1
|
Losciale JM, Truong LK, Zhang K, Silvester-Lee T, Miciak M, Pajkic A, Le CY, Xie H, Hoens AM, Mosewich AD, Hunt MA, Li LC, Roos EM, Whittaker JL. Assessing the efficacy of the Stop OsteoARthritis (SOAR) program: A randomized delayed-controlled trial in persons at increased risk of early onset post-traumatic knee osteoarthritis. Osteoarthritis Cartilage 2024; 32:1001-1012. [PMID: 38615974 DOI: 10.1016/j.joca.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Assess the efficacy of an 8-week virtual, physiotherapist (PT)-guided knee health program (Stop OsteoARthritis (SOAR)) to improve knee extensor strength in individuals at risk of post-traumatic knee osteoarthritis (PTOA). METHOD In this superiority, randomized delayed-control trial, persons aged 16-35 years, 1-4 years after a self-reported knee joint injury were randomly assigned (1:1) to receive the SOAR program immediately (experimental group) or after a 9-week delay (control group). SOAR includes 1) one-time Knee Camp (virtual PT-guided group education, knee assessment, 1:1 exercise and physical activity (PA) goal-setting); 2) Weekly personalized home-based exercise and PA program with tracking; 3) Weekly 1:1 PT counseling (virtual). The primary outcome was a change in isokinetic knee extensor strength (baseline to 9-weeks). Additional outcomes included change in self-reported knee-related quality-of-life (QOL), self-efficacy, self-management and kinesiophobia, and PA (accelerometer) at 9 and 18-weeks. Linear regression models estimated the effect of the 8-week intervention at the primary endpoint (9-week). RESULTS 49 of 54 randomized participants completed the study (91%). Participants were a mean ± standard deviation age of 27 ± 5.0 years, and 2.4 ± 0.9 years post-injury. No mean between group differences for the primary (0.05; 95% confidence interval (CI): -0.10, 0.19) or other outcomes were seen at 9 weeks except for greater improvements in perceived self-management (Partner in Health Scale; 11.3/96, 95%CI: 5.5, 17.1) and kinesiophobia (Tampa Scale of Kinesiophobia; -4.4/33, 95%CI: -7.0, -1.8). CONCLUSION For active persons with elevated risk of PTOA, an 8-week SOAR program did not change knee-related strength, QOL, self-efficacy, or PA, on average, but may benefit the ability to self-manage knee health and kinesiophobia.
Collapse
Affiliation(s)
- Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Kexin Zhang
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Pajkic
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Christina Y Le
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alison M Hoens
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Amber D Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Ewa M Roos
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, British Columbia, Canada.
| |
Collapse
|
2
|
Ramachandran AK, Pedley JS, Moeskops S, Oliver JL, Myer GD, Lloyd RS. Changes in Lower Limb Biomechanics Across Various Stages of Maturation and Implications for ACL Injury Risk in Female Athletes: a Systematic Review. Sports Med 2024; 54:1851-1876. [PMID: 38671176 PMCID: PMC11257789 DOI: 10.1007/s40279-024-02022-3] [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] [Accepted: 03/14/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Female athletes are four to six times more likely to sustain an anterior cruciate ligament (ACL) injury than male athletes. Jump-landing biomechanics are influenced by maturation, with post-pubertal female athletes at a heightened risk of ACL injuries. OBJECTIVE The aim of our systematic review was to identify and summarise the current evidence regarding the changes in kinematic and kinetic risk factors associated with ACL injuries during jump-landing tasks in female athletes at various stages of maturity. METHODS A systematic search was conducted in PubMed, CINAHL, Web of Science, SPORTDiscus, EMBASE and Scopus. Articles were included if they: (1) conducted the research on uninjured female athletes with no restriction on playing level/experience; (2) provided information regarding the stage of the maturity and the scale used for estimating the maturity status of the participants; and (3) reported a biomechanical risk factor associated with ACL injuries during jump-landing tasks across at least two different maturity groups (e.g. pre-pubertal vs post-pubertal). RESULTS Sixteen articles involving 2323 female athletes were included in our review. A total of 12 kinematic and 8 kinetic variables were identified across these studies. Of the 12 kinematic variables reported in our review, we found strong evidence for higher peak knee abduction angle in post-pubertal female individuals compared with pre-pubertal girls (p < 0.05). With regard to the 8 kinetic variables, we found strong evidence for lower relative peak vertical ground reaction force, higher external knee abduction moment and internal rotation moment in post-pubertal compared with pre-pubertal athletes. The strength of evidence for the remaining kinematic and kinetic variables ranged from conflicting to moderate and, in some instances, could not be determined. CONCLUSIONS Our study provides an overview of the changes in biomechanical risk factors in female athletes during jump-landing tasks at various stages of maturity. We found moderate-to-limited evidence for most kinematic and kinetic variables, highlighting the need for further research.
Collapse
Affiliation(s)
- Akhilesh Kumar Ramachandran
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK.
| | - Jason S Pedley
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
| | - Sylvia Moeskops
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
| | - Jon L Oliver
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
- Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
| | - Gregory D Myer
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Rhodri S Lloyd
- Youth Physical Development Centre, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD, UK
- Sport Performance Research Institute, New Zealand (SPRINZ), AUT University, Auckland, New Zealand
- Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand
| |
Collapse
|
3
|
Whittaker JL, Kalsoum R, Bilzon J, Conaghan PG, Crossley K, Dodge GR, Getgood A, Li X, Losina E, Mason DJ, Pietrosimone B, Risberg MA, Roemer F, Felson D, Culvenor AG, Meuffels D, Gerwin N, Simon LS, Lohmander LS, Englund M, Watt FE. Toward designing human intervention studies to prevent osteoarthritis after knee injury: A report from an interdisciplinary OARSI 2023 workshop. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100449. [PMID: 38440780 PMCID: PMC10910316 DOI: 10.1016/j.ocarto.2024.100449] [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: 11/06/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
Objective The global impact of osteoarthritis is growing. Currently no disease modifying osteoarthritis drugs/therapies exist, increasing the need for preventative strategies. Knee injuries have a high prevalence, distinct onset, and strong independent association with post-traumatic osteoarthritis (PTOA). Numerous groups are embarking upon research that will culminate in clinical trials to assess the effect of interventions to prevent knee PTOA despite challenges and lack of consensus about trial design in this population. Our objectives were to improve awareness of knee PTOA prevention trial design and discuss state-of-the art methods to address the unique opportunities and challenges of these studies. Design An international interdisciplinary group developed a workshop, hosted at the 2023 Osteoarthritis Research Society International Congress. Here we summarize the workshop content and outputs, with the goal of moving the field of PTOA prevention trial design forward. Results Workshop highlights included discussions about target population (considering risk, homogeneity, and possibility of modifying osteoarthritis outcome); target treatment (considering delivery, timing, feasibility and effectiveness); comparators (usual care, placebo), and primary symptomatic outcomes considering surrogates and the importance of knee function and symptoms other than pain to this population. Conclusions Opportunities to test multimodal PTOA prevention interventions across preclinical models and clinical trials exist. As improving symptomatic outcomes aligns with patient and regulator priorities, co-primary symptomatic (single or aggregate/multidimensional outcome considering function and symptoms beyond pain) and structural/physiological outcomes may be appropriate for these trials. To ensure PTOA prevention trials are relevant and acceptable to all stakeholders, future research should address critical knowledge gaps and challenges.
Collapse
Affiliation(s)
- Jackie L. Whittaker
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Raneem Kalsoum
- Department of Immunology and Inflammation, Imperial College London, London, UK
| | - James Bilzon
- Department for Health, University of Bath, Bath, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK
| | - Philip G. Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Kay Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - George R. Dodge
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Mechano Therapeutics LLC, Philadelphia, PA, USA
| | - Alan Getgood
- Division of Orthopedic Surgery, Bone and Joint Institute, Fowler Kennedy Sport Medicine Clinic, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, OH, USA
| | - Elena Losina
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, USA
| | - Deborah J. Mason
- Biomechanics and Bioengineering Research Centre Versus Arthritis, School of Biosciences, Cardiff University, Cardiff, UK
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina, USA
| | - May Arna Risberg
- Norwegian School Sport Sciences, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Frank Roemer
- Department of Radiology, Universitätsklinikum Erlangen & Friedrich- Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - David Felson
- Section of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Adam G. Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Duncan Meuffels
- Orthopedic and Sport Medicine Department, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | | | - L. Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Fiona E. Watt
- Department of Immunology and Inflammation, Imperial College London, London, UK
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, University of Oxford, UK
| |
Collapse
|
4
|
Marmura H, Bryant D, Getgood A, Webster F. 'It's just my knee': a qualitative study investigating the process of reframing and young athletes' perceived quality of life between anterior cruciate ligament injury and surgery. BMJ Open 2024; 14:e076799. [PMID: 38724051 PMCID: PMC11086484 DOI: 10.1136/bmjopen-2023-076799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES To understand the factors influencing young athletes' perceptions of quality of life (QOL) following an anterior cruciate ligament (ACL) rupture, prior to reconstructive surgery. DESIGN Qualitative descriptive study using semi-structured interviews and thematic analysis of data. SETTING Tertiary sports medicine clinic with patients recruited from the practices of three specialist orthopaedic surgeons. PARTICIPANTS Twenty athletes aged 14-25 provided consent to participate in the study and completed interviews prior to their ACL reconstruction surgery. Participants were eligible to participate if they were scheduled to undergo ACL reconstruction, were 25 years of age or younger, identified as athletes (participated in any level of organised sport), could communicate in English and agreed to be audio recorded. Participants were not eligible if they had experienced a multiligament injury or fracture. RESULTS Young athletes shared common factors that made up their QOL; social connections and support, sport, health, and independence. However, participants' perceptions of their current QOL were quite variable (13-95/100 on a Visual Analogue Scale). Participants who were able to reframe their injury experience by shifting focus to the positive or unaffected aspects of their lives tended to have more favourable perceptions of their QOL than participants who shifted focus to the losses associated with injury. CONCLUSIONS Young athletes who have experienced an ACL injury define their QOL based on social support, sport, health and independence. Individual processes of adaptation and cognitive reframing in response to an ACL injury may exert a greater influence on postinjury QOL than the physical ramifications of the injury itself. Understanding individual perceptions may help target potential interventions or supports to enhance athletes' adaptation to injury.
