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Hanimann J, Fitze DP, Götschi T, Fröhlich S, Frey WO, de Bruin ED, Sutter R, Spörri J. Changes in patellar tendon complaints and shear wave velocity patterns among competitive alpine skiers during a 4-year post-growth spurt follow-up. Front Physiol 2024; 15:1401632. [PMID: 39040077 PMCID: PMC11261000 DOI: 10.3389/fphys.2024.1401632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/30/2024] [Indexed: 07/24/2024] Open
Abstract
Patellar tendon (PT) complaints are frequent in competitive alpine skiers and such complaints are characterized by a long-lasting affection. Since PTs are subject to maturation up to 1-2 years after growth spurt, this early career stage may be decisive for the further course of complaints. The aim of this study was to investigate the evolution of PT complaints and shear wave velocity patterns among competitive alpine skiers during a 4-year post-growth spurt follow-up. The PT complaints and SWV patterns of forty-seven skiers were analysed at baseline (i.e., immediately after their peak height growth at 13-15 years of age) and were re-analysed at 4-year follow-up. The PTs were scanned via three-dimensional SWE. Symptomatic skiers were identified based on pain sensation under loading and pressure-induced pain around the PT. The prevalence of PT complaints decreased from 29.8% at baseline to 12.8% at follow-up (Pearson's χ2 = 9.429; p = 0.002). SWV decreased from the baseline assessment to the follow-up in the proximal and distal regions (p < 0.05). SWV coefficient of variation (CV) in the distal and mid-portion regions was greater at baseline than at follow-up (p < 0.05). At the follow-up assessment, compared to "healthy" skiers, "healed" skiers who recovered from PT complaints had lower SWVs in the proximal region (p = 0.020) and greater SWV CVs in the proximal region (p = 0.028). Moreover, symptomatic skiers had significantly greater SWV CVs in the mid-portion region than did "healthy" subjects with no history of PT complaints (p = 0.020). The average SWV was negatively correlated with the SWV (proximal: r = -0.74, p < 0.001; mid-portion: r = -0.37 p = 0.011; and distal: r = -0.58, p < 0.001). The occurrence of PT complaints decreased over a 4-year post-growth spurt follow-up. "Healed" skiers who were symptomatic at baseline had an even greater average decrease in the proximal and mid-portion SWV than "healthy" skiers with no history of PT complaints. This may lead to the hypothesis that PT complaints in adolescent skiers are not self-eliminating towards the end of adolescence, as at least structural irregularities appear to persist for several years after the onset of initial symptoms. Furthermore, "healed" and symptomatic tendons exhibited increased SWV variability, supporting the hypothesis that SWV CV may provide additional valuable information on the mechanical properties of PTs affected by overuse-related complaints.
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Affiliation(s)
- Jonas Hanimann
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Daniel P. Fitze
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Tobias Götschi
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Orthopaedic Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Stefan Fröhlich
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Walter O. Frey
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
- Department of Health, OST—Eastern Swiss University of Applied Sciences, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Allahabadi S, Yazdi AA, Weissman AC, Meeker ZD, Yanke AB, Cole BJ. Sport-specific Differences in Cartilage Treatment. Sports Med Arthrosc Rev 2024; 32:68-74. [PMID: 38978200 DOI: 10.1097/jsa.0000000000000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Articular cartilage defects in the knee are common in athletes who have a variety of loading demands across the knee. Athletes of different sports may have different baseline risk of injury. The most studied sports in terms of prevalence and treatment of cartilage injuries include soccer (football), American football, and basketball. At this time, the authors do not specifically treat patients by their sport; however, return to sports timing may be earlier in sports with fewer demands on the knee based on the rehabilitation protocol. If conservative management is unsuccessful, the authors typically perform a staging arthroscopy with chondroplasty, followed by osteochondral allograft transplantation with possible additional concomitant procedures, such as osteotomies or meniscal transplants. Athletes in a variety of sports and at high levels of competition can successfully return to sports with the appropriate considerations and treatment.
