Clinical Journal of Sport Medicine最新文献

Objective: This study characterizes Vermont City Marathon (VCM) exertional heat stroke (EHS) cases to better understand current EHS trends in US marathon runners.

Design: Retrospective review.

Setting: VCM medical tent for 10 years: 2012 to 2019 and 2022 to 2023.

Patients or participants: In total, 22 224 marathon runners, including 26 patients with EHS.

Independent variables: Demographic, treatment, and environmental data.

Main outcome measures: To characterize patients with EHS and incidence at VCM and compare with other marathons.

Results: Of 22 224 marathon starters, 26 patients with EHS yielded an incidence of EHS of 12/10 000 (0.12%). Compared with all VCM marathon starters, patients with EHS were younger (mean 33 vs 39 years, P = 0.01), but sex did not differ (62% vs 54% male, P = 0.44). All patients with EHS were treated with cold water immersion (CWI) with 100% survival. Cooling rate during CWI was 0.17°C/min and CWI time averaged 16 minutes. Since protocol updates in 2016, only 23% of patients with EHS have required hospital transport. For every 1°C of increasing wet bulb globe temperature (WBGT), EHS incidence at VCM increased by 1.2 cases per 10 000 runners (P = 0.04). Exertional heat stroke at VCM was more frequent than at the Boston Marathon (12 vs 3.7/10 000, P < 0.001), consistent with higher mean WBGT at VCM (20°C vs 14°C, P = 0.04).

Conclusions: This study is the first to characterize patients with EHS at VCM and compare these data to other US marathons. A linear correlation was established between WBGT and EHS incidence. Despite the early season and northerly setting of VCM, EHS was prevalent and important for medical tent preparation. Appropriate EHS treatment was life-saving.

Objectives: (1) Assess medial collateral ligament (MCL) laxity differences in nonoperatively treated acute MCL and anterior cruciate ligament (ACL)-MCL injuries with 2 range of motion (ROM) knee brace settings. (2) Describe knee ROM, brace satisfaction, overall knee score, adherence, pain, quality of life, and knee function. (3) Assess feasibility of larger trial.

Design: Prospective, randomized, single-blinded feasibility clinical trial.

Participants: Sixty-four adults with acute moderate-to-severe isolated MCL or combined ACL-MCL injuries at the University of Calgary Sport Medicine Centre.

Intervention: Random assignment to the protected (0-90 degrees) or restricted (30-90 degrees) brace group. Four weeks of constant brace wearing, followed by daytime wear until 6 weeks. Rehabilitation exercises prescribed from 2 weeks onward. Follow-up for 12 weeks.

Main outcome measures: Clinical outcomes included side-to-side difference (SSD) MCL laxity (mm) at 30 degrees knee flexion and 0 degree, ROM, patient-reported pain, overall knee ratings, brace satisfaction, daily adherence, international knee documentation committee subjective, and ACL-quality of life (QOL) collected throughout 12 weeks (baseline, 2, 4, 6, 8, and 12 weeks). The outcome assessor was masked to treatment group allocation.

Results: At 12 weeks, 73% had <1 mm SSD valgus laxity at 30 degrees knee flexion, with 82% in the restricted group and 67% in the protected group. All patients reported improved pain; none suffered a loss of knee ROM by 12 weeks. The 30 to 90 degrees brace group trended toward better adherence, satisfaction, function, overall knee scores, and QOL. A larger RCT would be feasible but challenging because of sample size needs and slow recruitment.

Conclusions: Favorable outcomes for bracing moderate-to-severe MCL injuries at 30 to 90 degrees for 6 weeks were observed in this feasibility trial.

Abstract: Infections after anterior cruciate ligament (ACL) reconstruction surgery pose a significant challenge in orthopedics, potentially jeopardizing the integrity and function of the graft. Among these, infections caused by Bacillus cereus are exceedingly rare. Bacillus cereus , a Gram-positive, aerobic, and facultative anaerobic bacillus, is predominantly recognized in soil, vegetation, and the gastrointestinal tract of humans and other animals. Despite its ubiquity in the environment, extraintestinal infections due to B. cereus are exceptionally uncommon in individuals with intact immune systems. By detailing our experience with this atypical infection, we aim to provide references to managing rare bacterial complications after ACL reconstruction.

Objective: To investigate the prevalence of low back pain (LBP) and disk degeneration (DD) and the relationship of DD with LBP among elite cross-country skiers.

Design: A cross-sectional study of elite cross-country skiers.

Setting: Study participants were recruited during autumn 2022 among elite cross-country skiers and collegiate skiers who were selected to national teams' training groups.

Participants: The original study group consisted of 44 skiers (16 national team skiers and 28 sports academy skiers).

Interventions: The study protocol included a 1.5T lumbar spine MRI, a clinical examination, and an interview with questions about general health and training as well as selected patient-reported outcomes. The morphology of intervertebral disks from T12/L1 to L5/S1 on sagittal T2-weighted midline images was visually assessed using the Pfirrmann classification with a grade 3 or higher considered degenerated in this age group.

Main outcome measures: Cross-sectional occurrence of DD on MRI and self-reported LBP.