Collapse
Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
| | - Dianne Bryant
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Alan Getgood
- Faculty of Health Sciences, Western University, London, ON, Canada
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Lawson Research, London Health Sciences Centre, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Fiona Webster
- Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
| |
Collapse
|
5
|
McKay CD, van den Berg CA, Marjoram RA, Hagel BE, Emery CA. Youth Injury Knowledge and Beliefs following Neuromuscular Training Warm-up Implementation in Schools. Int J Sports Med 2024; 45:141-148. [PMID: 38029780 DOI: 10.1055/a-2184-9201] [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: 12/01/2023]
Abstract
Neuromuscular training warm-up programs can reduce injury rates in youth sports, but they often have poor uptake and adherence. Delivering such programs in school physical education classes may provide greater public health benefit, particularly if they promote improved injury knowledge and prevention beliefs amongst students. The purpose of this secondary analysis of a large cluster-randomized controlled trial was to understand how students' (age 11-15 years) knowledge and beliefs change after exposure to an evidence-informed neuromuscular training warm-up program. Six schools delivered the program for a 12-week period in the initial study year (n=566) and two continued to use it in a subsequent "maintenance" year (n=255). Students completed a knowledge and beliefs questionnaire at baseline, 6-week, and 12-week timepoints. Knowledge scores ranged from 7/10 to 8/10 at all timepoints and students generally believed that injuries are preventable. On average, there was less than a one-point change in knowledge between timepoints and there was no change in the median belief scores. There were no meaningful differences between sexes, grades, or previous injury. These findings highlight that knowledge and beliefs are unlikely to change passively through program exposure. More active strategies are needed to improve injury prevention perceptions in this population.
Collapse
Affiliation(s)
- Carly D McKay
- Department for Health, Centre for Health and Injury and Illness Prevention in Sport, University of Bath, Bath, United Kingdom of Great Britain and Northern Ireland
- UK Collaborating Centre on Illness and Injury Prevention in Sport, Universities of Edinburgh and Bath, Bath, United Kingdom of Great Britain and Northern Ireland
| | - Carla A van den Berg
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Rebecca A Marjoram
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Brent E Hagel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Carolyn A Emery
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
6
|
Macri EM, Whittaker JL, Toomey CM, Jaremko JL, Galarneau JM, Ronsky JL, Kuntze G, Emery CA. Patellofemoral joint geometry and osteoarthritis features 3-10 years after knee injury compared with uninjured knees. J Orthop Res 2024; 42:78-89. [PMID: 37291985 DOI: 10.1002/jor.25640] [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] [Received: 10/26/2022] [Revised: 03/03/2023] [Accepted: 06/07/2023] [Indexed: 06/10/2023]
Abstract
In this cross-sectional study, we compared patellofemoral geometry in individuals with a youth-sport-related intra-articular knee injury to uninjured individuals, and the association between patellofemoral geometry and magnetic resonance imaging (MRI)-defined osteoarthritis (OA) features. In the Youth Prevention of Early OA (PrE-OA) cohort, we assessed 10 patellofemoral geometry measures in individuals 3-10 years following injury compared with uninjured individuals of similar age, sex, and sport, using mixed effects linear regression. We also dichotomized geometry to identify extreme (>1.96 standard deviations) features and assessed likelihood of having extreme values using Poisson regression. Finally, we evaluated the associations between patellofemoral geometry with MRI-defined OA features using restricted cubic spline regression. Mean patellofemoral geometry did not differ substantially between groups. However, compared with uninjured individuals, injured individuals were more likely to have extremely large sulcus angle (prevalence ratio [PR] 3.9 [95% confidence interval, CI: 2.3, 6.6]), and shallow lateral trochlear inclination (PR 4.3 (1.1, 17.9)) and trochlear depth (PR 5.3 (1.6, 17.4)). In both groups, high bisect offset (PR 1.7 [1.3, 2.1]) and sulcus angle (PR 4.0 [2.3, 7.0]) were associated with cartilage lesion, and most geometry measures were associated with at least one structural feature, especially cartilage lesions and osteophytes. We observed no interaction between geometry and injury. Certain patellofemoral geometry features are correlated with higher prevalence of structural lesions compared with injury alone, 3-10 years following knee injury. Hypotheses generated in this study, once further evaluated, could contribute to identifying higher-risk individuals who may benefit from targeted treatment aimed at preventing posttraumatic OA.
Collapse
Affiliation(s)
- Erin M Macri
- Department Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Clodagh M Toomey
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Jacob L Jaremko
- Department Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | | | - Janet L Ronsky
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department Mechanical and Manufacturing Engineering and Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Gregor Kuntze
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
7
|
Losciale JM, Truong LK, Zhang K, Scarr T, Xie H, Li LC, Mitchell C, Hunt MA, Whittaker JL. The association between knee muscle performance and clinical outcomes of knee function 1-4 years after a sport-related knee joint injury. Phys Ther Sport 2023; 64:147-155. [PMID: 37922747 DOI: 10.1016/j.ptsp.2023.10.003] [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: 08/07/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Estimate the association between index leg knee muscle strength and rate of torque development (RTD), and self-reported and performance-based (i.e., hop) knee function in persons 1-4 years after a sport-related knee joint injury. METHODS Data were collected at baseline of a clinical trial. Assessments included the Knee injury and Osteoarthritis Outcome Score Sport & Recreation subscale (KOOSsport), 6-m timed hop (TH), and peak concentric isokinetic knee extensor and flexor torque and isometric RTD. Associations between peak torque and RTD with KOOSsport and TH were assessed using multivariable regression with nonlinear transformations. RESULTS 53 participants (64.2% female) were included. Knee extensor peak torque was nonlinearly related to TH time, with a strong inverse relationship at lower torque values that changed as torque increased. Results were inconsistent for flexor peak torque, extensor RTD and flexor RTD, with inconsistencies in relationship shape and estimates of association between primary and sensitivity analyses. There was no association between strength/RTD and KOOSsport. CONCLUSION There was a nonlinear relationship between knee extensor strength and hop function, with lower strength being associated with a stronger relationship. As strength values increased, the relationship attenuated. Knee extensor and flexor strength, or RTD, were not associated with self-reported function.
Collapse
Affiliation(s)
- Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Kexin Zhang
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Thomas Scarr
- Allan McGavin Sports Medicine Clinic, Vancouver, Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada
| | - Cameron Mitchell
- Department of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Arthritis Research Canada, Vancouver, Canada.
| |
Collapse
|
8
|
Ni KN, Ye L, Zhang YJ, Fang JW, Yang T, Pan WZ, Hu XY, Lai HH, Pan B, Lou C, He DW. Formononetin improves the inflammatory response and bone destruction in knee joint lesions by regulating the NF-kB and MAPK signaling pathways. Phytother Res 2023; 37:3363-3379. [PMID: 37002905 DOI: 10.1002/ptr.7810] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 08/12/2023]
Abstract
Formononetin (FMN) is a phytoestrogen that belongs to the isoflavone family. It has antioxidant and anti-inflammatory effects, as well as, many other biological activities. Existing evidence has aroused interest in its ability to protect against osteoarthritis (OA) and promote bone remodeling. To date, research on this topic has not been thorough and many issues remain controversial. Therefore, the purpose of our study was to explore the protective effect of FMN against knee injury and clarify the possible molecular mechanisms. We found that FMN inhibited osteoclast formation induced by receptor activator of NF-κB ligand (RANKL). Inhibition of the phosphorylation and nuclear translocation of p65 in the NF-κB signaling pathway plays a role in this effect. Similarly, during the inflammatory response of primary knee cartilage cells activated by IL-1β, FMN inhibited the NF-κB signaling pathway and the phosphorylation of the ERK and JNK proteins in the MAPK signaling pathway to suppress the inflammatory response. In addition, in vivo experiments showed that both low- and high-dose FMN had a clear protective effect against knee injury in the DMM (destabilization of the medial meniscus) model, and the therapeutic effect of high-dose FMN was stronger. In conclusion, these studies provide evidence of the protective effect of FMN against knee injury.
Collapse
Affiliation(s)
- Kai-Nan Ni
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| | - Lin Ye
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Ye-Jin Zhang
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Jia-Wei Fang
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| | - Tao Yang
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| | - Wen-Zheng Pan
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| | - Xing-Yu Hu
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China
| | - He-Huan Lai
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| | - Bin Pan
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
- Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Chao Lou
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| | - Deng-Wei He
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, 323000, China
| |
Collapse
|
9
|
Patterson BE, Emery C, Crossley KM, Culvenor AG, Galarneau JM, Jaremko JL, Toomey CM, Guermazi A, Whittaker JL. Knee- and Overall Health-Related Quality of Life Following Anterior Cruciate Ligament Injury: A Cross-sectional Analysis of Australian and Canadian Cohorts. J Orthop Sports Phys Ther 2023; 53:402–413. [PMID: 37289467 DOI: 10.2519/jospt.2023.11838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE: To describe the knee- and overall health-related quality of life (QOL) 3 to 12 years after anterior cruciate ligament (ACL) tear, and to assess the association of clinical and structural features with QOL after ACL tear. DESIGN: Cross-sectional analysis of combined data from Australian (n = 76, 5.4 years postinjury) and Canadian (n = 50, 6.6 years postinjury) prospective cohort studies. METHODS: We conducted a secondary analysis of patient-reported outcomes and index knee magnetic resonance imaging (MRI) acquired in 126 patients (median 5.5 [range: 4-12] years postinjury), all treated with ACL reconstruction. Outcomes included knee (ACL Quality of Life questionnaire [ACL-QOL]) and overall health-related QOL (EQ-5D-3L). Explanatory variables were self-reported knee pain (Knee Injury and Osteoarthritis Outcome Score [KOOS-Pain subscale]) and function (KOOS-Sport subscale), and any knee cartilage lesion (MRI Osteoarthritis Knee Score). Generalized linear models were adjusted for clustering between sites. Covariates were age, sex, time since injury, injury type, subsequent knee injuries, and body mass index. RESULTS: The median [range] ACL-QOL score was 82 [24-100] and EQ-5D-3L was 1.0 [-0.2 to 1.0]. For every 10-point higher KOOS-Sport score, the ACL-QOL score increased by 3.7 points (95% confidence interval [CI]: 1.7, 5.7), whereas there was no evidence of an association with the EQ-5D-3L (0.00 points, 95% CI: -0.02, 0.02). There were no significant association between KOOS-Pain and ACL-QOL (4.9 points, 95% CI: -0.1, 9.9) or EQ-5D-3L (0.05 points, 95% CI: -0.01, 0.11), respectively. Cartilage lesions were not associated with ACL-QOL (-1.2, 95% CI: -5.1, 2.7) or EQ-5D-3L (0.01, 95% CI: -0.01, 0.04). CONCLUSION: Self-reported function was more relevant for knee-related QOL than knee pain or cartilage lesions after ACL tear. Self-reported function, pain, and knee structural changes were not associated with overall health-related QOL. J Orthop Sports Phys Ther 2023;53(7):1-12. Epub: 8 June 2023. doi:10.2519/jospt.2023.11838.
