Clinical Journal of Sport Medicine最新文献

Abstract: Narrowing of the ischiofemoral space leading to the entrapment of neurovascular structures is the pathologic basis of ischiofemoral impingement (IFI). In our clinical practice, we encountered a patient with secondary IFI because of an osteochondroma in the lesser trochanter region, presenting with typical posterior hip pain. Traditional surgical methods typically involve lesion resection through a posterolateral approach to the hip, with only a few patients reported using hip arthroscopy. We present a modified posterior hip arthroscopic technique for resecting an osteochondroma near the lesser trochanter. This technique allows for rapid access to the lesion site and provides clear visualization of the sciatic nerve under arthroscopy, facilitating safe and thorough lesion resection.Level of evidence V, Case Study.

Objective: The purpose of this study was to obtain expert consensus on the identification, management, and treatment of adverse reactions associated with the use of intra-articular hyaluronic acid (viscosupplementation) in any joint.

Design: A Delphi approach was used to establish expert consensus between February and October 2024.

Setting: The Delphi study was conducted virtually using the Welphi survey platform and Qualtrics.

Participants: An expert panel of 33 panelists was created after an open call to sports medicine physicians who were members of The American Medical Society for Sports Medicine. Snowball sampling was conducted to recruit additional experts outside of The American Medical Society for Sports Medicine.

Main outcome measures: Outcome measures consisted of demographic characteristics and clinical experience and beliefs of the expert panelists, and items that achieved and did not achieve consensus after the Delphi study.

Results: In total, 32 of 33 physicians completed all rounds of the Delphi study (97% completion rate). Most adverse reactions were agreed to be because of the administration of the injection rather than the substance itself. Severe adverse reactions including joint infection, pseudoseptic reaction, and large increase in pain at the injection site were deemed rare or very rare by the Delphi panel. Numerous prevention and treatment strategies were identified for mild and moderate adverse reactions. The only time discontinuation of viscosupplementation was recommended was in cases of pseudoseptic reactions and joint infections.

Conclusions: This study provides expert guidance to clinicians on ways to identify and manage adverse reactions associated with viscosupplementation in their clinical practice.

Objectives: To characterize helmet use, head injury risk, and to examine rider-related factors that influence these variables.

Design: Cross-sectional study.

Setting: The University of Alabama at Birmingham Equestrian Sports Medicine Collaborative.

Patients or participants: In total, 357 equestrians competing at the collegiate level participated in this study.

Interventions or assessment of risk factors or independent variables: χ 2 tests were used to evaluate potential associations between a rider's experience level, riding style, and use of helmet designed with MIPS with number of falls, past head injuries, and helmet use frequency.

Main outcome measures: Data regarding helmet use and equestrian-related injuries were collected. χ 2 analysis was used to determine potential associations.

Results: More than 50% of athletes reported falling off a horse during the course of 1 year. Head injuries occurred with high frequency. Concussion was the most frequently reported type. More than 50% of athletes with self-reported concussion denied receiving medical treatment. The risk of head injury was similar across helmet brands, and between helmets with Multi-Directional Impact Protection System (MIPS) and those without. Riders with the most experience were less likely to report sustaining a head injury than those with less experience. Contrary to current safety guidelines, 78% of equestrians said that they would not replace their helmet after every fall.

Conclusions: Collegiate equestrians have a high risk of fall-related traumatic head injury. Despite this risk, they report helmet use practices that are not in line with current recommendations regarding helmet replacement.  This suggests that many of the athletes are using protective equipment that does not adequately protect against head injury. Neither helmet brand nor liner type was associated with lower rate of head injury.

Objective: To compare head contact (HC) and suspected concussion incidence rates (IRs) in male and female university basketball players and describe associated game event and court location.

Design: Cross-sectional.

Setting: Canadian basketball courts.

Participants: Players from 5 male and 5 female 2019 to 2020 regular season basketball games.

Assessment of risk factors: Prerecorded game footage was analyzed using Dartfish video analysis software to compare sexes.

Main outcome measures: Poisson regression analysis was used to estimate IRs and incidence rate ratios (IRRs) for HCs and suspected concussions. Head contacts were classified as HC1 (direct, player-to-player) or HC2 (indirect, player-to-environment). Game event, court location, and penalization of HCs were reported.

Results: Two hundred thirty HCs (88.7% HC1s, 11.3% HC2s) were observed. The HC1 IR was higher in male than female players (IRR, 1.55; 95% CI, 1.16-2.06). Most HCs occurred within the key. Shooting was the primary offensive game event for male and female players for receiving HC1s (24.6% and 20.0%, respectively). Defensively, HC1s occurred most frequently while guarding an attacker for male players (40.6%) and rebounding for female players (31.0%). The suspected concussion IR was not significantly different between male and female players (IRR, 2.00; 95% CI, 0.20-19.8). In total, 11.2% of HC1s to defenders and 25.7% of HC1s to offensive players were assessed as a foul.

