Clinical Journal of Sport Medicine最新文献

Objective: To assess whether female sex is associated with higher lifetime concussion risk and if years of contact sport participation and/or concussion history are associated with negative long-term cognitive and psychiatric difficulties in females compared with males.

Design: Cross-sectional survey.

Setting: ResearchMatch, a national health-based volunteer registry.

Participants: A total of 330 participants (111 females) with contact sport exposure.

Interventions: Participants reported lifetime concussion history, age of first exposure, and duration of contact sport exposure.

Main outcome measures: Lifetime concussion history, depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), and cognitive symptoms (BC-CCI).

Results: Of 330 participants (N = 111 females), 57.1% of females reported at least one concussion. Females had fewer years of contact sport exposure than males (6.0 ± 4.5 vs 8.5 ± 8.9 years; P < 0.001). Age of first exposure was similar between sexes (females: 11.7 ± 8.9 years; males: 11.5 ± 5.3 years; P = 0.779). Female sex was not associated with a positive lifetime concussion history (OR = 1.13; 95% CI, 0.66-1.93; P = 0.662). Total years of contact sport exposure did not predict lifetime concussion history in females (OR = 1.02; 95% CI, 0.94-1.11; P = 0.667) but did in males (OR = 1.05; 95% CI, 1.01-1.10; P = 0.020). Increased lifetime concussions predicted increased late-life depressive, anxiety, and cognitive symptoms in both sexes.

Conclusions: Female sex was not associated with a higher likelihood of having a lifetime concussion history. Total years of contact sport exposure did not predict lifetime concussion risk in females but did in males. Increased lifetime concussions were associated with higher late-life depressive, anxiety, and cognitive symptoms in both sexes.

Clinical relevance: These findings highlight the importance of considering sex-specific differences in assessing long-term cognitive and psychiatric risks in former athletes.

Objective: To examine the association between the Mercy Rule (MR) and head impact incidence rates (IRs) in Canadian high school football games.

Design: Cross-sectional.

Setting: Calgary, Canada.

Participants: Two high school football teams (ages 15-16 years) had a total of 16 team-games videorecorded and analyzed.

Interventions: The MR mandates continuous running time in the second half of games when the score differential is 35 points or greater.

Main outcome measures: Head impact IRs and incidence rate ratios (IRRs) were used to compare head impact rates in MR and non-MR games.

Results: Mercy Rule games had 28% fewer plays, and the head impact IR per team-game was 27% lower [IRR, 0.73; 95% confidence interval (CI), 0.61-0.89] in MR games (IR, 241.67; 95% CI, 199.24, 293.13) than in non-MR games (IR, 328.91; 95% CI, 313.04, 345.57). Across all games (MR and non-MR), running plays accounted for more than half of all head impacts, and the head impact rates for running plays exceeded all other play types except for a sack of the quarterback. Players engaged in blocks (blocking or being blocked) accounted for 68.90% of all recorded head impacts. The highest proportion of impacts involved the front of the helmet (54.85%). There was no difference in head impact rates by player-play comparing MR and non-MR games (IRR, 1.01; 95% CI, 0.85, 1.19).

Conclusions: Given the concerns for potential long-term consequences of repetitive head impacts, the MR is a prevention strategy by which head impact rates can be significantly lowered when a significant score differential exists.

Objective: To identify specific tendon morphologies on ultrasonography of the Achilles tendon (AT) that later develop time-loss injury.

Design: Blinded post hoc analysis of a 2-year prospective, observational study of 944 AT sonographic videos to identify morphologic characteristics of diagnosed Achilles tendinopathies associated with future time-loss injury. The second year was used to validate the findings from the first year.

Setting: N/A.

Patients/participants: Four hundred seventy-three National Collegiate Athletic Association student-athletes from 3 institutions over 2 years of data collection (57.7% females; 20.1 ± 1.6 years of age; 23.1 ± 2.8 kg/m 2 of body mass index; 9.4 ± 3.6 years of sport experience).

Interventions/assessment of risk factors: Particular tendon morphologies were used to develop 3 ultrasonographic imaging rules that were used to predict AT injury leading to time loss in sport.

Main outcome measures: Positive predictive value (PPV) and negative predictive values of particular tendon morphologies associated with the development of time-loss injury within 1 year.

