Clinical Journal of Sport Medicine最新文献

Objective: To evaluate whether early age of first exposure to contact sports (AFE-CS) is associated with worse long-term brain health outcomes.

Design: A cross-sectional, survey study of older men with a history of contact sport participation was completed.

Setting: Tertiary care facility.

Participants: A cohort of community-dwelling older men dichotomized by using AFE-CS (<12 years vs ≥12 years).

Interventions: Independent variables included a dichotomized group of AFE-CS (<12 years vs ≥12 years).

Main outcome measures: Brain health outcomes measured by depression, anxiety, cognitive difficulties, and neurobehavioral symptoms. Endorsements of general health problems, motor symptoms, and psychiatric history were also collected. Age of first exposure groups was compared using t tests, χ 2 tests, and multivariable linear regressions, which included the following covariates: age, number of prior concussions, and total years of contact sport.

Results: Of 69 men aged 70.5 ± 8.0 years, approximately one-third of the sample (34.8%) reported AFE-CS before age 12 years. That group had more years of contact sports (10.8 ± 9.2 years) compared with those with AFE-CS ≥12 (5.6 ± 4.5 years; P = 0.02). No differences were found after univariate testing between AFE-CS groups on all outcomes ( P -values >0.05). Multivariable models suggest that AFE-CS is not a predictor of depression or anxiety. Those in the AFE-CS <12 group had fewer cognitive difficulties ( P = 0.03) and fewer neurobehavioral symptoms ( P = 0.03).

Conclusions: Those with AFE-CS <12 to contact sports did not have worse long-term brain health outcomes compared with those with AFE-CS ≥12. Individuals with AFE-CS <12 had significantly lower British Columbia Cognitive Complaints Inventory and Neurobehavioral Symptom Inventory scores compared with those with AFE-CS ≥12.

Clinical relevance: The benefits of earlier AFE-CS may outweigh the risks of head strikes and result in comparable long-term brain health outcomes.

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.

Objective: Compare time to recovery between initial and repeat concussions.

Design: Retrospective review of electronic medical record.

Setting: An interdisciplinary concussion clinic.

Patients: Fifty patients (14.4 years old [±2.5]; 24 [48%] female) who sustained >1 concussion between 2016 and 2020 and were evaluated within 30 days of their concussion.

Intervention: Injuries were divided into first, second, and/or last concussions.

Main outcome measures: The primary outcome was time to recovery, as defined by clearance for return to sport. This was compared between first versus second concussion (primary analysis) and first versus last concussion (secondary analysis) using Cox regression. Multivariable models accounted for time from concussion to initial clinic visit and Sport Concussion Assessment Tool symptom severity score at initial encounter. Sensitivity analyses explored potential influences of initial encounter timing and interval between concussions.

Results: Time to recovery did not differ between initial and repeat concussion in univariate or multivariable models (HR = 1.02, 95% CI, 0.65-1.62, P = 0.92; HR = 1.01, 95% CI, 0.64-1.62, P = 0.91 for multivariable models comparing first (ref) versus second and first (ref) versus last concussion, respectively). Similar results were obtained in sensitivity analyses stratifying by time to initial visit (≤7 days vs >7 days) or time between injuries (≤1 year vs >1 year).

Conclusions: There were no differences in time to recovery between initial and repeat concussions sustained by the same athlete. A nonsignificant trend of shorter recovery after repeat concussions was observed for patients presenting within 1 week of injury and when repeat injuries occurred within 1 year.

Objective: This study aims to analyze the ability of ChatGPT to answer frequently asked questions (FAQs) regarding FAI. We hypothesize that ChatGPT can provide accurate and thorough responses when presented with FAQs regarding FAI.

Design: Ten FAQs regarding FAI were presented to ChatGPT 3.5 and initial responses were recorded and analyzed against evidence-based literature. Responses were rated as "excellent response requiring no further clarification," "satisfactory response requiring minimal clarification," "satisfactory response requiring moderate clarification," or "unsatisfactory response requiring substantial clarification."

