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Jones E, Jochum J, Corn H, O’Brien M, Parks M, Armoush J, Annee A. Are Functional Performance Test Scores Better When Compared to Baseline or Contralateral Limb Scores Following LE Injury in Adolescent Athletes? Int J Sports Phys Ther 2024; 19:561-568. [PMID: 38707858 PMCID: PMC11065785 DOI: 10.26603/001c.116272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/29/2024] [Indexed: 05/07/2024] Open
Abstract
Background Functional performance tests (FPT) have been used with athletes following an injury to determine readiness to return-to-play (RTP), usually using limb symmetry indices to the contralateral limb or a baseline score. There is not a consensus as to which criterion scores are best compared. Hypothesis/Purpose This study aimed to compare common functional performance test scores from injured athletes at the time of release to RTP to both preseason baseline scores and to the contralateral limb. It was hypothesized that using baseline scores for comparison would be more responsive to residual deficits following injury than using the contralateral limb. Study Design Prospective longitudinal cohort study. Methods High school athletes (n=395) from all varsity sports completed a battery of FPTs including the Y-Balance Test (YBT), single limb hop tests and T-Test for agility (TT) during their preseason to establish baseline data. Injured athletes (n=19) were re-tested using all FTP's again at the time of RTP. Paired t-tests were used to detect if significant (p\<0.05) residual deficits were present at time of RTP when compared to baseline and to contralateral scores on FPTs. Results Differences in YBT scores were found in the anterior direction only (p=0.021) when comparing RTP to preseason, but there were no differences when compared to RTP data for the contralateral limb. Differences were detected with the single leg hop test (p = 0.001) when comparing the RTP to preseason and were also detected in both the single leg hop (p= 0.001) and triple hop (p=0.018) when compared to the contralateral limb. Differences in TT scores were detected when comparing RTP to preseason for cutting first with both the unaffected (p = 0.019) and affected (p = 0.014) limbs. Conclusions The YBT in the anterior direction and the TT are better able to detect residual deficits when comparing RTP to preseason scores. Hop tests are better able to detect deficits when compared to the contralateral limb. These results could make preseason testing more efficient when creating a reference for determining RTP readiness following lower extremity injury.
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Affiliation(s)
- Edward Jones
- Krannert School of Physical TherapyUniversity of Indianapolis
| | | | - Hannah Corn
- Physical TherapyTeam Rehabilitation Physical Therapy
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Knapic H, Shanley E, Thigpen CA, Prats-Uribe A, Fair CD, Bullock GS. Impact of Prolonged Sport Stoppage on Knee Injuries in High School Athletes: An Ecological Study. J Sport Rehabil 2024; 33:225-230. [PMID: 38412853 DOI: 10.1123/jsr.2023-0018] [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] [Received: 01/17/2023] [Revised: 01/03/2024] [Accepted: 01/16/2024] [Indexed: 02/29/2024]
Abstract
CONTEXT In March 2020, public health concerns resulted in school closure throughout the United States. The prolonged sport cessation may affect knee injury risk in high school athletes. The purpose of this study was to describe and compare risk of knee injuries in high school athletes during 2019-2020 and 2020-2021 academic years, and stratify by gender, severity, mechanism of injury, injury type, and knee anatomic region. DESIGN Historical-prospective cohort study. METHODS This historical-prospective cohort study included 176 schools in 6 states matched by sport participation in control and COVID years from July 1, 2019 to June 30, 2021. Injury rates per 1000 athletes per year were calculated with 95% confidence intervals. A negative binomial regression was performed to assess potential differences in knee injuries between academic years. RESULTS 94,847 and 72,521 high school athletes participated in the 2019-2020 (19-20) and 2020-2021 (20-21) seasons. Knee injury risk was higher in the 20-21 season (19-20: 28.89% [27.82-29.96]; 20-21: 33.82% [32.50-35.14]). Risk increased for male athletes from 2019-2020 to 2020-2021 (19-20: 29.42% [28.01-30.83]; 20-21: 40.32% [38.89-41.75]). Female knee injury risk was similar between years (19-20: 25.78% [24.29-27.27]; 20-21: 26.03% [24.31-27.75]). Knee injuries increased by a ratio of 1.2 ([95% CI, 1.1-1.3], P < .001) during 2020-2021. CONCLUSIONS Knee injury risk and relative risk increased among males in 2020-2021. Results indicate changes in knee injury risk following return from COVID shelter in place among high school athletes and implicate potential negative downstream effects of interrupted sports training and participation on high school injury risk.