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Bonell Monsonís O, Spörri J, Warsen M, Bolling C, Gouttebarge V, Verhagen E. We know a lot about little and little about a lot: A contextualized scoping review on injury prevention in alpine ski racing. Scand J Med Sci Sports 2024; 34:e14533. [PMID: 37955281 DOI: 10.1111/sms.14533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/19/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Our goal was to summarize and contextualize the available literature on alpine ski racing injury epidemiology, injury etiology, injury prevention measures, injury prevention context, and implementation issues. MATERIALS AND METHODS We searched four electronic databases using predetermined search terms. We included original studies that assessed injury, injury risk factors, and injury mechanisms, and assessed and reported the effect of an injury prevention measure in alpine ski racing. Two authors independently conducted title-abstract screening, and one performed the full-text review. For data synthesis and categorization, we used the Translating Research into the Injury Prevention Practice framework and a modified and adapted version of the Haddon matrix. RESULTS Of the 157 included studies, most corresponded to injury epidemiology and etiology, whereas few studies encompassed injury prevention measure development, implementation and evaluation. Preventive interventions targeting equipment, rules and regulations, course design and snow preparation were the most prevalent in the literature. Furthermore, various contextual factors in the current literature have been found, including gender, competition level, countries and federations, and time periods within a season. CONCLUSIONS We provided an in-depth and comprehensive overview of the current state-of-the-art in the alpine ski racing context. We know a lot about little and little about a lot across all the areas associated with injury prevention in such context. The limitations in the literature yield a road map for designing future injury prevention studies to address the key gaps identified. A more comprehensive context-driven approach throughout all stages of injury prevention would benefit the ultimate implementation of effective preventive strategies.
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Affiliation(s)
- Oriol Bonell Monsonís
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marit Warsen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline Bolling
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
| | - Vincent Gouttebarge
- Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
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Larid G, Duboe PO, Gervais E. Shoulder Focal Periphyseal Edema: An Unusual Cause of Shoulder Pain in an Adolescent. J Rheumatol 2023; 50:1192. [PMID: 36792113 DOI: 10.3899/jrheum.221291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Guillaume Larid
- Rheumatology Department, CHU de Poitiers, and University of Poitiers, LITEC, Poitiers;
| | | | - Elisabeth Gervais
- Rheumatology Department, CHU de Poitiers, and University of Poitiers, LITEC, Poitiers, France
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Mester B, Burggraf M, Beck P, Meyer HL, Polan C, Albrecht T, Guder W, Streitbürger A, Dudda M, Hardes J. Cortical Desmoid of the Distal Femur-Incidentaloma or Insertional Tendinopathy? J Clin Med 2023; 12:jcm12082969. [PMID: 37109304 PMCID: PMC10145125 DOI: 10.3390/jcm12082969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The cortical desmoid (DFCI) of the posteromedial femoral condyle is considered an asymptomatic incidental finding in adolescents without clinical relevance. The aim of this study was to evaluate the clinical relevance of DFCI from both a tumor orthopedic and sports medicine point of view. METHODS n = 23 patients (13.74 ± 2.74 years; nineteen female, four male) with DFCI of the posteromedial femoral condyle were included. A localized posteromedial knee pain on exertion was differentiated from non-specific knee pain. Symptom duration, additional pathologies, number of MRIs, sports activity and training intensity, downtime, therapeutic modalities, and relief/remission of symptoms were documented. The Tegner activity scale (TAS) and Lysholm score (LS) were collected. The influence of specific posteromedial pain, MRI presence of paratendinous cysts, sports level as well as physiotherapy on downtime and LS/TAS was statistically analyzed. RESULTS 100% reported knee symptoms at initial presentation. A localized posteromedial pain was documented in 52%. In 16/23 (70%) additional functional pathologies were diagnosed. Patients were physically highly active with high training intensities (6.52 ± 5.87 h/week) and performance level (65% competitive vs. 35% recreational). Patients underwent 1.91 ± 0.97 MRIs (max four). Symptom duration was 10.48 ± 11.02 weeks. A follow-up examination was performed after 12.62 ± 10.41 months (n = two lost to follow-up). 17/21 had physiotherapy, on average 17.06 ± 13.33 units. Overall downtime was 13.39 ± 12.50 weeks, the return-to-sports (RTS) rate 81%. 100%/38% reported a relief/remission of complaints. LS was 93.29 ± 7.95, median TAS before onset of knee complaints/at follow-up 7 (6-7)/7 (5-7). Specific posteromedial pain, presence of paratendinous cysts, sports level and physiotherapy had no significant influence on downtime and outcome parameters (n.s.). CONCLUSIONS DFCI as a pathognomonic finding is recurrently encountered in the MRIs of children and adolescents. This knowledge is essential to spare patients from overtreatment. Contrary to the literature, the present results implicate a clinical relevance of DFCI particularly in those who are physically highly active with localized pain on exertion. Structured physiotherapy as basic treatment is recommended.
