Clinical Journal of Sport Medicine最新文献

Objective: To investigate the relationship between isokinetic knee extension peak torque and specific biomechanical variables during hop tests in patients 6 months postanterior cruciate ligament reconstruction (ACLR).

Design: Prospective, cross-sectional study analyzing the correlations between isokinetic knee extension torque and biomechanical outcomes across various functional tests.

Setting: Sports clinic with a specialized biomechanics laboratory.

Participants: Sixty-one patients (47 males, 14 females), aged 16 to 55 years, who had undergone ACLR, participated. All met the inclusion criteria and completed the follow-up testing at 6 months postsurgery.

Assessment of risk factors: Key independent variables included isokinetic knee extension peak torque. Participants completed standardized functional tests: single-leg and double-leg drop jumps, single-leg hop tests, and double-leg countermovement jumps.

Main outcome measures: Outcome measures included biomechanical parameters related to dynamic knee stability, including peak knee extensor moments, knee joint power during push-off, peak knee flexion and valgus, and vertical ground reaction force and braking forces.

Results: Moderate correlations were observed between knee extension peak torque and select biomechanical variables, including peak knee extensor moments during single-leg drop jumps, knee joint power during push-off phases in both single and double-leg drop jumps, and peak braking forces in single-leg hop tests. However, these relationships suggest that additional factors play essential roles in dynamic stability.

Conclusions: Although quadriceps strength is moderately linked to key biomechanical markers, our findings indicate that a more comprehensive assessment, integrating both strength and biomechanical evaluation, could enhance ACLR rehabilitation strategies. This combined approach may better support recovery and minimize reinjury risk.

Objective: This investigation evaluated the relationships between skeletal muscle mass (SMM), fat-free mass (FFM), and hydration status measured through saliva osmolality (SOSM). It was hypothesized that SMM and FFM would positively associate with SOSM.

Design: A cross-sectional, observational study.

Setting: Laboratory and field collection.

Participants: Seventy-two adults (42 men, 30 women; 29.3 ± 10.6 years, 171 ± 9 cm, 78.8 ± 15.0 kg, 28.7% ± 8.1% body fat).

Independent variables: Skeletal muscle mass and FFM were measured through bioelectrical impedance analysis.

Outcomes: Saliva osmolality was measured using the MX3 Hydration Testing System, a portable, noninvasive osmometer. Participants presented 2 saliva samples 3 to 5 minutes apart. Fluid intake was avoided for at least 5 minutes before sampling.

Results: Linear regression analysis showed a nonsignificant association between SMM and SOSM (unstandardized B = 0.44, P = 0.144), as well as FFM and SOSM (unstandardized B = 0.23, P = 0.172). The adjusted analysis including covariates (age, sex, past 4-hour fluid intake, and time of sampling) showed nearly no effect, with insignificant associations between SMM and SOSM (unstandardized B = 0.98, P = 0.146) and FFM and SOSM (unstandardized B = 0.44, P = 0.173) remaining. Similarly, Spearman correlation coefficients between SMM and SOSM [ρ(72) = 0.10, P = 0.427] as well as FFM and SOSM [ρ(72) = 0.08 P = 0.487] were positive but nonsignificant and small.

Conclusions: Despite growing evidence that urinary hydration biomarkers naturally vary with SMM and FFM, these 2 body composition variables seem to be insignificantly associated with hydration status according to SOSM. This may be related to relatively small concentrations of muscle metabolites (eg, creatinine, uric acid, urea) found in saliva.

Objectives: Social determinants of health (SDOH) are a major driver of health care outcomes in the United States. This study sought to assess the prevalence of SDOH in varsity collegiate student-athletes as this has not been an area of study in the sports medicine literature.

Design: This cross-sectional cohort study included varsity student-athletes presenting for a preparticipation physical examination (PPE) for the 2024-2025 academic year.

Setting: This study was conducted within the athletic department at an NCAA Division I University.

Patients: All incoming and returning varsity student-athletes (n = 673) completing an annual PPE were included in the study.

Interventions: Student-athletes were asked to answer 8 SDOH questions on the PPE form.

Main outcome measures: Data were analyzed for the entire student-athlete group, by sex, and by self-reported academic year.