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Affiliation(s)
- Hannah Knapic
- Department of Public Health Studies, Elon University, Elon, NC, USA
| | - Ellen Shanley
- ATI Physical Therapy, Greenville, SC, USA
- Center for Rehabilitation and Reconstruction Sciences, University of South Carolina, Columbia, SC, USA
| | - Charles A Thigpen
- ATI Physical Therapy, Greenville, SC, USA
- Center for Rehabilitation and Reconstruction Sciences, University of South Carolina, Columbia, SC, USA
| | - Albert Prats-Uribe
- Pharmaco- and Device Epidemiology, Center for Statistics in Medicine, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Cynthia D Fair
- Department of Public Health Studies, Elon University, Elon, NC, USA
| | - Garrett S Bullock
- Department of Orthopedic Surgery and Rehabilitation, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, United Kingdom
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Nyland J, Sirignano MN, Richards J, Krupp RJ. Regenerative Anterior Cruciate Ligament Healing in Youth and Adolescent Athletes: The Emerging Age of Recovery Science. J Funct Morphol Kinesiol 2024; 9:80. [PMID: 38804446 PMCID: PMC11130880 DOI: 10.3390/jfmk9020080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
Anterior cruciate ligament (ACL) injuries mainly arise from non-contact mechanisms during sport performance, with most injuries occurring among youth or adolescent-age athletes, particularly females. The growing popularity of elite-level sport training has increased the total volume, intensity and frequency of exercise and competition loading to levels that may exceed natural healing capacity. Growing evidence suggests that the prevailing mechanism that leads to non-contact ACL injury from sudden mechanical fatigue failure may be accumulated microtrauma. Given the consequences of primary ACL injury on the future health and quality of life of youth and adolescent athletes, the objective of this review is to identify key "recovery science" factors that can help prevent these injuries. Recovery science is any aspect of sports training (type, volume, intensity, frequency), nutrition, and sleep/rest or other therapeutic modalities that may prevent the accumulated microtrauma that precedes non-contact ACL injury from sudden mechanical fatigue failure. This review discusses ACL injury epidemiology, current surgical efficacy, the native ACL vascular network, regional ACL histological complexities such as the entheses and crimp patterns, extracellular matrix remodeling, the concept of causal histogenesis, exercise dosage and ligament metabolism, central nervous system reorganization post-ACL rupture, homeostasis regulation, nutrition, sleep and the autonomic nervous system. Based on this information, now may be a good time to re-think primary ACL injury prevention strategies with greater use of modified sport training, improved active recovery that includes well-planned nutrition, and healthy sleep patterns. The scientific rationale behind the efficacy of regenerative orthobiologics and concomitant therapies for primary ACL injury prevention in youth and adolescent athletes are also discussed.
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Affiliation(s)
- John Nyland
- Norton Orthopedic Institute, 9880 Angie’s Way, Suite 250, Louisville, KY 40241, USA (J.R.); (R.J.K.)
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Shaw JW, Mattiussi AM, Clark R, Kelly S. Epidemiology and management of ankle sprain injuries over seven seasons in an elite professional ballet company. J Sci Med Sport 2024; 27:166-171. [PMID: 38123412 DOI: 10.1016/j.jsams.2023.11.014] [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] [Received: 04/20/2023] [Revised: 11/09/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To investigate the epidemiology and management of ankle ligament sprains over seven seasons in a professional ballet company. DESIGN Descriptive epidemiology study. METHODS Medical attention injury, time-loss injury, and exposure data pertaining to 140 professional ballet dancers were prospectively recorded by Chartered Physiotherapists over seven seasons (2015/16-2021/22); a period including the COVID-19 global pandemic. RESULTS Sixty-nine ankle sprains (46 time-loss) in 45 dancers (32 %) were recorded: 51 sprains were classified as grade I, 15 were classified as grade II, and three were classified as grade III; 53 sprains affected only one ligament, whilst 16 were multi-ligament sprains. For time-loss injuries, median time-loss durations varied by grading (I - 31 days, II - 54 days, and III - 147 days) and the number of ligaments affected (one - 31 days, two - 54 days, three - 134 days, four - 137 days), with time-loss ranging from 1 to 188 days. Of the 46 time-loss ankle sprains, eight were mild, nine were moderate, and 29 were severe. The incidence rate (injuries·1000 h-1) of medical attention ankle sprains was 0.073 (95 % CI: 0.046 to 0.117) in male dancers and 0.101 (95 % CI: 0.069 to 0.148) in female dancers, and the incidence of time-loss ankle sprains was 0.044 (95 % CI: 0.024 to 0.080) in male dancers and 0.064 (95 % CI: 0.040 to 0.103) in female dancers. No significant effect of sex was observed on either medical attention (p = .304) or time-loss (p = .327) ankle sprain incidence rates. Ten percent of dancers sustained multiple sprains across the seven seasons. Fifty and 39 % of ankle sprains in female and male dancers, respectively, were preceded by a history of ankle sprains. Jumping and landing (30 sprains) and non-dance movements (16 sprains) were the most common inciting movements. Bone bruising and synovitis were the most common concurrent pathologies. CONCLUSIONS Ankle sprains placed a considerable burden on the ballet company studied. These time-loss durations specified by number and grade of ligament sprain, injury history, and secondary pathologies can guide return-to-dance rehabilitation pathways.
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Affiliation(s)
- Joseph W Shaw
- Ballet Healthcare, Royal Opera House, UK; Faculty of Sport, Allied Health, and Performance Science, St Mary's University, UK.