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Affiliation(s)
- Bastian Mester
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Manuel Burggraf
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Paula Beck
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Heinz-Lothar Meyer
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Christina Polan
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Thomas Albrecht
- Department for Tumor Orthopedics, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Wiebke Guder
- Department for Tumor Orthopedics, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Arne Streitbürger
- Department for Tumor Orthopedics, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Marcel Dudda
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
- Department for Orthopedics and Trauma Surgery, BG-Klinikum Duisburg, University of Duisburg-Essen, Großenbaumer Allee 250, 47249 Duisburg, Germany
| | - Jendrik Hardes
- Department for Tumor Orthopedics, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
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Götschi T, Hanimann J, Schulz N, Huser S, Held V, Frey WO, Snedeker JG, Spörri J. Patellar Tendon Shear Wave Velocity Is Higher and has Different Regional Patterns in Elite Competitive Alpine Skiers than in Healthy Controls. Front Bioeng Biotechnol 2022; 10:858610. [PMID: 35757800 PMCID: PMC9218688 DOI: 10.3389/fbioe.2022.858610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Competitive alpine skiers are exposed to enormous forces acting on their bodies–particularly on the knee joint and hence the patellar tendon - during both the off-season preparation and in-season competition phases. However, factors influencing patellar tendon adaptation and regional pattern differences between alpine skiers and healthy controls are not yet fully understood, but are essential for deriving effective screening approaches and preventative countermeasures. Thirty elite competitive alpine skiers, all members of the Swiss Alpine Ski Team, and 38 healthy age-matched controls were recruited. A set of two-dimensional shear wave elastography measurements of the PT was acquired and projected into three-dimensional space yielding a volumetric representation of the shear wave velocity profile of the patellar tendon. Multivariate linear models served to quantify differences between the two cohorts and effects of other confounding variables with respect to regional shear wave velocity. A significant (p < 0.001) intergroup difference was found between skiers (mean ± SD = 10.4 ± 1.32 m/s) and controls (mean ± SD = 8.9 ± 1.59 m/s). A significant sex difference was found within skiers (p = 0.024), but no such difference was found in the control group (p = 0.842). Regional SWV pattern alterations between skiers and controls were found for the distal region when compared to the mid-portion (p = 0.023). Competitive alpine skiers exhibit higher SWV in all PT regions than healthy controls, potentially caused by long-term adaptations to heavy tendon loading. The presence of sex-specific differences in PT SWV in skiers but not in controls indicates that sex effects have load-dependent dimensions. Alterations in regional SWV patterns between skiers and controls suggest that patellar tendon adaptation is region specific. In addition to the implementation of 3D SWE, deeper insights into long-term tendon adaptation and normative values for the purpose of preventative screening are provided.
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Affiliation(s)
- Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jonas Hanimann
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nicole Schulz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Simon Huser
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Victoria Held
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Walter O Frey
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jess G Snedeker
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Götschi T, Franchi MV, Schulz N, Fröhlich S, Frey WO, Snedeker JG, Spörri J. Altered regional 3D shear wave velocity patterns in youth competitive alpine skiers suffering from patellar tendon complaints - A prospective case-control study. Eur J Sport Sci 2022; 23:1068-1076. [PMID: 35699187 DOI: 10.1080/17461391.2022.2088404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractPatellar tendon (PT) complaints are frequent throughout the population, with increased occurrence in athletes and, particularly, in youth competitive alpine skiers. Timely detection and treatment might improve prospects of recovery. Diagnostic modalities in clinical use to date rely on pain symptoms, manual palpation, and potentially, magnetic resonance imaging (MRI); however, MRI-based imaging yields limited sensitivity. Quantitatively measuring the morphological and mechanical properties of PTs by means of B-mode ultrasound and shear wave elastography (SWE), instead, may allow improved diagnosis or even early detection. We performed B-mode scans and three-dimensional ultrasound shear wave velocity (SWV) mapping and MRI of the PT in 106 youth skiers. A prospective one-year survey on health problems combined with clinical assessments served to categorize symptomatic and asymptomatic youth skiers. Skiers suffering from distal or proximal tendon complaints showed lower SWV in the respective tendon region than asymptomatic skiers (p = 0.035 and p = 0.019, respectively). Youth skiers with distal tendon complaints additionally exhibited decreased SWV in the proximal region compared to asymptomatic counterparts (p = 0.020). Cross-validated analysis of retrospective prediction indicated sensitivity and specificity in detecting tendon complaints in the range of 0.606-0.621 and 0.536-0.650, respectively. MRI detected distal tendon complaints with a sensitivity of 0.410 (12/29) but failed to detect any proximal cases. This study agrees with the most recent literature in that SWE holds promise as a valuable adjunct modality for the diagnosis of PT complaints or even the detection of subclinical prestages. However, to evaluate its prospective predictive value, long-term studies are warranted.