Results: Approximately 7.5% of student-athletes in this study reported at least 1 SDOH concern. Food insecurity and social isolation were the most frequently reported issues. Upper-year students were more likely to have SDOH concerns when compared with first-year or graduate students.

Conclusions: The SDOH are a concern for varsity student-athletes even at a well-resourced NCAA Division I university. Athletic departments can leverage this information as they work to support the health and well-being of their student-athletes. Attention to SDOH can not only affect the health of a student-athlete but also their performance on the field of play.

Objective: This study aimed to define the minimal clinically important difference (MCID) after triamcinolone acetonide (TA) injections for knee osteoarthritis, see if the value changes over time, and report the proportion of patients achieving MCID monthly for 6 months.

Study design: Retrospective case series; level of evidence, 4.

Setting: One large university-affiliated practice (13 providers).

Patients or participants: Two hundred seventy-seven patients receiving TA (40 mg) with 4cc 1% lidocaine for knee osteoarthritis (OA) were retrospectively reviewed.

Intervention: Patients receiving TA (40 mg) with 4cc 1% lidocaine for knee OA.

Main outcome measure: Knee Injury and Osteoarthritis Outcome Score (KOOS) preinjection and monthly for 6 months. MCID values, representing moderate clinical improvement, were calculated as 0.5 standard deviations from preinjection scores.

Results: Of 277 injections (116 men, 161 women; mean age 61.3 years), MCID values varied across KOOS subscales (7.98-12.35). At the 1-month through 6-month follow-ups, the proportion of patients reaching the MCID on the KOOS pain scale was 50.5%, 47.7%, 36.2%, 37.1%, 44.8%, and 39.4%, respectively. Twenty-three percent of patients received a repeat injection within 6 months. Patients who did not meet the calculated MCID for pain by 1 month had a 2.19 times higher odds ratio of receiving a repeat injection within 6 months.

Conclusions: This study establishes MCID values for KOOS subscales in patients with knee OA receiving TA injections using a distribution-based method, which are similar regardless of duration of follow-up within 6 months. Patients can expect significant pain improvement within the first month, with declining effects thereafter. Lack of early pain improvement correlates with a higher likelihood of repeat injection, supporting the need for follow-up assessments to guide ongoing treatment.

Objective: To evaluate the efficacy and outcomes of extracorporeal shockwave therapy (ESWT) for bone pathologies including fractures, osteonecrosis/avascular necrosis, bone stress injury (BSI), medial tibial stress syndrome (MTSS), and bone marrow edema syndrome (BMES).

Design: Systematic review.

Data sources: Search performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of 3 databases: Cochrane Library, Embase (Elsevier), and PubMed (NLM). Studies included randomized controlled trials, cohort studies, case series, and case reports that investigated the efficacy of ESWT for the management of BSI, BMES, MTSS, delayed or nonunion fracture, or osteonecrosis/avascular necrosis of bone.

Main results: Fifty-three studies with 1835 adult patients (608 women, 910 men, 317 unspecified) were included. Studies were defined using Oxford level of evidence rating: 7 level I (13.2%), 4 level II (7.5%), 4 level III (7.5%), 24 level IV (45.2%), and 14 level V (26.4%). Four of 7 level I studies showed similar effectiveness of ESWT compared with surgery for the treatment of long bone nonunion fractures (n = 1) and early stage osteonecrosis of the femoral head (n = 1), exercise program for MTSS (n = 1), and medication management for BMES (n = 1). Efficacy for management of BSI had lower level of evidence. Twenty-two studies reported on safety with no significant adverse events.

Conclusions: The limited high-level studies suggest ESWT may offer an effective noninvasive treatment of most bone pathologies with favorable safety profile. Additional high-quality studies particularly in BSI may inform use of ESWT for bone pathologies.

Objective: The purpose of this cross-sectional study was to evaluate associations among injury, quality of life (QOL), and mental health among elite youth soccer athletes.

Design: Study materials were sent to Elite Clubs National League (ECNL) clubs through an online survey link.

Setting: Soccer athletes were invited to participate in May and June of 2024 by their respective clubs.

Participants: Six hundred sixty-eight ECNL soccer athletes (ages 13-19 years) completed the study.

