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MacMillan C, Olivier B, Viljoen C, van Rensburg DCJ, Sewry N. The Association Between Menstrual Cycle Phase, Menstrual Irregularities, Contraceptive Use and Musculoskeletal Injury Among Female Athletes: A Scoping Review. Sports Med 2024:10.1007/s40279-024-02074-5. [PMID: 39215933 DOI: 10.1007/s40279-024-02074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The influence of menstrual cycle phases (MCPs), menstrual irregularities (MI) and hormonal contraceptive (HC) use on injury among female athletes has been scrutinised. Existing systematic reviews investigating the effect of exposures affecting the endogenous reproductive hormone status on sporting injuries are limited in terms of the types of studies included and injuries investigated. OBJECTIVE This scoping review aims to summarise the coverage of the literature related to the extent, nature and characteristics of the influence of MCP, MI and HC use on musculoskeletal injuries among athletes. It also aims to summarise key concepts and definitions in the relevant literature. Observational and experimental studies investigating the effect of MCP, MI, and HC on musculoskeletal injuries among female individuals of reproductive age were included. Studies specifically stating pregnant women, perimenopausal/postmenopausal athletes, or those using medication (other than HC) that affects reproductive hormone profiles or the musculoskeletal system were excluded. METHODS This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping reviews and JBI scoping review guidelines. Published and unpublished studies were sourced from several databases and resources. Initial keywords used included terms related to "menstrual cycle", "hormonal contraception" and "injury." Titles and abstracts of identified citations were screened independently and assessed for eligibility by two independent reviewers. Data from the included studies were extracted using a standard data extraction form. RESULTS The search yielded 10,696 articles, of which 96 met the eligibility criteria. Most studies investigated MI (77%), and 49% included MCP as a contributing injury risk factor. Publications have increased over the last two decades. Collectively, only 16% of research has been conducted in Africa, Asia and Oceania. There were no studies from South America. Seventy-five percent of the studies investigated individual versus team (25%) sport athletes. Most studies only investigated elite or professional (n = 24; 25%) level athletes. The definitions of injury, eumenorrhea and MI differ vastly among studies. Regarding MI, most studies (69%) investigated secondary amenorrhea, followed by oligomenorrhea (51%) and primary amenorrhea (43%). Concerning HC, the influence of oral contraceptive pills was mainly investigated. CONCLUSIONS Research related to MCP, MI and HC as contributing musculoskeletal injury risk factors is increasing; however, several gaps have been identified, including research from countries other than North America and Europe, the study population being non-professional/elite level athletes, athletes participating in team sports and specific injuries related to MCP, MI and HC, respectively. Differences in methodology and terminology of injury, MCP and MI hinder comparative summative research, and future research should consider current published guidelines during the study design. Identifying barriers to following standard guidelines or research investigating the most practical yet accurate methods to investigate the influence of MCP on musculoskeletal health might yield valuable insights for future research designs. CLINICAL TRIAL REGISTRATION Scoping review registration number: Open Science Framework ( https://doi.org/10.17605/OSF.IO/5GWBV ).
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Affiliation(s)
- Candice MacMillan
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, South Street, Pretoria, 0083, Gauteng, South Africa.
- Sport, Exercise Medicine, and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Benita Olivier
- Centre for Healthy Living Research, Oxford Institute of Allied Health Research, Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
- Wits Cricket Research Hub for Science, Medicine and Rehabilitation, Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carel Viljoen
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Nicola Sewry
- Sport, Exercise Medicine, and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
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Wang M, Chee J, Tanaka MJ, Lee YHD. Relative Energy Deficiency in Sport (REDs) and knee injuries: current concepts for female athletes. J ISAKOS 2024; 9:781-787. [PMID: 38795863 DOI: 10.1016/j.jisako.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 05/19/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
In athletes, a mismatch between caloric intake and energy expended in exercise can eventually lead to Relative Energy Deficiency in Sport (REDs), where the athlete suffers from physiological derangements and decreased sport performance. The prevalence of REDs is higher in females than males. Females are already at a higher risk of knee injuries, which has been attributed to a multitude of factors such as hormonal influences, differences in musculoskeletal anatomy and neuromuscular control compared to males. The literature demonstrates an even higher risk of knee injuries in female athletes with symptoms of REDs. We propose the various factors that influence this risk. A reduction in anabolic hormones can affect muscle development and tendon repair. A relationship between poor neuromuscular control and knee injury has been established, and this can be further worsened in patients with menstrual dysfunction. Chronic deficiency in nutrients such as collagen and vitamin D can result in poorer recovery from microtrauma in tendons and ligaments. All these factors may contribute to increasing the risk of knee injuries, which may include anterior cruciate ligament tears, patella tendinopathy and patellofemoral pain syndrome. This review aims to educate sports clinicians to have a high index of suspicion when treating knee injuries in females; to screen and then manage for REDs if present, for holistic patient care.
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Affiliation(s)
- Mingchang Wang
- Division of Sports, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital, NUHS Tower Block, Level 11, 1E Kent Ridge Road, 119288, Singapore.
| | - Jade Chee
- Division of Sports, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital, NUHS Tower Block, Level 11, 1E Kent Ridge Road, 119288, Singapore
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA, 02114, USA
| | - Yee Han Dave Lee
- Division of Sports, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital, NUHS Tower Block, Level 11, 1E Kent Ridge Road, 119288, Singapore
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Simonis KM, Cowan ML, Williams L, Baron HR. Surgical Repair of Psittacine Femorotibial Luxation: A Case Series. J Avian Med Surg 2024; 38:34-45. [PMID: 38686886 DOI: 10.1647/avianms-d-23-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Luxation of the psittacine femorotibial joint most commonly occurs following trauma or as a development abnormality. Historically, this injury is considered to have a poor prognosis in birds; however, surgical management may result in acceptable and functional outcomes. This case series describes the surgical techniques, complications, and outcomes of 7 cases of femorotibial luxation in psittacine birds. Of the 7 cases, 6 were chronic injuries. Surgical repair methods included conjoined intramedullary pinning, transarticular pinning with an external skeletal fixator (ESF), a combination of extracapsular stabilization and ESF, ESF alone, and a combination of conjoined intramedullary pins with an ESF. An acceptable outcome was achieved in 75% (6/8) of luxated femorotibial joints managed with surgical methods. All cases were female birds of various species, suggesting a possible sex predisposition for stifle luxation.
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Dehghan F, Soori R, Yusof A. Knee Laxities Changes with Sex-steroids throughout the Menstrual Cycle Phases in Athlete and Non-athlete Females. Rev Bras Ortop 2024; 59:e29-e37. [PMID: 38524710 PMCID: PMC10957278 DOI: 10.1055/s-0043-1771007] [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: 12/09/2022] [Accepted: 02/07/2023] [Indexed: 03/26/2024] Open
Abstract
Objective: Our study investigated changes of knee laxities in athletes and non-athletes females and relationship between knee laxity and sex-steroid at menstrual cycle phases. Methods: Forty six healthy females, twenty four athletes and twenty two non-athletes not on hormone contraceptive pills, had no previous knee injuries and with regular menstrual cycles for 3 consecutive months, participated in the study. Medial and lateral knee laxities were determined by varus-valgus tests at follicular, ovulatory and luteal phases. Serum level of relaxin, estrogen, progesterone and testosterone were determined by ELISA and radioimmunoassay. Results: Knee laxities in athletes and non-athletes at 0° and 20° flexion were the highest in luteal phase with non-athletes possess greater laxity than athletes. Positive correlation between progesterone and relaxin levels with knee laxities were observed. Meanwhile, the levels of both hormones were highest in the luteal phase. Conclusion: Increased medial and lateral knee laxities in athletes and non-athletes associated with high serum progesterone and relaxin levels in luteal phase may contribute toward increased risk of non-contact knee injury. However, lower knee laxity in athletes than non-athletes suggest that exercise could be a protective factor.
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Affiliation(s)
- Firouzeh Dehghan
- Departamento de Ciências do Esporte, Campus Internacional de Kish, Universidade de Teerã, Ilha de Kish, Irã
| | - Rahman Soori
- Departamento de Fisiologia do Exercício, Faculdade de Ciências do Esporte e Saúde, Universidade de Teerã, Teerã, Irã
| | - Ashril Yusof
- Departamento de Ciência do Exercício, Centro Esportivo, Universidade da Malásia, Kuala Lumpur, Malásia
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Thompson JD, Howe D, Griffith EH, Fisher MB. Neo-Natal Castration Leads to Subtle Differences in Porcine Anterior Cruciate Ligament Morphology and Function in Adolescence. J Biomech Eng 2024; 146:011002. [PMID: 37831117 PMCID: PMC10680984 DOI: 10.1115/1.4063744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023]
Abstract
Female adolescent athletes are at a higher risk of tearing their anterior cruciate ligament (ACL) than male counterparts. While most work related to hormones has focused on the effects of estrogen to understand the increased risk of ACL injury, there are other understudied factors, including testosterone. The purpose of this study was to determine how surgical castration in the male porcine model influences ACL size and function across skeletal growth. Thirty-six male Yorkshire crossbreed pigs were raised to 3 (juvenile), 4.5 (early adolescent), and 6 months (adolescent) of age. Animals were either castrated (barrows) within 2 weeks after birth or were left intact (boars). Posteuthanasia, joint and ACL size were assessed via MRI, and biomechanics were assessed via a robotic testing system. Joint size increased throughout age, yet barrows had smaller joints than boars. ACL cross-sectional area (CSA), length, volume, and in situ stiffness increased with age, as did the percent contribution of the ACL anteromedial (AM) bundle to resisting loads. Boar ACL, AM bundle, and PL bundle volumes were 19%, 25%, and 15% larger than barrows across ages. However, ACL CSA, in situ stiffness, and bundle contribution were similar between boars and barrows. The barrows had smaller temporal increases in AM bundle function than boars, but these data were highly variable. Early and sustained loss in testosterone leads to subtle differences in ACL morphology but may not influence measures associated with increased injury risk, such as CSA or bundle forces in response to applied loads.
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Affiliation(s)
- Jacob D. Thompson
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, Raleigh, NC 27695; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
| | - Danielle Howe
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, Raleigh, NC 27695; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
| | - Emily H. Griffith
- Department of Statistics, North Carolina State University, Raleigh, NC 27695
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, 4130 Engineering Building III, 1840 Entrepreneur Drive, CB 7115, Raleigh, NC 27695; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695; Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
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Inoue Y, Tamura A, Misu S. Age of Adolescent Female Soccer Players at First Ankle Sprain and Menarche. Prog Rehabil Med 2023; 8:20230042. [PMID: 38034061 PMCID: PMC10682156 DOI: 10.2490/prm.20230042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives : To provide targeted interventions for the prevention of first ankle sprains, this study determined the prevalence of ankle sprains in female adolescent soccer players and analyzed the correlation between the age at the first occurrence of ankle sprain and the age at menarche. Methods : The study included 131 female participants from three club teams. The mean age was 13.37 ± 0.96 years. A survey was conducted using a questionnaire that requested information regarding the age at which the first ankle sprain occurred, age at menarche, status of ankle problems, extent to which the ankle joint problem affected playing ability, use of medical facilities or other healthcare facilities for the first or recurrent ankle sprains, and methods used to care for their ankle. Results Ankle sprains most commonly occurred for the first time at 12 years, followed by the ages of 13, 10, and 11 years. About 25% of participants experienced their first ankle sprain at the age of menarche, 20% at 1 year after menarche, and 16% a year before menarche. The incidence of the first ankle sprain was high in the second and fifth years after starting to play soccer. Medical treatment was rarely received for the second or subsequent injury, although 36% had some sequelae. Conclusions Adolescent female soccer players were not injured early in their soccer careers. Most players experienced their first ankle sprain at the age of 12 years, which was at or close to the age of menarche.