Collapse
Affiliation(s)
- Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Australian International Olympic Committee Research Centre, La Trobe University, Melbourne, Australia
| | - Carolyn Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary Calgary Alberta, Canada
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Australian International Olympic Committee Research Centre, La Trobe University, Melbourne, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Australian International Olympic Committee Research Centre, La Trobe University, Melbourne, Australia
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Clodagh M Toomey
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA
| | - Jackie L Whittaker
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Bristish Columbia, Canada
- Arthritis Research Canada, Vancouver, Bristish Columbia, Canada
| |
Collapse
|
10
|
Gill SD, Stella J, Chatterton ML, Lowry N, Kloot K, Reade T, Baker T, Hayden G, Ryan M, Seward H, Page RS. Economic consequences of injury in female Australian footballers: A prospective observational study of emergency department presentations. Emerg Med Australas 2023; 35:496-503. [PMID: 36623933 DOI: 10.1111/1742-6723.14156] [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: 07/18/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Investigate the economic consequences of injuries to female Australian footballers from a health sector and societal perspective. METHODS This prospective observational study invited 242 females to complete an online questionnaire 3-6 months following an Australian football injury which involved presentation to an ED in Victoria, Australia. The questionnaire inquired regarding healthcare use, time off work, return to playing football and extent of recovery following injury. Relevant information was also extracted from respondents' medical records regarding injury-type, body part injured, investigations and treatments. Healthcare costs were determined for each respondent's ED presentation, hospital admission/s (when relevant), and subsequent healthcare use. Societal costs were determined as lost income to the respondent and/or carer. RESULTS A total of 108 people responded to the questionnaire. Sprains/strains and fractures accounted for 84.2% of respondents' injuries. Sixteen respondents (14.8%) required admission to hospital at the time of injury and 81 (75.0%) required subsequent healthcare appointments following discharge from the ED or hospital. Time off work or school following the injury was common (64.8% of respondents) and 27.8% of respondents had a carer take time off work. More than 80% of respondents missed training and matches following the injury. The median healthcare cost per respondent was AUD$753 and the median cost due to work absence was AUD$1393. One-quarter of respondents reported a full recovery. CONCLUSIONS Injuries to female Australian footballers can produce substantial healthcare and societal costs, which has important implications for healthcare provision and prioritising and implementing injury prevention programmes and post-injury rehabilitation.
Collapse
Affiliation(s)
- Stephen D Gill
- Barwon Centre for Orthopaedic Research and Education, School of Medicine, Deakin University and St John of God Geelong Hospital, Geelong, Victoria, Australia.,Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Julian Stella
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nicole Lowry
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Kate Kloot
- School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Tom Reade
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Tim Baker
- Centre for Rural Emergency Medicine, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Georgina Hayden
- Emergency Department, St John of God Geelong Hospital, Geelong, Victoria, Australia
| | - Matthew Ryan
- Emergency Department, Epworth Hospital Geelong, Geelong, Victoria, Australia
| | - Hugh Seward
- Newtown Medical Centre, Geelong, Victoria, Australia
| | - Richard S Page
- Barwon Centre for Orthopaedic Research and Education, School of Medicine, Deakin University and St John of God Geelong Hospital, Geelong, Victoria, Australia
| |
Collapse
|
11
|
Truong LK, Mosewich AD, Miciak M, Pajkic A, Silvester-Lee T, Li LC, Whittaker JL. "I feel I'm leading the charge." Experiences of a virtual physiotherapist-guided knee health program for persons at-risk of osteoarthritis after a sport-related knee injury. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 5:100333. [PMID: 36685259 PMCID: PMC9850175 DOI: 10.1016/j.ocarto.2022.100333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/25/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Objective Describe participants' perspectives about the feasibility of a virtual, physiotherapist-guided knee health program for people at risk of post-traumatic osteoarthritis after a sport-related knee injury. Design Qualitative description study nested within a quasi-experimental study evaluating the feasibility of the Stop OsteoARthritis (SOAR) with persons with sport-related knee injuries. SOAR includes: 1) one-time Knee Camp (group education, 1:1 exercise/activity goal-setting); 2) weekly home-based exercise/activity program with tracking, and; 3) weekly 1:1 physiotherapy-guided action-planning. Upon program completion, semi-structured 1:1 interviews were conducted with participants identified by convenience and maximum variation sampling (age, gender, program satisfaction). Open-ended questions elicited participants' experiences with the program. Content analysis was conducted. Results 12 women and 4 men [median (min-max) age; 30 (19-46) years] were interviewed. Four categories depicted participants' experiences: 1) 'SOAR satisfies an unmet need' portrayed the perceived relevance and need for a program that promotes knowledge about knee health and self-efficacy for independent exercise behaviour, 2) 'Regaining control of knee health' described how SOAR empowered participants and fostered a sense of 'leading the charge' to their own knee health, 3) 'Social support encourages exercise participation' highlighted that weekly physiotherapy interactions provided accountability for achieving exercise goals, and that relating to other participants was inspirational, 4) 'Program refinements and barriers' suggested enhancements to meet the needs of future participants. Conclusions Participants report the SOAR program to be acceptable, relevant, and empowering. Improved knowledge about one's knee health, self-efficacy, autonomy, and social support may encourage exercise adherence and self-management of future knee OA risk.
Collapse
Affiliation(s)
- Linda K. Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada,Arthritis Research Canada, Vancouver, Canada
| | - Amber D. Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Andrea Pajkic
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Linda C. Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada,Arthritis Research Canada, Vancouver, Canada
| | - Jackie L. Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada,Arthritis Research Canada, Vancouver, Canada,Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada,Corresponding author.Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada. #223, 212 Friedman Building 2177 Wesbrook Mall, Vancouver, British Columbia, Canada, V6T 1Z3.
| |
Collapse
|
12
|
Sniffen K, Noel-London K, Schaeffer M, Owoeye O. Is Cumulative Load Associated with Injuries in Youth Team Sport? A Systematic Review. SPORTS MEDICINE - OPEN 2022; 8:117. [PMID: 36114374 PMCID: PMC9481825 DOI: 10.1186/s40798-022-00516-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/03/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
High cumulative external and internal load may predispose athletes to increased risk for injury across a variety of sports, competition levels, and age groups. However, evidence of an association between cumulative load and injury in youth sport remains inconclusive. The objective of this study was to determine the current evidence for cumulative load and injury risk relationships in youth team sport through a systematic review of the existing literature.
Methods
A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature searches were conducted in PubMed, Web of Science, SCOPUS, and CINAHL for relevant articles published between January 2010 and April 2021. The authors conducted independent review and quality assessment of the eligible studies. Eleven articles evaluating youth (less than 18 years old) team sport were included for qualitative synthesis.
Results
Fifty-nine percent (n = 39/66) of the relationships assessed revealed an association between cumulative load and injury across the team sports studied, including the presence of load–injury associations in 84% (n = 16/19) of assessments in youth soccer. Of those relationships where an association was present, 79% (n = 31/39) were positive associations between cumulative load and injury. Risk of bias assessment scores ranged from three to six out of seven possible (median = 5) for cohort studies and from four to seven out of 10 possible (median = 5.5) for cross-sectional studies.
Conclusions
There is some evidence for a positive association between load and injury in youth team sport. Youth soccer was the most studied team sport, and a substantial number of positive load–injury associations were reported. Current evidence lacks consistency in the measures and metrics used in defining load–injury relationships.
Trial Registration PRISMA ID - CRD42020203622.
Collapse
|
13
|
Ezzat AM, Brussoni M, Mâsse LC, Barton CJ, Emery CA. New or Recurrent Knee Injury, Physical Activity, and Osteoarthritis Beliefs in a Cohort of Female Athletes 2 to 3 Years After ACL Reconstruction and Matched Healthy Peers. Sports Health 2022; 14:842-848. [PMID: 35499092 PMCID: PMC9631034 DOI: 10.1177/19417381221091791] [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: 11/16/2022] Open
Abstract
BACKGROUND At 2 to 3 years after anterior cruciate ligament reconstruction (ACLR), the relationship between known modifiable osteoarthritis (OA) risk factors and recurrent knee injury is unknown. This study aimed to determine the odds of new or recurrent traumatic knee injury in a cohort of young female athletes with ACLR 2 to 3 years postsurgery compared with healthy control participants. Secondary objectives were to explore the relationships of moderate and vigorous physical activity (MVPA) and body mass index (BMI) with knee injury, and to document self-reported MVPA satisfaction and beliefs about OA. STUDY DESIGN Prospective cohort. LEVEL OF EVIDENCE Level 2. METHODS A total of 51 female athletes with unilateral ACLR 1 to 2 years previously and 51 age and sport-matched control participants underwent assessment of MVPA (GT3X accelerometers) and BMI. One year later, participants self-reported knee injuries. Bivariable conditional logistic regression explored the association between knee injury, MVPA, and BMI in each group (injury/control). RESULTS At 1-year follow-up (n = 101), 19.6% of the injured cohort and 6.0% of control participants sustained a new or recurrent knee injury. The odds of knee injury for the injury group increased 7-fold over controls [odds ratio (OR) = 7.00 (95% CI = 0.86, 56.90)], although this was not statistically significant. The OR for MVPA was 0.98 (95% CI = 0.93, 1.03) and BMI was OR = 1.24 (95% CI = 0.85, 1.82). Half (56.0%) of injury participants and 66% of controls were satisfied with their MVPA; 81.6% of injury participants believed they had increased knee OA risk compared with someone who had never had a knee injury. CONCLUSION In the 2 to 3 years after ACLR, 1 in 5 young female athletes had a new or recurrent knee injury. Based on the point estimate, injured participants were more likely to suffer a traumatic knee injury than matched control participants. MVPA and BMI were not associated with increased odds of knee injury. CLINICAL RELEVANCE Clinicians should be encouraged to have in-depth conversations with female athletes with previous ACLR regarding enjoyable and sustainable MVPA participation to promote long-term joint health.