Assessment of risk factors: Injury history and risk factors were assessed using a demographic survey.

Main outcome measures: Outcomes including QOL (Pediatric Quality of Life Inventory), anxiety (General Anxiety Disorder-7), and depression (Patient Health Questionnaire-9) were compared between athletes by injury status (uninjured, recovered, injured) using Tukey-adjusted pairwise comparisons of estimated marginal means.

Results: Two hundred ninety-five (44.2%) respondents reported an injury in the prior 6 months, of whom 224 (33.5%) had recovered, and 71 (10.6%) were currently injured. Uninjured athletes reported significantly lower symptoms of anxiety (5.0, 95% CI [4.5-5.5]) than currently injured (6.6 [5.5-7.7], P = 0.008) and recovered athletes (6.0 [5.3-6.6], P < 0.001). Currently injured athletes reported higher levels of depression (6.9 [5.8-8.1]) than recovered (5.2 [4.5-5.8], P = 0.01) and uninjured athletes (4.6 [4.0-5.1], P < 0.001), while the difference between recovered and uninjured athletes was not statistically significant (P = 0.19). Uninjured athletes also demonstrated significantly higher total QOL (81 [80-82]) than recovered (79 [77-80], P = 0.021) and currently injured (73 [70-76], P < 0.001) athletes.

Conclusions: Injured youth soccer athletes report worse mental health and QOL than uninjured athletes, even after return to play. Stakeholders in youth sports should consider that negative psychosocial impacts of injury may persist beyond physical impacts.

Objectives: This study evaluates the performance of the International Olympic Committee's Sports Mental Health Assessment Tool-1 (SMHAT-1) in a collegiate athlete population. The SMHAT-1 was introduced by the International Olympic Committee in 2021 as a mental health screening tool in elite athletes. Recent studies have shown high false-negative rates in elite athletes but the tool has not been previously evaluated in a population of collegiate athletes.

Design: Cohort study.

Setting: National Collegiate Athletic Association (NCAA) collegiate athletic institutions.

Participants: 1.631 collegiate athletes (NCAA division 1 and 2).

Intervention: Athletes underwent mental health screening including the triage and follow-up Form 2 components of SMHAT-1 during preparticipation evaluation.

Main outcome measure: Sensitivity and specificity of Athlete Psychological Strain Questionnaire (APSQ) triage for detection of positive Form 2 screening.

Results: 9.7% of athletes were positive in the AQSP triage phase, while 41.8% were positive on at least 1 Form 2 instrument. The APSQ had a 19% sensitivity and 97% specificity for follow-up screening. 81% of athletes with a positive follow-up screen were missed during triage.

Conclusions: Sequential screening using SMHAT-1 ASPQ and Form 2 steps results in a high false-negative rate. APSQ showed low sensitivity for positive Form 2 follow-up screening. The false-negative rate of 81% is concerning as a triage step for the detection of mental health concerns in collegiate athletes. We do not recommend the use of SMHAT-1 for mental health screening in collegiate athletes without modification.

Objective: Determine the clinical utility of a novel, multimodal assessment battery in detecting acute post-concussion impairment relative to baseline performance.

Design: Prospective observational cohort study.

Setting: Outpatient Concussion Clinic.

Participants: Four hundred thirty-one ice hockey, alpine ski, freestyle ski, artistic swimming, and luge athletes (mean: 15.7 years) over one athletic season.

Independent variables: Concussion status.

Main outcome measures: Changes in performance between baseline and post-concussion for 4 primary assessments: (1) concussion symptom exacerbation (≥1 on a 10-point scale) during a submaximal exercise assessment, (2) eyes closed and eyes open postural sway ratio (Ec/Eo) using a head mounted accelerometer, (3) quantitative electroencephalography event-related potentials (ERPs) N100, P300, and N400 amplitude and latency, and (4) change in heart rate during a 30-second, 30% maximal handgrip contraction.

