Clinical Journal of Sport Medicine最新文献

Objective: To investigate the effects of a collegiate ice hockey season and the repetitive head impacts (RHI) experienced on the neurologic health using a multifaceted assessment battery.

Design: Cross-sectional.

Setting: Research laboratory.

Participants: Thirty-six male collegiate club ice hockey players.

Independent variables: Time (preseason, midseason, postseason) and head impact measures (number of impacts, mean linear acceleration).

Main outcome measures: Athletes wore Smart Impact Monitor (SIM-G) accelerometers throughout 1 season and completed testing at preseason, midseason, and postseason. The battery included a 22-item graded symptom checklist, Standardized Assessment of Concussion, Balance Error Scoring System, Trails A & B, King-Devick, Near Point Convergence, Clinical Reaction Time, Tandem Gait (single- and dual-task), and computerized neurocognitive testing (ImPACT).

Results: There was a significant main effect of time, with improved performance, on the Standardized Assessment of Concussion (F(2, 70) = 4.43, P = 0.015), Trails A (F(2, 67) = 7.16, P = 0.002), Trails B (F(2,71) = 5.19, P = 0.008), King-Devick (F(2, 72) = 4.31, P = 0.017), Clinical Reaction Time (F(2, 69) = 4.54, P = 0.014), ImPACT Verbal Memory (F(2, 76) = 3.82, P = 0.026), and Tandem Gait (ST: F(2, 76) = 6.11, P = 0.003; DT: F(2, 78) = 4.65, P = 0.012). Multiple regression analyses identified an association between the overall head impact model and Visual Motor score (R2 = 0.354, F(2, 29) = 3.698, P = 0.016), whereby increased head kinematics corresponded to higher (better) Visual Motor performance.

Conclusions: A season of collegiate ice hockey RHI did not negatively affect multifaceted clinical assessments. Additional investigation is warranted to determine the effect of RHI sustained during collegiate hockey participation later in life.

Abstract: This case series describes five patients with persistent shoulder pain and dysfunction consistent with Shoulder Injury Related to Vaccine Administration. All the patients here had a distinct sonographic pattern of multiple punctate hyperechoic foci within the rotator cuff (RC) tendons. These abnormal foci were confirmed to be a pain generator using an ultrasound-guided diagnostic anesthetic injections, and each patient underwent a successful tenotomy, vacuum aspiration, and debridement of these lesions. Ultrasound findings of vaccine-induced reactive changes within the RC have not been previously reported, and the sonographic findings presented in this case series are distinct from the findings traditionally seen in degenerative tendinopathy or acute RC tears. Identification of this pattern and confirmatory anesthetic injection may aid in the diagnosis of Shoulder Injury Related to Vaccine Administration and guide minimally invasive treatments in chronic cases unresponsive to conservative management.

Objective: Orthobiologics are increasingly sought-after interventions in sports medicine for treatment of musculoskeletal injuries and conditions. Despite this trend, differences exist across sports medicine fellowship programs regarding foundational knowledge, educational curricula, and practical experience with orthobiologic therapies (eg, platelet-rich plasma, bone marrow aspirate concentrate, microfragmented adipose tissue). This represents an important educational gap for those training in sports medicine fellowships. To address this gap, an educational toolkit was envisioned with the sports medicine fellowship director and trainee in mind.

Data sources: Collective observations from physician experts in sports medicine education established the variations in curricula and expertise of graduating fellows. A literature review was conducted to source English-language peer reviewed articles from the online PubMed database. The scope of this project did not include an independent systematic analysis or statistical assessments.

Main results: An educational toolkit consisting of 12 adaptable modules was developed, each with a suggested reading list from the published literature. The modules may be rearranged to support each program's learning schedule. The information and lessons contained herein may be valuable to all healthcare providers interested in the evidence-based application of orthobiologics and insightful interpretation of related research.

Conclusions: By implementing an educational toolkit, sports medicine fellowships may improve the quality of education on orthobiologics. This is intended to improve the knowledge and skill set of fellowship graduates, thus promoting the scientific, responsible use of orthobiologic interventions.

Objectives: To determine population values of femoroacetabular translation using dynamic hip ultrasonography (DHUS) in professional ballet dancers.

Design: Cross-sectional cohort.

Setting: Three ballet companies.

Participants: Ninety professional ballet dancers.

Interventions: Dynamic hip ultrasonography was performed (12 images/dancer, 1080 images). Biometrics included Trochanteric Prominence Angle Test and Beighton Score.

Main outcome measures: Anterior and posterior DHUS measures were documented, and femoroacetabular translation was calculated.