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Affiliation(s)
- Yuri Inoue
- Department of Physical Therapy, Faculty of Nursing and
Rehabilitation, Konan Women’s University, Kobe, Japan
| | - Akihiro Tamura
- Department of Physical Therapy, School of Health Sciences at
Narita, International University of Health and Welfare, Narita, Japan
- Research Institute for Health and Sport Science, Nippon
Sport Science University, 7-1-1 Fukasawa, Setagaya, Tokyo 158-8508, Japan
| | - Shogo Misu
- Department of Physical Therapy, Faculty of Nursing and
Rehabilitation, Konan Women’s University, Kobe, Japan
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Piasecki J, Guo Y, Jones EJ, Phillips BE, Stashuk DW, Atherton PJ, Piasecki M. Menstrual Cycle Associated Alteration of Vastus Lateralis Motor Unit Function. SPORTS MEDICINE - OPEN 2023; 9:97. [PMID: 37874413 PMCID: PMC10597975 DOI: 10.1186/s40798-023-00639-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Estrogen and progesterone are the primary female sex hormones and have net excitatory and inhibitory effects, respectively, on neuronal function. Fluctuating concentrations across the menstrual cycle has led to several lines of research in relation to neuromuscular function and performance; however evidence from animal and cell culture models has yet to be demonstrated in human motor units coupled with quantification of circulating hormones. Intramuscular electromyography was used to record motor unit potentials and corresponding motor unit potential trains from the vastus lateralis of nine eumenorrheic females during the early follicular, ovulation and mid luteal phases of the menstrual cycle, alongside assessments of neuromuscular performance. Multi-level regression models were applied to explore effects of time and of contraction level. Statistical significance was accepted as p < 0.05. RESULTS Knee extensor maximum voluntary contraction, jump power, force steadiness, and balance did not differ across the menstrual phases (all p > 0.4). Firing rate of low threshold motor units (10% maximum voluntary contraction) was lower during the ovulation and mid luteal phases (β = - 0.82 Hz, p < 0.001), with no difference in motor unit potentials analysed from 25% maximum voluntary contraction contractions. Motor unit potentials were more complex during ovulation and mid luteal phase (p < 0.03), with no change in neuromuscular junction transmission instability (p > 0.3). CONCLUSIONS Assessments of neuromuscular performance did not differ across the menstrual cycle. The suppression of low threshold motor unit firing rate during periods of increased progesterone may suggest a potential inhibitory effect and an alteration of recruitment strategy; however this had no discernible effect on performance. These findings highlight contraction level-dependent modulation of vastus lateralis motor unit function over the eumenorrheic cycle, occurring independently of measures of performance.
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Affiliation(s)
- Jessica Piasecki
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, Nottingham Trent University, Nottingham, UK.
| | - Yuxiao Guo
- Centre of Metabolism, Ageing and Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Eleanor J Jones
- Centre of Metabolism, Ageing and Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Bethan E Phillips
- Centre of Metabolism, Ageing and Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Daniel W Stashuk
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Philip J Atherton
- Centre of Metabolism, Ageing and Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mathew Piasecki
- Centre of Metabolism, Ageing and Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
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Jackson GR, Lee J, Tuthill T, Chan J, Sugrañes J, Mowers CC, Batra A, Khan ZA, Mameri ES, Brusalis CM, Chahla J, Verma NN. Higher Rates of Residual Postoperative Instability after Anterior Cruciate Ligament Reconstruction in Female Patients: A Systematic Review of Level II Studies. Arthrosc Sports Med Rehabil 2023; 5:100772. [PMID: 37560145 PMCID: PMC10407150 DOI: 10.1016/j.asmr.2023.100772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/03/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE To compare revision rates and residual postoperative instability after anterior cruciate ligament (ACL) reconstruction based on biological sex. METHODS A systematic review was conducted according to the 2020 PRISMA guidelines. PubMed, Embase, MEDLINE, and Cochrane library databases were queried from database inception through October 2022. Level I and II prospectively-enrolling human clinical studies that compared revision rates and physical examination of postoperative stability after ACL reconstruction between male and female patients were included. Outcomes were stratified by patient sex and quantitatively compared using a χ2 test. Study quality was assessed using the MINORS criteria. RESULTS Four studies consisting of 406 patients (50% males) with a mean age of 25 years (range, 13.9-62 years) were identified. Mean follow-up time was 34.4 months (range, 22-60 months). Hamstring tendon autografts were used in 62% of ACL reconstructions in males and in 65% of ACL reconstructions in females, whereas bone-patellar tendon-bone autografts were used in 38% and 35% of procedures in males and females, respectively. A residual positive Lachman test result was more frequently reported among females compared to males (5.8% vs 0.6%; P = 0.03). No significant difference in revision rates or residual pivot-shift on examination was observed between males and females (P = 0.38 and P = 0.08, respectively). CONCLUSION Female patients undergoing ACL reconstruction have higher reported rates of residual anterior instability with Lachman than male patients. However, no sex-based differences were identified with residual pivot-shift on examination or rate of revision ACL surgery. LEVEL OF EVIDENCE II; Systematic Review of level II studies.
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Affiliation(s)
- Garrett R. Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jonathan Lee
- Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Trevor Tuthill
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jimmy Chan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Joan Sugrañes
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- Department of Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Colton C. Mowers
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Anjay Batra
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Zeeshan A. Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Enzo S. Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- Instituto Brasil de Tecnologia da Saúde, Rio de Janeiro
- Department of Orthopedics and Traumatology, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | | | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nikhil N. Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Cerminaro RM, Gardner HM, Shultz SJ, Dollar JM, Wideman L, Duffy DM. The Accuracy of Early Reproductive History and Physical Activity Participation Recall Across Multiple Age Ranges. J Womens Health (Larchmt) 2023. [PMID: 36939903 DOI: 10.1089/jwh.2022.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Background: The ability to accurately recall specific reproductive health events is an integral aspect of medical decision making and evaluating a female's overall health and wellness across their lifespan. The Health and Reproductive Survey (HeRS) was developed to recall reproductive events and environmental influences on reproductive characteristics throughout the lifespan of a female. This study aimed to determine how reliably women recall certain events during menarche and early reproductive years. It was hypothesized that age at menarche, hormonal contraceptive use, and physical activity would be recalled reliably among all age ranges, while the recall reliability for cycle regularity and length would be more inconsistent with advancing age. Materials and Methods: A total of 144 participants (age: 32.73 ± 11.92), completed the HeRS on two occasions spaced 4 months apart to investigate recall reliability. Cohen's kappa coefficient was used to assess the consistency of categorical responses and 95% limits of agreement were used for continuous data. Results: Although physical activity changes had greater variability than anticipated (0.79), the recall reliability among the youngest (1) and oldest (0.89) age groups was high, and females were able to consistently recall the age of menarche (0.83), physical activity level (0.9), cessation of period during early reproductive years (0.91), and birth control use following menarche (0.85) and during the early reproductive years (0.9). Conclusions: The HeRS is a useful tool for reliably recalling reproductive history and physical activity participation across multiple age ranges and can be utilized to gather crucial information throughout the reproductive lifespan.
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Affiliation(s)
- Rebecca M Cerminaro
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.,School of Health of Human Sciences, Center for Women's Health and Wellness, UNCG, Greensboro, North Carolina, USA
| | - Hanna M Gardner
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.,School of Health of Human Sciences, Center for Women's Health and Wellness, UNCG, Greensboro, North Carolina, USA
| | - Jessica M Dollar
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.,School of Health of Human Sciences, Center for Women's Health and Wellness, UNCG, Greensboro, North Carolina, USA
| | - Laurie Wideman
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Donna M Duffy
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Miyamoto D, Saito A, Kimoto M, Terui Y, Okada K. Relationship between the knee valgus moment and the hip abductor and adductor activity during single-leg landing. Phys Ther Sport 2023; 61:129-134. [PMID: 37023591 DOI: 10.1016/j.ptsp.2023.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVES To reveal the relationship between the knee valgus moment (KVM) and the hip abductor and adductor activity during single-leg landing. DESIGN A cross-sectional study. SETTING Laboratory-based, between April 2020 and May 2021. PARTICIPANTS Thirty female collegiate athletes. MAIN OUTCOME MEASURES KVM, hip adduction angle, hip internal rotation angle, knee valgus angle (KVA), gluteus medius muscle activity, adductor longus muscle activity, adductor longus to gluteus medius activity ratio (ADD/GMED), and vertical component of the ground reaction force (vGRF). RESULTS Stepwise multiple regression analysis was performed. KVM was significantly positively associated with KVA (β = 0.613, p < 0.001), vGRF (β = 0.367, p = 0.010), and ADD/GMED (β = 0.289, p = 0.038). CONCLUSIONS Increased KVA, vGRF, and ADD/GMED were the independent factors that contributed to increased KVM during single-leg landing, and only ADD/GMED was found among the muscle activity values. The relative muscle activity of the gluteus medius and adductor longus, rather than those of the gluteus medius or adductor longus alone, may be useful in preventing anterior cruciate ligament injury during single-leg landing.
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Thompson JD, Howe D, Griffith EH, Fisher MB. Neo-natal castration leads to subtle differences in porcine anterior cruciate ligament morphology and function in adolescence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.24.524954. [PMID: 36747760 PMCID: PMC9900825 DOI: 10.1101/2023.01.24.524954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Female adolescent athletes are at a higher risk of tearing their anterior cruciate ligament (ACL) than male counterparts. While most work related to hormones has focused on the effects of estrogen to understand the increased risk of ACL injury, there are other understudied factors, including testosterone. The purpose of this study was to determine how surgical castration in the male porcine model influences ACL size and function across skeletal growth. Thirty-six male Yorkshire crossbreed pigs were raised to 3 (juvenile), 4.5 (early adolescent), and 6 months (adolescent) of age. Animals were either castrated (barrows) within 1-2 weeks after birth or were left intact (boars). Post-euthanasia, joint and ACL size were assessed via MRI, and biomechanics were assessed via a robotic testing system. Joint size increased throughout age, yet barrows had smaller joints than boars (p<0.001 for all measures). ACL cross-sectional area (CSA), length, volume, and stiffness increased with age (p<0.0001), as did ACL anteromedial (AM) bundle percent contribution to resisting loads (p=0.012). Boar ACL, AM bundle, and PL bundle volumes were 19% (p=0.002), 25% (p=0.003), and 15% (p=0.04) larger than barrows across ages. However, CSA, stiffness, and bundle contribution were similar between boars and barrows (p>0.05). The barrows had smaller temporal increases in AM bundle percent function than boars, but these data were highly variable. Thus, early and sustained loss in testosterone leads to subtle differences in ACL morphology, but may not influence measures associated with increased injury risk, such as CSA or bundle forces in response to applied loads.
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Martínez-Fortuny N, Alonso-Calvete A, Da Cuña-Carrera I, Abalo-Núñez R. Menstrual Cycle and Sport Injuries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3264. [PMID: 36833966 PMCID: PMC9958828 DOI: 10.3390/ijerph20043264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
The presence of female athletes has only increased in recent years, as has the incidence of injuries in female sports activities. These injuries are conditioned by multiple factors, including hormonal agents. It is estimated that the menstrual cycle may be related to the predisposition to suffer an injury. However, a causal relationship has not yet been established. The aim of this study was to analyse the relationship between the menstrual cycle and injuries in female sports practice. A systematic search of the scientific literature available in PubMed, Medline, Scopus, Web of Science, and Sport Discus was carried out in January 2022. With 138 articles, only eight studies were found that met the selection criteria for this study. Peak estradiol is associated with increased laxity, strength, and poor use of neuromuscular control. Thus, the ovulatory phase is associated with an increased risk of injury. In conclusion, it seems that hormonal fluctuations throughout the menstrual cycle alter values such as laxity, strength, body temperature, and neuromuscular control, among others. This fact causes women to constantly adapt to hormonal variations, which exposes them to a higher risk of injury.
