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Cushman DM, Catalano E, Hoffman J, Casey E. Achilles tendon rupture preceded by normal asymptomatic imaging in a collegiate gymnast: A case report. Radiol Case Rep 2024; 19:3470-3472. [PMID: 38872751 PMCID: PMC11169073 DOI: 10.1016/j.radcr.2024.05.028] [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: 02/17/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 06/15/2024] Open
Abstract
Female gymnasts are the athletes that are most likely to experience Achilles tendon rupture, due to the high energy and eccentric load place on their Achilles tendon related to their sport. It is postulated that degenerative changes, watershed vascular supply, calcifications, and high amounts of inflammatory cells may play a role. This case report highlights an athlete with an asymptomatic Achilles tendon that was visualized to be normal utilizing ultrasound. She was found to have no evidence of underlying tendon pathology. The athlete then ruptured her Achilles tendon 8 months later during a gymnastic meet with no proceeding symptoms. This case report challenges the accepted theory that preexisting tendinosis or pathology proceeds Achilles tendon rupture. In this case, it is postulated that tendon rupture may be secondary to significant mechanical force even without underlying pathology. Level of evidence: Level 4.
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Affiliation(s)
- Daniel M. Cushman
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT 84108, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Emily Catalano
- Department of Emergency Medicine, East Carolina University, Greenville, NC 27858, USA
| | | | - Ellen Casey
- Hospital for Special Surgery New York, NY 10021, USA
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Muhlenhaupt E, Stauss HM. Higher risk of Achilles tendon ruptures at competition than training sites in female collegiate gymnasts. J Sports Med Phys Fitness 2024; 64:392-401. [PMID: 38193754 DOI: 10.23736/s0022-4707.23.15558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Reportedly, 17.2% of collegiate female gymnasts experience Achilles tendon ruptures (ATRs). Cumulative microtraumas resulting in chronic tendinopathy/tendinitis may contribute to this high injury risk. We hypothesized that the risk of ATRs in female collegiate gymnasts increases with years of competitive gymnastics, that non-steroidal anti-inflammatory drug (NSAID) use is associated with less ATRs, and that the risk is larger during competition than training. METHODS Female gymnasts from 78 USA collegiate teams completed a survey assessing the prevalence of ATRs, NSAID use, age at which competitive gymnastics started and age at which ATR occurred, and whether ATRs occurred during training or competition. RESULTS Twenty-one of 103 gymnasts (20.4%, 95% CI: 13.6% to 29.4%) experienced ATRs. Eighteen of 21 ruptures (85.7%, 95% CI: 61.3% to 95.8%) occurred after more than ten years of competitive gymnastics (mean: 14.0±2.6 years, 95% CI: 12.8 to 15.2 years). ATRs occurred 0.08±0.01 (95% CI: 0.06 to 0.11) times per 1000 hours at training versus 1.85±0.11 (95% CI: 1.60 to 2.10) times per 1000 hours at competition (P<0.05). Prevalence of NSAID use was 27.6% (95% CI: 18.6% to 39.0%) in gymnasts without ATR but only 5.5% (95% CI: 0.6% to 35.5%, P=0.09) in gymnasts with ATR. Multiple regression analysis demonstrated a negative association between NSAID use and incidence of ATRs (P<0.05). CONCLUSIONS Female collegiate gymnasts are at high risk for ATRs, especially after more than ten years of competitive gymnastics and during competition.
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Affiliation(s)
- Emily Muhlenhaupt
- Department of Biomedical Sciences, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Harald M Stauss
- Department of Biomedical Sciences, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA -
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Talaski GM, Baumann AN, Salmen N, Curtis DP, Walley KC, Anastasio AT, de Cesar Netto C. Socioeconomic Status and Race Are Rarely Reported in Randomized Controlled Trials for Achilles Tendon Pathology in the Top 10 Orthopaedic Journals: A Systematic Review. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114231225454. [PMID: 38288287 PMCID: PMC10823864 DOI: 10.1177/24730114231225454] [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: 01/31/2024] Open
Abstract
Background Randomized controlled trials (RCTs) are crucial in comparative research, and a careful approach to randomization methodology helps minimize bias. However, confounding variables like socioeconomic status (SES) and race are often underreported in orthopaedic RCTs, potentially affecting the generalizability of results. This study aimed to analyze the reporting trends of SES and race in RCTs pertaining to Achilles tendon pathology, considering 4 decades of data from top-tier orthopaedic journals. Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and used PubMed to search 10 high-impact factor orthopaedic journals for RCTs related to the management of Achilles tendon pathology. The search encompassed all articles from the inception of each journal until July 11, 2023. Data extraction included year of publication, study type, reporting of SES and race, primary study location, and intervention details. Results Of the 88 RCTs identified, 68 met the inclusion criteria. Based on decade of publication, 6 articles (8.8%) reported on SES, whereas only 2 articles (2.9%) reported on race. No RCTs reported SES in the pre-1999 period, but the frequency of reporting increased in subsequent decades. Meanwhile, all RCTs reporting race were published in the current decade (2020-2030), with a frequency of 20%. When considering the study location, RCTs conducted outside the United States were more likely to report SES compared with those within the USA. Conclusion This review revealed a concerning underreporting of SES and race in Achilles tendon pathology RCTs. The reporting percentage remains low for both SES and race, indicating a need for comprehensive reporting practices in orthopaedic research. Understanding the impact of SES and race on treatment outcomes is critical for informed clinical decision making and ensuring equitable patient care. Future studies should prioritize the inclusion of these variables to enhance the generalizability and validity of RCT results.