Results: Low back pain was reported by 33 (75%) skiers. Half of the skiers had at least 1 disk of ≥grade 3 in the Pfirrmann classification. At least 1 disk grade ≥3 in the Pfirrmann classification was found in 61% (20 of 33) of skiers with LBP and 18% (2 of 11) of skiers without LBP (P = 0.034).

Conclusions: The most important findings in our study were the high prevalence of self-reported LBP and a statistically significant difference in the occurrence of at least 1 degenerated disk in the Pfirrmann classification between skiers who reported LBP compared with those who did not.

Objective: The objective of this study was to evaluate whether percussive massage reduces the intensity of quadriceps pain and perceived fatigue and improves perceived recovery and vertical jump after habitual running.

Design: Randomized clinical trial.

Settings: Road race.

Participants: Eighty-four runners aged 18 to 60 years, 1-year experience in running and a training frequency of twice a week, were included (experimental group: n = 39, 34.33 ± 1.61 years, 61% M, 5.68 ± 1.16 years of running experience; control group: n = 45; 34.51 ± 1.50 years; 71% M; 6.01 ± 1.02 years of running experience).

Interventions: The experimental group received 10 minutes of percussive massage on the quadriceps, and the control group received sham hip and knee joint mobilization.

Main outcome measures: Quadriceps pain intensity and fatigue (visual analog scale), perceived recovery (perceived global effect scale), and vertical jump after habitual running.

Results: The experimental group showed better results for quadriceps pain intensity (0.98; 95% confidence interval [CI], -1.63 to -0.34), fatigue (0.7; 95% CI, -1.45 to -0.05) and perceived recovery (0.54; 95% CI, 0.02-1.07), but not for vertical jump performance (0.95; 95% CI, -1.57-3.47).

Conclusions: Percussive massage improved pain intensity, fatigue, and perceived recovery after running but had no effect on vertical jump.

Objective: Low back pain (LBP) is a prevalent musculoskeletal condition, often mechanical in nature, affecting millions globally. Mechanical LBP originating from sacroiliac joint (SIJ) discomfort is common but underappreciated. Determining sacroiliac joint pain or dysfunction (SIJP/D) prevalence poses challenges because of varied diagnostic criteria and characteristics. This systematic review aims to explore SIJP/D risk factors, biomechanics, and prevalence, in athletic populations, to inform preventive strategies.

Data sources: We conducted a systematic review following PRISMA guidelines. Searches were performed in Web of Science, Embase, MEDLINE, and Scopus databases up to February 2024. Eligible studies reported sacroiliac joint pain or dysfunction in athletes in English. Data extraction included prevalence and risk factors. NIH quality assessment tool was used for bias assessment. Proportional meta-analysis was used, and forest plots were generated using STATA 18 and SPSS-25.

Main results: A systematic review identified 1515 studies, of which 913 were excluded after screening titles and abstracts. Full-text evaluation led to the inclusion of 13 studies. These studies involved 2842 athletes from various sports, predominantly males. The prevalence of SIJP/D varied widely across studies, with mean prevalence of 10.72% among all athletes, 5.61% among injured athletes, 32.39% among athletes with low back pain, and 35.99% among those with pelvic or pubis pain. Risk factors for SIJP/D included stress injuries, biomechanical movements, and years of experience, with exercise showing potential for prevention. Methodological quality ranged from low to moderate, with bias mainly due to lack of exposure confirmation and sample size justification.

Conclusions: Based on the current literature assessed in this review, we cannot report an accurate prevalence of SIJ pain or dysfunction in athletes. Owing to heterogeneity of the available data, further evaluation is necessary.

Objectives: (1) To estimate adherence to brace wearing for medial collateral ligament (MCL) injuries across 3 phases of conventional treatment and (2) to explore predictors of adherence for each phase.

Design: Exploratory cohort study.

Setting: Primary care center.

Patients: Fifty-nine patients aged 18 to 65 (27 men, 32 women) from a randomized clinical trial examined the effectiveness of 2 bracing techniques (0-90 degrees or 30-90 degrees) for acute isolated MCL or combined anterior cruciate ligament injuries. Patients were prescribed a 6-week bracing protocol and were followed for 12 weeks.

Interventions: Patients were prescribed constant brace wearing for 4 weeks (∼23 h/d), then daytime wear only (∼15 h/d) until brace discontinuation at 6 weeks. Rehabilitation exercises were prescribed from 2 weeks onward. Adherence to the protocol was assessed through daily self-reported logs. Clinical and patient-reported outcomes were collected throughout the randomized clinical trial (baseline, 2, 4, and 6 weeks). This study interpreted them as predictor variables of treatment adherence alongside patient and treatment characteristics.

Main outcome measures: Adherence to each 2-week phase, interpreted dichotomously (adherer or nonadherer). Adherers were identified as those who wore their brace according to the protocol.

Results: Adherence and pain decreased, while overall knee ratings improved throughout the treatment. Pain, affected knee, and brace range-of-motion settings were significant predictors of adherence in the exploratory logistic regressions.

Conclusions: Pain, affected knee, and brace range-of-motion settings were the primary predictors of brace wearing in the first 4 weeks of treatment. This study is the first to provide insight into MCL bracing adherence, potentially aiding clinicians in treatment management.

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.