Setting: Institutional.

Independent variables: Frequently asked questions regarding femoroacetabular impingement.

Main outcome measures: Accuracy and thoroughness of ChatGPT responses to FAQs. Hypothesis was formulated before data collection.

Results: Most responses from ChatGPT were rated as satisfactory and required only minimal clarification. Two responses received an excellent rating and required no further clarification, while only 1 response from ChatGPT was rated unsatisfactory and required substantial clarification.

Conclusions: ChatGPT provided largely accurate and thorough responses to FAQs regarding FAI while appropriately reiterating the importance of always consulting a medical professional.

Objective: To retrospectively analyze publicly available elbow ulnar collateral ligament reconstruction (UCLR) injury data for professional baseball players.

Design: Descriptive epidemiology study.

Setting: A retrospective analysis using an open-source database was performed. The database contained all known UCLR surgeries among Major League Baseball (MLB) and Minor League Baseball (MiLB) players.

Participants: In total, 1801 professional male professional baseball pitchers (age: 24.5 ± 3.9 years) who have undergone UCLR between 1974 and 2024.

Main outcome measures: The number of UCLR procedures each year.

Independent variables: Change-point analysis was used to identify changes in the number of UCLR surgeries over time among MLB and MiLB players. For MLB players, number of UCLR surgeries from 1974 to 2023 was analyzed, while for MiLB players, data starting from 1981 to 2024 were analyzed.

Results: For MLB players, 3 change points were identified, occurring around 1989 (95% confidence interval [CI], 1988-1990), 2000 (95% CI, 2000-2000), and 2012 (95% CI, 2011-2017). For MiLB players, 3 change points were identified occurring around 2001 (95% CI, 2001-2001), 2009 (95% CI, 2008-2010), and 2013 (95% CI, 2013-2015).

Conclusions: Overall, there has been a rise in the number of UCLR surgeries per year for the past 50 years in professional baseball, with distinct time points identified, representing increases in the number of UCLR surgeries each year. A higher number of UCLR surgeries are performed per year in the MiLB than in the MLB.

Objectives: The primary objective of this study was to analyze the correlation between the pain experienced at the time of a hamstring muscle injury and the hyperintense T2 weighted volume of the lesion measured on MRI. The secondary objectives were to analyze the differences in this pain with the lesion grade and the hamstring muscle head involved.

Design: We performed a retrospective analysis of the data collected in a prospective, multicenter, noninterventional cohort study (HAMMER).

Patients: A total of 61 patients were included in this analysis.

Interventions: Patients with suspected hamstring muscle injury had an MRI after the injury.

Main outcomes measures: They were evaluated for their pain intensity experienced at the time of injury with a Numeric Pain Rating Scale (NPRS) from 0 to 10.

Results: There was a significant but weak correlation between the pain experienced at the time of hamstring muscle injury and the hyperintense T2 weighted volume (r = 0.287; P = 0.025). There were no significant differences in the pain according to the lesion grade (F(3,57) = 0.982; P = 0.408) nor according to the muscle involved (F(3,57) = 1.013; P = 0.394).

Conclusions: Pain at the time of injury seemed to be weakly correlated with the extent of muscle lesion at medical imaging. Pain at the time of injury alone seems not enough to give us a clinical meaningful indication of the MRI hyperintense T2 weighted volume.

Objective: Treadmill test protocols for concussion assessment have been validated for patients aged 13 years and older; however, no evidence-based guidelines exist for younger children. We designed and assessed the safety and utility of the Morahan Pediatric Concussion Exercise Tolerance Test (MPCETT) for assessing exercise tolerance in symptomatic children (SC) and recovered, asymptomatic children (AC) from 6 to 12 years of age.

Design: Retrospective case series.

Setting: Secondary care center.

