Clinical Journal of Sport Medicine最新文献

Objective: To summarize the prevalence, incidence, and factors associated with fencing injuries among able-bodied (AFs) and wheelchair fencers (WFs).

Data sources: Literature was searched on 7 databases from inception to June 30, 2023. Two independent reviewers screened abstracts and full texts, extracted data, and conducted risk of bias assessments and meta-analyses. Studies were included if they reported the prevalence/incidence of fencing injuries/pain, and associated factors with relevant statistics in AFs or WFs. The quality of evidence of all factors was evaluated by GRADE.

Main results: In total, 19 out of 298 identified studies were included. These included studies demonstrated very low to moderate methodological quality. Eight included studies investigated the prevalence of fencing injuries in 1151 AFs, while 11 studies reported its incidence in 164 485 AFs and 14 WFs. The prevalence of fencing injuries in AFs ranged from 51.5% to 92.8%. Professional fencers had higher injury rates than nonprofessional counterparts. Moderate-quality evidence supported that older age, more fencing experiences, and Functional Movement Screen scores <15 were independently related to a higher prevalence of fencing injuries among nonprofessional AFs. Very low-quality evidence showed that male sabreurs, higher competitive levels, and regular involvement in fitness programs were associated with more fencing injuries in AFs. Very low-quality evidence suggested that older age and sabreurs were risk factors for fencing injuries in AFs, while poor trunk control was a risk factor for fencing injuries in WFs.

Conclusions: This is the first systematic review and meta-analysis to reveal the high prevalence and incidence of fencing injuries among AFs and WFs. However, the insufficient evidence regarding risk factors for these injuries highlights the importance of conducting prospective studies to investigate potential environmental, physical, and psychological risk factors for fencing injuries among AFs and WFs. Future research should also investigate the mechanisms underlying fencing injuries in AFs and WFs.

Objective: Muscle-tendon injuries are critical setbacks in professional football, significantly affecting player availability and team performance. Understanding these injury mechanisms through video analysis is crucial for developing effective prevention and rehabilitation strategies that enhance player welfare and optimize performance. This review aimed to synthesize data from articles that used video analysis to explore mechanisms of thigh muscle-tendon injuries in football.

Data source: A comprehensive literature search was conducted from 2010 to 2025 using a scoping review methodology. The quality of the included studies was assessed using the Quality Appraisal for Sports Injury Video Analysis Studies (QA-SIVAS) scale.

Main results: The review of 10 studies identified that noncontact and indirect contact mechanisms are predominantly responsible for severe thigh muscle-tendon injuries in football. Common injury scenarios involved sprinting-induced strains and kicking actions, highlighting the significant role of eccentric loading and rapid biomechanical changes.

Conclusions: Video analysis has emerged as a vital tool in sports medicine, providing deep insights into the complex mechanisms of thigh muscle-tendon injuries in football. The continuous improvement of analytical methods, including the adoption of advanced technologies such as artificial intelligence, is imperative for refining prevention and rehabilitation protocols.

Objective: Despite the identification of persistent neuromusculoskeletal control deficits and secondary musculoskeletal (MSK) injury after a concussion, no clear explanation exists to explain this interaction. This article explored the association between the intention to disclose a concussion and intention to disclose an MSK injury among adolescent athletes.

Design: Cross-Sectional.

Setting: Online Survey.

Patients or other participants: Five hundred sixty-four athletes between the ages of 12 and 18 years [male = 58.2%, age = 15.8 (1.8)].

Independent variables: Sex, gender, age, and socioeconomic status.

Main outcome measures: Online survey exploring determinants of musculoskeletal and concussion injury disclosure intentionality, knowledge of signs and symptoms, as well as attitudes, perceived social norms, and perceived behavioral control surrounding injury disclosure.