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Affiliation(s)
| | - Alejandra Alonso-Calvete
- Facultade de Fisioterapia, Universidade de Vigo, 36005 Pontevedra, Spain
- REMOSS Research Group, Universidade de Vigo, 36005 Pontevedra, Spain
| | - Iria Da Cuña-Carrera
- Facultade de Fisioterapia, Universidade de Vigo, 36005 Pontevedra, Spain
- Fisioterapia Clínica (FS1) Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, 36005 Pontevedra, Spain
| | - Rocío Abalo-Núñez
- Facultade de Fisioterapia, Universidade de Vigo, 36005 Pontevedra, Spain
- Fisioterapia Clínica (FS1) Research Group, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, 36005 Pontevedra, Spain
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13
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Liu Y, Rodeo SA, Deng XH, Song Z, Chen D, Casey E. Evaluation of sex differences in rodent anterior cruciate ligament injury. J Orthop Res 2023; 41:32-43. [PMID: 35451139 DOI: 10.1002/jor.25346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/31/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
The relative contributions of sex differences in anatomy, biomechanics, and hormones to the increased risk of anterior cruciate ligament (ACL) injury in female athletes remains unknown. The purpose of this study is to investigate sex differences in anatomy and biomechanics of the native and reconstructed ACL using our established murine model. A total of 140 12-week-old wild-type C57Bl/6 (70 male vs. 70 female) mice were used for this study. ACL reconstruction was performed on 120 mice who were split into four groups: Group 1 (30 males sacrificed at 14 days), Group 2 (30 females sacrificed at 14 days), Group 3 (30 males sacrificed at 28 days), and Group 4 (30 females sacrificed at 28 days). Tendon graft-to-bone healing was assessed by biomechanical, histological, and micro-CT analysis. Twenty mice were used for baseline testing. Females showed significantly higher anterior (p < 0.05) and total displacement (p < 0.05). Males demonstrated a significantly higher load-to-failure force of native ACLs compared to females (p < 0.05). There was no significant difference in load-to-failure force in the ACL autograft. There were no significant sex differences in histological analysis of graft integration or tibial slope. The increased knee laxity and reduced load-to-failure of the native ACL observed in the female mice are consistent with some of the proposed risk factors driving the increased risk of ACL injury in females. Understanding the relative contributions of factors driving sex differences in material properties of the ACL will provide insight into the sex differences in ACL injury and future prevention strategies.
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Affiliation(s)
- Yake Liu
- Hospital for Special Surgery, New York, New York, USA.,The Affiliate Hospital to Nantong University, Nantong, Jiangsu, China
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
| | | | - Zhe Song
- Hospital for Special Surgery, New York, New York, USA
| | - Daoyun Chen
- Hospital for Special Surgery, New York, New York, USA
| | - Ellen Casey
- Hospital for Special Surgery, New York, New York, USA
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14
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Romer C, Czupajllo J, Zessin E, Fischer T, Wolfarth B, Lerchbaumer MH. Stiffness of Muscles and Tendons of the Lower Limb of Professional and Semiprofessional Athletes Using Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3061-3068. [PMID: 35900250 DOI: 10.1002/jum.16062] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Shear wave elastography (SWE) allows assessment of muscle and tendon stiffness and can be used to diagnose soft tissue pathologies such as tendinopathies. In sports medicine, SWE may have the potential to uncover structural changes early on before they lead to functional impairment. To systematically analyze possible differences in tendon and muscle stiffness of the lower limb between professional (PG) and semiprofessional female athletes (SG) using SWE and to compile reference values for developing preventive medicine approaches for professional athletes. METHODS Standardized SWE of both lower limb tendons and muscles (Achilles tendon [AT], soleus muscle insertion [SM], patellar tendon [PT], quadriceps tendon [QT], vastus medialis muscle [VM]) in the longitudinal plane was performed with the tendons in relaxed position in 24 healthy professional female athletes (PG) in comparison with 24 healthy semiprofessional female athletes (SG). RESULTS Median tendon and muscle stiffness was significantly higher in professional athletes (AT:PG, 11.12 m/s vs SG, 7.33 m/s, P < .001; SM: 1.77 m/s vs 1.14 m/s, P < .001; VM: 1.63 m/s vs 0.87 m/s, P < .001; QT: 3.31 m/s vs 2.61 m/s, P < .05). There was no significant difference in patellar tendon stiffness between PG and SG (PT: 2.57 m/s vs 3.21, P = .25). CONCLUSION Professional female athletes have higher stiffness values than semiprofessional female athletes in lower limb muscles and tendons, except for the patellar tendon. Knowledge of such differences is necessary for diagnosing tendinopathy and injuries. Musculoskeletal SWE could offer great benefits in sports medicine as well as in rehabilitation and preventive medicine.
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Affiliation(s)
- Claudia Romer
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Czupajllo
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Enrico Zessin
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bernd Wolfarth
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Markus H Lerchbaumer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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15
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Edison BR, Pandya N, Patel NM, Carter CW. Sex and Gender Differences in Pediatric Knee Injuries. Clin Sports Med 2022; 41:769-787. [DOI: 10.1016/j.csm.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Römer C, Czupajllo J, Wolfarth B, Lerchbaumer MH, Legerlotz K. Effects of orally administered hormonal contraceptives on the musculoskeletal system of healthy premenopausal women-A systematic review. Health Sci Rep 2022; 5:e776. [PMID: 35957969 PMCID: PMC9364327 DOI: 10.1002/hsr2.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/12/2022] [Accepted: 07/17/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction The musculoskeletal system (MSK) is one of the extragonadal target tissues of sex hormones: osteoblasts and osteocytes express estrogen receptors, while in fibroblasts of the anterior cruciate ligament (ACL) and myocytes of the vastus lateralis muscle (MVL), estrogen and progesterone receptors can be detected by immunoassay. Indeed, upon binding of sex hormones to the extragonadal receptors, the MSK seems to respond to varying levels of sex hormones with structural adaptation. Hormonal contraceptives can affect the musculoskeletal system; however, there is a lack of high-quality studies, and no recommendation for female athletes exists. Material and Methods This is a systematic review of publications on the effects of oral hormonal contraceptives on the biomechanical properties of tendons, muscles and ligaments, muscle strength, and soft tissue regeneration. A systematic database search was performed using MESH keywords and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology in Pubmed and Cochrane to identify studies investigating the influence of oral hormonal contraceptives on muscles, tendons, and ligaments of healthy, adult, premenopausal women. The risk of bias in the studies included was assessed by two independent researchers using the ROBINS-I Tool. Results Nine comparative studies were identified that met the inclusion criteria. Endpoints were muscle strength and biomechanical tissue properties. No significant influence of oral hormonal contraceptives on muscle strength was found, although general muscle growth and Type I fiber growth were found to be significantly increased in a dose-dependent manner. There was a negative effect on regeneration of muscle strength after exercise. The stiffness of tendons remained unchanged, while their size adaptation to load increased. Conclusion The anabolic effect could be beneficial for specific sports, whereas reduced muscle regeneration could be disadvantageous for women exercising with high-performance demands. The different effects on tendons and ligaments and the functional consequences of altered ligament and muscle stiffness, especially with regard to synthetic hormones, should be further investigated.
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Affiliation(s)
- Claudia Römer
- Department of Sports Medicine, Charité—University Medicine BerlinHumboldt‐University of BerlinBerlinGermany
| | - Julia Czupajllo
- Department of Sports Medicine, Charité—University Medicine BerlinHumboldt‐University of BerlinBerlinGermany
| | - Bernd Wolfarth
- Department of Sports Medicine, Charité—University Medicine BerlinHumboldt‐University of BerlinBerlinGermany
| | - Markus H. Lerchbaumer
- Department of RadiologyCharité—University Medicine Berlin, Humboldt‐University of BerlinBerlinGermany
| | - Kirsten Legerlotz
- Movement Biomechanics, Institute of Sport SciencesHumboldt‐University of BerlinBerlinGermany
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17
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King DA, Hume PA, Hind K, Clark TN, Hardaker N. The Incidence, Cost, and Burden of Concussion in Women's Rugby League and Rugby Union: A Systematic Review and Pooled Analysis. Sports Med 2022; 52:1751-1764. [PMID: 35113388 PMCID: PMC9325800 DOI: 10.1007/s40279-022-01645-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The extent of concussion injury in the rugby codes for women is unclear. OBJECTIVE Our aim was to review all published studies reporting concussion injuries from match and training participation in rugby codes and report the pooled data estimates for rugby league and union concussion injury epidemiology. METHODS We conducted a systematic literature analysis of concussion in rugby league and rugby union for published studies from January 1990 to July 2021. Data from 16 studies meeting the inclusion criteria were extracted for women's concussion injuries and were subsequently pooled. Costs from Accident Compensation Corporation (ACC) data were attributed to the results to provide cost estimates. RESULTS The pooled analysis match injury incidence of women's concussion was higher for rugby league (10.3 per 1000 match hours) than rugby 15 s (2.8 per 1000 match hours) or rugby 7 s (8.9 per 1000 match hours). There was a fourfold difference in the pooled incidence of concussion in women's rugby league (risk ratio [RR] 4.53, 95% confidence interval [CI] 1.8-11.3]; p = 0.0001) when compared with rugby 15 s. There was also a ninefold higher risk of a concussion during match participation compared with training participation for women's rugby 15 s (RR 9.3, 95% CI 1.29-66.78; p = 0.0070). The total estimated costs for the concussions reported were NZ$1,235,101. For rugby 7 s, the pooled concussive injury burden was 33.2 days. CONCLUSIONS Our pooled analysis clarified the extent of concussion injury and the possible associated costs at several levels of the game for women's rugby codes. The pooled mean days lost because of concussions was 33 days. As this was considerably longer than the 7- to 10-day expected timeframe outlined in the Concussion in Sport Consensus statement, these guidelines need to be updated to include sex-specific differences.
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Affiliation(s)
- Doug A King
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand.
- Traumatic Brain Injury Network (TBIN), Auckland University of Technology, Auckland, New Zealand.
- School of Science and Technology, University of New England, Armidale, NSW, Australia.
- Wolfson Research Institute for Health and Wellbeing, Department of Sport and Exercise Sciences, Durham University, Durham, UK.