Results: One of 3 morphologies, a deep mid-substance focal hypoechogenic area, was validated on 2 separate data sets and found to have a 33.3% PPV in both years for the development of time-loss injury.

Conclusion: Results suggest a specific phenotype of sonographic abnormality of the AT that suggests a 1-in-3 chance of developing time-loss injury within a year. Detecting abnormality of future AT before symptoms develop may allow for rehabilitation strategies to prevent or reduce time-loss.

Abstract: We present a case of a professional basketball player who suffered from nonunion bilateral chronic tibial fractures, successfully treated with ultrasound-guided intraosseous injection with bone marrow aspirate concentrate. The patient was able to return to play full time after recovery from the procedure.

Objectives: The clinical consequences of coronavirus infection in elite judokas with exercise-induced bronchoconstriction (EIB) are unclear. We aimed to determine potential respiratory function abnormalities and recovery in athletes with and without EIB after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.

Design: Retrospective cohort study.

Setting: Türkiye Olympic Preparation Centre.

Participants: This retrospective study analyzed data collected from 25 consecutive elite judokas diagnosed with and without EIB and SARS-CoV-2 infection, routinely followed at an Olympic Sports Center between September 2020 and 2021.

Independent variables: Respiratory muscle strength and pulmonary function data were collected before and up to 90 days after SARS-CoV-2 infection.

Main outcome measures: Measurements included maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 second (FEV 1 ), forced vital capacity (FVC), FEV 1 /FVC ratio, and peak expiratory flow (PEF).

Results: Infected athletes with EIB had more markedly reduced respiratory muscle strength and pulmonary function than those without EIB. Maximal inspiratory pressure was decreased by 14% and MEP by 8% from baseline in infected athletes with EIB during follow-up. Likewise, FEV 1 and FVC decreased by 4%. Maximal inspiratory pressure, MEP, FEV 1 , and FVC remained abnormal after 90 days of SARS-CoV-2 infection in EIB athletes but normalized rapidly in non-EIB athletes. Peak expiratory flow seemed unaffected during follow-up. Exercise-induced bronchoconstriction severity was moderately correlated with the maximum fall in MEP during follow-up.

Conclusions: Severe acute respiratory syndrome coronavirus-2 infection notably decreases respiratory muscle strength and pulmonary function in judokas, especially those with pre-existing EIB, thereby prolonging spontaneous recovery time.

Objective: The purpose of this systematic review is to evaluate the original peer-reviewed studies on athletes who developed myocarditis after coronavirus disease (COVID-19) infection or after COVID-19 mRNA vaccination. Both entities likely have an immunologic component. We discuss elite, professional, college, and adolescent athletes. The athletes are generally young and healthy, representing a distinctive population group that differs from the general population. This review includes diagnosis of myocarditis, incidence, complications, prognosis, and return-to-play guidance for sports medicine clinicians and coaches.

Data sources: We surveyed the PUBMED, Embase, and Web of Science databases for the relevant peer-reviewed articles in the English language published from the onset of the pandemic until April 2023. Included were original observational studies and case series. Excluded were individual case reports and a small series with incomplete data. The resulting search yielded 30 original articles.

Main results: Reported myocardial abnormalities in athletes were rare after COVID-19 infection and even less frequent after COVID-19 mRNA vaccination. True incidence, however, may be higher because of under-reporting and frequent asymptomatic presentation. Male gender was prevalent for both manifestations; postvaccination myocarditis occurrence was the highest after the second vaccine dose. Diagnostic and return-to-play algorithms were developed and should be adopted and followed.

Conclusions: The risk of myocarditis from COVID-19 infection and COVID-19 mRNA vaccination is very low. The long-term prognosis and evolution of the observed cardiac magnetic resonance abnormalities are currently unknown. Although inferences can be made from the published data, COVID-19 and postvaccine myocarditis in athletes may represent only a small fraction of the true incidence of those who have been affected worldwide and not evaluated.

Objective: To examine the impact of the COVID-19 pandemic on the psychological health of key stakeholders within an elite UK sports organization.

Design: The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) was sent electronically to 500 employees, and 8 face-to-face interviews were conducted at an elite-level professional football club.

Setting: English Premier League (EPL) Football Club.

Participants: Office/stadium staff, coaching/backroom staff, players from the male U23, women's and men's senior teams.

