induced substance P (SP) depletion during rat Achilles tendon repair by biomechanical testing. Capsaicin treatment reduced the concentrations of SP by ∼60% and calcitonin gene-related peptide by ∼40% as compared with the control group, as assessed by radioimmunoassay in the dorsal root ganglia, at 1 and 4 weeks post-tendon rupture. Also, the peripheral neuronal presence of SP and calcitonin gene-related peptide, as assessed by immunohistochemistry, was lower at both weeks 1 and 4. The decreased peripheral neuronal presence of SP at week 1 correlated with the corresponding levels in the dorsal root ganglia (r = 0.54, p = 0.018). The reduced presence of SP/calcitonin gene-related peptide after capsaicin treatment was verified by a decreased sensitivity to painful mechanical and thermal stimuli (p < 0.05). Correlation analyses between individual residual SP levels and biomechanical tissue properties were performed because of differences in failure mode between the groups and high individual variations in the SP levels after capsaicin treatment. Thus, the residual SP levels in the dorsal root ganglia correlated with transverse area, ultimate tensile strength, and stress at failure (r = 0.39, p = 0.036; r = 0.53, p = 0.005; and r = 0.43, p = 0.023, respectively). Furthermore, individual pain sensitivity at week 2 correlated with peripheral occurrence of SP and was correlated with tensile strength and stress at failure (r = 0.89, p = 0.006 and r = 0.78, p = 0.015) at week 4. In conclusion, rats with higher residual SP levels after capsaicin-induced neuropathy develop improved tensile strength and stress at failure in the healing of Achilles tendon.

Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon

Introduction

With evolutions in surgical techniques, minimally invasive surgical (MIS) repair with Achillon applicator has been introduced. However, there is still a lack of literature to investigate into the clinical merits of MIS over open surgery. This study aims to investigate the correlation between clinical outcome, gait analysis and biomechanical properties comparing both surgical methods.

Materials and methods

A single centre retrospective review on all the consecutive operated patients between January 2004 and December 2008 was performed. Twenty-six patients (19 male and 7 female; age 40.4 ± 9.2 years) had experienced a complete Achilles tendon rupture with operative repair. Nineteen of the patients, 10 MIS versus 9 open repairs (13 men with a mean age of 40.54 ± 10.43 (range 23-62 yrs) and 6 women with a mean age of 45.33 ± 7.71 (range 35-57 yrs) were further invited to attend a thorough clinical assessment using Holz's scale and biomechanical evaluation at a mean of 25.3 months after operation. This study utilized the Cybex II isokinetic dynamometer to assess the isokinetic peak force of plantar-flexion and dorsiflexion of both ankles. The patients were also invited to return to our Gait Laboratory for analysis. The eight-infrared camera motion capture system (VICON, UK) was utilized for the acquisition of kinematic variables. Their anthropometric data was measured according to the Davis and coworkers' standard.

Results

The mean operative time and length of hospital stay were shorter in the MIS group. The operative time was 54.55 ± 15.15 minutes versus 68.80 ± 18.23 minutes of the MIS group and Open group respectively (p = 0.045), whereas length of stay was 3.36 ± 1.21 days versus 6.40 ± 3.70 days respectively (p = 0.039). There is statistically significant decrease (p = 0.005) in incision length in MIS group than the open surgery group, 3.23 ± 1.10 cm versus 9.64 ± 2.55 cm respectively. Both groups attained similar Holz's scores, 11.70 ± 0.95 versus 12.0 ± 1.50 respectively (p = 0.262). The mean percentage stance time of the injured leg for MIS patient was 58.44% while the mean percentage stance time of the injured leg for patients with open repair was 56.57%. T-test has shown there were no significance differences between the results of the two groups of patients. The loss of peak torque and total work done with respect to the injured side were similar between the MIS and open group.

Discussion and conclusion

MIS using Achillon method can achieve smaller incisions, shorter operative time and hospital stay. There is no statistical significance difference in clinical outcome, the stance time to strike time ratio and biomechanical properties on the leg receiving Achilles tendon repair using MIS method and open surgery.