- Emergency Department, Hutt Valley District Health Board, Private Bag 31-907, Lower Hutt, New Zealand.
| | - Patria A Hume
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
- Traumatic Brain Injury Network (TBIN), Auckland University of Technology, Auckland, New Zealand
- National Institute of Stroke and Applied Neuroscience (NISAN), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - Karen Hind
- Wolfson Research Institute for Health and Wellbeing, Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Trevor N Clark
- Faculty of Sport, Event Management, Tourism and Hospitality, International College of Management Sydney, Manly, NSW, Australia
| | - Natalie Hardaker
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
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18
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Ellison TM, Flagstaff I, Johnson AE. Sexual Dimorphisms in Anterior Cruciate Ligament Injury: A Current Concepts Review. Orthop J Sports Med 2022; 9:23259671211025304. [PMID: 34993256 PMCID: PMC8725014 DOI: 10.1177/23259671211025304] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/28/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Although most anterior cruciate ligament (ACL) injuries occur in male athletes, female athletes are consistently observed to be at a higher risk for sports-specific ACL injury. Purpose: To provide a thorough review of what is known about the sexual dimorphisms in ACL injury to guide treatment and prevention strategies and future research. Study Design: Narrative review. Methods: We conducted a comprehensive literature search for ACL-related studies published between January 1982 and September 2017 to identify pertinent studies regarding ACL injury epidemiology, prevention strategies, treatment outcomes, and dimorphisms. By performing a broad ACL injury search, we initially identified 11,453 articles. After applying additional qualifiers, we retained articles if they were published in English after 1980 and focused on sex-specific differences in any of 8 different topics: sex-specific reporting, difference in sports, selective training, hormonal effects, genetics, neuromuscular and kinematic control, anatomic differences, and outcomes. Results: A total of 122 articles met the inclusion criteria. In sum, the literature review indicated that female athletes are at significantly higher risk for ACL injuries than are their male counterparts, but the exact reasons for this were not clear. Initial studies focused on intrinsic differences between the sexes, whereas recent studies have shifted to focus on extrinsic factors to explain the increased risk. It is likely both intrinsic and extrinsic factors contribute to this increased risk, but further study is needed. In addition to female patients having an increased risk for ACL injuries, they are less likely than are male patients to undergo reconstructive surgery, and they experience worse postsurgical outcomes. Despite this, reconstructive surgery remains the gold standard when knee stability, return to sports, and high functional outcome scores are the goal, but further research is needed to determine why there is disparity in surgical rates and what surgical techniques optimize postsurgical outcomes for female patients. Conclusion: Male athletes often predominated the research concerning ACL injury and treatment, and although sex-specific reporting is progressing, it has historically been deficient. ACL injuries, prevention techniques, and ACL reconstruction require further research to maximize the health potential of at-risk female athletes.
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Affiliation(s)
- Tayt M Ellison
- Department of Orthopaedics, San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas, USA
| | - Ilexa Flagstaff
- Department of Orthopaedics, University of Minnesota, Minneapolis, Minnesota, USA
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19
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The effect of the menstrual cycle on collagen metabolism, growth hormones and strength in young physically active women. Biol Sport 2021; 38:721-728. [PMID: 34937983 PMCID: PMC8670799 DOI: 10.5114/biolsport.2021.107314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/04/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to investigate the effect of the menstrual cycle on strength, functioning of the GH/IGF-1 axis and collagen metabolism in physically active women. Twenty-four physically active and eumenorrheic women volunteered to participate in the study (body mass 60.3 ± 9.18 kg, age 21.8 ± 0.92 years). Blood samples were obtained between the 5th and 8th days (the follicular phase) and between the 19th and 22th days (the luteal phase) of the menstrual cycle to determine sex steroid concentrations (follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), oestradiol (E2) and progesterone (P)). Also insulin-like growth factor 1 (IGF-1) and collagen metabolism markers (synthesis (PICP) and breakdown (ICTP)) and maximum voluntary contraction (MVC) were measured. MVC was higher in the luteal phase 164.1 ± 34.77 [N m] (F(1.23) = 4.59; p = 0.043). The recorded collagen synthesis marker (PICP = 296.4 ± 35.61 [ng/ml]) was at the upper level of the reference range (30-300), with an insignificant decrease in the luteal phase (Z = 1.612; p = 0.107) and a significant increase in oestradiol concentration (Z = 4.286; p = 0.0001). The marker of collagen breakdown (ICTP = 4.16 ± 0.68 [μg/l]) was reduced by 6.8% in the same phase (Z = 1.764; p = 0.137). The variability of physical abilities (MVC) during the menstrual cycle showed that menstrual status should be taken into account in determination of the training loads. Increasing the load in the luteal phase seems to be favoured by a beneficial change in collagen metabolism (lower synthesis decrease, lower breakdown increase) observed in physically active women.
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20
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Spinella G, Arcamone G, Valentini S. Cranial Cruciate Ligament Rupture in Dogs: Review on Biomechanics, Etiopathogenetic Factors and Rehabilitation. Vet Sci 2021; 8:vetsci8090186. [PMID: 34564580 PMCID: PMC8472898 DOI: 10.3390/vetsci8090186] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 01/13/2023] Open
Abstract
Cranial cruciate ligament (CrCL) rupture is one of the most common orthopaedic conditions in veterinary medicine. CrCL plays a fundamental role in the stability and biomechanics of the femoral-tibio-patellar joint, and its incorrect functionality severely impacts on the quality of life of patients. In dogs, the structural weakening of this joint due to the progressive degeneration of the ligament is the most accredited etiopathogenetic hypothesis in relation to the dog signalment (breed, sex and age) and the stifle joint conformation. In humans, this injury is often traumatic and generally occurs during sporting activities. CrCL rupture can be managed conservatively or surgically, and decisions regarding treatment are due to numerous factors: the patient’s age and health, the degree of stifle instability, and cost. Physiotherapy protocols play an important role in rehabilitation, with similar goals in humans and dogs: pain management, physiological articular range of motion recovery, periarticular and core muscle strengthening, and proprioceptive deficit correction. Physiotherapy, even if often neglected in veterinary medicine, is mandatory for the recovery of the correct functionality of the injured limb and for the return to normal daily and sporting activities.
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21
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Cejudo A, Ruiz-Pérez I, Hernández-Sánchez S, De Ste Croix M, Sainz de Baranda P, Ayala F. Comprehensive Lower Extremities Joints Range of Motion Profile in Futsal Players. Front Psychol 2021; 12:658996. [PMID: 34194363 PMCID: PMC8236511 DOI: 10.3389/fpsyg.2021.658996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/17/2021] [Indexed: 01/28/2023] Open
Abstract
The purposes of this study were to describe the lower extremities joints range of motion (ROM) profile using a comprehensive approach in futsal players and to examine potential player position (goalkeepers vs. outfield players), competitive level (first [top] division vs. second division), number of playing years, sex (males vs. females), and bilateral (dominant limb vs. non-dominant limb) differences. A total of 72 male and 67 female elite futsal players from 11 clubs were measured of passive hip (flexion with knee flexed [HFKF] and extended [HFKE], extension [HE], abduction [HA], external [HER], and internal [HIR] rotation), knee (flexion [KF]) and ankle (dorsiflexion with knee flexed [ADFKF] and extended [ADFKE]) ROMs. Bayesian inferences exploring differences between player position, competitive level, sex and limb were made. A Bayesian correlation analysis was conducted to explore the influence of playing years on joints ROMs. The results showed no significant player position or competitive level related differences in any average ROM score. However, statistically significant sex-related differences were documented whereby female players reported higher hip and knee joints ROM average values than their male counterparts. Especially relevant were the proportions of males (72%) and players from teams engaged in the second division (61%) displaying limited HFKE ROMs. Likewise, around 35% of all players showed restricted ADFKF ROMs. In addition, approximately 21, 18, 22, and 25% of the futsal players were identified as having bilateral asymmetries (≥8°) for HA, HIR, HER, and KF ROMs, respectively. Finally, Bayesian correlation analysis did not report any significant association between years of playing futsal and ROM measures (all r values < 0.34). The implications that these restricted HFKE and ADFKF ROMs and bilateral asymmetries in hip (abduction, internal and external rotation) and knee (flexion) ROMs caused by the practice of futsal may have on physical performance and injury risk warrant future research.
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Affiliation(s)
- Antonio Cejudo
- Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain
| | - Iñaki Ruiz-Pérez
- Department of Sport Sciences, Sports Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Sergio Hernández-Sánchez
- Department of Pathology and Surgery, Physiotherapy Area, Miguel Hernandez University of Elche, Alicante, Spain
| | - Mark De Ste Croix
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Pilar Sainz de Baranda
- Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain
| | - Francisco Ayala
- Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain.,School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom.,Ramón y Cajal Postdoctoral Fellowship, Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Murcia, Spain
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22
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Patel AD, Bullock GS, Wrigley J, Paterno MV, Sell TC, Losciale JM. Does sex affect second ACL injury risk? A systematic review with meta-analysis. Br J Sports Med 2021; 55:873-882. [PMID: 34001504 DOI: 10.1136/bjsports-2020-103408] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine sex-based differences in risk of a second ACL injury (overall and by laterality) following primary ACL reconstruction in athletes who are attempting to return to sport. DESIGN Systematic review with meta-analysis. DATA SOURCES Systematic search of five databases conducted in August 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies reporting sex-based differences in the incidence of second ACL injury in athletes attempting to return-to-sports and who were followed for at least 1 year following primary ACL reconstruction. RESULTS Nineteen studies were included in this review, with seven studies excluded from the primary meta-analysis due to high risk of bias. The remaining 12 studies (n=1431 females, n=1513 males) underwent meta-analysis, with all 19 studies included in a sensitivity analysis. Total second ACL injury risk was 21.9% (females: 22.8%, males: 20.3%). Females were found to have 10.7% risk of an ipsilateral ACL injury and 11.8% risk of a contralateral ACL injury. Males were found to have 12.0% risk of an ipsilateral ACL injury and 8.7% risk of a contralateral ACL injury. No statistically significant differences were observed for total second ACL injury risk (risk difference=-0.6%, 95% CI -4.9 to 3.7, p=0.783, I2=41%) or contralateral ACL injury risk (risk difference=1.9%, 95% CI -0.5% to 4.4%, p=0.113, I2=15%) between sexes. Females were found to have a 3.4% absolute risk reduction in subsequent ipsilateral ACL injury risk compared with males (risk difference=-3.4%, 95% CI -6.7% to -0.02%, p=0.037, I2=35%). CONCLUSION Both sexes have >20% increased risk of experiencing a second ACL injury. Any difference in the absolute risk of either a subsequent ipsilateral or contralateral ACL injury between sexes appears to be small. REGISTRATION PROSPERO (CRD42020148369).
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Affiliation(s)
- Akash D Patel
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Garrett S Bullock
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jordan Wrigley
- Duke University Medical Center, Durham, North Carolina, USA
| | - Mark V Paterno
- Division of Occupational Therapy and Physical Therapy, Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Timothy C Sell
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Justin M Losciale
- Faculty of Medicine, Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada .,Arthritis Research Canada, Vancouver, British Columbia, Canada
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23
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Detherage JP, Divine JG, Donaworth MA, Palmer TG, Hagen JA, Hasselfeld KA, Eifert-Mangine M, Mangine RE, Clark JF, Grawe BM. Physiological Monitoring Detected Changes During Women's Soccer Anterior Cruciate Ligament Injury. Cureus 2021; 13:e14838. [PMID: 34123609 PMCID: PMC8191855 DOI: 10.7759/cureus.14838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A growing number of studies utilizing wearable technologies are examining the influence of the autonomic nervous system (ANS) on intense training, recovery, and injury risk. Exercise biometric (EB) data were collected on collegiate, female soccer players during a preseason camp. One player sustained an anterior cruciate ligament (ACL) injury. Baseline anthropometric and EB data were compared to non-injured, position-matched teammates. All players had similar baseline testing. The injured athlete had a higher body mass index (BMI) and slower vision reaction time (RT). On the day of her injury (DOI), relative percentage heart rate recovery (tHRR) between intense training sets was calculated. Relative percentage tHRR was much lower for the injured athlete, indicating reduced recovery between training sets immediately prior to the injury. Also on DOI, the injured athlete had a lower glomerular filtration rate (GFR). In addition to BMI and RT differences, the lower relative percentage tHRR and GFR on the DOI observed for the injured athlete may reflect an imbalanced ANS recovery, and potentially to risk factors leading to her ACL injury.