Collapse
Affiliation(s)
- Allison M. Ezzat
- La Trobe Sport and Exercise Medicine
Research Centre, School of Allied Health, Human Services and Sport, La Trobe
University, Northcote, Australia
- Department of Physical Therapy,
University of British Columbia, Vancouver, BC, Canada
| | - Mariana Brussoni
- School of Population and Public Health,
University of British Columbia, Vancouver, BC, Canada
- British Columbia Children’s Hospital
Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, University of
British Columbia, Vancouver, BC, Canada
- Human Early Learning Partnership,
University of British Columbia, Vancouver, BC, Canada
| | - Louise C. Mâsse
- School of Population and Public Health,
University of British Columbia, Vancouver, BC, Canada
- British Columbia Children’s Hospital
Research Institute, Vancouver, BC, Canada
| | - Christian J. Barton
- La Trobe Sport and Exercise Medicine
Research Centre, School of Allied Health, Human Services and Sport, La Trobe
University, Northcote, Australia
- Department of Surgery, St Vincent’s
Hospital, The University of Melbourne, Australia
| | - Carolyn A. Emery
- Sport Injury Prevention Research
Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta,
Canada
- Departments of Pediatrics and
Community Health Sciences, Cumming School of Medicine, University of Calgary,
Alberta, Canada
- The Alberta Children’s Hospital
Research Institute, O’Brien Institute of Public Health and McCaig Institute for Bone
and Joint Health, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
14
|
Marmura H, Firth A, Batty L, Bryant DM, Getgood AMJ, Bryant D, Litchfield R, Willits K, Birmingham T, Hewison C, Wanlin S, Firth A, Pinto R, Martindale A, O’Neill L, Jennings M, Daniluk M, Boyer D, McCormack B, Zomar M, Moon K, Moon R, Fan B, Mohan B, Heard M, Buchko GM, Hiemstra LA, Kerslake S, Tynedal J, MacDonald P, Stranges G, Mcrae S, Gullett L, Brown H, Legary A, Longo A, Christian M, Ferguson C, Rezansoff A, Mohtadi N, Barber R, Chan D, Campbell C, Garven A, Pulsifer K, Mayer M, Peterson D, Simunovic N, Duong A, Robinson D, Levy D, Skelly M, Shanmugaraj A, Bardana D, Howells F, Tough M, Spalding T, Thompson P, Metcalfe A, Asplin L, Dube A, Clarkson L, Brown J, Bolsover A, Bradshaw C, Belgrove L, Millan F, Turner S, Verdugo S, Lowe J, Dunne D, McGowan K, Suddens CM, Verdonk P, Declerq G, Vuylsteke K, Van Haver M. Meniscal repair at the time of primary ACLR does not negatively influence short term knee stability, graft rupture rates, or patient-reported outcome measures: the STABILITY experience. Knee Surg Sports Traumatol Arthrosc 2022; 30:3689-3699. [PMID: 35451638 DOI: 10.1007/s00167-022-06962-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess how meniscal repair and excision impact short term patient-reported outcome measures (PROMs), knee stability, and early graft rupture rates following primary hamstring anterior cruciate ligament reconstruction (ACLR) with or without lateral extra-articular tenodesis (LET) in a group of young active patients where meniscal repair is commonly advocated. METHODS Six hundred and eighteen patients under 25 years of age at high-risk of graft failure following ACLR were recruited to the Stability 1 study. Multivariable regression models were developed to identify statistically and clinically significant surgical and demographic predictors of Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Subjective Knee Form (IKDC), ACL Quality of Life Questionnaire (ACL-QOL) and Marx Activity Rating Scale (MARS) scores. Chi-Square tests of independence were used to explore the association between meniscal status (torn, not torn), meniscal treatment (excision or repair), graft rupture, and rotatory knee laxity. RESULTS Medial meniscus repair was associated with worse outcomes on the KOOS (β = -1.32, 95% CI: -1.57 to -1.10, p = 0.003), IKDC (β = -1.66, 95% CI: -1.53 to -1.02, p = 0.031) and ACL-QOL (β = -1.25, 95% CI: -1.61 to 1.02, p = n.s.). However, these associations indicated small, clinically insignificant changes based on reported measures of clinical relevance. Other important predictors of post-operative PROMs included age, sex, and baseline scores. Medial meniscus excision and lateral meniscus treatment (repair or excision) did not have an important influence on PROMs. There was no significant association between meniscal treatment and graft rupture or rotatory knee laxity. CONCLUSION While repairing the medial meniscus may result in a small reduction in PROM scores at two-year follow-up, these differences are not likely to be important to patients or clinicians. Any surgical morbidity associated with meniscal repair appears negligible in terms of PROMs. Meniscal repair does not affect rotatory laxity or graft failure rates in the short term. Therefore, meniscal repair should likely be maintained as the standard of care for concomitant meniscal tears with ACLR. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,Bone and Joint Institute, Western University, London, Canada.,Lawson Research, London Health Sciences Centre, London, Canada
| | - Andrew Firth
- Faculty of Health Sciences, Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,Bone and Joint Institute, Western University, London, Canada.,Lawson Research, London Health Sciences Centre, London, Canada
| | - Lachlan Batty
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,OrthoSport Victoria Research Unit, Richmond, Australia.,St. Vincent's Hospital, Melbourne, Australia
| | - Dianne M Bryant
- Faculty of Health Sciences, Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,Bone and Joint Institute, Western University, London, Canada.,Lawson Research, London Health Sciences Centre, London, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Alan M J Getgood
- Faculty of Health Sciences, Western University, London, Canada. .,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada. .,Bone and Joint Institute, Western University, London, Canada. .,Lawson Research, London Health Sciences Centre, London, Canada. .,Schulich School of Medicine and Dentistry, Western University, London, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
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]
|
16
|
Evers BJ, Van Den Bosch MHJ, Blom AB, van der Kraan PM, Koëter S, Thurlings RM. Post-traumatic knee osteoarthritis; the role of inflammation and hemarthrosis on disease progression. Front Med (Lausanne) 2022; 9:973870. [PMID: 36072956 PMCID: PMC9441748 DOI: 10.3389/fmed.2022.973870] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Knee injuries such as anterior cruciate ligament ruptures and meniscal injury are common and are most frequently sustained by young and active individuals. Knee injuries will lead to post-traumatic osteoarthritis (PTOA) in 25–50% of patients. Mechanical processes where historically believed to cause cartilage breakdown in PTOA patients. But there is increasing evidence suggesting a key role for inflammation in PTOA development. Inflammation in PTOA might be aggravated by hemarthrosis which frequently occurs in injured knees. Whereas mechanical symptoms (joint instability and locking of the knee) can be successfully treated by surgery, there still is an unmet need for anti-inflammatory therapies that prevent PTOA progression. In order to develop anti-inflammatory therapies for PTOA, more knowledge about the exact pathophysiological mechanisms and exact course of post-traumatic inflammation is needed to determine possible targets and timing of future therapies.
Collapse
Affiliation(s)
- Bob J. Evers
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
- Canisius Wilhelmina Hospital, Nijmegen, Netherlands
- *Correspondence: Bob J. Evers
| | - Martijn H. J. Van Den Bosch
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Arjen B. Blom
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Peter M. van der Kraan
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | | | - Rogier M. Thurlings
- Department of Experimental Rheumatology, Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| |
Collapse
|
17
|
Blaney TCR, Ronsky JL, Macri EM, Jaremko JL, Kuntze G, Pakdel A, Whittaker JL, Emery CA. Concurrent validity and reliability of a semi-automated approach to measuring the magnetic resonance imaging morphology of the knee joint in active youth. Proc Inst Mech Eng H 2022; 236:1023-1035. [DOI: 10.1177/09544119221095337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Post-traumatic knee osteoarthritis is attributed to alterations in joint morphology, alignment, and biomechanics triggered by injury. While magnetic resonance (MR) imaging-based measures of joint morphology and alignment are relevant to understanding osteoarthritis risk, time consuming manual data extraction and measurement limit the number of outcomes that can be considered and deter widespread use. This paper describes the development and evaluation of a semi-automated software for measuring tibiofemoral and patellofemoral joint architecture using MR images from youth with and without a previous sport-related knee injury. After prompting users to identify and select key anatomical landmarks, the software can calculate 37 (14 tibiofemoral, 23 patellofemoral) relevant geometric features (morphology and alignment) based on established methods. To assess validity and reliability, 11 common geometric features were calculated from the knee MR images (proton density and proton density fat saturation sequences; 1.5 T) of 76 individuals with a 3–10-year history of youth sport-related knee injury and 76 uninjured controls. Spearman’s or Pearson’s correlation coefficients (95% CI) and Bland-Altman plots were used to assess the concurrent validity of the semi-automated software (novice rater) versus expert manual measurements, while intra-class correlation coefficients (ICC2,1; 95%CI), standard error of measurement (95%CI), 95% minimal detectable change, and Bland-Altman plots were used to assess the inter-rater reliability of the semi-automated software (novice vs resident radiologist rater). Correlation coefficients ranged between 0.89 (0.84, 0.92; Lateral Trochlear Inclination) and 0.97 (0.96, 0.98; Patellar Tilt Angle). ICC estimates ranged between 0.79 (0.63, 0.88; Lateral Patellar Tilt Angle) and 0.98 (0.95, 0.99; Bisect Offset). Bland-Altman plots did not reveal systematic bias. These measurement properties estimates are equal, if not better than previously reported methods suggesting that this novel semi-automated software is an accurate, reliable, and efficient alternative method for measuring large numbers of geometric features of the tibiofemoral and patellofemoral joints from MR studies.