Results: Anterior exam mean values for female dancers in neutral (N), neutral flexed (NF), and extension external rotation (EER) positions were 4.3 ± 2.05, 9.4 ± 2.61, and 11.4 ± 2.83, respectively, and anterior translation 2.1 ± 2.08; for posterior exam, posterior neutral, posterior flexion adduction internal rotation, and posterior stand positions showed a median value (interquartile range [IQR]) 0 (0-2) and mean values of 11.7 ± 4.89 and 8.8 ± 4.63, respectively, and posterior femoroacetabular translation 10.4 ± 4.62. Ultrasound measures for male dancers' anterior exam showed 5.5 ± 2.86, 10.9 ± 2.82, and 12.9 ± 2.78 and anterior translation 1.9 ± 1.62, and posterior exam measures showed median (IQR) 0 (0-3) and mean 11.3 ± 4.69 and 10.1 ± 5.36 and posterior femoroacetabular translation 9.6 ± 3.82. Differences by sex were found in N and NF positions: male dancers had greater translation versus female dancers in the left (P = 0.03 and P = 0.03, respectively) and right hips (P = 0.02 and P = 0.004, respectively). Males had greater EER in the right hip compared with females (P < 0.001).

Conclusions: Dynamic hip ultrasonography determined population values in professional ballet dancers. Sex-based differences among dancers were found.

Objective: To investigate the relationship between injury factors, nonsteroidal anti-inflammatory medication (NSAID) use, and concussion outcomes.

Design: Prospective cohort.

Participants: Adolescents (N = 118) ≤14 days of concussion seen at a sports medicine center between November 2020 and May 2025.

Independent variable: Participants who reported ibuprofen and/or naproxen use were assigned to the "NSAID use" group, all others were assigned to the "No NSAID use" group.

Main outcome measures: Symptom severity, medical history, and medication use information were collected. The development of persisting symptoms after concussion (symptoms > 28 days, [PSaC]) was monitored via time to symptom resolution.

Results: We enrolled 118 participants with concussion (15.4 ± 1.7 years, 54% female, 8.4 ± 3.1 days postinjury): 29 (25%) reported taking NSAIDs (n = 24 ibuprofen, n = 3 naproxen, n = 2 ibuprofen/naproxen) before their evaluation. Those who reported NSAID use were evaluated sooner (7.4 ± 2.8 vs 8.7 ± 3.2 days postinjury; P = 0.05), weighed less (57.2 ± 11.0 vs 63.5 ± 17.0 kg; P = 0.06), and had more severe symptoms (59.9 ± 32.6 vs 39.3 ± 22.2; P < 0.001). More participants who reported NSAID use sustained a sport-related concussion (93% vs 73%; P = 0.02), and fewer participants who reported NSAID use started physical activity before evaluation (17% vs 39%; P = 0.03). Severe symptoms were associated with NSAID use (OR = 1.03; 95% confidence interval [CI], 1.01-1.05). Non-sport-related injuries (OR = 0.27; 95% CI, 0.08-0.91) and higher symptom severity (OR = 1.02; 95% CI = 1.00, 1.04) were associated with greater odds of PSaC, but NSAID use was not (OR = 0.62; 95% CI, 0.19-1.97).

Conclusions: In adolescents, NSAID use was associated with more severe symptoms but not PSaC. To optimize clinical guidance, future research should further evaluate the role of NSAIDs in concussion recovery.

Objective: To compare the clinical outcome of patients electing to undergo the Cross Bracing Protocol (CBP) for ACL rupture with those choosing surgical stabilization.

Design: Observational prospective cohort study with 2-year follow-up.

Setting: Private subspecialist sports orthopedics and sports medicine practice.

Patients: The 80 patients who both entered and completed the study were skeletally mature 16 to 40 years old, presenting with an acute noncontact isolated ACL rupture, taking part in pivoting sports and intent on returning to that activity. ACL rupture was diagnosed on both clinical assessment and MRI. Patients were fit for general anesthetic and free of significant medical conditions.

Interventions: Group A (40 patients) underwent surgical stabilization, and group B (40 patients) followed the CBP. The groups were similar regarding the following independent variables: age, body mass index, gender, dominance of the injured knee, and posterior tibial slope (P > 0.05).

Main outcome measures: Recurrent instability, incidence of meniscal tears, and the following patient-reported outcome measures (PROMs); Tegner Activity Scores; Knee Injury Osteoarthritis Outcome Score subscales of sport/recreation and knee-related quality of life; subjective International Knee Documentation Committee score; and Lysholm Knee Score.