Results: Forty-six athletes with a diagnosed concussion were enrolled. The exercise assessment found that 15 of the 22 athletes experienced worsening symptoms (P < 0.001, large effect size for the raw proportion (PR) = 0.969). Postural sway between timepoints showed a moderate effect size (dav = 0.491) (baseline: 1.4 ± 0.5 W, post-concussion: 1.9 ± 1.4 W, P = 0.005). Neither ERPs nor heart rate change during the handgrip task demonstrated significant group differences. Of 21 athletes with both postural sway and exercise evaluations, a flagged postural sway ratio (Ec/Eo ≥ 2.0) was seen for 3 athletes not previously identified by the exercise evaluation.

Conclusions: Symptom exacerbation during submaximal cardiovascular exercise and postural sway demonstrated clinical utility in detecting impairment within 7 days of a sport-related concussion, whereas event-related potentials and heart rate change during sustained handgrip did not.

Objective: To (1) report the prevalence of hip pain in professional table tennis players registered at a National Sports Institute, (2) describe their hip pathologies, and (3) evaluate expectations regarding hip pain before and after becoming high-level athletes.

Design: Case series.

Setting: French National Sports Institute.

Patients: Nineteen professional table tennis players.

Interventions: None.

Main outcome measures: UCLA activity score, training information, prevalence of hip pain, expectations regarding hip pain, and hip joint injuries/pathologies.

Results: The cohort comprised 19 table tennis players, 6 women and 13 men, aged 24.9 ± 4.1 years. Before playing table tennis professionally, 8 players thought that becoming high-level players could cause pain at their joints; however, none thought that becoming high-level players could cause pain at their hip joint. Eleven athletes reported experiencing hip pain, with 8 having femoroacetabular impingement (FAI), which was concomitant with chondropathy in 6, hip dysplasia in 5, and coxarthrosis in 3. Five athletes required femoroplasty for FAI or total hip arthroplasty for coxarthrosis. All athletes who underwent surgery returned to sport. At the time of the questionnaire, 15 athletes thought it was common for high-level table tennis players to have hip pain.

Conclusions: Professional table tennis players registered at the institute had a high prevalence of hip pain (58%) and FAI (42%), with 26% of athletes requiring surgery. These findings could allow coaches to align expectations in professional table tennis players, as well as to anticipate hip pathologies and design specific prevention programs.

Objective: Published data suggest that knee brace use may reduce the risk of primary noncontact knee ligament injury. However, the use of knee braces remains contentious due to concerns about performance hindrance. As knee brace use is a potentially modifiable risk factor, this study aimed to identify whether after 17.5 hours of functional knee brace (FKB) use, discounting and continued use of FKB hamper performance during anaerobic and aerobic tasks.

Design: Prospective repeated-measures crossover study.

Setting: Academic laboratory testing.

Participants: Twenty-seven healthy male provincial basketball and national field hockey athletes.

Interventions: Over 6 days of 12 testing sessions, during 3 test conditions (nonbraced, braced, and removed brace or continued brace use), anaerobic and aerobic performance was evaluated after removing a custom-fitting FKB after 17.5 hours and with continued FKB for 21.0 hours.

Main outcome measures: Anaerobic and aerobic, predicted maximum oxygen uptake (V̇O 2max ), performance.

Results: In the anaerobic endurance test, after 17.5 hours of FKB use, FKB removal led to a slower performance of nonsignificant 0.27 ± 0.26 s and higher fatigue levels ( P = 0.741, 95% CI, 16.00-17.23, Cohen effect size (ES) = small); continued FKB use for 21 hours resulted in nonsignificantly 0.25 ± 0.24 s faster performance and lower fatigue levels ( P = 0.626, 95% CI, 15.96-16.94, ES = trivial). In the aerobic capacity test, FKB removal resulted in a nonsignificantly lower V̇O 2max (3.0 ± 0.5 mL·kg -1 ·minute -1 , P = 0.518, 95% CI, 43.58-45.62, ES = large); continued FKB use led to a significantly higher V̇O 2max (1.5 ± 0.5 mL·kg -1 ·minute -1 , P = 0.005, 95% CI, 46.72-48.54, ES = large).

Conclusions: Removal of FKB led to lower performance levels in both tests, while prolonged FKB use resulted in greater anaerobic endurance, lower fatigue level, and significantly higher aerobic capacity performance.

Clinical relevance: These findings should help the decision-making process of practitioners about FKB use and performance.