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Affiliation(s)
- John P Detherage
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Jon G Divine
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Michael A Donaworth
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Thomas G Palmer
- Department of Rehabilitation Sciences, University of Cincinnati, Cincinnati, USA
| | - Joshua A Hagen
- Human Performance Innovation Center, Wright-Patterson Air Force Base, Dayton, USA
| | - Kimberly A Hasselfeld
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, USA
| | | | - Robert E Mangine
- Department of Athletics, NovaCare Rehabilitation, University of Cincinnati, Cincinnati, USA
| | - Joseph F Clark
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Brian M Grawe
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, USA
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Acute Effects of a High Volume vs. High Intensity Bench Press Protocol on Electromechanical Delay and Muscle Morphology in Recreationally Trained Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094874. [PMID: 34063665 PMCID: PMC8124453 DOI: 10.3390/ijerph18094874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/17/2022]
Abstract
The purpose of the present investigation was to compare the acute responses on muscle architecture, electromechanical delay (EMD) and performance following a high volume (HV: 5 sets of 10 reps at 70% of 1 repetition maximum (1RM)) and a high intensity (HI: 5 sets of 3 reps at 90% of 1RM) bench press protocol in women. Eleven recreationally trained women (age = 23.3 ± 1.8 y; body weight = 59.7 ± 6.0 kg; height = 164.0 ± 6.3 cm) performed each protocol in a counterbalanced randomized order. Muscle thickness of pectoral (PEC MT) and triceps muscles (TR MT) were collected prior to and 15 min post each trial. In addition, EMD of pectoral (PEC EMD) and triceps (TR EMD) muscles were calculated during isometric bench press maximum force tests performed at the same timepoints (IBPF). Significantly greater increases in PEC MT (p < 0.001) and TR MT (p < 0.001) were detected following HV compared to HI. PEC EMD showed a significantly greater increase following HV compared to HI (p = 0.039). Results of the present study indicate that the HV bench press protocol results in greater acute morphological and neuromuscular changes compared to a HI protocol in women. Evaluations of muscle morphology and electromechanical delay appear more sensitive to fatigue than maximum isometric force assessments.
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Gilotra MN, Fridman J, Enobun B, Kuntz AF, Glaser DL, Huffman GR. Risk factors associated with atraumatic posterolateral rotatory instability. JSES Int 2021; 5:827-833. [PMID: 34223438 PMCID: PMC8245999 DOI: 10.1016/j.jseint.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Traumatic posterolateral rotatory instability after elbow dislocation or fracture dislocation has been well described. However, few reports cover atraumatic posterolateral rotatory instability as a cause of lateral-sided elbow pain. We assessed the risk factors and epidemiology of atraumatic posterolateral rotatory instability in a case-control study. Methods A retrospective review of all patients treated operatively for atraumatic posterolateral rotatory instability during a 6-year period was compared with a group of patients with extensor carpi radialis brevis tendinopathy without instability treated during the same time period. Bivariate and multiple logistic regression statistical analyses were used to investigate the following risk factors: gender, age, hand dominance, diabetes, smoking, body mass index, corticosteroid injection history, and duration of symptoms. Disabilities of the Arm, Shoulder, and Hand and pain scores were obtained preoperatively and postoperatively. Results Thirteen patients with atraumatic posterolateral rotatory instability were compared with 12 patients with extensor carpi radialis brevis tendinopathy. Multivariate analysis revealed patients with atraumatic posterolateral rotatory instability were more likely to have multiple corticosteroid injections (P = .05) and present with a longer duration of symptoms (P = .03). Postoperative pain scores improved in both groups. Conclusions Atraumatic posterolateral rotatory instability should be considered in the differential diagnosis of lateral elbow when patients present with a protracted clinical course. Statistically, posterolateral rotatory instability patients more often present with a history of multiple corticosteroid injections.
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Affiliation(s)
- Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jake Fridman
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Blessing Enobun
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew F Kuntz
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - David L Glaser
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - G Russell Huffman
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Edama M, Inaba H, Hoshino F, Natsui S, Maruyama S, Omori G. The relationship between the female athlete triad and injury rates in collegiate female athletes. PeerJ 2021; 9:e11092. [PMID: 33868810 PMCID: PMC8034341 DOI: 10.7717/peerj.11092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to clarify the relationship between the triad risk assessment score and the sports injury rate in 116 female college athletes (average age, 19.8 ± 1.3 years) in seven sports at the national level of competition; 67 were teenagers, and 49 were in their 20s. Methods Those with menstrual deficiency for >3 months or <6 menses in 12 months were classified as amenorrheic athletes. Low energy availability was defined as adolescent athletes having a body weight <85% of ideal body weight, and for adult athletes in their 20s, a body mass index ≤17.5 kg/m2. Bone mineral density (BMD) was measured on the heel of the right leg using an ultrasonic bone densitometer. Low BMD was defined as a BMD Z-score <−1.0. The total score for each athlete was calculated. The cumulative risk assessment was defined as follows: low risk (a total score of 0–1), moderate risk (2–5), and high risk (6). The injury survey recorded injuries referring to the injury survey items used by the International Olympic Committee. Results In swimming, significantly more athletes were in the low-risk category than in the moderate and high-risk categories (p = 0.004). In long-distance athletics, significantly more athletes were in the moderate-risk category than in the low and high-risk categories (p = 0.004). In the moderate and high-risk categories, significantly more athletes were in the injury group, whereas significantly more athletes in the low-risk category were in the non-injury group (p = 0.01). Significantly more athletes at moderate and high-risk categories had bone stress fractures and bursitis than athletes at low risk (p = 0.023). Discussion These results suggest that athletes with relative energy deficiency may have an increased injury risk.
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Affiliation(s)
- Mutsuaki Edama
- Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan.,Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan
| | - Hiromi Inaba
- Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan.,Department of Health and Nutrition, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Japan
| | - Fumi Hoshino
- Department of Health and Nutrition, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Japan
| | - Saya Natsui
- Department of Health and Nutrition, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan
| | - Go Omori
- Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan.,Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan
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Abstract
There is an ever-evolving debate about the best treatment option for Achilles tendon ruptures. There was a relative consensus that operative treatment yielded the best outcomes. Much of this is based on results in athletic populations. Conservative treatment was considered only for the elderly and those with very inactive lifestyles. There has been an evolution, however, with more surgeons utilizing an aggressive functional rehabilitation with conservative management. Surgical intervention still is the treatment of choice for elite-level athletes. The treatment of choice for patient populations other than elite athletes remains an individual choice between patient and physician.
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Maruyama S, Yamazaki T, Sato Y, Suzuki Y, Shimizu S, Ikezu M, Kaneko F, Matsuzawa K, Hirabayashi R, Edama M. Relationship Between Anterior Knee Laxity and General Joint Laxity During the Menstrual Cycle. Orthop J Sports Med 2021; 9:2325967121993045. [PMID: 33855094 PMCID: PMC8010836 DOI: 10.1177/2325967121993045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) injury has been reported to have a higher incidence in women than in men. Purpose/Hypothesis The purpose was to examine the relationship of anterior knee laxity (AKL), stiffness, and generalized joint laxity (GJL) with respect to the menstrual cycle. It was hypothesized that AKL and GJL would increase during the ovulation phase, when estrogen levels are high. Study Design Descriptive laboratory study. Methods A total of 15 female university students aged >20 years and with normal menstrual cycles were evaluated. AKL was measured as anterior tibial displacement of the femur after application of 44-, 89-, and 133-N loads to the tibia. Stiffness was calculated as Δ force/Δ displacement at loads between 44 and 89 N and between 89 and 133 N. The University of Tokyo joint laxity test was used for evaluation of GJL. The participants' menstrual cycle was divided into the early follicular, late follicular, ovulation, and luteal phases using the basal body temperature method and an ovulation kit; AKL and GJL were measured once during each phase. Participants were also stratified according to the presence or absence of genu recurvatum (GR). Results There was no significant difference in AKL, stiffness, or GJL among the menstrual phases. In the GR group, AKL values at 89 N and 133 N were significantly higher in the ovulation phase than in the early follicular phase (P = .025 and P =.018, respectively); there were no significant differences in AKL among the phases in the non-GR group. In addition, the GR group in the ovulation phase had significantly higher AKL values at 44 N, 89 N, and 133 N compared with the non-GR group (P = .013, P = .005, and P = .010, respectively). There were no significant differences in GJL among the phases in the GR or non-GR groups. Conclusion Women with GR may have increased AKL in the ovulation phase when compared with the early follicular phase, which may be a risk factor for ACL injury. Clinical Relevance The results of this study suggest that the ovulation phase may be related to the greater incidence of ACL injuries in women.
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Affiliation(s)
- Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Tomomi Yamazaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Yuuki Sato
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Yukako Suzuki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Sohei Shimizu
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Masahiro Ikezu
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Fumiya Kaneko
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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Martin D, Timmins K, Cowie C, Alty J, Mehta R, Tang A, Varley I. Injury Incidence Across the Menstrual Cycle in International Footballers. Front Sports Act Living 2021; 3:616999. [PMID: 33733235 PMCID: PMC7956981 DOI: 10.3389/fspor.2021.616999] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: This study aimed to assess how menstrual cycle phase and extended menstrual cycle length influence the incidence of injuries in international footballers. Methods: Over a 4-year period, injuries from England international footballers at training camps or matches were recorded, alongside self-reported information on menstrual cycle characteristics at the point of injury. Injuries in eumenorrheic players were categorized into early follicular, late follicular, or luteal phase. Frequencies were also compared between injuries recorded during the typical cycle and those that occurred after the cycle would be expected to have finished. Injury incidence rates (per 1,000 person days) and injury incidence rate ratios were calculated for each phase for all injuries and injuries stratified by type. Results: One hundred fifty-six injuries from 113 players were eligible for analysis. Injury incidence rates per 1,000 person-days were 31.9 in the follicular, 46.8 in the late follicular, and 35.4 in the luteal phase, resulting in injury incidence rate ratios of 1.47 (Late follicular:Follicular), 1.11 (Luteal:Follicular), and 0.76 (Luteal:Late follicular). Injury incident rate ratios showed that muscle and tendon injury rates were 88% greater in the late follicular phase compared to the follicular phase, with muscle rupture/tear/strain/cramps and tendon injuries/ruptures occurring over twice as often during the late follicular phase compared to other phases 20% of injuries were reported as occurring when athletes were “overdue” menses. Conclusion: Muscle and tendon injuries occurred almost twice as often in the late follicular phase compared to the early follicular or luteal phase. Injury risk may be elevated in typically eumenorrheic women in the days after their next menstruation was expected to start.