Collapse
Affiliation(s)
- Traven CR Blaney
- McCaig Institute of Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Engineering, McGill University, Montreal, Canada
| | - Janet L Ronsky
- McCaig Institute of Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Erin M Macri
- Department of General Practice, Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, Amsterdam, The Netherlands
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gregor Kuntze
- McCaig Institute of Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Amir Pakdel
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jackie L Whittaker
- McCaig Institute of Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Deparment of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Carolyn A Emery
- McCaig Institute of Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- The Alberta Children’s Hospital Research Institute for Child and Maternal Health, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
18
|
Does a history of youth sport-related knee injury still impact accelerometer-measured levels of physical activity after 3–12 years? Phys Ther Sport 2022; 55:90-97. [DOI: 10.1016/j.ptsp.2022.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/16/2022]
|
19
|
Whittaker JL, Truong LK, Losciale JM, Silvester-Lee T, Miciak M, Pajkic A, Le CY, Hoens AM, Mosewich A, Hunt MA, Li LC, Roos EM. Efficacy of the SOAR knee health program: protocol for a two-arm stepped-wedge randomized delayed-controlled trial. BMC Musculoskelet Disord 2022; 23:85. [PMID: 35078446 PMCID: PMC8790851 DOI: 10.1186/s12891-022-05019-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/11/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Knee trauma permanently elevates one's risk for knee osteoarthritis. Despite this, people at-risk of post-traumatic knee osteoarthritis rarely seek or receive care, and accessible and efficacious interventions to promote knee health after injury are lacking. Exercise can ameliorate some mechanisms and independent risk factors for osteoarthritis and, education and action-planning improve adherence to exercise and promote healthy behaviours. METHODS To assess the efficacy of a virtually-delivered, physiotherapist-guided exercise-based program (SOAR) to improve knee health in persons discharged from care after an activity-related knee injury, 70 people (16-35 years of age, 12-48 months post-injury) in Vancouver Canada will be recruited for a two-arm step-wedged assessor-blinded delayed-control randomized trial. Participants will be randomly allocated to receive the intervention immediately or after a 10-week delay. The program consists of 1) one-time Knee Camp (group education, 1:1 individualized exercise and activity goal-setting); 2) weekly individualized home-based exercise and activity program with tracking, and; 3) weekly 1:1 physiotherapy-guided action-planning with optional group exercise class. Outcomes will be measured at baseline, 9- (primary endpoint), and 18-weeks. The primary outcome is 9-week change in knee extension strength (normalized peak concentric torque; isokinetic dynamometer). Secondary outcomes include 9-week change in moderate-to-vigorous physical activity (accelerometer) and self-reported knee-related quality-of-life (Knee injury and OA Outcome Score subscale) and self-efficacy (Knee Self Efficacy Scale). Exploratory outcomes include 18-week change in primary and secondary outcomes, and 9- and 18- week change in other components of knee extensor and flexor muscle function, hop function, and self-reported symptoms, function, physical activity, social support, perceived self-care and kinesiophobia. Secondary study objectives will assess the feasibility of a future hybrid effectiveness-implementation trial protocol, determine the optimal intervention length, and explore stakeholder experiences. DISCUSSION This study will assess the efficacy of a novel, virtually-delivered, physiotherapist-guided exercise-based program to optimize knee health in persons at increased risk of osteoarthritis due to a past knee injury. Findings will provide valuable information to inform the management of osteoarthritis risk after knee trauma and the conduct of a future effectiveness-implementation trial. TRIAL REGISTRATION Clinicaltrials.gov reference: NTC04956393. Registered August 5, 2021, https://clinicaltrials.gov/ct2/show/NCT04956393?term=SOAR&cond=osteoarthritis&cntry=CA&city=Vancouver&draw=2&rank=1.
Collapse
Affiliation(s)
- Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
- Arthritis Research Canada, Vancouver, Canada.
| | - Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Justin M Losciale
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | | | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Andrea Pajkic
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Canada
| | - Christina Y Le
- Arthritis Research Canada, Vancouver, Canada
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Alison M Hoens
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Amber Mosewich
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Canada
| | - Michael A Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Ewa M Roos
- Department of Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
20
|
Truong LK, Mosewich AD, Miciak M, Pajkic A, Le CY, Li LC, Whittaker JL. Balance, reframe, and overcome: The attitudes, priorities, and perceptions of exercise-based activities in youth 12-24 months after a sport-related ACL injury. J Orthop Res 2022; 40:170-181. [PMID: 33951223 DOI: 10.1002/jor.25064] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/13/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
Attitudes, priorities, and perceptions of exercise directly influence exercise behaviors. Despite the benefits of exercise-based activities for future health, little is known about how youth who experience an ACL injury view exercise-based activity beyond the immediate recovery period. A qualitative (interpretative description) approach with one-to-one semistructured interviews was used to probe the current attitudes, priorities, and perceptions of exercise-therapy, physical activity, and sport participation with a purposive sample of youth from an ongoing inception cohort study who experienced an ACL tear or reconstruction in the past 12-24 months. Analyses followed an inductive approach guided by an analytic interpretative description process. Reflexive journaling, memoing, and a detailed audit trail promoted data trustworthiness. A patient-partner was involved throughout. Ten youth (six women, four men), 15-19 years of age, and a median of 20-months (16-26) from injury were interviewed. Three overarching themes were identified. 'Balancing physical activity and future knee health' highlighted ongoing negotiations between what were perceived to be competing priorities for return-to-sport and future knee health. 'Reframing the value of exercise-therapy and physical activity' reflected the importance of reshaping attitudes toward exercise as positive and was linked to exercise adherence. 'Overcoming unforeseen exercise challenges' encompassed persisting psychological and physical challenges perceived to limit exercise-based activities. Clinical significance: reframing exercise-based activities in a positive light and leveraging motivation for return-to-sport and life-long knee health may be important strategies for encouraging ongoing exercise therapy and physical activity following a youth ACL injury.
Collapse
Affiliation(s)
- Linda K Truong
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Arthritis Research Centre, Richmond, Canada
| | - Amber D Mosewich
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Alberta Innovates, Edmonton, Canada
| | - Andrea Pajkic
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Christina Y Le
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Arthritis Research Centre, Richmond, Canada
| | - Linda C Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Arthritis Research Centre, Richmond, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Arthritis Research Centre, Richmond, Canada
| |
Collapse
|
21
|
Owoeye OBA, Whittaker JL, Toomey CM, Räisänen AM, Jaremko JL, Carlesso LC, Manske SL, Emery CA. Health-Related Outcomes 3-15 Years Following Ankle Sprain Injury in Youth Sport: What Does the Future Hold? Foot Ankle Int 2022; 43:21-31. [PMID: 34353138 DOI: 10.1177/10711007211033543] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study examined the association between youth sport-related ankle sprain injury and health-related outcomes, 3-15 years postinjury. METHODS A historical cohort study in which uninjured controls were cluster-matched with injured cases. The primary outcome was self-reported Foot and Ankle Outcome Score (FAOS). Secondary outcomes included measures of adiposity, validated questionnaires for physical activity, athletic identity, fear of pain, and tests of strength, balance, and function. RESULTS We recruited 86 participants (median age of 23 years; 77% female); 50 with a time-loss ankle sprain, median of 8 years postinjury, and 36 uninjured controls cluster-matched by sex and sport. Based on mixed effects multivariable regression models, previously injured participants demonstrated poorer outcomes than controls on all 5 FAOS subscales regardless of sex and time since injury, with the largest differences observed in symptoms (-20.9, 99% CI: -29.5 to -12.3) and ankle-related quality of life (-25.3, 99% CI: -34.7 to -15.9) subscales. Injured participants also had poorer unipedal dynamic balance (-1.9, 99% CI: 3.5 to -0.2) and greater fear of pain (7.2, 99% CI: 0.9-13.4) compared with controls. No statistically significant differences were found for other secondary outcomes. CONCLUSION At 3-15 years following time-loss ankle sprain injury in youth sport, previously injured participants had more pain and symptoms, poorer self-reported function, ankle-related quality of life, reduced sport participation, balance, and greater fear of pain than controls. This underlines the need to promote the primary prevention of ankle sprains and secondary prevention of potential health consequences, including posttraumatic osteoarthritis. LEVEL OF EVIDENCE Level III, historical cohort study.
Collapse
Affiliation(s)
- Oluwatoyosi B A Owoeye
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St Louis, MO, USA.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jackie L Whittaker
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Clodagh M Toomey
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
| | - Anu M Räisänen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Department of Physical Therapy Education, College of Health Sciences, Western University of Health Sciences, Lebanon, OR, USA
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa C Carlesso
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sarah L Manske
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
22
|
Whittaker JL, Truong LK, Silvester-Lee T, Losciale JM, Miciak M, Pajkic A, Le CY, Hoens AM, Mosewich AD, Hunt MA, Li LC, Roos EM. Feasibility of the SOAR (Stop OsteoARthritis) program. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100239. [DOI: 10.1016/j.ocarto.2022.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/26/2022] [Indexed: 10/19/2022] Open
|
23
|
Kuntze G, Nettel-Aguirre A, Lorenzen KN, Küpper J, Ronsky JL, Whittaker JL, Emery CA. Vertical Drop Jump Biomechanics of Patients With a 3- to 10-Year History of Youth Sport-Related Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:23259671211058105. [PMID: 34917690 PMCID: PMC8669131 DOI: 10.1177/23259671211058105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background A better understanding of movement biomechanics after anterior cruciate ligament reconstruction (ACLR) could inform injury prevention, knee injury rehabilitation, and osteoarthritis prevention strategies. Purpose To investigate differences in vertical drop jump (VDJ) biomechanics between patients with a 3- to 10-year history of youth sport-related ACLR and uninjured peers of a similar age, sex, and sport. Study Design Cross-sectional study. Level of evidence III. Methods Lower limb kinematics and bilateral ground-reaction forces (GRFs) were recorded for participants performing 10 VDJs. Joint angles and GRF data were analyzed, and statistical analysis was performed using 2 multivariate models. Dependent variables included sagittal (ankle, knee, and hip) and coronal (knee and hip) angles at initial contact and maximum knee flexion, the rate of change of coronal knee angles (35%-90% of the support phase; ie, slopes of linear regression lines), and vertical and mediolateral GRFs (normalized to body weight [BW]). Fixed effects included group, sex, and time since injury. Participant clusters, defined by sex and sport, were considered as random effects. Results Participants included 48 patients with a history of ACLR and 48 uninjured age-, sex-, and sport-matched controls (median age, 22 years [range, 18-26 years]; 67% female). Patients with ACLR demonstrated steeper negative coronal knee angle slopes (β = -0.04 deg/% [95% CI, -0.07 to -0.00 deg/%]; P = .025). A longer time since injury was associated with reduced knee flexion (β = -0.2° [95% CI, -0.3° to -0.0°]; P = .014) and hip flexion (β = -0.1° [95% CI, -0.2° to -0.0°]; P = .018). Regardless of ACLR history, women displayed greater knee valgus at initial contact (β = 2.1° [95% CI, 0.4° to 3.8°]; P = .017), greater coronal knee angle slopes (β = 0.05 deg/% [95% CI, 0.02 to 0.09 deg/%]; P = .004), and larger vertical GRFs (landing: β = -0.34 BW [95% CI, -0.61 to -0.07 BW]; P = .014) (pushoff: β = -0.20 BW [95% CI, -0.32 to -0.08 BW]; P = .001). Conclusion Women and patients with a 3- to 10-year history of ACLR demonstrated VDJ biomechanics that may be associated with knee motion control challenges. Clinical Relevance It is important to consider knee motion control during activities such as VDJs when developing injury prevention and rehabilitation interventions aimed at improving joint health after youth sport-related ACLR.