| | - Adam M Mattiussi
- Ballet Healthcare, Royal Opera House, UK; Faculty of Sport, Allied Health, and Performance Science, St Mary's University, UK
| | - Richard Clark
- Ballet Healthcare, Royal Opera House, UK; Sports Science and Medicine Department, Tottenham Hotspur Football Club, UK
| | - Shane Kelly
- Ballet Healthcare, Royal Opera House, UK; Faculty of Sport, Allied Health, and Performance Science, St Mary's University, UK
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Loflin BE, Ahn T, Colglazier KA, Banaszak Holl MM, Ashton-Miller JA, Wojtys EM, Schlecht SH. An Adolescent Murine In Vivo Anterior Cruciate Ligament Overuse Injury Model. Am J Sports Med 2023; 51:1721-1732. [PMID: 37092727 PMCID: PMC10348391 DOI: 10.1177/03635465231165753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Overuse ligament and tendon injuries are prevalent among recreational and competitive adolescent athletes. In vitro studies of the ligament and tendon suggest that mechanical overuse musculoskeletal injuries begin with collagen triple-helix unraveling, leading to collagen laxity and matrix damage. However, there are little in vivo data concerning this mechanism or the physiomechanical response to collagen disruption, particularly regarding the anterior cruciate ligament (ACL). PURPOSE To develop and validate a novel in vivo animal model for investigating the physiomechanical response to ACL collagen matrix damage accumulation and propagation in the ACL midsubstance, fibrocartilaginous entheses, and subchondral bone. STUDY DESIGN Controlled laboratory study. METHODS C57BL/6J adolescent inbred mice underwent 3 moderate to strenuous ACL fatigue loading sessions with a 72-hour recovery between sessions. Before each session, randomly selected subsets of mice (n = 12) were euthanized for quantifying collagen matrix damage (percent collagen unraveling) and ACL mechanics (strength and stiffness). This enabled the quasi-longitudinal assessment of collagen matrix damage accrual and whole tissue mechanical property changes across fatigue sessions. Additionally, all cyclic loading data were quantified to evaluate changes in knee mechanics (stiffness and hysteresis) across fatigue sessions. RESULTS Moderate to strenuous fatigue loading across 3 sessions led to a 24% weaker (P = .07) and 35% less stiff (P < .01) ACL compared with nonloaded controls. The unraveled collagen densities within the fatigued ACL and entheseal matrices after the second and third sessions were 38% (P < .01) and 15% (P = .02) higher compared with the nonloaded controls. CONCLUSION This study confirmed the hypothesis that in vivo ACL collagen matrix damage increases with tissue fatigue sessions, adversely impacting ACL mechanical properties. Moreover, the in vivo ACL findings were consistent with in vitro overloading research in humans. CLINICAL RELEVANCE The outcomes from this study support the use of this model for investigating ACL overuse injuries.
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Affiliation(s)
- Benjamin E. Loflin
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Taeyong Ahn
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kaitlyn A. Colglazier
- Purdue School of Engineering and Technology, Purdue University–Indianapolis, Indianapolis, Indiana, USA
| | - Mark M. Banaszak Holl
- Department of Orthopaedic Surgery, Heersink School of Medicine, University of Alabama–Birmingham, Birmingham, Alabama, USA
| | | | - Edward M. Wojtys
- Department of Orthopaedic Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Stephen H. Schlecht
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Purdue School of Engineering and Technology, Purdue University–Indianapolis, Indianapolis, Indiana, USA
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Dobscha M, Peterson C, Powers WS, Goetschius J. Youth sport specialization associated with poorer lower extremity function & pain as young adults. PHYSICIAN SPORTSMED 2022; 51:254-259. [PMID: 35179435 DOI: 10.1080/00913847.2022.2042167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Examine the link between youth sports specialization and long-term lower extremity joint health after sports by comparing lower extremity function, pain, and history of sport-related injuries between young adults that were highly, moderately, and low specialized in youth sports. METHODS We used a cross-sectional design, and all data was collected using an electronic survey. Our sample included N = 356 young adults who participated in a primary sport during youth and high school sports but were no longer participating in that sport as a young adult. Participants were stratified into high (n = 111), moderate (n = 119), and low (n = 126) specialization groups using a 3-criteria sport specialization questionnaire based on youth sports participation prior to high school. We compared participants current Lower Extremity Functional Scale (LEFS) score (0-80), the proportion of participants with clinically important deficits in LEFS score (≤71/80), current lower extremity (foot/ankle, knee, hip) pain scores (0-10), and history of lower extremity (foot/ankle, knee, hip) injuries between the high, moderate, and low specialization groups. RESULTS The high specialization group reported significantly lower overall LEFS scores, and a greater proportion (40%) reported clinically important deficits in LEFS scores compared to the low specialization group (20%). The high specialization group also reported greater foot/ankle and knee pain and a greater proportion of sport-related knee injuries than the low specialization group (49% vs 25%). CONCLUSIONS Our findings suggest that even after discontinuing sports, young adults who were highly specialized in youth sports before high school reported clinically important deficits in lower extremity function, greater foot/ankle and knee pain, and a greater history of knee injuries than young adults who were not specialized in youth sports, suggesting a possible link between youth sports specialization and long-term lower extremity health after sports.
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Affiliation(s)
- Madison Dobscha
- Department of Health Professions, James Madison University, Harrisonburg, Virginia, USA
| | - Connie Peterson
- Department of Health Professions, James Madison University, Harrisonburg, Virginia, USA
| | | | - John Goetschius
- Department of Health Professions, James Madison University, Harrisonburg, Virginia, USA
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Krug MI, Vacek PM, Choquette R, Beynnon BD, Slauterbeck JR. Compliance and Fidelity With an Injury Prevention Exercise Program in High School Athletics. Sports Health 2021; 14:483-489. [PMID: 34490822 DOI: 10.1177/19417381211043120] [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: 11/15/2022] Open
Abstract
BACKGROUND Use of injury prevention programs (IPPs) by high school athletes has increased but their success in reducing injury depends on program compliance and fidelity of exercise performance. HYPOTHESIS Compliance with the 11+ IPP and exercise performance fidelity by high school athletic teams depend on sex, sport, and level of play. STUDY DESIGN Secondary analyses of data from a randomized controlled trial (RCT). LEVEL OF EVIDENCE Level 2. METHODS The 11+ IPP was implemented by 100 male and female high school athletic teams (American football, soccer, basketball, and lacrosse). Team compliance and fidelity with the program were evaluated by direct observation of warm-up routines and a weekly online survey completed by coaches. Differences in compliance and fidelity due to sport, sex, and level of play were assessed by analysis of variance. RESULTS Coaches reported that their teams performed the full IPP an average of 1.45 times per week, and 28% of observed warm-ups included all exercises in the IPP. Compliance differed by sport but not by level of play or the athletes' sex. At the end of the season, cueing was observed 19% of the time and differed by sport. Good technique was observed 66% of the time and varied by level of play. CONCLUSION Team compliance with the IPP varied by sport and was below the recommended number of sessions per week needed to reduce injury. Removal of implementation barriers and improved support from coaches are needed at all levels of play for IPPs to be effective. CLINICAL RELEVANCE Clinical and sports practitioners intending to implement an IPP at the high school level should anticipate and address barriers that affect program compliance and fidelity of exercise performance. Frequent follow-up and instruction may be necessary for successful adoption of the IPP.