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Affiliation(s)
- Dan Martin
- School of Sport and Exercise Science, University of Lincoln, Lincoln, United Kingdom
| | - Kate Timmins
- School of Sport and Exercise Science, University of Lincoln, Lincoln, United Kingdom
| | | | - Jon Alty
- The Football Association, London, United Kingdom
| | - Ritan Mehta
- The Football Association, London, United Kingdom
| | - Alicia Tang
- The Football Association, London, United Kingdom
| | - Ian Varley
- Department of Sport and Exercise Science, Nottingham Trent University, Nottingham, United Kingdom
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Somerson JS, Isby IJ, Hagen MS, Kweon CY, Gee AO. The Menstrual Cycle May Affect Anterior Knee Laxity and the Rate of Anterior Cruciate Ligament Rupture: A Systematic Review and Meta-Analysis. JBJS Rev 2020; 7:e2. [PMID: 31490339 DOI: 10.2106/jbjs.rvw.18.00198] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Women have a higher risk of anterior cruciate ligament (ACL) tears than men, the causes of which are multifactorial. The menstrual cycle and its hormonal effect on the knee may contribute to knee laxity and ACL injury. This work reviewed published studies examining the effects of the phases of the menstrual cycle on anterior knee laxity and the rate of ACL tears. METHODS A systematic review with meta-analysis and meta-regression was performed. Studies with data comparing the menstrual cycle phase with ACL injury or anterior knee laxity were included for analysis. Data with regard to patient demographic characteristics, anterior knee laxity, ACL injury, and menstrual cycle phases were extracted from the included studies. RESULTS In this study, 1,308 search results yielded 396 articles for review, of which 28 met inclusion criteria. Nineteen studies of knee laxity with 573 combined subjects demonstrated a mean increase in laxity (and standard deviation) of 0.40 ± 0.29 mm in the ovulatory phase compared with the follicular phase and a mean increase in laxity of 0.21 ± 0.21 mm in the luteal phase compared with the follicular phase. Nine studies examining ACL tears with 2,519 combined subjects demonstrated a decreased relative risk (RR) of an ACL tear in the luteal phase compared with the follicular and ovulatory phases combined (RR, 0.72 [95% confidence interval, 0.56 to 0.89]). There were no differences in ACL tear risk between any of the other phases. CONCLUSIONS An increased risk of an ACL tear does not appear to be associated with periods of increased laxity in this meta-analysis. Although this suggests that hormonal effects on an ACL tear may not be directly related to increases in knee laxity, the methodologic heterogeneity between published studies limits the conclusions that can be drawn and warrants further investigation. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
| | - Ian J Isby
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Mia S Hagen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Christopher Y Kweon
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | - Albert O Gee
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
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31
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Tramer JS, Khalil LS, Ziedas A, Mehran N, Okoroha KR. Return to Play and Performance in the Women's National Basketball Association After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2020; 8:2325967120947078. [PMID: 32984422 PMCID: PMC7498979 DOI: 10.1177/2325967120947078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/06/2020] [Indexed: 01/13/2023] Open
Abstract
Background: The incidence of anterior cruciate ligament (ACL) injuries in Women’s
National Basketball Association (WNBA) athletes continues to increase. There
is a paucity of data regarding return-to-play (RTP) rates and performance
after ACL reconstruction in these athletes. Purpose: To quantify RTP rates and performance after ACL reconstruction in WNBA
athletes. Study Design: Cohort study; Level of evidence, 3. Methods: All ACL tears sustained in the WNBA from 1997 through 2018 were identified.
Body mass index (BMI), age, and position at the time of injury were
collected for each player. RTP rates were calculated, and performance data
were collected for each player before and after injury to determine changes
in playing time and statistical performance. Players who successfully
returned to play after ACL reconstruction were compared with a group of
healthy controls who were matched by age, years of experience, position,
height, and BMI. Statistics at 1 and 3 years after injury were compared to
assess acute and longitudinal changes in performance relative to preinjury
baseline. Results: A total of 59 WNBA players sustained ACL tears during the study period, and
41 (69.5%) were able to successfully RTP. Players played a mean of 7.5 ±
12.8 fewer games, played 5.0 ± 9.2 fewer minutes per game, and scored 3.7 ±
5.0 fewer points per game in their first year after RTP compared with the
year before injury. Athletes with ACL reconstruction demonstrated
significantly decreased performance measures regarding games played, games
started, minutes, rebounds, assists, and blocks per game in their first
season after RTP compared with control athletes in the same indexed year;
however, these differences resolved by year 3 after surgery. Conclusion: WNBA athletes have a high RTP rate after ACL reconstruction. Players may
experience an initial decrease in playing time and performance when
returning to play; however, these variables were found to return to baseline
over time.
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Affiliation(s)
- Joseph S Tramer
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lafi S Khalil
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Alexander Ziedas
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nima Mehran
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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Ground Reaction Forces Are Predicted with Functional and Clinical Tests in Healthy Collegiate Students. J Clin Med 2020; 9:jcm9092907. [PMID: 32916814 PMCID: PMC7563648 DOI: 10.3390/jcm9092907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 12/26/2022] Open
Abstract
Increased vertical and posterior ground reaction forces (GRFs) are associated with anterior cruciate ligament (ACL) injury. If a practical means to predict these forces existed, ACL injury risk could be attenuated. Forty-two active college-age individuals (21 females, 20.66 ± 1.46 y, 70.70 ± 2.36 cm, 82.20 ± 7.60 kg; 21 males, 21.57 ± 1.28 y, 65.52 ± 1.87 cm, 64.19 ± 9.05 kg) participated in this controlled laboratory study. GRFs were ascertained by having the subjects perform a unilateral landing task onto a force plate. Several clinical measures (Fat Free Mass (FFM), dorsiflexion passive range of motion (DPROM), isometric peak force of the lateral hip rotators, knee flexor/extensor peak force ratio (H:Q), the completion of the overhead deep squat), two functional tests (Margaria–Kalamen, Single Leg Triple Hop (SLTH)), and sex served as the predictor variables. Regression models to predict the GRFs normalized to the FFM (nGRFz, nGRFy) were generated. nGRFz was best predicted with a linear regression equation that included SLTH and DPROM (adjusted R2 = 0.274; p = 0.001). nGRFy was best predicted with a linear regression equation that included H:Q, FFM, and DPROM (adjusted R2 = 0.476; p < 0.001). Simple clinical measures and functional tests explain a small to moderate amount of the variance associated with the FFM normalized vertical and posterior GRFs in active college-age individuals.
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Duggan JD, Moody J, Byrne PJ, Ryan L. Strength and Conditioning Recommendations for Female GAA Athletes: The Camogie Player. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hermann A, Senner V. Knee injury prevention in alpine skiing. A technological paradigm shift towards a mechatronic ski binding. J Sci Med Sport 2020; 24:1038-1043. [PMID: 32631774 DOI: 10.1016/j.jsams.2020.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Skiing can be beneficial for the sense of delight and wellbeing. Nonetheless, the risk of injury should not be ignored. The traditional ski binding, working solely on a mechanical principle, performs well with regards to a prevention of mid-shaft tibia fracture. However, with respect to knee injuries, it is not able to provide protection. Future concepts, such as mechatronic binding designs have the potential to decrease knee injuries that traditional bindings cannot prevent. In addition to mechanical loads, this kind of binding design uses additional parameters, e.g. knee kinematics and the skier's muscle state, to control the binding release. METHODS This paper provides a review about our knowledge of injury mechanisms in recreational alpine skiing and previous work regarding mechatronic ski binding concepts. Also, our own biomechanical approach towards a mechatronic ski binding is described. Four input variables for an algorithm are discussed with respect to existing sensor solutions and designs of our own. A concept for an algorithm, based on our current knowledge in injury mechanisms is presented. CONCLUSIONS Though first designs were described in the 80s, for decades the idea of a mechatronic ski binding was not further pursued by research. Technological improvements in the field of micro-electronics and wearable sensors, as well as decreasing costs of these devices, make a mechatronic concept feasible. Main challenge is still the missing knowledge about injury mechanisms in alpine skiing and hence the quantification of the influence of possible input variables for the mechatronic system on those injuries.
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Affiliation(s)
- Aljoscha Hermann
- Professorship of Sport Equipment and Materials, Department of Mechanical Engineering, Technical University of Munich, Germany.
| | - Veit Senner
- Professorship of Sport Equipment and Materials, Department of Mechanical Engineering, Technical University of Munich, Germany.
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Kiefel CA, Kutzler MA. Assessment of luteinizing hormone receptor expression in structural support tissues of canine hip and femorotibial joints. Am J Vet Res 2020; 81:565-571. [PMID: 32584181 DOI: 10.2460/ajvr.81.7.565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether luteinizing hormone receptors (LHRs) are expressed in canine femoral head subchondral bone (FHSB), hip joint round ligament (RL), cranial cruciate ligament (CCL), and femorotibial joint synovium (FJS) specimens. SAMPLE 1 specimen each of the FHSB, RL, CCL, and FJS obtained from the left hind limbs of 19 fresh canine cadavers. PROCEDURES 1 section of each FHSB, RL, CCL, and FJS specimen was processed with rabbit polyclonal IgG anti-human LHR antibody, and 1 section was treated with negative control reagents. Percentage immunoexpression of LHRs in FHSB and FJS sections was analyzed by assessment of 100 bone marrow cells or synoviocytes in 3 adjacent hpf (400×). In each RL and CCL section, immunoexpression of LHRs in fibrocytes was semiquantitatively analyzed on the basis of the mean of the product of percentage staining score (from 0 [no staining] to 3 [> 50% of cells stained]) and staining intensity score (from 0 [no staining] to 2 [moderate to strong staining]) for 3 adjacent hpf. RESULTS All tissues examined had variable LHR expression. Expression of LHRs in FHSB, CCL, or FJS specimens did not differ between sexes or between sexually intact and gonadectomized dogs. However, RL specimens from female dogs had significantly greater LHR expression scores, compared with findings for male dogs. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that LHRs are expressed in structural support tissues of canine hip and femorotibial joints. Further research is required to determine the LHRs' function, mechanism of action, and potential contribution to the pathogenesis of hip dysplasia or CCL rupture in dogs.
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King D, Hume P, Cummins C, Pearce A, Clark T, Foskett A, Barnes M. Match and Training Injuries in Women's Rugby Union: A Systematic Review of Published Studies. Sports Med 2020; 49:1559-1574. [PMID: 31292854 DOI: 10.1007/s40279-019-01151-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is a paucity of studies reporting on women's injuries in rugby union. OBJECTIVE The aim of this systematic review was to describe the injury epidemiology for women's rugby-15s and rugby-7s match and training environments. METHODS Systematic searches of PubMed, SPORTDiscus, Web of Science Core Collection, Scopus, CINAHL(EBSCO) and ScienceDirect databases using keywords. RESULTS Ten articles addressing the incidence of injury in women's rugby union players were retrieved and included. The pooled incidence of injuries in women's rugby-15s was 19.6 (95% CI 17.7-21.7) per 1000 match-hours (h). Injuries in women's rugby-15s varied from 3.6 (95% CI 2.5-5.3) per 1000 playing-h (including training and games) to 37.5 (95% CI 26.5-48.5) per 1000 match-h. Women's rugby-7s had a pooled injury incidence of 62.5 (95% CI 54.7-70.4) per 1000 player-h and the injury incidence varied from 46.3 (95% CI 38.7-55.4) per 1000 match-h to 95.4 (95% CI 79.9-113.9) per 1000 match-h. The tackle was the most commonly reported injury cause with the ball carrier recording more injuries at the collegiate [5.5 (95% CI 4.5-6.8) vs. 3.5 (95% CI 2.7-4.6) per 1000 player-game-h; χ2(1) = 6.7; p = 0.0095], and Women's Rugby World Cup (WRWC) [2006: 14.5 (95% CI 8.9-23.7) vs. 10.9 (95% CI 6.2-19.2) per 1000 match-h; χ2(1) = 0.6; p = 0.4497; 2010: 11.8 (95% CI 6.9-20.4) vs. 1.8 (95% CI 0.5-7.3) per 1000 match-h; χ2(1) = 8.1; p = 0.0045] levels of participation. Concussions and sprains/strains were the most commonly reported injuries at the collegiate level of participation. DISCUSSION Women's rugby-7s had a higher un-pooled injury incidence than women's rugby-15s players based on rugby-specific surveys and hospitalisation data. The incidence of injury in women's rugby-15s and rugby-7s was lower than men's professional rugby-15s and rugby-7s competitions but similar to male youth rugby-15s players. Differences in reporting methodologies limited comparison of results. CONCLUSION Women's rugby-7s resulted in a higher injury incidence than women's rugby-15s. The head/face was the most commonly reported injury site. The tackle was the most common cause of injury in both rugby-7s and rugby-15s at all levels. Future studies are warranted on injuries in women's rugby-15s and rugby-7s. PROSPERO REGISTRATION NUMBER CRD42018109054 (last updated on 17 January 2019).
