Clinical Journal of Sport Medicine最新文献

Abstract: Criteria that identify combat sports athletes with significantly increased risk of injury and mortality in combat sports competition include the following:• Age younger than 13 years or older than 35 years (LOE V).• Three consecutive losses, particularly by KO/TKO (professional) or Referee Stops Contest (RSC) (amateur) (LOE III).• Inactivity exceeding 1 year (professional) (LOE V).• No prior wins (LOE V).• Significant mismatches in record, experience, age, or physical conditioning (LOE V).• History of concussion, lack of full recovery and clearance from most recent concussion, or history of other significant neurological injury (LOE II).• Severe prebout hypertension (SBP >160 or DBP >100 mm Hg in adults, or stage 2 hypertension in pediatric athletes) (LOE V).• Any medical condition identified on licensing or prebout medical examination that compromises defensive abilities (LOE V).

Objective: To explore perceptions of professional male footballers from an English Premier League club on heading in football and the Football Association's (FA) Heading Guidelines.

Design: Focus group interview using a 6-stage thematic analysis approach.

Setting: A Premier League football club in England.

Patients or participants: Eight male professional footballers.

Assessment of risk factors: Risk factors related to heading in football were discussed, including the safety of the game and long-term implications of heading.

Main outcome measures: Perceptions of heading in professional male football and the existing Heading Guidelines.

Results: Many footballers perceived the risk of sustaining a head injury to be much lower compared with other sports and stated that the potential long-term risk associated with heading is not a pressing concern. Some justified continuing to play football and head the ball by reasoning that significant safety-related changes have already been made to football. Heading is viewed as a fundamental skill, but players argue that it is already limited in training, further negating the need for Heading Guidelines. Finally, footballers expressed that if they were to follow current FA Heading Guidelines, this would negatively affect their development causing selection and career progression issues.

Conclusions: This is the first study to explore the perceptions of professional footballers related to heading and the current Heading Guidelines in England. To increase buy-in and adherence to current and future iterations of Heading Guidelines, the perceptions of footballers and other key stakeholders should be taken into consideration, along with the scientific evidence base.

Objective: To investigate the relationship between hip and knee muscle volume and neuromuscular function (isokinetic strength, rate of torque development, and torque variability) in women with patellofemoral pain (PFP).

Design: Cross-sectional study.

Setting: University research laboratory.

Participants: Twenty women with PFP.

Main outcome measures: Isokinetic strength (60 degrees/second and 180 degrees/second), rate of torque development, and torque variability were assessed with an isokinetic dynamometer for hip extension, hip abduction, knee extension, and knee flexion. Muscle volume of the lower extremity muscles (cm3/kg·m) was quantified through magnetic resonance imaging. Pearson r correlation or Spearman ρ coefficients were calculated to evaluate the relationship between muscle volume and neuromuscular function, with significance set at P < 0.05.

Results: Muscle volume for all muscle groups was moderately correlated with isokinetic strength at 60 degrees/second, r ≥ 0.452, P ≤ 0.046. Hip abduction and extension were moderately correlated with isokinetic strength at 180 degrees/second, r ≥ 0.485, P ≤ 0.030; however, no significant correlations were identified between muscle volume and rate of force development or torque variability, P < 0.05.

Conclusions: The results suggest that isokinetic strength is associated with hip and knee muscle volume in women with PFP; however, additional measures of neuromuscular function (rate of torque development and torque variability) are not associated with muscle volume in lower extremity muscles.

Objective: Less-experienced fencers may present with a different injury profile compared with higher-level athletes. Goal of this study is to analyze the epidemiology of fencing injuries in the United States across all experience levels and age groups.

Design: Retrospective cross-sectional study.

Setting: Raw and weighted data from the National Electronic Injury Surveillance System database from 2003 to 2022 and 2022 United States Fencing Association membership data were analyzed by 2 Division I level fencers to determine eligibility.

Participants: Athletes presenting to emergency departments in the United States with fencing-related injuries.

Independent variables: Age, sex, and type and nature of athletes' injury are independent variables.

Main outcome measures: Incidence rate was calculated, and weighted χ2 tests and Poisson regression determined statistically significant associations among injury incidences.

Results: A weighted estimate of 4551 fencing injuries across the United States demonstrated that mean and median ages of patients were 24.26 and 18 years, respectively, with a male:female ratio of 1.26:1. The incidence was 5.72 injuries per 1000 athlete-years. The most common injury was strain/sprain (28.0%) followed by lacerations (16.8%), and the most common location was the finger (17.7%).

Conclusions: Fencing-related injuries are most common in the Division age group. Strain/sprain injuries seem more common at higher levels of fencing, whereas lacerations have a sizable presence at lower levels. Male fencers have a significantly higher risk of the 2 most common injuries. Regulation at national or individual coaching levels could reduce laceration injuries in less-experienced fencers.

Abstract: Narrowing of the ischiofemoral space leading to the entrapment of neurovascular structures is the pathologic basis of ischiofemoral impingement (IFI). In our clinical practice, we encountered a patient with secondary IFI because of an osteochondroma in the lesser trochanter region, presenting with typical posterior hip pain. Traditional surgical methods typically involve lesion resection through a posterolateral approach to the hip, with only a few patients reported using hip arthroscopy. We present a modified posterior hip arthroscopic technique for resecting an osteochondroma near the lesser trochanter. This technique allows for rapid access to the lesion site and provides clear visualization of the sciatic nerve under arthroscopy, facilitating safe and thorough lesion resection.Level of evidence V, Case Study.