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Affiliation(s)
- Mickey I Krug
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Pamela M Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - Rebecca Choquette
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Bruce D Beynnon
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - James R Slauterbeck
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont
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Ritzer EE, Yang J, Kistamgari S, Collins CL, Smith GA. An epidemiologic comparison of acute and overuse injuries in high school sports. Inj Epidemiol 2021; 8:51. [PMID: 34380551 PMCID: PMC8356388 DOI: 10.1186/s40621-021-00344-8] [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: 05/09/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background Acute and overuse injuries affect millions of high school athletes annually and a better understanding of differences between these injuries is needed to help guide prevention, treatment, and rehabilitation strategies. This study compares acute and overuse injuries using a nationally representative sample of high school athletes. Methods Injuries among United States high school athletes participating in 5 boys’ sports (football, soccer, basketball, wrestling, baseball) and 4 girls’ sports (soccer, volleyball, basketball, softball) reported in the High School RIO™ surveillance system during the 2006-07 through 2018-19 school years were classified as acute or overuse. National estimates and injury rates were calculated. Results Of 17 434 646 estimated injuries, 92.0 % were acute and 8.0 % were overuse. The acute injury rate was higher than the overuse injury rate among both male (Rate Ratio [RR] 16.38, 95 % CI: 15.70–17.10) and female (RR 8.14, 95 % CI: 7.71–8.60) athletes. The overuse injury rate per 10,000 athlete exposures among female athletes (1.8) was slightly higher than among males (1.4). The rate of acute injury compared with the rate of overuse injury was higher during competition (RR 32.00, 95 % CI: 29.93–34.22) than practice (RR 7.19, 95 % CI: 6.91–7.47). Boys’ football contributed the most acute (42.1 %) and overuse (23.7 %) injuries among the 9 sports. Among female sports, girls’ soccer contributed the most acute (15.6 % of all acute injuries) and overuse (19.4 % of all overuse injuries) injuries. The lower extremity was most commonly injured in acute (48.9 %) and overuse (65.9 %) injuries. Ligament sprain (31.7 %) and concussion (21.0 %) were the most common acute injury diagnoses, while muscle strain (23.3 %) and tendonitis (23.2 %) were the most common overuse injury diagnoses. Compared with acute injuries, overuse injuries were more likely to result in time loss from sports participation of < 1 week among both boys and girls and across most sports. Acute injuries were more likely than overuse injuries to cause a time loss of 1–3 weeks or medical disqualification from sports participation. Conclusions Acute and overuse injuries display many differences that provide opportunities for data-informed athlete preparation, treatment, and rehabilitation, which may reduce injuries and improve injury outcomes in high school athletics.
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Affiliation(s)
- Erin E Ritzer
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Lake Erie College of Osteopathic Medicine, 5000 Lakewood Ranch Blvd, FL, 34211, Bradenton, USA
| | - Jingzhen Yang
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sandhya Kistamgari
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, 401 West Michigan Street, Suite 500, Indianapolis, IN, USA
| | - Gary A Smith
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. .,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. .,Child Injury Prevention Alliance, Columbus, OH, USA.
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Lisman P, Hildebrand E, Nadelen M, Leppert K. Association of Functional Movement Screen and Y-Balance Test Scores With Injury in High School Athletes. J Strength Cond Res 2021; 35:1930-1938. [PMID: 30844987 DOI: 10.1519/jsc.0000000000003082] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Lisman, P, Hildebrand, E, Nadelen, M, and Leppert, K. Association of functional movement screen and Y-Balance Test scores with injury in high school athletes. J Strength Cond Res 35(7): 1930-1938, 2021-The purpose of this study was to determine the association between functional movement screen (FMS) and Y-Balance Test (YBT) performance and lower extremity injury in a sample of male high school athletes. A total of 124 high school football (n = 89), lacrosse (n = 25), and baseball (n = 10) players underwent FMS and YBT before the start of their competitive seasons. Time loss lower extremity injury incidence data were tracked by each team's certified athletic trainer and used for analysis. Receiver operating characteristic (ROC) curves were calculated to determine the optimal cutpoints for FMS composite score (CS) and YBT measures, including CS and reach distance asymmetry for anterior, posteromedial, and posterolateral directions, for predicting injury. No cutpoints on the ROC curves maximized sensitivity and specificity; therefore, FMS CS and YBT measures (CS and asymmetry) were analyzed as continuous variables. Logistic regression models adjusted for age and sport revealed no significant associations between FMS CS and lower extremity injury (odds ratio [OR] = 0.99; 95% confidence interval [CI] = 0.83-1.20). Similar findings were found for YBT asymmetry in all directions (ORs ranged from 0.98 to 1.08) and CS (OR = 0.99; 95% CI = 0.95-1.04). There were also no significant associations between the presence of asymmetry and low score (score of 1) on any individual FMS test and injury. Overall, FMS and YBT were not associated with increased risk of lower extremity injury in this sample of high school athletes. These findings do not support the use of FMS and YBT as stand-alone injury risk assessments in high school athletes.