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Affiliation(s)
- Doug King
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand.
- Sport Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand.
- School of Science and Technology, University of New England, Armidale, NSW, Australia.
| | - Patria Hume
- Sport Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand
- National Institute of Stroke and Applied Neuroscience (NISAN), Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand
| | - Cloe Cummins
- School of Science and Technology, University of New England, Armidale, NSW, Australia
- Institute for Sport Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
- National Rugby League, Sydney, Australia
| | - Alan Pearce
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | - Trevor Clark
- Sports Performance, Faculty of Human Performance, Australian College of Physical Education, Sydney Olympic Park, NSW, Australia
| | - Andrew Foskett
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Matt Barnes
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
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Sommerfield LM, Harrison CB, Whatman CS, Maulder PS. A prospective study of sport injuries in youth females. Phys Ther Sport 2020; 44:24-32. [PMID: 32388016 DOI: 10.1016/j.ptsp.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine sports and physical education (PE) injury rates in youth females during a school year and to investigate if an association exists between injury and phase of the menstrual cycle. DESIGN Prospective cohort. SETTING An online questionnaire was used to record training and competition exposure and self-reported injuries for 30-weeks. PARTICIPANTS 103 PE students (12-15 years) from a girls' secondary school. MAIN OUTCOME MEASURES Injury rates and prevalence of acute, gradual onset/overuse and substantial injuries. RESULTS On average, girls trained 3.4 h/week and competed 1 h/week. During the study, 74 participants reported 595 injuries. The average weekly prevalence of all injuries was 20.7% (95% CI: 20.0-21.3), of which 8.6% (95% CI: 8.3-9.0) were acute injuries and 12.0% (95% CI: 11.4-12.6) were gradual onset/overuse injuries. The overall rate of sport and PE injuries was 10.4 injuries/1000 h of exposure. The most common acute injury involved the ankle (35%) while the most common gradual onset/overuse injury involved the knee (51%). There was no significant association between the stage of the menstrual cycle and the likelihood of injury (P = 0.18). CONCLUSION The high number of injuries in this population of girls suggests preventative measures, particularly targeting the lower extremity, are needed.
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Affiliation(s)
- Lesley M Sommerfield
- Sports Performance Research Institute New Zealand, AUT University, 17 Antares Place, Mairangi Bay, Auckland, 0632, New Zealand.
| | - Craig B Harrison
- Sports Performance Research Institute New Zealand, AUT University, 17 Antares Place, Mairangi Bay, Auckland, 0632, New Zealand.
| | - Chris S Whatman
- Sports Performance Research Institute New Zealand, AUT University, 17 Antares Place, Mairangi Bay, Auckland, 0632, New Zealand.
| | - Peter S Maulder
- Sports Performance Research Institute New Zealand, AUT University, 17 Antares Place, Mairangi Bay, Auckland, 0632, New Zealand; Centre for Sport Science and Human Performance, Waikato Institute of Technology, Tristram Street, Whitiora, Hamilton, 3200, New Zealand.
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Comparison of some intrinsic risk factors of shoulder injury in three phases of menstrual cycle in collegiate female athletes. Phys Ther Sport 2020; 43:195-203. [PMID: 32220759 DOI: 10.1016/j.ptsp.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES present study aims to investigate the changes in the shoulder joint stability factors during the menstrual cycle. DESIGN cross-sectional study; SETTING: laboratory. PARTICIPANTS 15 healthy collegiate female athletes with normal menstrual cycles. MAIN OUTCOME MEASURES shoulder strength, proprioception, laxity and functional stability were the primary outcomes. Participants were assessed in three phases (mense, ovulation, midluteal (day 21) by 4 different categories of tests, each designed for a different factor. Shapiro-Wilk Test was used to determine normality of data, ANOVA and Friedman Test were used to compare results. Significance level and alpha were considered 95 percent and ≥0.05, respectively. Data shown a relation between proprioception, strength and menstrual cycle. RESULTS shoulder strength was significantly increased in ovulation phase compared to other phases (p < 0.5) (effect size >0.14). Proprioception was significantly decreased in luteal phase than in mense and ovulation phases (p < 0.5) (effect size >0.14). Finally, ligament laxity and functional stability showed no change in all phases (p < 0.5). CONCLUSION Menstrual cycle and sexual hormones affect muscle strength and proprioception of shoulder joint, but have no effect on ligament laxity and functional stability.
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Samani M, Kordi Yoosefinejad A, Campos MH, de Lira CAB, Motealleh A. Changes in Knee Vastii Muscle Activity in Women with Patellofemoral Pain Syndrome During the Menstrual Cycle. PM R 2019; 12:382-390. [PMID: 31408276 DOI: 10.1002/pmrj.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/29/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Changes in hormonal levels during the menstrual cycle are known to affect muscle electromyographic (EMG) activity, but no studies have investigated the effect of hormonal changes on the EMG activity of muscles around the knee in patients with patellofemoral pain syndrome (PFPS). OBJECTIVE To evaluate the EMG activity of the vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles during toe rise and heel rock tasks in different phases of the menstrual cycle in women with PFPS. DESIGN Cross sectional study. SETTING Rehabilitation Research Center at the School of Rehabilitation Sciences of Shiraz University of Medical Sciences. PARTICIPANTS Ten women with PFPS between 18 and 40 years of age. INTERVENTION Not applicable. MAIN OUTCOME MEASURES The VL/VMO amplitude ratio and differences between onset (onset VL-onset VMO) of vastii muscle activity were measured in the affected limb during rise and rock tasks in the follicular and ovulatory phases of the menstrual cycle. The signals were analyzed with MATLAB software. RESULTS During both tasks, there were no significant changes in onset differences in vastii muscles between the ovulatory and follicular phases. However, the amplitude ratio (VL/VMO) was significantly lower in the ovulatory phase compared to the follicular phase (P = .035 for rise tasks and .010 for rock tasks). CONCLUSION The menstrual cycle may affect some EMG parameters. These factors can be taken into account when planning sports and rehabilitation training programs.
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Affiliation(s)
- Mahbobeh Samani
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Kordi Yoosefinejad
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mario H Campos
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Claudio A B de Lira
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Alireza Motealleh
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
Context: Alpine skiing is a popular sport worldwide but has significant risk for injury. The epidemiology of skiing-related injuries has been described, which has led to the identification of risk factors for specific types of injuries. Evidence Acquisition: Pertinent literature from peer-reviewed publications was reviewed. Study Design: Clinical review. Level of Evidence: Level 5. Results: The adoption of international standards for ski-boot-binding systems has changed the profile of skiing-related injuries over time, as has the widespread use of helmets. An understanding of mechanisms of injury, risk factors, and preventative measures may decrease the incidence of skiing-related injuries. Conclusion: Advances in standards for skiing equipment have been effective at decreasing both the frequency and severity of skiing-related injuries, but additional efforts are required to improve the safety of the sport.
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Affiliation(s)
- Annabelle Davey
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - Nathan K Endres
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
| | - Robert J Johnson
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, Vermont
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Chidi-Ogbolu N, Baar K. Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Front Physiol 2019; 9:1834. [PMID: 30697162 PMCID: PMC6341375 DOI: 10.3389/fphys.2018.01834] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/06/2018] [Indexed: 12/14/2022] Open
Abstract
Estrogen has a dramatic effect on musculoskeletal function. Beyond the known relationship between estrogen and bone, it directly affects the structure and function of other musculoskeletal tissues such as muscle, tendon, and ligament. In these other musculoskeletal tissues, estrogen improves muscle mass and strength, and increases the collagen content of connective tissues. However, unlike bone and muscle where estrogen improves function, in tendons and ligaments estrogen decreases stiffness, and this directly affects performance and injury rates. High estrogen levels can decrease power and performance and make women more prone for catastrophic ligament injury. The goal of the current work is to review the research that forms the basis of our understanding how estrogen affects muscle, tendon, and ligament and how hormonal manipulation can be used to optimize performance and promote female participation in an active lifestyle at any age.
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Affiliation(s)
- Nkechinyere Chidi-Ogbolu
- Biomedical Engineering Graduate Group, University of California, Davis, Davis, CA, United States
| | - Keith Baar
- Biomedical Engineering Graduate Group, University of California, Davis, Davis, CA, United States.,Department of Neurobiology, Physiology and Behavior, University of California, Davis, Davis, CA, United States.,Department of Physiology and Membrane Biology, University of California, Davis, Davis, CA, United States
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Panagodage Perera NK, Joseph C, Kemp JL, Finch CF. Epidemiology of Injuries in Women Playing Competitive Team Bat-or-Stick Sports: A Systematic Review and a Meta-Analysis. Sports Med 2018; 48:617-640. [PMID: 29249082 DOI: 10.1007/s40279-017-0815-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Team bat-or-stick sports, including cricket, softball and hockey, are popular among women. However, little is known about the injury profile in this population. OBJECTIVE The aim was to describe the incidence, nature and anatomical location of injuries in bat-or-stick sports played by women in a competitive league. METHODS This review was prospectively registered (PROSPERO CRD42015026715). CINAHL, MEDLINE, PsycINFO, PubMed, SPORTDiscus were systematically searched from January 2000 to September 2016, inclusive. Peer-reviewed original research articles reporting the incidence, nature and anatomical location of injuries sustained by women aged 18 + years in competitive bat-or-stick sports were included. Two meta-analyses based on injury incidence proportions (injury IP) and injury rates per 1000 person-days of athletic exposure (AE) were performed. RESULTS A total of 37 studies satisfied the inclusion criteria, and five had low risk of bias. The weighted injury IP was 0.42 [95% confidence interval (CI) 0.39-0.45]. The weighted injury rate was 6.12 (95% CI 6.05-6.18) overall, and greater in games [15.79 (95% CI 15.65-15.93)] than in practice [3.07 (95% CI 2.99-3.15)]. The ankle was the most commonly injured anatomical location, followed by the hand (including wrist and fingers), knee and head. Soft tissue and ligament injuries were most common types of injuries. CONCLUSION Injury prevention in women's sports is a novel and emerging field of research interest. This review highlights that injury incidence is high among female bat-or-stick players, but little information is known about direct causal mechanisms. This review clearly establishes the need for enhancements to injury data collection. Without this information, it will not be possible to develop evidence-based injury prevention interventions.