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Affiliation(s)
- Tobias Götschi
- Orthopaedic Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Switzerland.,Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Martino V Franchi
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,Institute of Physiology, Department of Biomedical Sciences, University of Padova, Padua, Italy
| | | | - Stefan Fröhlich
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Walter O Frey
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Jess G Snedeker
- Orthopaedic Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
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Schoeb T, Fröhlich S, Frey WO, Verhagen E, Farshad M, Spörri J. The ISPA Int Injury Prevention Programme for Youth Competitive Alpine Skiers: A Controlled 12-Month Experimental Study in a Real-World Training Setting. Front Physiol 2022; 13:826212. [PMID: 35309082 PMCID: PMC8929391 DOI: 10.3389/fphys.2022.826212] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/28/2022] [Indexed: 01/14/2023] Open
Abstract
Evidence-based injury prevention programmes for youth competitive alpine skiers are widely absent. The aims of this controlled 12-month experimental study were to introduce a novel injury prevention programme targeted to the injury patterns of youth skiers, called ISPAInt, and to compare the differences in injury occurrence between an intervention group (IG) additionally performing the ISPAInt programme and an independent, historical control group (CG) following their regular training routines. None of the skiers of the CG were part of the IG and vice versa. The study was directly conducted within the real-world youth development structures of skiers competing at the under 16 years (U16) level in Switzerland. Seventy-one skiers (aged 14.4 ± 0.3 years) assigned to the IG were compared to 58 age- and gender-matched controls. The IG was offered the ISPAInt programme with the recommendation to perform it at least once per week. Skiers’ adherence to this recommendation was surveyed but not enforced. Injuries were recorded using the Oslo Sports Trauma Research Centre Questionnaire. Primary outcomes were the absolute injury rates (number of injuries/100 athletes per season) and epidemiological incidence proportion (number of injured athletes/100 athletes per season). The secondary outcome was the average 2-weekly prevalence of traumatic knee, knee overuse, and lower back overuse injuries. There were lower absolute rates of all traumatic injuries [rate/risk difference, RD: −57.1 (−98.1, −16.0); rate/risk ratio, RR: 0.665 (0.485, 0.884)] and overuse injuries [RD: −35.9 (−71.0, −0.7); RR: 0.699 (0.493, 0.989)] in the IG than in the CG. Likewise, the epidemiological incidence proportion for all overuse injuries was smaller in the IG [RD: −28.4 (−44.8, −12.0); RR: 0.598 (0.435, 0.822)], while the proportion of skiers suffering from traumatic injuries did not significantly differ between the groups. Notably, the IG particularity differed from the CG in the average 2-weekly prevalence of knee trauma, knee overuse, and lower back overuse complaints, three of the major injury-related hot spots in youth skiers. Based on these promising results, the ISPAInt programme may have great potential to prevent injuries in youth competitive alpine skiers, and the underlying exercises should be considered complementary training content at the U16 level.