Collapse
Affiliation(s)
- Gregor Kuntze
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Centre for Health and Social Analytics, National Institute for Applied Statistics Research Australia, School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kristin N Lorenzen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Küpper
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Janet L Ronsky
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
24
|
Whittaker JL, Runhaar J, Bierma-Zeinstra S, Roos EM. A lifespan approach to osteoarthritis prevention. Osteoarthritis Cartilage 2021; 29:1638-1653. [PMID: 34560260 DOI: 10.1016/j.joca.2021.06.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 02/02/2023]
Abstract
Prevention is an attractive solution for the staggering and increasingly unmanageable burden of osteoarthritis. Despite this, the field of osteoarthritis prevention is relatively immature. To date, most of what is known about preventing osteoarthritis and risk factors for osteoarthritis is relative to the disease (underlying biology and pathophysiology) of osteoarthritis, with few studies considering risk factors for osteoarthritis illness, the force driving the personal, financial and societal burden. In this narrative review we will discuss what is known about osteoarthritis prevention, propose actionable prevention strategies related to obesity and joint injury which have emerged as important modifiable risk factors, identify where evidence is lacking, and give insight into what might be possible in terms of prevention by focussing on a lifespan approach to the illness of osteoarthritis, as opposed to a structural disease of the elderly. By targeting a non-specialist audience including scientists, clinicians, students, industry employees and others that are interested in osteoarthritis but who do not necessarily focus on osteoarthritis, the goal is to generate discourse and motivate inquiry which propel the field of osteoarthritis prevention into the mainstream.
Collapse
Affiliation(s)
- J L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Arthritis Research Canada, Canada.
| | - J Runhaar
- Erasmus MC University Medical Center Rotterdam, Department of General Practice, Rotterdam, the Netherlands.
| | - S Bierma-Zeinstra
- Erasmus MC University Medical Center Rotterdam, Department of General Practice, Rotterdam, the Netherlands; Erasmus MC University Medical Center Rotterdam, Department of General Practice, and Department of Orthopaedics, Rotterdam, the Netherlands.
| | - E M Roos
- Department of Sports Science and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Denmark.
| |
Collapse
|
25
|
Whittaker JL. 'Every new beginning comes from some other beginning's end' Anterior cruciate ligament injury and post-traumatic knee osteoarthritis. Arthritis Care Res (Hoboken) 2021; 74:337-339. [PMID: 34738342 DOI: 10.1002/acr.24810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Research Scientist, Arthritis Research Canada, Vancouver, Canada
| |
Collapse
|
26
|
Leppänen M, Parkkari J, Vasankari T, Äyrämö S, Kulmala JP, Krosshaug T, Kannus P, Pasanen K. Change of Direction Biomechanics in a 180-Degree Pivot Turn and the Risk for Noncontact Knee Injuries in Youth Basketball and Floorball Players. Am J Sports Med 2021; 49:2651-2658. [PMID: 34283648 PMCID: PMC8355634 DOI: 10.1177/03635465211026944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Studies investigating biomechanical risk factors for knee injuries in sport-specific tasks are needed. PURPOSE To investigate the association between change of direction (COD) biomechanics in a 180-degree pivot turn and knee injury risk among youth team sport players. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 258 female and male basketball and floorball players (age range, 12-21 years) participated in the baseline COD test and follow-up. Complete data were obtained from 489 player-legs. Injuries, practice, and game exposure were registered for 12 months. The COD test consisted of a quick ball pass before and after a high-speed 180-degree pivot turn on the force plates. The following variables were analyzed: peak vertical ground-reaction force (N/kg); peak trunk lateral flexion angle (degree); peak knee flexion angle (degree); peak knee valgus angle (degree); peak knee flexion moment (N·m/kg); peak knee abduction moment (N·m/kg); and peak knee internal and external rotation moments (N·m/kg). Legs were analyzed separately and the mean of 3 trials was used in the analysis. Main outcome measure was a new acute noncontact knee injury. RESULTS A total of 18 new noncontact knee injuries were registered (0.3 injuries/1000 hours of exposure). Female players sustained 14 knee injuries and male players 4. A higher rate of knee injuries was observed in female players compared with male players (incidence rate ratio, 6.2; 95% CI, 2.1-21.7). Of all knee injuries, 8 were anterior cruciate ligament (ACL) injuries, all in female players. Female players displayed significantly larger peak knee valgus angles compared with male players (mean for female and male players, respectively: 13.9°± 9.4° and 2.0°± 8.5°). No significant associations between biomechanical variables and knee injury risk were found. CONCLUSION Female players were at increased risk of knee and ACL injury compared with male players. Female players performed the 180-degree pivot turn with significantly larger knee valgus compared with male players. However, none of the investigated variables was associated with knee injury risk in youth basketball and floorball players.
Collapse
Affiliation(s)
- Mari Leppänen
- Tampere Research Center of Sports
Medicine, UKK Institute, Tampere, Finland,Tampere University Hospital, Tampere,
Finland,Mari Leppänen, PhD, Tampere
Research Center of Sport Medicine, UKK Institute, Kaupinpuistonkatu 1, Tampere,
33501, Finland () (Twitter:
@mari_leppanen)
| | - Jari Parkkari
- Tampere Research Center of Sports
Medicine, UKK Institute, Tampere, Finland,Tampere University Hospital, Tampere,
Finland
| | - Tommi Vasankari
- Tampere Research Center of Sports
Medicine, UKK Institute, Tampere, Finland,Faculty of Medicine and Health
Technology, Tampere University, Tampere, Finland
| | - Sami Äyrämö
- Faculty of Information Technology,
University of Jyväskylä, Jyväskylä, Finland
| | - Juha-Pekka Kulmala
- Motion Analysis Laboratory, Children’s
Hospital, University of Helsinki and Helsinki University Hospital, Helsinki,
Finland
| | - Tron Krosshaug
- Oslo Sports Trauma Research Center,
Department of Sports Medicine, Norwegian School of Sport Science, Oslo, Norway
| | - Pekka Kannus
- Tampere Research Center of Sports
Medicine, UKK Institute, Tampere, Finland,Tampere University Hospital, Tampere,
Finland
| | - Kati Pasanen
- Tampere Research Center of Sports
Medicine, UKK Institute, Tampere, Finland,Faculty of Kinesiology, Sport Injury
Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada,Alberta Children’s Hospital Research
Institute, University of Calgary, Calgary, Alberta, Canada,McCaig Institute for Bone and Joint
Health, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
27
|
Le CY, Toomey CM, Emery CA, Whittaker JL. What Does the Future Hold? Health-Related Quality of Life 3-12 Years Following a Youth Sport-Related Knee Injury. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136877. [PMID: 34206869 PMCID: PMC8295930 DOI: 10.3390/ijerph18136877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022]
Abstract
Knee trauma can lead to poor health-related quality of life (HRQoL) and osteoarthritis. We aimed to assess HRQoL 3–12 years following youth sport-related knee injury considering HRQoL and osteoarthritis determinants. Generic (EQ-5D-5L index, EQ-VAS) and condition-specific (Knee injury and Osteoarthritis Outcome Score quality of life subscale, KOOS QOL) HRQoL were assessed in 124 individuals 3–12 years following youth sport-related knee injury and 129 uninjured controls of similar age, sex, and sport. Linear regression examined differences in HRQoL outcomes by injury group. Multivariable linear regression explored the influence of sex, time-since-injury, injury type, body mass index, knee muscle strength, Intermittent and Constant Osteoarthritis Pain (ICOAP) score, and Godin Leisure-Time Exercise Questionnaire (GLTEQ) moderate-to-strenuous physical activity. Participant median (range) age was 23 years (14–29) and 55% were female. Injury history was associated with poorer KOOS QOL (−8.41; 95%CI −10.76, −6.06) but not EQ-5D-5L (−0.0074; −0.0238, 0.0089) or EQ-VAS (−3.82; −8.77, 1.14). Injury history (−5.14; −6.90, −3.38), worse ICOAP score (−0.40; −0.45, −0.36), and anterior cruciate ligament tear (−1.41; −2.77, −0.06) contributed to poorer KOOS QOL. Worse ICOAP score contributed to poorer EQ-5D-5L (−0.0024; −0.0034, −0.0015) and higher GLTEQ moderate-to-strenuous physical activity to better EQ-VAS (0.10; 0.03, 0.17). Knee trauma is associated with poorer condition-specific but not generic HRQoL 3–12 years post-injury.
Collapse
Affiliation(s)
- Christina Y. Le
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada;
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC V6X 2C7, Canada
| | - Clodagh M. Toomey
- School of Allied Health, Faculty of Education & Health Sciences, University of Limerick, V94 T9PX Limerick, Ireland;
- Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
| | - Carolyn A. Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, Health Sciences Centre Foothills Campus, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Room 293, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, HRIC 3A08, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
| | - Jackie L. Whittaker
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada;
- Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC V6X 2C7, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, HRIC 3A08, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, #223 212 Friedman Building, 2177 Wesbrook Road, Vancouver, BC V6T 1Z3, Canada
- Correspondence:
| |
Collapse
|
28
|
Kuwabara A, Kraus E, Fredericson M. Narrative Review - Knee Pain in the Pediatric Athlete. Curr Rev Musculoskelet Med 2021; 14:239-245. [PMID: 33818701 PMCID: PMC8137791 DOI: 10.1007/s12178-021-09708-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW This review article seeks to highlight common youth athlete knee conditions due to overuse or trauma and elucidate differences from the adult populations. RECENT FINDINGS Overuse conditions presented include apophysitis, osteochondritis dissecans plica syndrome, and discoid meniscus. Traumatic conditions presented include patellar instability, patellar sleeve fracture, and patellofemoral osteochondral fractures. Knee injuries affect a significant proportion of youth athletes. These injuries place athletes at higher risk of chronic pain and potentially osteoarthritis. We have reviewed common overuse and traumatic knee injuries and differentiating factors between the adult population to improve and expedite the diagnosis, treatment, and prognosis for youth athletes with knee injuries.