Results: There was a strong, positive correlation between intention to disclose a concussion and intention to disclose an MSK injury (r = 0.578, P < 0.001). Knowledge of signs, symptoms, and consequences, attitudes toward disclosure, and perceived social norms surrounding injury disclosure of both concussion and MSK injury were also shown to be significant predictive determinates. Male adolescent athletes were significantly more likely to report both an MSK injury and a concussion. In addition, although a history of concussion decreased concussion disclosure intentionality, a history of MSK injury increased MSK injury disclosure intentionality.

Conclusions: Intention to disclose a concussion was positively associated with intention to disclose an MSK injury. Future studies should address the effect of cross-cutting interventions to improve attitudes surrounding concussion and MSK injury disclosure that may also influence perceived social norms surrounding injury reporting.

Objective: Identify the effect size of mild and moderate levels of exertion on common sideline concussion assessment tool scores in healthy adolescent athletes.

Design: Three arm randomized controlled trial.

Setting: High school training rooms.

Participants: Forty-seven healthy adolescents who participate in school sports and have not had a concussion within the past month.

Interventions: Participants performed the Sport Concussion Assessment Tool 5 (SCAT5) and Vestibular Ocular Motor Screen (VOMS) at rest. Participants were randomized to perform No Exertion (n = 16, 15-minute seated rest), Mild Exertion [n = 16, 50%-55% of heart rate (HR) max for 15 minutes on a treadmill], or Moderate Exertion (n = 15, 70%-75% of HR max). Participants then repeated the SCAT5 and VOMS immediately after a 2-minute cool down.

Main outcome measures: Effect size of change after exertion.

Results: Few differences were seen after mild and moderate levels of exertion. In the combined sample, there was a small increase in the number of modified balance error scoring system errors [d = -0.17 (-0.52, 0.19)], a medium degree of improvement in symptoms [d = 0.38 (0.01, 0.74)], and a small degree of improvement in cognitive scores [d = 0.20 (-0.16, 0.55)] after exercise. No differences on VOMS testing were observed.

Conclusions: The SCAT5 and VOMS seem to be consistent measures even after mild and moderate levels of exertion (HR <75% of age-appropriate maximum). A future study should aim to identify the effect of maximal exertion.

Objective: This study aimed to identify factors affecting baseline performance in collegiate athletes using the Concussion Balance Test (COBALT © ).

Design: Cross-sectional study design.

Setting: Sports medicine research laboratory.

Participants: NCAA Division-I collegiate athletes (n = 127; 77 male, 50 female).

Independent variables: Sport, sex, history of concussion, and time since last concussion.

Main outcome measures: Postural sway and the number of errors across 4 COBALT conditions.

Results: Significant differences in postural sway and errors were observed based on sex. Female athletes demonstrated higher postural sway (0.34 degrees/s; P < 0.001) and more errors (1.69 errors; P < 0.001) on Condition 7 than male athletes. Concussion history and time since last concussion had no significant effect on postural sway or errors ( P > 0.05). Differences between sports were identified, with cheerleaders demonstrating more errors than football players (Conditions 3, 7, 8; errors; P < 0.05) and soccer players (Conditions 3, 7, 8; P < 0.05), and soccer athletes demonstrating more errors than football players on Condition 7 (1.47 errors; P < 0.05).

Conclusions: Our findings suggest that the COBALT is a useful tool for measuring balance performance, offering insights into baseline performance that may influence concussion management. Differences in performance based on sex and sport, but not concussion history, were observed, highlighting the importance of considering individual factors when interpreting baseline test results.

Clinical relevance: Based on the data presented and results of this investigation, clinicians should consider an athlete's sex, sport, and concussion history when interpreting COBALT performance at baseline. Further research is needed to explore the impact of these factors on postinjury performance.

Objective: To determine efficacy of screening-based versus testing COVID-19 management protocols.

Design: Retrospective analysis.

Setting: Athletic departments of a National Association of Intercollegiate Athletics (NAIA) and National Collegiate Athletic Association (NCAA) Division I institution.