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Affiliation(s)
- Thierry Schoeb
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Stefan Fröhlich
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Walter O Frey
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Mazda Farshad
- Spine Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Spine Centre, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
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Strutzenberger G, Ellenberger L, Bruhin B, Frey WO, Scherr J, Spörri J. Deadbug Bridging Performance in 6- to 15-Year-Old Competitive Alpine Skiers—A Cross-Sectional Study. BIOLOGY 2022; 11:biology11020329. [PMID: 35205195 PMCID: PMC8869284 DOI: 10.3390/biology11020329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary In competitive alpine skiing, a stable trunk plays an important role in increasing performance and preventing injuries. The aim of the present study was to investigate the ability to stabilize the trunk during so-called deadbug bridging (DBB) exercises, a stabilizing, dynamic movement task in the supine position with the pelvis lifted and unilateral leg raising, in 6- to 15-year-old skiers. Trunk stabilization performance was better in female skiers of the under 15-year (U15) category than in their male counterparts, whereas there was no sex difference at ages under 10 years (U10). The only potential confounder when testing youth skiers revealed being body height, but only in female U10 skiers. In summary, this study provided sport-specific normative reference data that may be of equal interest to both researchers and sport practitioners. Abstract In competitive alpine skiing, a superior antirotation and rear-chain stabilization capacity is essential to constantly remain in dynamic equilibrium while skiing and to counteract the ski-specific adverse loading patterns of the back. As such, skiers’ trunk stabilization performance during deadbug bridging (DBB) exercises has been shown to be associated with both skiing performance and overuse complaints of the lower back in skiers under 16 years of age (U16). However, to date, little is known about the corresponding stabilization abilities in younger skiers, i.e., 6- to 15-year-old skiers. As part of a biomechanical field experiment during a national off-snow fitness competition, a total of 101 youth competitive alpine skiers were tested with respect to their trunk stabilization performance during DDB exercise. The maximum contralateral displacement of the pelvic drop during leg lift (DBBdisplacement) was quantified using reflective markers and a motion capture system (Vicon, Oxford, UK). Potential age group and sex differences in DBBdisplacement were assessed using analysis of variance (ANOVA) at p < 0.05. Within each subgroup, the associations of DBBdisplacement with age, anthropometrics and maturity offset were analysed using Pearson’s correlation (p < 0.05). Female skiers under 15 years of age (U15) showed better DBB performance than male U15 skiers, while there was no sex difference at the under 10-year (U10) level. In female U10 skiers, DBBdisplacement was moderately associated with body height, while in all other subgroups, no confounding associations with anthropometrics or biological maturation were found. Biomechanically quantifying DBB performance may be considered a feasible and nonconfounded screening test approach in young skiers older than 6 years. Body height may represent a confounding bias in exclusively the U10 female skier cohort and, therefore, should be considered when interpreting the test results. In summary, this study provided sport-specific normative reference data that may be of equal interest to both researchers and sport practitioners.
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Affiliation(s)
- Gerda Strutzenberger
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (G.S.); (L.E.); (W.O.F.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Motion Analysis Zurich, Department of Orthopedics, Balgrist University Hospital, Children’s Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Lynn Ellenberger
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (G.S.); (L.E.); (W.O.F.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | | | - Walter O. Frey
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (G.S.); (L.E.); (W.O.F.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Johannes Scherr
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (G.S.); (L.E.); (W.O.F.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Motion Analysis Zurich, Department of Orthopedics, Balgrist University Hospital, Children’s Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (G.S.); (L.E.); (W.O.F.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Motion Analysis Zurich, Department of Orthopedics, Balgrist University Hospital, Children’s Hospital, University of Zurich, 8008 Zurich, Switzerland
- Correspondence: ; Tel.: +41-44-510-70-09
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Common Biochemical and Magnetic Resonance Imaging Biomarkers of Early Knee Osteoarthritis and of Exercise/Training in Athletes: A Narrative Review. Diagnostics (Basel) 2021; 11:diagnostics11081488. [PMID: 34441422 PMCID: PMC8391340 DOI: 10.3390/diagnostics11081488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 12/24/2022] Open
Abstract
Knee osteoarthritis (OA) is the most common joint disease of the world population. Although considered a disease of old age, OA also affects young individuals and, more specifically among them, those practicing knee-joint-loading sports. Predicting OA at an early stage is crucial but remains a challenge. Biomarkers that can predict early OA development will help in the design of specific therapeutic strategies for individuals and, for athletes, to avoid adverse outcomes due to exercising/training regimens. This review summarizes and compares the current knowledge of fluid and magnetic resonance imaging (MRI) biomarkers common to early knee OA and exercise/training in athletes. A variety of fluid biochemical markers have been proposed to detect knee OA at an early stage; however, few have shown similar behavior between the two studied groups. Moreover, in endurance athletes, they are often contingent on the sport involved. MRI has also demonstrated its ability for early detection of joint structural alterations in both groups. It is currently suggested that for optimal forecasting of early knee structural alterations, both fluid and MRI biomarkers should be analyzed as a panel and/or combined, rather than individually.