Participants: Children were diagnosed with concussion using consensus guidelines. At assessment, SC [n = 17; median (range) 10 (6-12) years; 18% female; 28 (13-50) days since injury] had persistent concussive symptoms, while AC [n = 24; 9 (7-12) years; 21% female; 21 (8-37) days since injury] required assessment for return to activity.

Interventions: The MPCETT is a modified Buffalo Concussion Treadmill Test for pediatric populations. The test was administered to establish exercise tolerance and was terminated for increased symptoms or self-reported exhaustion.

Main outcome measures: Presence of adverse events and exercise intolerance.

Results: The number of adverse events was 0 in both groups. Exercise intolerance occurred in 64.7% (95% CI, 38.3%-85.8%) of children within the SC group versus 12.5% (95% CI, 2.7%-32.4%) within the AC group (P < 0.001).

Conclusions: Pediatric exercise tolerance testing is safe and effective for assessing exercise intolerance in concussed children.

Objective: To identify sport-related concussion (SRC) assessments sports medicine physicians perform and in which they place confidence when making return-to-play (RTP) decisions.

Design: Cross-sectional study.

Setting: Online survey.

Participants: Active members of the American Medical Society for Sports Medicine (AMSSM) at the fellowship level or higher making RTP decisions following concussion within the last year.

Interventions: An electronic REDCap survey gathering demographic and practice information and responses to clinical scenarios was sent to AMSSM members.

Main outcome measures: The primary outcome was the SRC assessment(s) in which physicians expressed the most confidence for RTP decisions.

Results: Four hundred thirty AMSSM members responded to the survey, 392 of which met inclusion criteria. The graded symptom checklist was rated the most useful test for making return-to-play decisions, and respondents felt most confident starting the RTP process if the graded symptom checklist was normal. An assessment was considered most useful if it closely reflected resolution of SRC's pathological processes. Computerized neurocognitive testing was most likely to be ignored if abnormal. An abnormal neurological examination made physicians feel least confident SRC had resolved.

Conclusions: Sports medicine physicians view the graded symptom checklist as a useful tool for making RTP decisions. Physicians expressed less confidence in computerized neurocognitive testing to determine RTP readiness. This study uncovered reliance on symptom reporting by sports medicine physicians and an opportunity for the creation of concussion clinical decision tools.

Objective: To describe the incidence, location, and type of musculoskeletal injuries in ballet dancers at the Opéra de Paris from 2018 to 2023 and to evaluate the effect of COVID-19 on injury incidence.

Design: Descriptive Retrospective Study.

Setting: Primary.

Patients: Professional ballet dancers registered at the Opéra de Paris across 5 seasons (September 1, 2018-June 30, 2023).

Independent variables: Demographics (age, body mass index, sex, rank).

Main outcome measures: Injury data (duration, mechanism, location, and type).

Results: The incidence proportion of musculoskeletal injuries ranged from 47.1% to 72.6% per season between 2018 and 2023. Dancers most commonly sustained foot (49.3%) and ankle (45.1%) injuries, with 75.6% of dancers sustaining a lower limb injury. Compared with the 2018 to 2019 season, the risk of a dancer sustaining an injury was significantly lower in the COVID-19 season (2019-2020) (OR, 0.34; 95% CI, 0.21-0.53; P < 0.001), while the risk of an injury resulting in time loss was significantly lower in the 2022 to 2023 season (OR, 0.42; 95% CI, 0.27-0.64; P < 0.001).

Conclusions: The incidence of musculoskeletal injuries in professional ballet dancers was as high as 72.6% per season between 2018 and 2023, with the most common injury location being the foot and ankle. Compared with that in the 2018 to 2019 season, the risk of a dancer sustaining an injury was significantly lower in the COVID-19 season (2019-2020). These findings can help anticipate musculoskeletal injuries in professional ballet dancers and improve injury prevention programs, by developing targeted training schemes.