Independent variables: Stakeholder groups that were invited to participate in the study: office/stadium staff, coaching/backroom staff, players from the U23, women's and men's senior teams, and variables of age and gender.

Main outcome measure: WEMWBS scores across the office/stadium staff, coaching/backroom staff, and player cohort.

Results: Of 122 responses (24% response rate) and 8 face-face interviews, the average WEMWBS score was 51.2 (SD ±8.4) and 14% of the cohort presented with scores suggestive of a higher risk of depression. The main findings were moderate effect size differences in WEMWBS scores with the players scoring higher than both the office/stadium staff ( P = 0.01) and the coaching/backroom staff ( P = 0.01).

Conclusions: Office/stadium staff experienced greater compromising mental health effects from the COVID-19 pandemic, as compared with the coaching/backroom staff and players, respectively, suggesting that elite sports organizations should also consider providing mental health education and signposting strategies for this area of the workforce.

Objective: To describe 3.0-Tesla (T) magnetic resonance imaging (MRI) findings of hamstring muscles in clinically recovered athletes who were cleared for return to play (RTP).

Design: Prospective observational study.

Setting: Hospital.

Participants: Athletes (amateur and professional) who were cleared for RTP after hamstring injury. Fifty-eight participants were included in the analysis.

Independent variables: 3-T MRI at baseline (within 7 days from initial injury) and MRI at RTP (within 10 days of RTP).

Main outcome measures: Injury location, grade of injury (modified Peetrons and British Athletics Muscle Injury Classification/BAMIC), presence and the extent of intramuscular signal abnormality, intramuscular tendon disruption, and thickness. Reinjuries within 1 year of RTP were recorded.

Results: Magnetic resonance images at RTP showed that 55 (95%) participants had intramuscular increased signal intensity (edema) and 44 (76%) participants had intramuscular abnormal low-signal intensity (suggesting fibrosis) on MRI. There was an overall reduction of injury grades according to the modified Peetrons and BAMIC classification at initial injury to RTP. Three (5%) participants had no abnormal signal intensities (grade 0 or grade 0A) on MRI at RTP. Intramuscular tendon disruption, waviness, and tendon thickening were present at RTP in, respectively, 22 (38%), 15 (26%), and 36 (62%). We recorded 3 (5%) reinjuries.

Conclusions: At RTP, 3.0-T MRI shows high percentages of MRI abnormalities (edema, fibrosis, and intramuscular tendon disruption and thickening). We conclude that complete normalization of 3.0-T MRI is not expected for RTP decision after a hamstring injury. Its possible association with reinjury risk has to be determined in larger cohorts.

Objective: COVID-19 has been associated with myocardial involvement in collegiate athletes. The first report from the Big Ten COVID-19 Cardiac Registry (Registry) was an ecological study that reported myocarditis in 37 of 1597 athletes (2.3%) based on local clinical diagnosis. Our objective was to assess the relationship between athlete and clinical characteristics and myocardial involvement.

Design: Cross-sectional study.

Setting: We analyzed data from 1218 COVID-19 positive Big Ten collegiate athletes who provided informed consent to participate in the Registry.

Participants: 1218 athletes with a COVID-19-positive PCR test before June 1, 2021.

Assessment of independent variables: Demographic and clinical characteristics of athletes were obtained from the medical record.

Main outcome measures: Myocardial involvement was diagnosed based on local clinical, cardiac magnetic resonance (CMR), electrocardiography, troponin assay, and echocardiography. We assessed the association of clinical factors with myocardial involvement using logistic regression and estimated the area under the receiver operating characteristic (ROC) curve.

Results: 25 of 1218 (2.0%) athletes met criteria for myocardial involvement. The logistic regression model used to predict myocardial involvement contained indicator variables for chest pain, new exercise intolerance, abnormal echocardiogram (echo), and abnormal troponin. The area under the ROC curve for these indicators was 0.714. The presence of any of these 4 factors in a collegiate athlete who tested positive for COVID-19 would capture 55.6% of cases. Among noncases without missing data, 86.9% would not be flagged for possible myocardial involvement.

Conclusion: Myocardial involvement was infrequent. We predicted case status with good specificity but deficient sensitivity. A diagnostic approach for myocardial involvement based exclusively on symptoms would be less sensitive than one based on symptoms, echo, and troponin level evaluations. Abnormality of any of these evaluations would be an indication for CMR.