Collapse
Affiliation(s)
- Anne Kuwabara
- Department of Physical Medicine and Rehabilitation, Stanford University, 500 Jefferson Avenue #823, Redwood City, CA 94063 USA
| | - Emily Kraus
- Department of Physical Medicine and Rehabilitation, Stanford University, 500 Jefferson Avenue #823, Redwood City, CA 94063 USA
| | - Michael Fredericson
- Department of Physical Medicine and Rehabilitation, Stanford University, 500 Jefferson Avenue #823, Redwood City, CA 94063 USA
| |
Collapse
|
29
|
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).
Collapse
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
| |
Collapse
|
30
|
Ezzat AM, Brussoni M, Mâsse LC, Emery CA. Effect of Anterior Cruciate Ligament Rupture on Physical Activity, Sports Participation, Patient-Reported Health Outcomes, and Physical Function in Young Female Athletes. Am J Sports Med 2021; 49:1460-1469. [PMID: 33830821 DOI: 10.1177/03635465211002530] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Return to sports (RTS) is frequently considered an indicator of successful recovery after anterior cruciate ligament reconstruction (ACLR). However, despite the well-recognized health benefits of physical activity (PA), little is known about objectively measured PA in the 1 to 2 years after ACLR. Given that young female athletes have a high prevalence of ACLR and lower RTS rates as compared with their male counterparts, an in-depth examination of PA in this subgroup is warranted. HYPOTHESIS We hypothesized that female youth and young adults who have had ACLR in the previous 1 to 2 years would have less moderate or vigorous PA (MVPA) compared with healthy matched controls. We also hypothesized that the ACLR group would report lower levels of sports participation, patient-reported health outcomes, and physical function. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Participants included 51 female athletes with primary unilateral ACLR for a sports-related injury in the previous 1 to 2 years and 51 age- and sports-matched controls. Outcomes included objectively measured PA (GT3X accelerometers), previous and current sports participation and RTS, body mass index, Knee injury and Osteoarthritis Outcome Score (KOOS), triple single-leg hop, and one-leg rise. Mean within-pair differences with 95% CIs were used to assess differences between groups across all outcomes. Multivariable linear regression (clustered by pair) was used to examine whether the ACLR group had less MVPA than did the age- and sports-matched control group, adjusting for total wear time, age, time since injury, and body mass index. RESULTS Median age was 17.8 years (range, 14.6-22.6 years). There was no significant difference between groups in MVPA. However, the injury group had fewer mean minutes per day of vigorous PA (-1.22; 95% CI, -2.40 to -0.04), poorer KOOS values on all subscales, and shorter triple single-leg hop distance. In the injury group, 28 (55%) returned to sports, including 14 (27.5%) who returned at preinjury performance level. Across both groups, over one-third changed their most important sport, shifting toward an individual-based sport. CONCLUSION At 1 to 2 years after ACLR, female athletes demonstrated no differences in combined MVPA and only a very small reduction in vigorous PA, yet they had higher levels of self-reported knee pain and symptoms, reduced knee function in sports, lower quality of life, and poorer objective knee function compared with matched controls.
Collapse
Affiliation(s)
- Allison M Ezzat
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
| | - Mariana Brussoni
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- BC Injury Research and Prevention Unit, Vancouver, Canada
| | - Louise C Mâsse
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, O'Brien Institute of Public Health, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| |
Collapse
|
31
|
Palmer D, Engebretsen L, Carrard J, Grek N, Königstein K, Maurer DJ, Roos T, Stollenwerk L, Tercier S, Weinguni R, Soligard T. Sports injuries and illnesses at the Lausanne 2020 Youth Olympic Winter Games: a prospective study of 1783 athletes from 79 countries. Br J Sports Med 2021; 55:968-974. [PMID: 33658186 DOI: 10.1136/bjsports-2020-103514] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe the injury and illness characteristics among participating athletes during the Lausanne 2020 Youth Olympic Winter Games (YOG 2020), 9-22 January 2020. METHODS The daily number of athlete injuries and illnesses were recorded (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Lausanne 2020 medical staff. RESULTS In total, 1783 athletes from 79 NOCs were observed. NOC and Lausanne 2020 medical staff reported 228 injuries and 167 illnesses, equating 11.7 injuries and 8.6 illnesses per 100 athletes over the 14-day period. Injury incidence was highest for snowboard slopestyle (39%), bobsleigh (36%), snowboard big air (29%), ski slopestyle (29%), snowboard cross (24%) and ski cross (21%), and lowest for speed skating, snowboard halfpipe and curling (2%-4%). The highest incidence of illness was recorded for curling (21%), ski mountaineering (15%), snowboard halfpipe (13%), bobsleigh (11%), cross-country skiing (10%) and figure skating (10%). Almost one-third of injuries were expected to result in time loss and 17% of illnesses. Most injuries occurred to the knee (12%) and head (11%), and 64% of illnesses affected the respiratory system. Overall, women suffered more injuries and illness than males. CONCLUSION Overall, injury and illness rates were similar compared with recent YOG. While the rate and characteristics of injury and illness varied between sports, consistent patterns across YOG are emerging. If addressed, changes in highlighted areas of risk could have a positive impact on the health and well-being of these young athletes.
Collapse
Affiliation(s)
- Debbie Palmer
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK .,Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Lars Engebretsen
- Oslo Sports Trauma Research Centre, Norwegian School of Sport Sciences Department of Sports Medicine, Oslo, Norway.,Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Justin Carrard
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Natalia Grek
- GE Healthcare Moscow, Moscow, Russian Federation
| | - Karsten Königstein
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Debbie J Maurer
- Department of Internal Medicine and Department of Sports Medicine, Davos Hospital, Davos, Switzerland.,Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Thomas Roos
- International Academy of Sport Science and Technology, University of Lausanne, Lausanne, Switzerland
| | | | - Stephane Tercier
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland.,SportAdo Centre, Department of Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Raphael Weinguni
- Advanced Medical Post Detachment, Protection and Rescue Service, Lausanne, Switzerland
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
32
|
Knee Injury and Osteoarthritis Outcome Score (KOOS) Responder Criteria and Minimal Detectable Change 3-12 Years Following a Youth Sport-Related Knee Injury. J Clin Med 2021; 10:jcm10030522. [PMID: 33535702 PMCID: PMC7867131 DOI: 10.3390/jcm10030522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
The applicability of thresholds that constitute an acceptable score or meaningful change on the Knee injury and Osteoarthritis Outcome Score (KOOS) in cohorts ≥ 5 years following knee injury is not well understood. The primary objective of this study was to evaluate the association between intra-articular knee injury type and two different KOOS pain thresholds (patient acceptable symptom state (PASS) and Englund symptomatic knee criteria) in the Alberta Youth Prevention of Osteoarthritis (PrE-OA) cohort, which includes participants 3–12 years following a youth sport-related knee injury and uninjured controls with similar age, sex and sport characteristics. Analyses accounted for sex, time since injury and the interaction between time since injury and injury type. Secondary objectives were to report proportions meeting thresholds for KOOS outcomes and minimal detectable change (MDC) from published test–retest reliability data, over a 1–4-year follow-up. Two hundred and fifty-three (253) participants (124 injured, 129 controls) were included in analyses, of which 153 (77 injured, 76 controls) had follow-up data. Similar odds were observed for presence of pain (below PASS threshold) in participants with anterior cruciate ligament (ACL)/meniscus injury (odds ratio (OR) 4.2 (97.5% confidence interval (CI): 1.8, 9.9)) and other knee injuries (OR 4.9 (97.5% CI: 1.2, 21.0)), while there were higher odds for presence of Englund “symptomatic knee” criteria in participants with ACL/meniscus injury (OR 13.6 (97.5% CI: 2.9, 63.4)) than other knee injuries (OR 7.3 (97.5% CI: 0.8, 63.7)) compared to controls. After a median 23.4 (8 to 42) month follow-up, 35% of previously injured participants had at least one KOOS sub-scale score that worsened by more than the MDC published threshold. Despite limited research, this study shows that individuals with youth sport knee injuries other than ACL or meniscus injury may also experience significant pain and symptoms 3–12 years following injury. Replication and further follow-up are needed to identify a possible clinical trajectory towards osteoarthritis.
Collapse
|
33
|
Schilaty ND, Bates NA, Kruisselbrink S, Krych AJ, Hewett TE. Linear Discriminant Analysis Successfully Predicts Knee Injury Outcome From Biomechanical Variables. Am J Sports Med 2020; 48:2447-2455. [PMID: 32693617 PMCID: PMC7566284 DOI: 10.1177/0363546520939946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The most commonly damaged structures of the knee are the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and menisci. Given that these injuries present as either isolated or concomitant, it follows that these events are driven by specific mechanics versus coincidence. This study was designed to investigate the multiplanar mechanisms and determine the important biomechanical and demographic factors that contribute to classification of the injury outcome. HYPOTHESIS Linear discriminant analysis (LDA) would accurately classify each injury type generated by the mechanical impact simulator based on biomechanical input variables (ie, ligament strain and knee kinetics). STUDY DESIGN Controlled laboratory study. METHODS In vivo kinetics and kinematics of 42 healthy, athletic participants were measured to determine stratification of injury risk (ie, low, medium, and high) in 3 degrees of knee forces/moments (knee abduction moment, anterior tibial shear, and internal tibial rotation). These stratified kinetic values were input into a cadaveric impact simulator to assess ligamentous strain and knee kinetics during a simulated landing task. Uniaxial and multiaxial load cells and implanted strain sensors were used to collect mechanical data for analysis. LDA was used to determine the ability to classify injury outcome by demographic and biomechanical input variables. RESULTS From LDA, a 5-factor model (Entropy R2 = 0.26) demonstrated an area under the receiver operating characteristic curve (AUC) for all 5 injury outcomes (ACL, MCL, ACL+MCL, ACL+MCL+meniscus, ACL+meniscus) of 0.74 or higher, with "good" prediction for 4 of 5 injury classifications. A 10-factor model (Entropy R2 = 0.66) improved the AUC to 0.86 or higher, with "excellent" prediction for 5 injury classifications. The 15-factor model (Entropy R2 = 0.85), produced 94.1% accuracy with the AUC 0.98 or higher for all 5 injury classifications. CONCLUSION Use of LDA accurately predicted the outcome of knee injury from kinetic data from cadaveric simulations with the use of a mechanical impact simulator at 25° of knee flexion. Thus, with clinically relevant kinetics, it is possible to determine clinical risk of injury and also the likely presentation of singular or concomitant knee injury. CLINICAL RELEVANCE LDA demonstrates that injury outcomes are largely characterized by specific mechanics that can distinguish ACL, MCL, and medial meniscal injury. Furthermore, as the mechanics of injury are better understood, improved interventional prehabilitation can be designed to reduce these injuries.