Results: Group B had significantly higher risk of recurrent instability (70% vs 2.5%, P < 0.001), medial meniscal tear (62% vs 2.5%, P < 0.001), and inferior performance on all PROMs (P < 0.001).

Conclusions: The CBP is associated with an unacceptably high rate of recurrent instability when used to treat ACL ruptures in patients taking part in pivoting sports.

Abstract: Lactation is a metabolically & physiologically complex process. Even more complex are the potential feedback mechanisms involved in regulating hyperlactation. As elite athletes are increasingly choosing to have children and return to high level competition, it is important to explore the potential intersection of exercise and lactation physiology. To our knowledge, there are no case reports documenting hyperlactation in an elite female endurance athlete and possible relationship with sport performance. We present 1 case that suggests hyperlactation negatively influences performance, necessitating further research to explore this potential relationship.

Objective: Single- and dual-task tandem gait are key components of the Sport Concussion Assessment Tool 6 and Sport Concussion Office Assessment Tool 6 (SCOAT6) balance assessment. However, the performance criteria for tandem gait remain unclear for male and female healthy athletes, and those with a concussion. This study aimed to establish normative performance outcomes for single- and dual-task tandem gait in healthy male and female athletes, and to compare their performance with SCOAT6 criteria.

Design: Cross-sectional.

Setting: Interuniversity athletics program.

Participants: Healthy interuniversity athletes (N = 103; female = 43).

Independent variables: N/A.

Outcome measures: Three trials of single- and dual-task tandem gait-time to completion, motor errors, and cognitive accuracy were obtained.

Results: Female athletes were generally slower than male athletes across both task types on average across all three trials, with a difference of 1.6 seconds [90% Credible Interval (CrI) = 0.5 to 2.6, posterior probability above zero seconds (pprob) = 99.3%] for single-task and 2.8 seconds (90% CrI = 0.6-5.1, pprob = 98.1%) for dual-task. This trend persisted when analyzing the fastest single trial, with female athletes exhibiting slower times by 1.4 seconds (90% CrI = 0.2-2.4, pprob = 97.8%) and 2.1 seconds (90% CrI = 0-4.2, pprob = 94.8%) for single- and dual-tasks, respectively. Furthermore, based on SCOAT6 criteria, most athletes were categorized as "very slow" for single-task (>12.5 seconds; females = 88.4%, males = 71.7%) and dual-task conditions (>16.3 seconds; females = 88.4%, males = 76.7%).

Conclusions: Healthy male athletes performed single- and dual-task tandem gait faster than female athletes. In addition, most athletes performed below the "normal" ranges according to SCOAT6 criteria, suggesting that normative performance values for tandem gait may need revisiting to enhance clinical interpretation.

Abstract: A 33-year-old woman participating in a physically high-intensity event experienced a heat injury and was incidentally found to be pregnant. Other contributing factors to the heat injury were the event taking place during the hottest month of the year, consumption of creatine and preworkout supplements, and abstaining from breakfast on the day of the event. She suffered heat stroke with AST and ALTs reaching 8k and CK peak of 36k. The concern for acute liver failure prompted discussions for a possible liver transplant, ultimately not required. Viability of the pregnancy was indeterminable during admission. Follow-up after discharge revealed quadriceps soreness with light activity, CK levels peaking to 5k, and ALT/AST increased to 1062/234 roughly a month after her admission. BUN and Cr were slightly elevated on presentation to ED (23 and 1.8), normalizing with 3L of IVF before admission. UA unremarkable. With continued rest, the patient's symptoms resolved; CK, AST, and ALT normalized; and her pregnancy is proceeding normally. The patient is considered high risk for dehydration, shock liver, and repeat heat injury during her first delivery. This is due to increased CK/AST/ALT levels with moderate walking for 1 h. In addition, the patient meets criteria for heat tolerance testing to determine risk of future heat injuries.

Background: Fasciculoventricular pathways (FVPs) are an uncommon cause of pre-excitation that can be mistaken for other more common accessory pathways in clinical practice. This case report highlights the key features of FVPs and their management.

Case summary: A 12-year-old male athlete was referred to the pediatric arrhythmia outpatient clinic with an asymptomatic pre-excitation on baseline routine electrocardiogram. Exercise stress test showed sustained pre-excitation throughout maximum heart rate. An electrophysiologic study documented an FVP and no inducible arrhythmia. No ablation was attempted, and the patient was discharged with return to play authorization without restrictions.

Discussion: Although they are not substrates for re-entrant tachycardia and are not associated with sudden death, diagnosis of FVPs is important to prevent unnecessary ablation and undue exercise restriction.