Conclusion: Head contact rates were higher for male varsity basketball players compared with female players; however, suspected concussion rates did not differ. Game event and court locations differed by sex. A priority target for injury prevention is penalization of HCs because most HCs in competition went unpenalized.

Abstract: Carpometacarpal joint (CMCJ) osteoarthritis (OA) is a common condition that can cause significant pain and functional limitations. Although mild-to-moderate CMCJ OA symptoms can be managed with conservative measures, effective nonsurgical options for patients with moderate-to-severe OA unresponsive to conservative measures are limited. This case report introduces a novel approach involving intra-articular incobotulinumtoxinA (BoNTA) injection for CMCJ OA, resulting in significant and prolonged pain relief and enhanced functionality. This groundbreaking intervention effectively bridges the gap between nonsurgical and surgical treatments, offering a promising alternative for individuals with CMCJ OA.

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 compare the injury risk between natural grass and artificial turf in the male Finnish premier division (Veikkausliiga) matches during the 2019 league season.

Design: A retrospective reanalysis of prospectively collected season-long injury surveillance cohort study.

Setting: Finnish elite-level male football.

Participants: All 12 teams of Veikkausliiga participated in the study. All players were eligible to participate. Two hundred thirty-six players took part in the follow-up between February and November 2019.

Interventions: Matches were played between April and November 2019. Injury data were collected using standard injury reports from the team medicals and weekly player questionnaires. Individual player exposure in matches was collected. Artificial turf was classified as exposure and natural grass as control in the analyses.

Main outcome measures: Match-related injury incidence and incidence rate ratios (IRR) with 95% confidence intervals (CI) on natural grass and artificial turf.

Results: A total of 113 injuries (65 on artificial turf, 48 on natural grass) in 167 matches (90 on artificial turf, 77 on natural grass) were included. Injury incidence was 27.2/1000 hours on artificial turf and 23.9/1000 hours on natural grass and (IRR, 1.1; 95% CI, 0.8-1.7). There was no difference in injury types, anatomical regions, injury recurrence, injury severity, or injury contact. Forwards may have had an increased injury incidence on artificial turf compared with natural grass (IRR, 3.4; 95% CI, 1.0-11.8).

Conclusions: This study supports previous reports that there is no significant increase in the overall risk of injury in professional football played on artificial turf compared with that on natural grass.

Objective: To investigate the impact of high-intensity exercise on the vestibular and oculomotor systems in a group of sedentary and active males and females.

Design: Prospective observational study.

Setting: Performance laboratory; Institute of Sport, Exercise and Health, London.

Participants: Forty-five collegiate athletes and 30 age-matched sedentary participants.

Interventions: A baseline Vestibular and Oculomotor Screening (VOMS) test was performed on all participants before undertaking a self-paced 5-minute treadmill run maintaining an intensity of 17/20 on the Borg scale. Post-run, participants were tested using the VOMS tool a further 3 times with each test 30 seconds apart.

Main outcome measures: Symptom provocation on testing of the VOMS tool.

Results: At baseline testing, 25.3% of participants had 1 or more positive VOMS domains although there was no significant differences between sex, sport, or activity level. At postrun testing, 62.5% of participants had 1 or more positive VOMS domains; this was a significant change from baseline with large effect size (Z = 6.12, r = 0.72, P < 0.001).

Conclusions: High-intensity exercise has a deleterious impact on vestibular and oculomotor function. This change in function is consistent across all groups when considering activity level, sex, and sporting participation. These findings have implications when considering the timing of VOMS in relation to sporting participation and clinical testing that involves exercise.

Objective: To investigate static balance differences in college athletes based on history and timing of sports-related concussion (SRC), while considering sport impact type (contact/noncontact).

Design: Prospective cohort study.

Setting: Tertiary academic center.

Participants: Collegiate athletes (contact/noncontact) were recruited and stratified across 3 groups: (1) acute, (2) chronic, and (3) nonconcussed.

Interventions: Static balance testing.

Main outcome measures: Balance data were assessed using a force plate that measured mediolateral sway (ML), anteroposterior sway (AP), and path velocity (PV). Each metric was assessed under 4 different positions: eyes open feet together, eyes closed feet together, eyes open tandem, eyes closed tandem.

Results: Contact versus noncontact sport athletes demonstrated significant difference in PV after Bonferroni correction (P = 0.009, η2 = 0.135). Secondary pair-wise analysis demonstrated significant differences on all 4 balance conditions. There were no significant differences in average ML or AP sway based on sport impact type. Multiple linear regression demonstrated that balance metrics were significantly related to concussion symptom severity after Bonferroni correction (Adj R2 = 0.213, P = 0.010; ML sway [std B = -0.679, P = 0.003]; AP sway [std B = 0.847, P = 0.0001]; PV [std B = 0.042, P = 0.792]). There were no statistically significant effects on average PV, ML, or AP sway based on concussion history/timing alone.

Conclusions: Static balance was most influenced by sport impact type with contact athletes demonstrating reduced PV and ML sway. This highlights the importance of understanding each individual athlete and their respective sport when interpreting balance data and considering return to play after SRC.