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Affiliation(s)
- Peter Lisman
- Department of Kinesiology, Towson University, Towson, Maryland
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Acceleration and Jerk After a Jump Stabilization Task in Individuals With and Without Chronic Ankle Instability. J Appl Biomech 2021; 37:359-364. [PMID: 34140416 DOI: 10.1123/jab.2020-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 03/19/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022]
Abstract
Studies have demonstrated that individuals with chronic ankle instability (CAI) have diminished dynamic stability. Jerk-based measures have been utilized to examine dynamic balance because of their ability to quantify changes in acceleration and may provide an understanding of the postural corrections that occur during stabilizing following a jumping task. The purpose of this study was to compare acceleration and jerk following a jump stabilization task between individuals with CAI and the uninjured controls. Thirty-nine participants volunteered to participate in this case control study. Participants completed a jump stabilization task requiring them to jump off 2 feet, touch a marker set at 50% of their maximal vertical jump height, land on a single limb, and maintain balance for 3 seconds. Acceleration was calculated as the second derivative, and jerk was calculated as the third derivative of the displacement of the resultant vector position. Participants with CAI had greater acceleration (mean difference = 55.6 cm/s2; 95% confidence interval, 10.3 to 100.90; P = .017) and jerk compared with the uninjured controls (mean difference = 1804.5 cm/s3; 95% confidence interval, 98.7 to 3510.3; P = .039). These results suggest that individuals with CAI made faster and more frequent active postural control corrections to regain balance following a jump compared with the uninjured controls.
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Greiwe J, Cooke A, Nanda A, Epstein SZ, Wasan AN, Shepard KV, Capão-Filipe M, Nish A, Rubin M, Gregory KL, Dass K, Blessing-Moore J, Randolph C. Work Group Report: Perspectives in Diagnosis and Management of Exercise-Induced Bronchoconstriction in Athletes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2542-2555. [PMID: 32636147 DOI: 10.1016/j.jaip.2020.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 11/26/2022]
Abstract
Exercise-induced bronchoconstriction, otherwise known as exercise-induced bronchoconstriction with asthma or without asthma, is an acute airway narrowing that occurs as a result of exercise and can occur in patients with asthma. A panel of members from the American Academy of Allergy, Asthma & Immunology Sports, Exercise, & Fitness Committee reviewed the diagnosis and management of exercise-induced bronchoconstriction in athletes of all skill levels including recreational athletes, high school and college athletes, and professional athletes. A special emphasis was placed on the recommendations and regulations set forth by professional athletic organizations after a detailed review of their collective bargaining agreements, substance abuse policies, antidoping program manuals, and the World Anti-Doping Agency antidoping code. The recommendations in this review are based on currently available evidence in addition to providing guidance for athletes of all skill levels as well as their treating physicians to better understand which pharmaceutical and nonpharmaceutical management options are appropriate as well as which medications are permitted or prohibited, and the proper documentation required to remain compliant.
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Affiliation(s)
- Justin Greiwe
- Bernstein Allergy Group Inc, Cincinnati, Ohio; Division of Immunology/Allergy Section, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Andrew Cooke
- Lake Allergy, Asthma & Immunology PA, Tavares, Fla
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Kirk V Shepard
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine and James A. Haley Veterans' Hospital, Tampa, Fla
| | | | - Andy Nish
- Northeast Georgia Physician's Group Allergy and Asthma, Gainesville, Ga
| | - Mark Rubin
- Asthma and COPD Emmi Solutions, Chicago, Ill; CME Education Program Steering Committee, The France Foundation, Old Lyme, Conn
| | - Karen L Gregory
- Oklahoma Allergy and Asthma Clinic, Oklahoma City, Okla; School of Nursing and Health Studies, Georgetown University, Washington, DC
| | - Kathleen Dass
- Michigan Allergy, Asthma & Immunology Center PLLC, Oak Park, Mich; Division of Immunology/Allergy Section, Department of Internal Medicine, Oakland University William Beaumont Hospital, Rochester, Mich
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Schmidt JD, Rawlins MLW, Lynall RC, D'Lauro C, Clugston JR, McAllister TW, McCrea M, Broglio SP. Medical Disqualification Following Concussion in Collegiate Student-Athletes: Findings from the CARE Consortium. Sports Med 2020; 50:1843-1855. [PMID: 32557231 DOI: 10.1007/s40279-020-01302-y] [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: 11/26/2022]
Abstract
BACKGROUND The absence of evidence-based guidelines make medical disqualification (MDQ) following concussion one of the most challenging decision-making processes faced by sports medicine professionals. OBJECTIVE We aimed to compare premorbid and postmorbid factors between student-athletes that were and were not medically disqualified from sport following a concussion. METHODS Among 1832 student-athletes diagnosed with concussion within the CARE Consortium, 53 (2.9%) were medically disqualified (MDQ +) and 1779 (97.1%) were not medically disqualified (MDQ-). We used contingency tables and descriptive statistics for an initial evaluation of a broad list of premorbid and postmorbid factors. For those factors showing association with MDQ status, we calculated odds ratios and 95% confidence intervals for the odds of being MDQ + in the presence of the identified factor. RESULTS History of 2 (OR: 3.2, 95% CI 1.5, 6.9) or 3 + (OR: 7.4, 95% CI 3.4, 15.9) previous concussions; 1 + headaches in past 3 months (OR: 1.8, 95% CI 1.0, 3.2); immediate removal from play (OR: 2.4, 95% CI 1.2, 4.9); alcohol (OR: 2.6, 95% CI 1.2, 5.4), tobacco (OR: 3.3, 95% CI 1.1, 9.5), or marijuana use since injury (OR: 5.4, 95% CI 1.5, 19.0); as well as prolonged recovery due to mental health alterations (OR: 5.3, 95% CI 2.0, 14.1) or motivation/malingering (OR: 7.5, 95% CI 3.3, 17.0) increased odds of being MDQ + . The MDQ + group took longer to become asymptomatic relative to the MDQ- group (MDQ + : 23.5 days, 95% CI 15.8, 31.2; MDQ-: 10.6 days, 95% CI 9.5, 11.6; p < 0.001). CONCLUSIONS MDQ following concussion was relatively rare. We identified three patterns related to MDQ following concussion: (1) concussion and headache history were the only premorbid factors that differed (2) initial concussion presentation was more severe and more immediate in the MDQ + group, and (3) post-concussion recovery outcomes expressed the greatest differences between groups.