Objective: The purpose of this study was to obtain expert consensus on the identification, management, and treatment of adverse reactions associated with the use of intra-articular hyaluronic acid (viscosupplementation) in any joint.

Design: A Delphi approach was used to establish expert consensus between February and October 2024.

Setting: The Delphi study was conducted virtually using the Welphi survey platform and Qualtrics.

Participants: An expert panel of 33 panelists was created after an open call to sports medicine physicians who were members of The American Medical Society for Sports Medicine. Snowball sampling was conducted to recruit additional experts outside of The American Medical Society for Sports Medicine.

Main outcome measures: Outcome measures consisted of demographic characteristics and clinical experience and beliefs of the expert panelists, and items that achieved and did not achieve consensus after the Delphi study.

Results: In total, 32 of 33 physicians completed all rounds of the Delphi study (97% completion rate). Most adverse reactions were agreed to be because of the administration of the injection rather than the substance itself. Severe adverse reactions including joint infection, pseudoseptic reaction, and large increase in pain at the injection site were deemed rare or very rare by the Delphi panel. Numerous prevention and treatment strategies were identified for mild and moderate adverse reactions. The only time discontinuation of viscosupplementation was recommended was in cases of pseudoseptic reactions and joint infections.

Conclusions: This study provides expert guidance to clinicians on ways to identify and manage adverse reactions associated with viscosupplementation in their clinical practice.

Objective: Anterior cruciate ligament reconstruction (ACLR) leads to high rates of knee post-traumatic osteoarthritis (PTOA). Physical activity may mitigate PTOA risk but levels after ACLR have not been extensively studied. We aimed to review self-reported and device-measured physical activity levels in individuals with ACLR and compare them with international guidelines, and with uninjured controls.

Data sources: MEDLINE, Embase, Scopus, Google Scholar, Cochrane Library, Web of Science, and SPORTDiscus were searched from inception to 22 June 2023.

Main results: Of the 5391 studies identified on our initial search, 15 satisfied the inclusion criteria for analysis (N = 544 individuals with ACLR). Across all studies, the average physical activity levels for individuals with ACLR were 343 ± 185 moderate-to-vigorous physical activity (MVPA) min/wk and 8453 ± 233 steps/day. In studies measuring the proportion of individuals with ACLR reaching MVPA guidelines, 147/213 (69%) achieved ≥150 min/wk. Of those using step counts, 22/85 (26%) achieved ≥10 000 steps/day. Individuals with ACLR engaged in less physical activity than uninjured controls (SMD = -0.37 [95% CI = -0.60 to -0.15]; P < 0.001).

Conclusions: Individuals typically meet recommended MVPA, but not steps, after ACLR. Optimal volume, type, and weight-bearing nature of physical activity should be further investigated given the beneficial role of moderate mechanical loading in knee health. Our findings suggest that steps per day may represent a potentially modifiable prevention target and may help guide the future development of tailored physical activity guidelines for PTOA prevention after ACLR.

Prospero registration number: CRD42022330699.

Objective: To investigate the associations between physician recommendations for early physical activity (PA) after concussion and prolonged recovery in youth.

Design: Retrospective observational study.

Setting: Seven concussion clinics affiliated with a children's hospital.

Patients: Youth aged 10 to 18 years diagnosed with a concussion who visited a concussion clinic within 14 days of injury.

Main independent variable: Physician PA recommendations.

Main outcome measure: Experiencing a prolonged recovery (yes/no).

Results: Of 3249 youth included, 63.1% were males and 79.0% were White, with more than half in the 15 to 18 age group (54.6%). From 2012 to 2019, the proportion of physicians recommending light aerobic activity or noncontact PA increased from 12.6% to 62.0% and from 19.3% to 72.5% for youth seen in week 1 and week 2 postinjury, respectively. Youth who received light aerobic activity [adjusted odds ratio (aOR) = 0.37, 95% confidence interval (CI) = 0.29-0.48] or noncontact PA (aOR = 0.27, 95% CI = 0.12-0.64) recommendations had significantly lower odds of experiencing prolonged recovery than youth with recommendations for no PA. In addition, patients evaluated in the second week postinjury were more likely to experience prolonged recovery than those seen within 1 week postinjury (aOR = 2.52, 95% CI = 2.07-3.07).

Conclusions: Youth who received recommendations for light aerobic or noncontact activities had a reduced likelihood of prolonged recovery compared with those recommended no PA, suggesting early PA may play a role in hastening concussion recovery in youth. Further research is needed to explore patient adherence to these prescriptions.

Abstract: We present 3 cases of Ethiopian endurance athletes with electrocardiographic patterns resembling the historically described "Black athlete" ECG phenotype. Two athletes presented with symptoms-palpitations and presyncope-and were evaluated in emergency settings. Their ECGs showed T-wave inversions and ST-segment elevation in right precordial leads. Comprehensive workup, including imaging and stress testing, excluded structural or arrhythmic pathology. The third case involved an asymptomatic female marathon runner undergoing routine screening, with similar ECG findings. Longitudinal follow-up confirmed a physiological basis. These cases illustrate the phenotypic overlap between Ethiopian athletes and ECG patterns historically attributed to athletes of African descent, despite limited data validating such patterns in specific subpopulations. The findings underscore limitations of race-based ECG interpretation and highlight the need for more inclusive, phenotype-driven research in sports cardiology to improve accuracy and reduce misclassification. This case series supports the consideration of broader population diversity in developing athlete ECG criteria.