Hypermobility and sports injury

Injuries in Male and Female Wrestlers

» With historical exclusion from the sport and lack of research on the subject, there is a paucity of data regarding the injury incidence, treatment, and recovery of female wrestlers as compared with their male counterparts.» Data demonstrate that female wrestlers are more likely to experience sprains/strains, whereas male wrestlers experience more concussions and fractures.» Variations in behavior and physiology including risk-taking habits and ligament laxity may contribute to differences in injury incidence between male and female wrestlers.» Rapid weight loss and eating disorders are important areas of future investigation for male and female wrestlers alike.

Assessing construct validity of the Beighton Score as a measure of generalized joint hypermobility in varsity athletes

The Beighton Score (BS) is a tool that dichotomizes those who have generalized joint hypermobility (GJH) and those who do not. Unfortunately, the BS is often used in populations that it was not originally developed for, including athletes for screening purposes. The construct validity of the BS remains unknown in this population. This secondary analysis investigated the construct validity of the BS by comparing varsity athletes' passive shoulder and hip ranges of motion (ROMs) to their respective BS and individual forward bend tests (FBTs). There were statistically significant but weak correlations between shoulder ROMs and the BS (r=0.142, p=0.021). Mean hip ROMs were greater by 5-degrees in those with positive FBTs compared to those with negative FBTs. This difference falls within typical measurement errors that occur in practice. Therefore, our results do not support the construct validity of the BS as a measure of GJH in healthy athletes.

Posterior Shoulder Instability in Tennis Players: Aetiology, Classification, Assessment and Management

Background

Micro-traumatic posterior shoulder instability (PSI) is an often missed and misdiagnosed pathology presenting in tennis players. The aetiology of micro-traumatic PSI in tennis players is multifactorial, including congenital factors, loss of strength and motor control, and sport-specific repetitive microtrauma. Repetitive forces placed on the dominant shoulder, particularly combinations of flexion, horizontal adduction, and internal rotation contribute to the microtrauma. These positions are characteristic for kick serves, backhand volleys, and the follow-through phase of forehands and serves. The aim of this clinical commentary is to present an overview of the aetiology, classification, clinical presentation, and treatment of micro-traumatic PSI, with a particular focus on tennis players.

Level of Evidence

5.

Improvement in pain and patient-related outcome measures following hip arthroscopy in patients with femoroacetabular impingement syndrome and concomitant generalized ligamentous laxity: a systematic review

PURPOSE

Within orthopaedic sports medicine, concomitant ligamentous laxity is often found to be a negative prognostic factor for post-operative outcomes following various procedures. The effect of ligamentous laxity on outcomes following hip arthroscopy remains infrequently reported. Therefore, the purpose of this study is to report on the outcomes of hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) with concomitant generalized ligamentous laxity (GLL).

METHODS

A systematic search was performed in Medline, EMBASE, CENTRAL, and SPORTDiscus (from inception to April 2021) for studies reporting outcomes following hip arthroscopy for symptomatic FAIS in patients with concomitant GLL.

RESULTS

Six studies representing 213 patients and 231 hips were included. Outcomes of pain and functional scores as measured by VAS, Harris Hip Score, and Hip Disability and Osteoarthritis Outcomes Score were tabulated. A mean improvement of 4.8 on VAS was observed. Improvements of 30.0 on HHS, 33.1 for ssHOS, and 23.9 for ADL-HOS were observed.

CONCLUSION

Hip arthroscopy is an effective method of alleviating pain and improving function with statistically significant improvements in all PROM in patients with concomitant FAIS with GLL.

LEVEL OF EVIDENCE

IV.

PROSPERO REGISTRATION

CRD42021248864.

Combined medial patellofemoral and patellotibial reconstruction with soft tissue fixation in recurrent patellar dislocation

INTRODUCTION

The medial patellofemoral and patellotibial ligaments (MPFL and MPTL) are the main passive restraints to lateral patellar translation. When nonoperative management of patellofemoral dislocations fails, surgical options can be considered to restore patellofemoral stability. Several reconstruction procedures of the MPFL with semitendinosus, gracilis, quadriceps tendon, and synthetic grafts have been described. No clear superiority of one surgical technique over another is evident.

MATERIALS AND METHODS

Patients who suffered at least two documented episodes of unilateral patellar dislocation, confirmed radiographically and at clinical examination, underwent combined MPFL and MPTL reconstruction. Patients were regularly followed-up postoperatively at 2, 4, 8, 12, and 24 weeks, and then annually for a minimum of 2.5 years. Clinical and functional evaluations were performed using the modified Cincinnati rating system and the Kujala score, while anthropometry values including thigh volume and cross-sectional area of the thigh were measured before the operation and at the latest follow-up bilaterally.

RESULTS

There were 7 males and 27 females with a mean age of 26.5 ± 10.7 years (range, 13-39 years). The mean follow-up was 3.1 years (range, 2.5-4 years). The mean modified Cincinnati score Increased from 51 ± 22 preoperatively to 90 ± 19 (P = .001). The mean Kujala scores increased from 47 ± 17 preoperatively to 82 ± 17 (P = .02), with no significant differences between patients with or without osteochondral lesions (P ≥ .05), and between male and female patients (P ≥ .08). The Insall-Salvati index was 1.1 preoperatively and remained within normal range (P = .05) at the latest follow-up.

CONCLUSION

Combined reconstruction of MPFL and MPTL using an ipsilateral autologous gracilis tendon is satisfactory and effective and can be considered as suitable management option to treat recurrent dislocation of the patella. However, randomized studies are needed to compare different techniques.

STUDY DESIGN

Case series.

Beighton scoring of joint laxity and injury incidence in Middle Eastern male youth athletes: a cohort study

Objectives

To examine the association between generalised joint laxity (GJL) and injury rates in Middle Eastern male youth athletes.

Design

Prospective observational study consisting of GJL screen and injury audit (season 2009/2010).

Setting

Aspire Sports Academy Doha, Qatar.

Participants

A total of 226 adolescent male athletes (mean age: 14.2 years; SD: 1.7; range: 10–18) involved in 15 sporting activities were grouped into contact and non-contact sports. All available athletes were included in this study.

Outcome measures

A seasonal injury audit, athletes’ anthropometric characteristics, for example, weight, height and body mass index and screen for GJL to determine Beighton Score (BS).

Results

The 226 athletes sustained 596 injuries and 75% reported at least one injury over a seasonal injury audit. Players in contact sports were injured more often than players in non-contact sports (more frequent injuries than injury-free time in contact sports; 127 days (95% CI 93 to 160) vs 176 days in non-contact sports (95% CI 118 to 234) (p<0.001). Survival analysis showed that gradient BS was not associated with injury HR=1.004 (95% CI 0.95 to 1.06) in the overall cohort. However, BS was associated with a greater injury risk in contact sports (HR: 1.29; 95% CI 1.05 to 1.59; p=0.015).

Conclusion

Greater GJL, defined by gradient BS, plus involvement in contact sports together influence injury risk in youth athletes. Preseason documentation of GJL scoring should be considered specifically for contact sports as injury pre-emptive measure.