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Affiliation(s)
- Julianne D Schmidt
- UGA Concussion Research Laboratory, University of Georgia, 330 River Rd, Athens, GA, USA.
- Department of Kinesiology, University of Georgia, 330 River Rd, Athens, GA, USA.
| | | | - Robert C Lynall
- UGA Concussion Research Laboratory, University of Georgia, 330 River Rd, Athens, GA, USA
- Department of Kinesiology, University of Georgia, 330 River Rd, Athens, GA, USA
| | - Christopher D'Lauro
- Department of Behavioral Science and Leadership, United States Air Force Academy, USAF, Air Force Academy, CO, USA
| | - James R Clugston
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
| | - Tom W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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13
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Al-Hajj S, Nehme R, Hatoum F, Zheng A, Pike I. Child school injury in Lebanon: A study to assess injury incidence, severity and risk factors. PLoS One 2020; 15:e0233465. [PMID: 32530949 PMCID: PMC7292362 DOI: 10.1371/journal.pone.0233465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND School-based injuries represent a sizeable portion of child injuries. This study investigated the rates of school-based injuries in Lebanon, examining injury mechanisms, outcomes and associated risk factors. METHODS Data were prospectively collected by intern school nurses at 11 private schools for the 2018-2019 academic year. Descriptive and inferential analyses were performed. Chi-square comparisons were conducted to determine the significance of any differences in injury rates between boys and girls for each category of school. RESULTS 4,619 injury cases were collected. The yearly rate for school injuries was 419.1 per 1,000 children for the year 2018-2019. Boys demonstrated a significantly higher injury rate for all mechanisms of injuries, with the exception of being injured while walking, injured in the gym/sports areas, and other areas outside the playground and classroom. Elementary school children had the highest rate of injuries, nearly 2.4 times higher than kindergarten, 2.8 times higher than middle school, and 14.5 times higher than high school. Injuries to the face, upper extremities, and lower extremities were nearly 3 times more common than injuries to other areas of the body. Bumps/hits and bruises were most common-almost 3 times more likely than all other injury types. Injuries were mainly minor or moderate in severity-severe injuries were about 10 times less likely. Most injuries were unintentional, with rates nearly 5 times higher than those with unclear intent and 12 times higher than intentional injuries. CONCLUSIONS School injuries represent a relatively common problem. Compliance with playground safety standards coupled with the implementation of injury prevention strategies and active supervision at schools can curtail child injuries and ensure a safe and injury-free school environment.
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Affiliation(s)
- Samar Al-Hajj
- Health Management and Policy Department, American University of Beirut, Riad El-Solh, Beirut, Lebanon
| | - Ricardo Nehme
- Department of Biology, American University of Beirut, Beirut, Lebanon
| | - Firas Hatoum
- Department of Biology, American University of Beirut, Beirut, Lebanon
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Provance AJ, Howell DR, Potter MN, Wilson PE, D'Lauro AM, Wilson JC. Presence of Neck or Shoulder Pain Following Sport-Related Concussion Negatively Influences Recovery. J Child Neurol 2020; 35:456-462. [PMID: 32192408 DOI: 10.1177/0883073820909046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Our objective was to examine the effect of current neck or shoulder pain on concussion outcomes. Variables included symptom resolution and return-to-sport time, symptom severity, amount of school missed, and sleep disturbances. Three hundred twelve patients (37% female; median age = 15.0 years; evaluated median = 9 days postinjury) reported experiencing current neck or shoulder pain at initial evaluation, and 268 did not (31% female; median age = 14.7 years; evaluated median = 8 days postinjury). Neck or shoulder pain was associated with longer symptom resolution time (β = 6.38, 95% confidence interval [CI] = 2.44, 10.31; P = .002), more severe symptoms (β = 7.06, 95% CI = 4.91, 9.21; P < .001), and greater odds of missing >5 days of school (adjusted odds ratio [aOR] = 1.89, 95% CI = 1.23, 2.93; P = .004), and postinjury sleep problems (aOR = 2.20, 95% CI = 1.51, 3.21; P < .001). Experiencing neck or shoulder pain during the initial postinjury clinical evaluation was associated with worsened clinical outcomes. Clinicians may consider referral to early rehabilitation following concussion among those who report neck or shoulder pain.