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Affiliation(s)
- Nirmala Kanthi Panagodage Perera
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), SMB Campus, Federation University Australia, Lydiard Street South, Ballarat, VIC, 3350, Australia.
| | - Corey Joseph
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), SMB Campus, Federation University Australia, Lydiard Street South, Ballarat, VIC, 3350, Australia.,Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Joanne Lyn Kemp
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), SMB Campus, Federation University Australia, Lydiard Street South, Ballarat, VIC, 3350, Australia.,Latrobe Sports and Exercise Medicine Research Centre, College of Science, Health and Engineering, Latrobe University, Bundoora, VIC, 3086, Australia
| | - Caroline Frances Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), SMB Campus, Federation University Australia, Lydiard Street South, Ballarat, VIC, 3350, Australia
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Abstract
BACKGROUND Infertility has been described as a devastating life crisis for couples, and has a particularly severe effect on women, in terms of anxiety and depression. Anovulation accounts for around 30% of female infertility, and while lifestyle factors such as physical activity are known to be important, the relationship between exercise and ovulation is multi-factorial and complex, and to date there are no clear recommendations concerning exercise regimes. OBJECTIVES The objective of this review was to systematically assess the effect of physical activity on ovulation and to discuss the possible mechanisms by which exercise acts to modulate ovulation in reproductive-age women. This was done with a view to improve existing guidelines for women wishing to conceive, as well as women suffering from anovulatory infertility. SEARCH METHODS The published literature was searched up to April 2016 using the search terms ovulation, anovulatory, fertility, sport, physical activity and exercise. Both observational and interventional studies were considered, as well as studies that combined exercise with diet. Case studies and articles that did not report anovulation/ovulation or ovarian morphology as outcomes were excluded. Studies involving administered drugs in addition to exercise were excluded. RESULTS In total, ten interventions and four observational cohort studies were deemed relevant. Cohort studies showed that there is an increased risk of anovulation in extremely heavy exercisers (>60 min/day), but vigorous exercise of 30-60 min/day was associated with reduced risk of anovulatory infertility. Ten interventions were identified, and of these three have studied the effect of vigorous exercise on ovulation in healthy, ovulating women, but only one showed a significant disruption of ovulation as a result. Seven studies have investigated the effect of exercise on overweight/obese women suffering from polycystic ovary syndrome (PCOS) or anovulatory infertility, showing that exercise, with or without diet, can lead to resumption of ovulation. The mechanism by which exercise affects ovulation is most probably via modulation of the hypothalamic-pituitary-gonadal (HPG) axis due to increased activity of the hypothalamic-pituitary-adrenal (HPA) axis. In heavy exercisers and/or underweight women, an energy drain, low leptin and fluctuating opioids caused by excess exercise have been implicated in HPA dysfunction. In overweight and obese women (with or without PCOS), exercise contributed to lower insulin and free androgen levels, leading to the restoration of HPA regulation of ovulation. CONCLUSIONS Several clear gaps have been identified in the existing literature. Short-term studies of over-training have not always produced the disturbance to ovulation identified in the observational studies, bringing up the question of the roles of longer term training and chronic energy deficit. We believe this merits further investigation in specific cohorts, such as professional athletes. Another gap is the complete absence of exercise-based interventions in anovulatory women with a normal body mass index (BMI). The possibly unjustified focus on weight loss rather than the exercise programme means there is also a lack of studies comparing types of physical activity, intensity and settings. We believe that these gaps are delaying an efficient and effective use of exercise as a therapeutic modality to treat anovulatory infertility.
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Affiliation(s)
- Osnat Hakimi
- Laboratory of Protein Biochemistry, Federal University of State of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Luiz-Claudio Cameron
- Laboratory of Protein Biochemistry, Federal University of State of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Biochemistry, Olympic Laboratory, Brazil Olympic Committee, Rio de Janeiro, Brazil
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Dave AJ, Chen DB, Seeto BG, MacDessi SJ. Gender and age based differences in behavioural patterns following anterior cruciate ligament injury. J Orthop 2018; 15:655-657. [PMID: 29881214 DOI: 10.1016/j.jor.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/06/2018] [Indexed: 01/13/2023] Open
Abstract
ACL injury can be clinically diagnosed prior to imaging, and therefore understanding any symptomatology differences between age-groups and genders is critical. Data gathered from 341 patients with ACL injuries over six years showed no gender-based difference in ability to continue playing sport post-injury. Fewer males required crutches (37.2% vs. 49.5%, p = 0.04) and more males returned to sports prior to treatment (24.4% vs. 14.1%, p = 0.04). There was no age based difference in play continuation post-injury, however more elderly patients fell post-injury (<30 y: 91.9%, 30 y 83.8%, p = 0.02). Therefore, there are few differences in behavioural patterns following ACL injury based on age or sex.
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Affiliation(s)
- Aneesh J Dave
- Discipline of Anatomy and Histology, The University of Sydney, NSW, Australia
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Pfeiffer TR, Burnham JM, Hughes JD, Kanakamedala AC, Herbst E, Popchak A, Shafizadeh S, Irrgang JJ, Debski RE, Musahl V. An Increased Lateral Femoral Condyle Ratio Is a Risk Factor for Anterior Cruciate Ligament Injury. J Bone Joint Surg Am 2018; 100:857-864. [PMID: 29762281 DOI: 10.2106/jbjs.17.01011] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to examine the relationship between distal femoral morphology and anterior cruciate ligament (ACL) injury, ACL reconstruction (ACLR) failure, and contralateral ACL injury. It was hypothesized that increased posterior femoral condylar depth, quantified as the lateral femoral condyle ratio, would correlate with increased risk of primary ACL injuries, ACLR failures, and contralateral ACL injuries. METHODS The charts of consecutive patients who underwent arthroscopic knee surgery at an academic medical center from 2012 to 2016 with minimum follow-up of 24 months were retrospectively reviewed. Patients were stratified into 4 groups: (1) a control group of patients with no ACL injury, (2) patients with primary ACL injury, (3) patients with failed ACLR, and (4) patients with previous ACL injury and subsequent contralateral ACL injury. With use of lateral radiographs, the ratio of posterior femoral condylar depth to total condylar length was defined as the lateral femoral condyle ratio. Differences between study groups were identified with use of analysis-of-variance (ANOVA) and post-hoc testing with significance set at p < 0.05. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff for detecting increased risk of ACL injury. RESULTS Two hundred patients met the inclusion criteria. The mean lateral femoral condyle ratios (and standard deviations) were 61.2% ± 2.4% in the control group, 64.2% ± 3.8% in the primary ACL injury group, 64.4% ± 3.6% in the failed ACLR group, and 66.9% ± 4.3% in the contralateral ACL injury group. Patients who had a primary ACL injury, failed ACLR, or contralateral ACL injury had significantly higher ratios compared with the control group (p < 0.008). ROC curve analysis demonstrated that a lateral femoral condyle ratio of >63% was associated with an increased risk for ACL injury, with a sensitivity of 77% and a specificity of 72%. CONCLUSIONS The data from this study show that increased posterior femoral condylar depth, quantified as the lateral femoral condyle ratio, is associated with an increased risk of ACL injury, including primary and contralateral ACL injuries. The data from this study may help clinicians to identify patients at a greater risk of ACL injury. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thomas R Pfeiffer
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ajay C Kanakamedala
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany
| | - Adam Popchak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sven Shafizadeh
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Richard E Debski
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Abstract
Musculoskeletal injuries account for more than 70% of time away from sports. One of the reasons for the high number of injuries and long return to play is that we have only a very basic understanding of how our training alters tendon and ligament (sinew) structure and function. Sinews are highly dense tissues that are difficult to characterize both in vivo and in vitro. Recently, engineered ligaments have been developed in vitro using cells from human anterior cruciate ligaments or hamstring tendons. These three-dimensional tissues can be grown in a laboratory, treated with agents thought to affect sinew physiology, and then mechanically tested to determine their function. Using these tissues, we have learned that sinews, like bone, quickly become refractory to an exercise stimulus, suggesting that short (<10 min) periods of activity with relatively long (6 h) periods of rest are best to train these tissues. The engineered sinews have also shown how estrogen decreases sinew function and that a factor released following intense exercise increases sinew collagen synthesis and function. Last, engineered sinews are being used to screen possible nutritional interventions that may benefit tendon or ligament function. Using the data derived from these tissue-engineered sinews, new nutritional and training regimes are being designed and tested with the goal of minimizing injury and accelerating return to play.
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Affiliation(s)
- Keith Baar
- Department of Neurobiology, Physiology and Behavior, University of California Davis, One Shields Ave, Davis, CA, 95616, USA.
- Department of Physiology and Membrane Biology, University of California Davis, One Shields Ave, Davis, CA, 95616, USA.
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Turner C, Crow S, Crowther T, Keating B, Saupan T, Pyfer J, Vialpando K, Lee SP. Preventing non-contact ACL injuries in female athletes: What can we learn from dancers? Phys Ther Sport 2018; 31:1-8. [DOI: 10.1016/j.ptsp.2017.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/14/2017] [Accepted: 12/19/2017] [Indexed: 12/17/2022]
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Pierson E, Althoff T, Leskovec J. Modeling Individual Cyclic Variation in Human Behavior. PROCEEDINGS OF THE ... INTERNATIONAL WORLD-WIDE WEB CONFERENCE. INTERNATIONAL WWW CONFERENCE 2018; 2018:107-116. [PMID: 29780976 PMCID: PMC5959299 DOI: 10.1145/3178876.3186052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cycles are fundamental to human health and behavior. Examples include mood cycles, circadian rhythms, and the menstrual cycle. However, modeling cycles in time series data is challenging because in most cases the cycles are not labeled or directly observed and need to be inferred from multidimensional measurements taken over time. Here, we present Cyclic Hidden Markov Models (CyH-MMs) for detecting and modeling cycles in a collection of multidimensional heterogeneous time series data. In contrast to previous cycle modeling methods, CyHMMs deal with a number of challenges encountered in modeling real-world cycles: they can model multivariate data with both discrete and continuous dimensions; they explicitly model and are robust to missing data; and they can share information across individuals to accommodate variation both within and between individual time series. Experiments on synthetic and real-world health-tracking data demonstrate that CyHMMs infer cycle lengths more accurately than existing methods, with 58% lower error on simulated data and 63% lower error on real-world data compared to the best-performing baseline. CyHMMs can also perform functions which baselines cannot: they can model the progression of individual features/symptoms over the course of the cycle, identify the most variable features, and cluster individual time series into groups with distinct characteristics. Applying CyHMMs to two real-world health-tracking datasets-of human menstrual cycle symptoms and physical activity tracking data-yields important insights including which symptoms to expect at each point during the cycle. We also find that people fall into several groups with distinct cycle patterns, and that these groups differ along dimensions not provided to the model. For example, by modeling missing data in the menstrual cycles dataset, we are able to discover a medically relevant group of birth control users even though information on birth control is not given to the model.
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Effect of different phases of menstrual cycle in heart rate variability of physically active women. SPORT SCIENCES FOR HEALTH 2018. [DOI: 10.1007/s11332-018-0426-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Legerlotz K, Bey ME, Götz S, Böhlke N. Constant performance in balance and proprioception tests across the menstrual cycle - a pilot study in well trained female ice hockey players on hormonal contraception. Health Sci Rep 2018; 1:e18. [PMID: 30623036 PMCID: PMC6266417 DOI: 10.1002/hsr2.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/04/2017] [Accepted: 10/16/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION It has yet to be explained why female athletes appear to suffer more often from non-contact ligament injuries during the first half of the menstrual cycle. Fluctuations in balance, caused by impaired proprioception due to increased fluid retention, may be relevant factors contributing to this anomaly in distribution. The aim of this study was therefore to uncover relationships between dynamic stability, proprioception and fluid retention in association with the menstrual cycle as a possible explanation for the observed changes in injury rates. METHODS Nine healthy, female, well trained ice hockey players on hormonal contraception with regular cycles were tested at least twelve times during one menstrual cycle. Bioimpedance analysis was applied to investigate body composition and fluid distribution. A joint position sense test was performed to characterize changes in proprioception, while unexpected perturbations on a balance board were used to obtain measures for dynamic postural control. RESULTS No distinct changes in proprioception, dynamic stability and fluid retention were identified across the menstrual cycle in this population. Weak correlations were found between parameters for dynamic stability and proprioception. CONCLUSION Variations in proprioception, dynamic stability and fluid retention seem unlikely to be major contributors to injury risk peaks, at least in this population of healthy trained athletes using hormonal contraception.
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Affiliation(s)
- Kirsten Legerlotz
- Department of Training and Movement SciencesHumboldt UniversityBerlinGermany
| | - Marie Elena Bey
- Department of Training and Movement SciencesHumboldt UniversityBerlinGermany
| | - Susann Götz
- Division of Training and Movement ScienceUniversity of PotsdamPotsdamGermany
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