Patients: All student-athletes (n = 303 and 437) and staff (n = 34 and 291) within the NAIA and NCAA athletic departments. Total cohort (n = 1065).

Interventions: The authors analyzed the independent variables of screening and testing rates.

Main outcome measures: Dependent variables of positive rates, percent positive rates, competition missed, and cost were analyzed.

Results: The screening-based protocol (n = 20 798) generated 139 tests and a percent positive rate of 10.07% for student-athletes. Half of the staff (17 of 34) also had positive results. Protocol costs were $45,038 and 29 games were missed among all teams. The testing-based protocol did not screen but tested student-athletes 14 837 times, which resulted in 158 positives ( P < 0.00001) and a percent positive rate of 1.06%. Only 14.37% (43 of 291) of staff tested positive ( P < 0.00001). Protocol costs were $1,616 570 and 43 games were missed among all teams.

Conclusions: The testing-based protocol protected student-athletes and staff better than the screening-based protocol, but at >35 times the cost. Neither protocol resulted in severe infections necessitating hospitalizations, and fewer games were missed in the screening-based protocol. Because institutions have different levels of financial support, varied but viable protocols are needed.

Objective: Gymnasts and baseball players have different mechanisms of loading their elbows, and there is little data comparing osteochondritis dissecans (OCD) lesions between these 2 sports. Our objective is to compare the clinical and imaging characteristics of elbow OCD lesions between weight-bearing and throwing athletes.

Design: Review from 2015 to 2022.

Setting: Sports medicine clinics at a large academic center.

Patients: Thirty-four patients were included.

Independent variables: Patients were divided into 2 groups: gymnastics and baseball.

Main outcome measures: Location of elbow OCD lesion on the capitellum, stability of lesion, lesion size, and the presence of a radial head deformity.

Results: Twenty-two (65%) baseball players and 12 (35%) gymnasts were included with 97% (33/34) of athletes presenting with a capitellar lesion. Seventy-six percent of athletes had a radial head deformity with no difference in frequency between groups ( P = 0.61). There was also no difference in frequency of lesion instability ( P = 0.56) or lesion size. Baseball players had a higher frequency of lesions located anteriorly on the capitellum compared with gymnasts (28% vs 0%, P = 0.02), and gymnasts had a higher frequency of lesions located centrally (24% vs 58%, P = 0.02). Gymnasts had significantly different presenting symptoms ( P = 0.03) with a higher frequency of isolated pain.

Conclusions: There are no significant differences in the size, stability, or location of OCD lesions in weight-bearing and throwing athletes. The presence of an associated radial head deformity was seen on most radiographs without any difference between sport. Lesion location and symptoms at presentation are significantly different between gymnastics and baseball.

Level of evidence: III.

Objective: To evaluate the prognostic utility of 10-word immediate memory and delayed recall assessments at an initial post-concussion evaluation for predicting persisting post-concussion symptom (PPCS) development.

Design: Retrospective cohort study.

Participants: Adolescents (N = 160) seen for concussion at a sports medicine center between June 2018 and November 2019.

Independent variables: We categorized participants based on their symptom recovery time, as PPCS (symptoms >28 days) and no PPCS (symptoms ≤28 days).

Main outcomes: Patients completed 10-word immediate memory and delayed recall assessments at the time of their initial evaluation. We grouped patients based on timing of their initial visit: 1 to 7 days post-concussion versus 8 to 21 days post-concussion and calculated their symptom duration (time from injury until symptom resolution).