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Affiliation(s)
- Aaron J Provance
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.,Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.,Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA
| | - Morgan N Potter
- School of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Pamela E Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, CO, USA
| | - Allison M D'Lauro
- Department of Physical Therapy, Children's Hospital Colorado, Aurora, CO, USA
| | - Julie C Wilson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.,Sports Medicine Center, Children's Hospital Colorado, Aurora, CO, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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15
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Rosen AB, McGrath ML, Maerlender AL. Males with chronic ankle instability demonstrate deficits in neurocognitive function compared to control and copers. Res Sports Med 2020; 29:116-128. [PMID: 31992081 DOI: 10.1080/15438627.2020.1723099] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to determine if there were neurocognitive deficits among controls, copers and those with chronic ankle instability (CAI). Participants included those without history of ankle injury (n = 14), ankle sprain copers (n = 13) and patients with self-reported CAI (n = 14). They completed a battery of valid and reliable computer-based neurocognitive tests. The differences between neurocognitive domain scores were compared across the Control, Coper and CAI groups. Patients with CAI had lower composite memory, visual memory and simple attention compared to controls. In males with CAI, large differences in memory and attention were found relative to control participants. These differences may contribute to uncontrolled episodes of giving way through deficits in spatial awareness and/or an inability to identify environmental obstacles. Clinicians should explore ways to provide additional stimuli through innovative rehabilitation protocols aimed at maximizing neurocognitive abilities in patients with CAI.
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Affiliation(s)
- Adam B Rosen
- School of Health and Kinesiology, University of Nebraska at Omaha , Omaha, NE, USA
| | - Melanie L McGrath
- Department of Health and Human Performance, University of Montana , Missoula, MO, USA
| | - Arthur L Maerlender
- Center for Brain, Biology and Behavior, University of Nebraska at Lincoln , Lincoln, NE, USA
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16
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Patient-Reported Outcomes and Perceived Confidence Measures in Athletes With a History of Ankle Sprain. J Sport Rehabil 2019; 29:795-800. [PMID: 31628274 DOI: 10.1123/jsr.2018-0310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 04/11/2019] [Accepted: 06/19/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Patient-reported outcome measures (PROs) and functional performance tests are recommended in the National Athletic Trainers' Association's position statement on the prevention and management of ankle sprains during the return-to-play process. Evaluating perceived confidence may be another valuable method to evaluate an athlete's readiness to return-to-play following an ankle sprain. OBJECTIVE To evaluate the relationship between PROs and perceived confidence when performing functional performance tasks in high school athletes with a history of ankle sprain. DESIGN Descriptive study. SETTING Public high school. PATIENTS OR OTHER PARTICIPANTS A total of 25 high school student-athletes (6 males and 19 females, age 16.2 [1.1] y, height 169.3 [7.7] cm, mass 63.2 [9.8] kg). INTERVENTION(S) None. MAIN OUTCOME MEASURES The Cumberland Ankle Instability Tool, visual analog scale (VAS) for pain, Identification of Functional Ankle Instability, and Tampa Scale of Kinesiophobia-11 were completed by all participants. Participants then completed the weight-bearing lunge test; star excursion balance test; lateral, up-down, and triple hop tests; the single-leg vertical jump; and Southeast Missouri agility test and were asked to report their confidence in completing each task using a VAS with anchors of "no confidence" and "complete confidence." Pearson r correlations were calculated between the PROs and the confidence VAS scores of the functional tests. RESULTS Moderate to strong negative correlations were identified between pain VAS measures and confidence VAS measures for all functional tests except the star excursion balance test and vertical jump. Moderate negative correlations were found between Tampa Scale of Kinesiophobia-11 scores and perceived confidence during the star excursion balance test and vertical jump. Finally, a moderate positive correlation was identified between Cumberland Ankle Instability Tool scores and perceived confidence measures during the Southeast Missouri agility test. CONCLUSIONS High school athletes with a history of ankle sprain demonstrated significant correlations between several PROs and perceived confidence during various functional performance tests. The value of perceived confidence measures when making return-to-play decisions after ankle sprains warrants further investigation.
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17
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Raad M, Thevenin Lemoine C, Bérard E, Laumonerie P, Sales de Gauzy J, Accadbled F. Delayed reconstruction and high BMI z score increase the risk of meniscal tear in paediatric and adolescent anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 2019; 27:905-911. [PMID: 30353211 DOI: 10.1007/s00167-018-5201-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to identify epidemiologic risk factors for secondary meniscal tears in paediatric and adolescent patients who sustain an anterior cruciate ligament (ACL) tear. The hypothesis was that delayed reconstruction and elevated BMI z score, increase the risk for secondary meniscal tears. METHODS A prospective, descriptive and analytical study of consecutively accrued children and adolescents with an ACL tear was performed. One hundred and sixty subjects (114 males and 46 females) were identified between 2006 and 2015 at one institution. The age range was between 7 and 19 years. Fifteen parameters were recorded and analysed: age at initial trauma, initial trauma circumstance, sex, BMI z score, affected side, type of sport, Tegner score, athletic level, time to MRI, time to first referral, time to surgery, age at surgery, attempted non-operative treatment, operative report and associated meniscal tear. These meniscal lesions could be diagnosed by an MRI and / or during surgery. RESULTS Out of the 160 cases, 143 were treated surgically and 17 cases non-operatively. Median corrected BMI z score was 0.5 (range - 1.8 to 4.7). 41.9% had one or more meniscal lesions. 55 patients were initially treated non-operatively, of which 39 patients were secondarily operated. There was a positive relationship between meniscal lesion and: BMI z score (p = 0.0364), attempted non-operative treatment (p = 0.001) and time to surgery (p = 0.002). The median time to ACL reconstruction was 229 days for patients with secondary meniscal lesions. CONCLUSIONS Patients with ACL tears treated non-operatively developed secondary meniscal lesions requiring delayed surgical management. There was a positive correlation between BMI z score and secondary meniscal lesions. Thus, early ACL reconstruction is advocated in young athletes. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Maroun Raad
- CHU Toulouse, Hôpital des enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse cedex 9, France.