Collapse
Affiliation(s)
- Nathan D. Schilaty
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Nathaniel A. Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | | | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Sports Medicine Center, Mayo Clinic, Rochester, Minnesota
| | - Timothy E. Hewett
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky
| |
Collapse
|
34
|
Whittaker JL, Chan M, Pan B, Hassan I, Defreitas T, Hui C, Macedo L, Otto D. Towards improving the identification of anterior cruciate ligament tears in primary point-of-care settings. BMC Musculoskelet Disord 2020; 21:252. [PMID: 32303217 PMCID: PMC7165371 DOI: 10.1186/s12891-020-03237-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/25/2020] [Indexed: 01/13/2023] Open
Abstract
Background Only a small proportion of anterior cruciate ligament (ACL) tears are diagnosed on initial healthcare consultation. Current clinical guidelines do not acknowledge that primary point-of-care practitioners rely more heavily on a clinical history than special clinical tests for diagnosis of an ACL tear. This research will assess the accuracy of combinations of patient-reported variables alone, and in combination with clinician-generated variables to identify an ACL tear as a preliminary step to designing a primary point-of-care clinical decision support tool. Methods Electronic medical records (EMRs) of individuals aged 15–45 years, with ICD-9 codes corresponding to a knee condition, and confirmed (ACL+) or denied (ACL−) first-time ACL tear seen at a University-based Clinic between 2014 and 2016 were eligible for inclusion. Demographics, relevant diagnostic indicators and ACL status based on orthopaedic surgeon assessment and/or MRI reports were manually extracted. Descriptive statistics calculated for all variables by ACL status. Univariate between group comparisons, clinician surveys (n = 17), availability of data and univariable logistic regression (95%CI) were used to select variables for inclusion into multivariable logistic regression models that assessed the odds (95%CI) of an ACL-tear based on patient-reported variables alone (consistent with primary point-of-care practice), or in combination with clinician-generated variables. Model performance was assessed by accuracy, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (95%CI). Results Of 1512 potentially relevant EMRs, 725 were included. Participant median age was 26 years (range 15–45), 48% were female and 60% had an ACL tear. A combination of patient-reported (age, sport-related injury, immediate swelling, family history of ACL tear) and clinician-generated (Lachman test result) variables were superior for ACL tear diagnosis [accuracy; 0.95 (90,98), sensitivity; 0.97 (0.88,0.98), specificity; 0.95 (0.82,0.99)] compared to the patient-reported variables alone [accuracy; 84% (77,89), sensitivity; 0.60 (0.44,0.74), specificity; 0.95 (0.89,0.98)]. Conclusions A high proportion of individuals without an ACL tear can be accurately identified by considering patient-reported age, injury setting, immediate swelling and family history of ACL tear. These findings directly inform the development of a clinical decision support tool to facilitate timely and accurate ACL tear diagnosis in primary care settings.
Collapse
Affiliation(s)
- Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 2177 Westbrook Mall, Vancouver, V6T 1Z3, Canada. .,Arthritis Research Canada, Richmond, Canada. .,Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
| | - Michelle Chan
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada
| | - Bo Pan
- EPICORE Centre & Alberta SPOR Support Unit, Consultation & Research Services, University of Alberta, Edmonton, Canada
| | - Imran Hassan
- EPICORE Centre & Alberta SPOR Support Unit, Consultation & Research Services, University of Alberta, Edmonton, Canada
| | - Terry Defreitas
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada.,Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Catherine Hui
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada.,Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Luciana Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - David Otto
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Canada.,Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| |
Collapse
|
35
|
Emery CA, van den Berg C, Richmond SA, Palacios-Derflingher L, McKay CD, Doyle-Baker PK, McKinlay M, Toomey CM, Nettel-Aguirre A, Verhagen E, Belton K, Macpherson A, Hagel BE. Implementing a junior high school-based programme to reduce sports injuries through neuromuscular training (iSPRINT): a cluster randomised controlled trial (RCT). Br J Sports Med 2019; 54:913-919. [DOI: 10.1136/bjsports-2019-101117] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2019] [Indexed: 11/03/2022]
Abstract
ObjectiveTo evaluate the effectiveness of a junior high school-based sports injury prevention programme to reduce injuries through neuromuscular training (NMT).MethodsThis was a cluster randomised controlled trial. Students were recruited from 12 Calgary junior high schools (2014–2017). iSPRINT is a 15 min NMT warm-up including aerobic, agility, strength and balance exercises. Following a workshop, teachers delivered a 12-week iSPRINT NMT (six schools) or a standard-of-practice warm-up (six schools) in physical education classes. The definition of all recorded injuries included injuries that resulted in participants being unable to complete a sport and recreation (S&R) session, lost time from sport and/or seek medical attention. Incidence rate ratios (IRRs) were estimated based on multiple multilevel Poisson regression analyses (adjusting for sex (considering effect modification) and previous injury, offset by S&R participation hours, and school-level and class-level random effects were examined) for intent-to-treat analyses.Results1067 students (aged 11–16) were recruited across 12 schools (6 intervention schools (22 classes), 6 control schools (27 classes); 53.7% female, 46.3% male). The iSPRINT programme was protective of all recorded S&R injuries for girls (IRR=0.543, 95% CI 0.295 to 0.998), but not for boys (IRR=0.866, 95% CI 0.425 to 1.766). The iSPRINT programme was also protective of each of lower extremity injuries (IRR=0.357, 95% CI 0.159 to 0.799) and medical attention injuries (IRR=0.289, 95% CI 0.135 to 0.619) for girls, but not for boys (IRR=1.055, 95% CI 0.404 to 2.753 and IRR=0.639, 95% CI 0.266 to 1.532, respectively).ConclusionThe iSPRINT NMT warm-up was effective in preventing each of all recorded injuries, lower extremity injuries and medically treated S&R injuries in female junior high school students.Trial registration numberNCT03312504
Collapse
|
36
|
Abstract
The classification and monitoring of individuals with early knee osteoarthritis (OA) are important considerations for the design and evaluation of therapeutic interventions and require the identification of appropriate outcome measures. Potential outcome domains to assess for early OA include patient-reported outcomes (such as pain, function and quality of life), features of clinical examination (such as joint line tenderness and crepitus), objective measures of physical function, levels of physical activity, features of imaging modalities (such as of magnetic resonance imaging) and biochemical markers in body fluid. Patient characteristics such as adiposity and biomechanics of the knee could also have relevance to the assessment of early OA. Importantly, research is needed to enable the selection of outcome measures that are feasible, reliable and validated in individuals at risk of knee OA or with early knee OA. In this Perspectives article, potential outcome measures for early symptomatic knee OA are discussed, including those measures that could be of use in clinical practice and/or the research setting.
Collapse
|
37
|
A pragmatic approach to prevent post-traumatic osteoarthritis after sport or exercise-related joint injury. Best Pract Res Clin Rheumatol 2019; 33:158-171. [PMID: 31431269 DOI: 10.1016/j.berh.2019.02.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Lower extremity musculoskeletal injuries are common in sport and exercise, and associated with increased risk of obesity and post-traumatic osteoarthritis (PTOA). Unlike other forms of osteoarthritis, PTOA is common at a younger age and associated with more rapid progression, which may impact career choices, long-term general health and reduce quality of life. Individuals who suffer an activity-related joint injury and present with abnormal joint morphology, elevated adiposity, weak musculature, or become physically inactive are at increased risk of PTOA. Insufficient exercise therapy or incomplete rehabilitation, premature return-to-sport and re-injury, unrealistic expectations, or poor nutrition may further elevate this risk. Delay in surgical interventions in lieu of exercise therapy to optimize muscle strength and neuromuscular control while addressing fear of movement to guarantee resumption of physical activity, completeness of rehabilitation before return-to-sport, education that promotes realistic expectations and self-management, and nutritional counseling are the best approaches for delaying or preventing PTOA.
Collapse
|
38
|
Kiningham RB. Latest Clinical Research Published by ACSM. Curr Sports Med Rep 2019. [DOI: 10.1249/jsr.0000000000000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
39
|
Perera NKP, Åkerlund I, Hägglund M. Motivation for sports participation, injury prevention expectations, injury risk perceptions and health problems in youth floorball players. Knee Surg Sports Traumatol Arthrosc 2019; 27:3722-3732. [PMID: 30982108 PMCID: PMC6800853 DOI: 10.1007/s00167-019-05501-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 04/01/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Describe the motivation for floorball participation, injury prevention expectations, injury risk perceptions and prevalence of health problems in youth floorball players at the start of the season. METHODS This cross-sectional survey is part of a larger Sport Without Injury ProgrammE (SWIPE) project and provides baseline data before a cluster randomised controlled trial of an injury prevention program (Knee Control). A baseline survey (online and paper based) was collected from 47 teams with 471 youth floorball players from two provinces of Sweden before the start of the 2017 season. RESULTS The mean age for 140 females and 331 males was 13.7 (± 1.5) and 13.3 (± 1.0) years, respectively. The two most significant motivators for floorball participation were being part of the team (82% females, 75% males) and friends (65% females, 70% males). Fractures (84% females, 90% males), eye injuries (90% females, 83% males) and concussion (82% females, 83% males) were perceived as the most severe injuries. 93% of players believed that sports injuries can be prevented, while 74% believed it is unlikely that they will sustain an injury. Existing health problems at the beginning of the season were prevalent in 33% of players, with 65% being injuries and 35% illnesses. 17% of existing injuries at the start of the season caused time-loss from play and 17% required medical attention. CONCLUSION Social aspects were the greatest motivators for floorball participation in youths, suggesting that these factors are important to retain sports participants. The high number of health problems in youth is a concern; as such more effort, resources and priority should be given to sports safety programs. Many players believed that sports injuries can be prevented, possibly providing a fertile ground for implementation of such programs. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
| | - Ida Åkerlund
- Division of Physiotherapy, Department of Medical and Health Science, Linköping University, Linköping, Sweden
| | - Martin Hägglund
- Division of Physiotherapy, Department of Medical and Health Science, Linköping University, Linköping, Sweden.
| |
Collapse
|