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Affiliation(s)
- Grayson M. Talaski
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Anthony N. Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Natasha Salmen
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Deven P. Curtis
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Kempland C. Walley
- Department of Orthopedic Surgery, University of Michigan/Michigan Medicine, Ann Arbor, MI, USA
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Casey E, Bonanno J, Cheng J, Abutalib Z, Kranz K, Kruse D, Thomas C, Faustin M. Return to sport in elite gymnastics: Unprecedented training interruptions provide lessons for the future. PM R 2023; 15:881-890. [PMID: 36281922 DOI: 10.1002/pmrj.12880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/07/2022] [Accepted: 07/20/2022] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Year-round training is standard for elite gymnasts in the United States, but the coronavirus disease 2019 (COVID-19) pandemic led to unprecedented training interruptions. The effect of these training disruptions is unknown. OBJECTIVE This study aimed to describe and compare training interruptions in elite gymnasts before and during the pandemic, the time it took to return to the prior level of gymnastics training, the development of injuries during return to gymnastics training, and gymnast-reported difficulty in and nervousness about returning to prior level of gymnastics training. DESIGN Retrospective study. SETTING Anonymous online surveys distributed to elite gymnasts in the United States. PARTICIPANTS A total of 184 current elite gymnasts who completed the surveys were included. This represented an overall response rate of 52.3% (184/352). INTERVENTIONS None. MAIN OUTCOME MEASURES Information was collected about training interruptions and time, nervousness, difficulty, and injury during return to gymnastics. RESULTS Gymnasts reported significantly longer training interruptions due to COVID-19 than before the pandemic (8.7 ± 4.4 vs. 4.4 ± 7.9 weeks, p < .001), but duration of return to prior gymnastics level was similar (4.6 ± 2.7 vs. 3.7 ± 4.8 weeks, p = .106). Of the 137 gymnasts who had returned to training by the time of the survey, 46 (33.6%) reported an injury during their return to gymnastics. A high degree of nervousness to return to gymnastics was significantly associated with greater risks of injury upon return (risk ratio [RR] 2.7, 95% confidence interval [CI]: 1.6-4.7; p < .001) and difficulty returning to prior level (RR 3.4, 95% CI: 1.7-6.6; p < .001). CONCLUSION Pandemic-related training interruption was significantly greater in duration than prior interruptions, but time required for return to gymnastics was similar. Gymnasts may be at increased risk of injury during return to gymnastics if experiencing nervousness about returning following a break in training. These findings provide guidance for gymnasts' return from training interruptions and may refute the long-held belief that gymnasts should not take time away from training due to fear of injury or difficulty regaining skills.