Epidemiology of Injuries in Hong Kong Elite Badminton Athletes

This study retrospectively reviewed the injury epidemiology on 44 Hong Kong elite badminton players in 2003. Team training records were reviewed to retrieve the training and competition hours, while the medical records from the physiotherapy department were reviewed to obtain information regarding injuries. A total of 253 injuries (128 recurrent and 125 new injuries) were recorded, which accounted for an overall incidence rate of 5.04 per 1,000 player hours. Elite senior athletes had a higher incidence rate of recurrent injuries, while elite junior and potential athletes had a higher incidence rate of new injuries. A total of 1,219 visits (4.82 per athlete) to the physiotherapy department were recorded, which cost HK$487,600 (HK$1,928 per injury). Most new injuries were strain (80 injuries), and the most frequently injured body sites were the back (17 injuries), the shoulder (15 injuries), the thigh (15 injuries), and the knee (15 injuries). One-sided exact test showed that a previous injury experience significantly associated with the occurrence of new injury.

A systematic review on ankle injury and ankle sprain in sports

This article systematically reviews epidemiological studies on sports injury from 1977 to 2005 in which ankle injury was included. A total of 227 studies reporting injury pattern in 70 sports from 38 countries were included. A total of 201,600 patients were included, with 32,509 ankle injuries. Ankle injury information was available from 14,098 patients, with 11 847 ankle sprains. Results show that the ankle was the most common injured body site in 24 of 70 included sports, especially in aeroball, wall climbing, indoor volleyball, mountaineering, netball and field events in track and field. Ankle sprain was the major ankle injury in 33 of 43 sports, especially in Australian football, field hockey, handball, orienteering, scooter and squash. In sports injuries throughout the countries studied, the ankle was the second most common injured body site after the knee, and ankle sprain was the most common type of ankle injury. The incidence of ankle injury and ankle sprain was high in court games and team sports, such as rugby, soccer, volleyball, handball and basketball. This systematic review provides a summary of the epidemiology of ankle injury in sports.

Ultrasonographic investigation of the Achilles tendon in elite badminton players using color Doppler

BACKGROUND

The most frequent injuries in badminton players are in the lower extremities, especially in the Achilles tendon.

HYPOTHESIS

The game of badminton may be related to abnormal intratendinous flow in the Achilles tendon as detected by color Doppler ultrasound. To a certain extent, this blood flow might be physiological, especially when examined after match.

STUDY DESIGN

Cohort study (prevalence); Level of evidence, 3.

METHODS

Seventy-two elite badminton players were interviewed regarding Achilles tendon pain (achillodynia) in the preceding 3 years. Color Doppler was used to examine the tendons of 64 players before their matches and 46 players after their matches. Intratendinous color Doppler flow was graded from 0 to 4. The Achilles tendon was divided into dominant (eg, right side for right-handed players and vice versa) and nondominant side and classified as midtendon, preinsertional, and calcaneal areas.

RESULTS

Of 72 players, 26 had experienced achillodynia in 34 tendons, 18 on the dominant side and 16 on the nondominant side. In 62% of the players with achillodynia, the problems had begun slowly, and the median duration of symptoms was 4 months (range, 0-36 months). Thirty-five percent had ongoing pain in their tendons for a median duration of 12 months (range, 0-12 months). Achillodynia was not associated with the self-reported training load or with sex, age, weight, singles or doubles players, or racket side. Forty-six players were scanned before and after match. At baseline, color Doppler flow was present in the majority of players, and only 7 (16%) players had no color Doppler flow in either tendon. After match, all players had some color Doppler flow in 1 or both tendons. Achillodynia and color Doppler flow were related in the nondominant Achilles tendon (chi-square, P = .008). The grades of Doppler flow also increased significantly after match in the preinsertional area in both the nondominant (P = .0002) and dominant (P = .005) side tendons.

CONCLUSION

A large proportion of the players had experienced achillodynia and habitually played with a degree of pain that demanded medication. The self-reported pain was associated with increased intratendinous color Doppler flow in the nondominant Achilles tendon. Doppler flow was found in most players before and in all players after the match and therefore may in part be a physiological response to activity.