Results: For patients seen 1 to 7 days post-concussion (N = 69; 14.4 ± 2.4 years; 41% female), those who developed PPCS (N = 19, 28%) had significantly worse immediate memory (6.2 ± 1.8 vs 7.2 ± 1.7 words correct; P = 0.04; Cohen d = 0.55) and delayed recall (3.6 ± 1.8 vs 5.5 ± 2.2 words correct; P = 0.002; Cohen d = 0.87) performance compared with those who did not develop PPCS. For patients seen 8 to 21 days post-concussion (N = 91; 14.1 ± 2.6 years; 53% female), there were no significant differences between those who developed PPCS (N = 45, 49%) and did not on immediate memory (7.2 ± 1.7 vs 6.7 ± 2.1 words correct; P = 0.21; Cohen d = 0.26) or delayed recall (5.2 ± 2.3 vs 5.4 ± 2.1 words correct; P = 0.61; Cohen d = 0.11) performance.

Conclusions: The 10-word immediate memory and delayed recall assessments have prognostic utility for PPCS when administered within the first week post-concussion and may help clinicians identify those at greatest risk of developing PPCS.

Objective: Anterior cruciate ligament reconstruction (ACLR) leads to high rates of knee post-traumatic osteoarthritis (PTOA). Physical activity may mitigate PTOA risk but levels after ACLR have not been extensively studied. We aimed to review self-reported and device-measured physical activity levels in individuals with ACLR and compare them with international guidelines, and with uninjured controls.

Data sources: MEDLINE, Embase, Scopus, Google Scholar, Cochrane Library, Web of Science, and SPORTDiscus were searched from inception to 22 June 2023.

Main results: Of the 5391 studies identified on our initial search, 15 satisfied the inclusion criteria for analysis (N = 544 individuals with ACLR). Across all studies, the average physical activity levels for individuals with ACLR were 343 ± 185 moderate-to-vigorous physical activity (MVPA) min/wk and 8453 ± 233 steps/day. In studies measuring the proportion of individuals with ACLR reaching MVPA guidelines, 147/213 (69%) achieved ≥150 min/wk. Of those using step counts, 22/85 (26%) achieved ≥10 000 steps/day. Individuals with ACLR engaged in less physical activity than uninjured controls (SMD = -0.37 [95% CI = -0.60 to -0.15]; P < 0.001).

Conclusions: Individuals typically meet recommended MVPA, but not steps, after ACLR. Optimal volume, type, and weight-bearing nature of physical activity should be further investigated given the beneficial role of moderate mechanical loading in knee health. Our findings suggest that steps per day may represent a potentially modifiable prevention target and may help guide the future development of tailored physical activity guidelines for PTOA prevention after ACLR.

Prospero registration number: CRD42022330699.

Objective: To investigate the associations between physician recommendations for early physical activity (PA) after concussion and prolonged recovery in youth.

Design: Retrospective observational study.

Setting: Seven concussion clinics affiliated with a children's hospital.

Patients: Youth aged 10 to 18 years diagnosed with a concussion who visited a concussion clinic within 14 days of injury.

Main independent variable: Physician PA recommendations.

Main outcome measure: Experiencing a prolonged recovery (yes/no).

Results: Of 3249 youth included, 63.1% were males and 79.0% were White, with more than half in the 15 to 18 age group (54.6%). From 2012 to 2019, the proportion of physicians recommending light aerobic activity or noncontact PA increased from 12.6% to 62.0% and from 19.3% to 72.5% for youth seen in week 1 and week 2 postinjury, respectively. Youth who received light aerobic activity [adjusted odds ratio (aOR) = 0.37, 95% confidence interval (CI) = 0.29-0.48] or noncontact PA (aOR = 0.27, 95% CI = 0.12-0.64) recommendations had significantly lower odds of experiencing prolonged recovery than youth with recommendations for no PA. In addition, patients evaluated in the second week postinjury were more likely to experience prolonged recovery than those seen within 1 week postinjury (aOR = 2.52, 95% CI = 2.07-3.07).

Conclusions: Youth who received recommendations for light aerobic or noncontact activities had a reduced likelihood of prolonged recovery compared with those recommended no PA, suggesting early PA may play a role in hastening concussion recovery in youth. Further research is needed to explore patient adherence to these prescriptions.