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Affiliation(s)
- Ellen Casey
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
- USA Gymnastics, Indianapolis, Indiana, USA
| | - Joseph Bonanno
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Zafir Abutalib
- Biostatistics Core, Hospital for Special Surgery, New York, New York, USA
| | | | - David Kruse
- USA Gymnastics, Indianapolis, Indiana, USA
- Hoag Orthopedic Institute, Irvine, California, USA
| | | | - Marcia Faustin
- USA Gymnastics, Indianapolis, Indiana, USA
- Department of Physical Medicine and Rehabilitation, University of California, Davis, Sacramento, California, USA
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Kobayashi JK, Kobayashi EF, Tomasevich KM, Lorens KL, Aoki SK. Characterization of Achilles Tendon Ruptures in Collegiate Women's Gymnastics. Orthopedics 2023; 46:205-210. [PMID: 36853933 DOI: 10.3928/01477447-20230224-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Collegiate female gymnasts are at high risk of Achilles tendon injuries. Achilles tendon ruptures can negatively impact an athlete's ability to return to competitive sport. Understanding the natural history of Achilles tendon tears in collegiate female gymnasts is important in the development of preventive treatment. To expand our knowledge of the natural history of Achilles tendon ruptures among collegiate female gymnasts, a REDCap retrospective survey was emailed to athletic trainers on all 80 National Collegiate Athletic Association (NCAA) women's gymnastics teams. The survey gathered information regarding number of Achilles tendon injuries, pain prior to injuries, events and skills on which injuries occurred, and functional outcome after injuries among athletes competing in the 2013 to 2018 NCAA seasons. Forty-two of 80 (52.5%) programs responded to the survey. Seventy-one Achilles tendon ruptures were reported between 2013 and 2018. Among these, 46% had antecedent pain. Gymnasts sustained 95% of Achilles tendon ruptures while performing on floor exercise, with 98% of ruptures occurring during the take-off portion of a tumbling skill. Of the 61% of gymnasts who were able to return to competition, 59% were able to achieve the same level of function after injury. Achilles tendon ruptures in collegiate female gymnasts primarily occur during the take-off motion while tumbling on the floor exercise. Future studies should evaluate degenerative Achilles tendon changes in collegiate female gymnasts. A collaborative effort among gymnasts, coaches, judges, and medical experts is required to identify at-risk athletes and develop and implement injury prevention programs. [Orthopedics. 2023;46(4):205-210.].
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Fryar C, Tilley D, Casey E, Vincent H. A Research and Clinical Framework for Understanding Achilles Injury in Female Collegiate Gymnasts. Curr Sports Med Rep 2023; 22:260-267. [PMID: 37417663 DOI: 10.1249/jsr.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
ABSTRACT Gymnastics is a popular sport with a high injury rate, particularly at the collegiate level. Achilles tendon rupture is a catastrophic injury with career-changing impact. Over the last decade, there has been a growing incidence of Achilles tendon ruptures, especially in female gymnasts. Currently, neither the effects of contributing risk factors on Achilles tendon rupture nor the research frameworks to guide future intervention strategies have been well described. This article reviews the functional anatomy and mechanical properties of the Achilles tendon, provides precollegiate and collegiate intrinsic and extrinsic risk factors for Achilles tendon rupture, and proposes a research framework to address this injury from a systemic perspective. Potential clinical interventions to mitigate Achilles tendon injury are proposed based on currently available peer-reviewed evidence.
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Affiliation(s)
- Caroline Fryar
- Department of Physical Medicine and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
| | - Dave Tilley
- Champion Physical Therapy & Performance, Watham, MA
| | - Ellen Casey
- Department of Physiatry, Hospital for Special Surgery, New York, NY
| | - Heather Vincent
- University of Florida College of Medicine, UF Physical Medicine & Rehabilitation
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Anderson RB. Foot and Ankle Awareness in the Athlete. Sports Health 2022; 14:309-310. [PMID: 35546065 PMCID: PMC9112715 DOI: 10.1177/19417381221089976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Wang YH, Zhou HH, Nie Z, Cui S. Prevalence of Achilles tendinopathy in physical exercise: A systematic review and meta-analysis. SPORTS MEDICINE AND HEALTH SCIENCE 2022; 4:152-159. [PMID: 36090915 PMCID: PMC9453689 DOI: 10.1016/j.smhs.2022.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/11/2022] Open
Abstract
This comprehensive systematic review and meta-analysis assessed the prevalence of Achilles tendinopathy (AT) in physical exercise (PE). Specifically, we estimate the overall risk of AT in physical exercise and compare sport-specific estimates of AT risk. PubMed, Web of Science, Cochrane Library, and SPORTDiscus were searched before the 1st of October 2021. Random-effects, subgroup analysis, sensitivity analysis and meta-regressions were conducted, involving 16 publications. This meta-analysis found that the overall prevalence of AT was 0.06 (95%CI, 0.04–0.07). The prevalence of Achilles tendon rupture was 0.03 (95%CI, 0.02–0.05). Subgroup analysis showed that the prevalence of AT increased with age, the highest among the group aged over 45 (0.08; 95%CI, 0.04–0.11), and the lowest among the group under 18 years old (0.02; 95%CI, 0.01–0.03). The gymnastics and ball games had the highest prevalence of AT, at (0.17; 95%CI, 0.14–0.20) and (0.06; 95%CI, 0.02–0.11), respectively. The prevalence of AT in athletes (0.06; 95%CI, 0.04–0.08) was higher than that of amateur exercisers (0.04; 95%CI, 0.02–0.06) and there was no difference in the prevalence of AT between males and females. There are differences in the prevalence of AT in different ages, sport events and characteristics of participants. This systematic review and meta-analysis suggested that it was necessary to pay more attention to AT in people who were older or engaged in gymnastics.
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