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Ellenberger L, Casutt S, Fröhlich S, Frey WO, Snedeker JG, Spörri J. Thigh muscle activation patterns and dynamic knee valgus at peak ground reaction force during drop jump landings: Reliability, youth competitive alpine skiing-specific reference values and relation to knee overuse complaints. J Sci Med Sport 2021; 24:1230-1234. [PMID: 34238661 DOI: 10.1016/j.jsams.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/19/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES (1) To evaluate the reliability of quantifying thigh muscle activation patterns and dynamic knee valgus during drop jump landings, (2) to provide reference values for female and male youth alpine skiers, and (3) to study their associations with age, anthropometrics, biological maturation and knee overuse complaints. DESIGN Cross-sectional biomechanical experiment including questionnaires. METHODS One hundred fourteen skiers of the under 16 category (main experiment) and twelve healthy participants (reliability experiment) volunteered. Quadriceps-to-hamstring-activation ratio and medial knee displacementat peak ground reaction force during drop jump landings were measured using marker-based motion analysis, force plates and electromyography. Additionally, age, anthropometrics, biological maturation and knee overuse complaints were assessed. RESULTS There were good test-retest reliabilities and moderate standardized typical errors for both quadriceps-to-hamstring-activation ratio (intraclass correlation coefficient(3,1) = 0.84 [95% confidence interval: 0.69, 0.94]; standardized typical errors = 0.43 [0.35, 0.56]) and medial knee displacement (intraclass correlation coefficient(3,1) = 0.87 [0.74, 0.95]; standardized typical errors = 0.39 [0.32, 0.50]). Male skiers had a significantly higher quadriceps-to-hamstring-activation ratio (3.9 ± 2.0 vs. 2.9 ± 1.4, p = 0.011), whilst medial knee displacement was comparable to females (12 mm ± 11 mm vs. 13 mm ± 9 mm; p = 0.419). In male skiers, medial knee displacement correlated with anthropometrics and maturity offset; in female skiers, quadriceps-to-hamstring-activation ratio and medial knee displacement were associated with knee overuse complaints (p < 0.05). CONCLUSIONS Female and male youth skiers use different thigh muscle activation strategies, but show comparable dynamic knee valgus motions during drop jump landings. In females, a combination of increased relative quadriceps activity and medial knee displacement may favour knee overuse complaints.
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Affiliation(s)
- Lynn Ellenberger
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Selina Casutt
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Stefan Fröhlich
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Walter O Frey
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
| | - Jess G Snedeker
- Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Switzerland.
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland; Motion Analysis Zurich, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.
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Physical Activity and Investigation With Magnetic Resonance Imaging Partly Explain Variability in the Prevalence of Patellar Tendon Abnormalities: A Systematic Review With Meta-analysis of Imaging Studies in Asymptomatic Individuals. J Orthop Sports Phys Ther 2021; 51:216-231. [PMID: 33779217 DOI: 10.2519/jospt.2021.10054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the pooled prevalence of, and factors associated with, the presence of patellar tendon abnormalities observed on imaging in people without symptoms. DESIGN Systematic review with stratified meta-analysis and meta-regression. LITERATURE SEARCH We searched Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science from 1980 to August 2020. STUDY SELECTION CRITERIA We included studies that reported the prevalence of asymptomatic patellar tendon abnormalities on imaging. We excluded studies of participants with current tendon pain, a history of tendon pain, or other systemic conditions. DATA SYNTHESIS Stratification and meta-regression of studies based on study-level descriptive statistics (mean age, body mass index, proportion of female participants, physical activity participation, imaging modality) were performed using a random-effects model to account for between-study heterogeneity. Risk of bias was assessed using the modified Newcastle-Ottawa scale. RESULTS Meta-analysis of 64 studies (7125 limbs from 4616 participants) found significant between-study heterogeneity (I2≥90%, P<.01), which precluded a summary prevalence estimate. Heterogeneity was partially explained by studies that included participants who were physically active and studies that assessed tendon abnormalities using magnetic resonance imaging compared to ultrasound (P<.05). Mean age, body mass index, proportion of female participants, and sample size did not explain the remaining heterogeneity. CONCLUSION There was substantial variability in the reported prevalence of asymptomatic patellar tendon abnormalities. A clear and valid method is needed to assess and report the presence of patellar tendon abnormalities to increase research capacity and establish the clinical value of imaging the patellar tendon. J Orthop Sports Phys Ther 2021;51(5):216-231. Epub 28 Mar 2021. doi:10.2519/jospt.2021.10054.
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