| | - Camille Thevenin Lemoine
- CHU Toulouse, Hôpital des enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse cedex 9, France
| | - Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM-University of Toulouse III, Toulouse University Hospital (CHU), Toulouse, France
| | - Pierre Laumonerie
- CHU Toulouse, Hôpital des enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse cedex 9, France
| | - Jerome Sales de Gauzy
- CHU Toulouse, Hôpital des enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse cedex 9, France
| | - Franck Accadbled
- CHU Toulouse, Hôpital des enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse cedex 9, France
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18
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Witmer CM. How I approach managing student athletes at risk for bleeding. Pediatr Blood Cancer 2019; 66:e27523. [PMID: 30362247 DOI: 10.1002/pbc.27523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 01/19/2023]
Abstract
Frequently, pediatric hematologists need to provide guidance regarding sports participation for children with congenital coagulopathies, immune thrombocytopenia, and those receiving anticoagulation. Although sports participation has clear health and psychosocial benefits, it can be associated with harm secondary to bleeding from injury. Decision-making for sports involvement should be individualized, patient centered, and well informed. This review focuses on the current data regarding the benefit as well as risks for sports participation and provides a framework for advising and supporting the student athlete who is at risk for bleeding.
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Affiliation(s)
- Char M Witmer
- The Children's Hospital of Philadelphia, Division of Hematology, Philadelphia, Pennsylvania
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19
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Choisne J, McNally A, Hoch MC, Ringleb SI. Effect of simulated joint instability and bracing on ankle and subtalar joint flexibility. J Biomech 2019; 82:234-243. [PMID: 30442430 DOI: 10.1016/j.jbiomech.2018.10.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 12/26/2022]
Abstract
It is clinically challenging to distinguish between ankle and subtalar joints instability in vivo. Understanding the changes in load-displacement at the ankle and subtalar joints after ligament injuries may detect specific changes in joint characteristics that cannot be detected by investigating changes in range of motion alone. The effect of restricting joints end range of motion with ankle braces was already established, but little is known about the effect of an ankle brace on the flexibility of the injured ankle and subtalar joints. Therefore, the purposes of this study were to (1) understand how flexibility is affected at the ankle and subtalar joints after sectioning lateral and intrinsic ligaments during combined sagittal foot position and inversion and during internal rotation and (2) investigate the effect of a semi-rigid ankle brace on the ankle and subtalar joint flexibility. Kinematics and kinetics were collected from nine cadaver feet during inversion through the range of ankle flexion and during internal rotation. Motion was applied with and without a brace on an intact foot and after sequentially sectioning the calcaneofibular ligament (CFL) and the intrinsic ligaments. Segmental flexibility was defined as the slope of the angle-moment curve for each 1 Nm interval. Early flexibility significantly increased at the ankle and subtalar joint after CFL sectioning during inversion. The semi-rigid ankle brace significantly decreased early flexibility at the subtalar joint during inversion and internal rotation for all ligament conditions and at the ankle joint after all ligaments were cut.
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Affiliation(s)
- Julie Choisne
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Anthony McNally
- Mechanical and Aerospace Engineering, Old Dominion University, Norfolk, VA, USA
| | - Matthew C Hoch
- Division of Athletic Training and Sports Medicine Research Institute, University of Kentucky, Lexinton, KY, USA
| | - Stacie I Ringleb
- Mechanical and Aerospace Engineering, Old Dominion University, Norfolk, VA, USA.
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20
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Andia I, Maffulli N. How far have biological therapies come in regenerative sports medicine? Expert Opin Biol Ther 2018; 18:785-793. [PMID: 29939773 DOI: 10.1080/14712598.2018.1492541] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Regular engagement in sports produces many health benefits, but also exposes to increased injury risk. The quality of medical care available is crucial not only for sports trauma but also to avoid overuse syndromes and post-traumatic degenerative conditions. AREAS COVERED We provide background information on some clinical needs in sport injuries and describe the main families of biological products used in clinical practice. We also discuss limitations of the current clinical experience. EXPERT OPINION Sport and exercise impairment affects different segments of the population with different needs. The exceptional demands of elite athletes and subsequent media coverage have created hype around regenerative therapies. Statistical evidence, whether weak (cell products) or moderate (PRPs), is not enough to drive medical decisions because of the heterogeneity of the biological products available and their application procedures. Moreover, the specific needs of the different segments of the population along with the available clinical evidence for each musculoskeletal condition should be considered in the decision-making process. There is urgent need to develop regenerative protocols combined with post-intervention rehabilitation, and gather meaningful clinical data on the safety and efficacy of these interventions in the different populations segments.
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Affiliation(s)
- Isabel Andia
- a Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital , Barakaldo , Spain
| | - Nicola Maffulli
- b Department of Musculoskeletal Disorders , University of Salerno School of Medicine and Dentristry , Salerno , Italy.,c Centre for Sport and Exercise Medicine , Queen Mary University of London, Barts and the London School of Medicine and Dentistry , London , England
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