Clinical Journal of Sport Medicine最新文献

Objective: This systematic literature review was undertaken to identify the main design features of sport-related concussion (SRC) education programs, examine their outcomes, and consider the relationship between design and effectiveness.

Design: Systematic review.

Main outcome measures: Studies which report on educational interventions (a dedicated in-person or online teaching session) that purport to change knowledge, attitudes, and/or behavior toward sports-related concussion. Searches were performed across 5 databases.

Results: Out of the 9192 records that were initially screened, 28 retrieved studies were identified. The review found considerable diversity in the content, mode of delivery, and aims of SRC education programs. Sport-related concussion programs were largely successful in increasing recipients' knowledge, but these gains were often transitory, and stronger among adults than among children. There was little evidence of a tangible impact on behavior.

Conclusions: We recommend that future research should (1) seek to clarify what constitutes achievable goals for education programs, (2) move toward better intervention standardization through greater consolidation and coordination of the field, (3) feature explicit attempts to tailor interventions to specific target audiences, and (4) ensure the greater involvement of participants in the creation and design of SRC educational interventions.

Objective: Describe the factor structure of the 22-symptom Sport Concussion Assessment Tool (SCAT), using confirmatory factor analysis (CFA) for a priori hypothesized symptom domains.

Study design: Prospective observational study.

Setting/participants: Collegiate student-athletes with concussion.

Independent variables: Symptoms were collected via the SCAT symptom checklist.

Outcome measures: We created symptom domains based on previous literature, guided by clinical expertise. To determine which symptom grouping best represent the data, we used CFA and compared a single-domain model to 3- and 6-domains. We examined fit statistics to assess relative and absolute model fit. Motivated by differences in the prevalence of some individual symptoms by sex in our study, we also examined model invariance by sex to determine if symptoms were being measured as part of the same underlying construct(s).

Results: Among 1160 concussions (male, n = 667; female, n = 493) between 2015 and 2020, all 3 symptom structures seemed to fit the data well, with 3- and 6-domains fitting better than 1-domain. The 6-domain structure fit the data best with the following domains: headache, vestibulo-ocular, sensory, cognitive, sleep, and affective. All 3 structures showed configural and metric invariance by sex.

Conclusions: We demonstrate that the SCAT symptom structure is best represented through 6 specific factors; however, the 3-factor model also demonstrated good fit. Key differences between the 3- and 6-domain models may make 1 model more appropriate than the other depending on the research question being addressed. Symptom structures were configurally and metrically invariant by sex, meaning that symptom measures represent symptom domain factors in the same way across sex.

Objective: Patients with lower leg deep posterior chronic exertional compartment syndrome (dp-CECS) experience exercise-induced calf pain and tightness. Retrospective studies suggest that outcome after a fasciotomy is suboptimal. This prospective case series determined success rates of a fasciotomy and identified factors predicting outcome.

Design: Severity and intensity of pain and tightness were scored at baseline (BL) and 3 and 12 months postoperatively (follow-up [FU]3, FU12). Outcome measures were symptoms, return to sports, and patient-reported success.

Patients: Data of patients with dp-CECS (n = 74, 51% males, age 28 ± 12 years) operated between 2013 and 2022 in a single center were analyzed.

Results: Pain scores during rest and during exercise were greatly attenuated (rest BL: 8 ± 1, FU3: 4 ± 1, FU12: 3 ± 0; exercise BL: 20 ± 1, FU3: 8 ± 1, FU12: 8 ± 1; both P < 0.001). At FU3, rates of success and return to sports were 56% and 63%, respectively. At FU12, success was maintained in 48% and 80% had returned to sports. Length of symptom duration and not opening the flexor hallucis compartment were related to a lower chance of return to sports (P < 0.05).

Conclusions: Outcome after a fasciotomy for lower leg dp-CECS is successful in approximately half of patients. Long duration of symptoms and not opening the flexor hallucis compartment are risk factors for failure.

Objective: To evaluate the efficacy of platelet-poor plasma injections for the treatment of acute hamstring muscle strains.

Design: Cohort study.

Setting: Outpatient Sports Medicine Clinic.

Participants: Twenty consecutive patients with an acute hamstring muscle injury from 2021 to 2022 were included.

Interventions: Platelet-poor plasma injection into the hamstring muscle strain.

Main outcome measures: Time (days) until return to full unrestricted participation in sport.

Results: All patients were male collegiate football athletes, with an average age of 20 (±1.6) years old. The most commonly injured muscle was the semitendinosus (65%). After treatment with platelet-poor plasma, patients on average returned to full, unrestricted participation in sport at 29.4 (±7.2) days postinjury, with a statistically significant improvement in pain as early as 2 weeks postinjection. No recurrent injuries to the affected hamstring muscles were seen within 12 months.

Conclusions: PPP may be a safe and effective treatment for acute hamstring muscle strains and may potentially expedite time to return to play.

Objective: The primary aim of this study was to examine sex differences in energy availability (EA) and its relationships with disordered eating, compulsive exercise, and body mass index (BMI) among adolescent athletes.

Design: Cross-sectional study.

Setting: University hospital pediatric sports medicine center.

Participants: Sixty-four participants (61% female) of ages 13 to 18 years, actively participating in at least 1 organized sport.

Main independent variable: Participant sex.

Main outcome measures: Average 7-day EA (kcal/kg FFM/d; calculated using participant-recorded dietary intake and exercise expenditure from a wrist-worn heart rate/activity monitor), Eating Disorder Examination Questionnaire (EDE-Q) score (range 0-6), Compulsive Exercise Test (CET) score (range 0-25), and age- and sex-adjusted BMI percentile.

Results: There were no significant sex differences in EA (females: 40.37 ± 12.17 kcal/kg FFM/d; males: 35.99 ± 12.43 kcal/kg FFM/d; P = 0.29), EDE-Q (females: 0.68 ± 0.70; males: 0.68 ± 0.83; P = 0.99), or CET scores (females: 11.07 ± 0.44; males: 10.73 ± 0.63; P = 0.66). There were low and insignificant negative correlations between EA and EDE-Q and CET scores for female athletes (EDE-Q: r = -0.22, P = 0.18; CET: r = -0.21, P = 0.09) and male athletes (EDE-Q: r = -0.09, P = 0.66; CET: r = -0.35, P = 0.08). EA and BMI-for-age percentile were inversely correlated in both male (r = -0.451, P = 0.009) and female (r = -0.37, P = 0.02) participants.

Conclusions: In our sample of adolescent athletes, lower EA occurred in the absence of notable disordered eating or compulsive exercise behaviors, suggesting unintentional underfueling (and/or underreporting of energy intake), without significant sex differences. Low BMI can be an imperfect surrogate marker for low EA. These findings inform risk factors and screening practices for low EA among adolescent athletes.

Abstract: Bacterial and viral cutaneous infections pose a great risk of serious complications in combat athletes and contribute to a significant amount of time lost in practice and competition. Although these infections can be treated with standard antimicrobials, the rise in resistance of Staphylococcus aureus and dermatophytes calls for updated treatment recommendations. Methicillin-resistant S. aureus (MRSA) is becoming a highly prevalent culprit of impetigo, folliculitis, and cellulitis and must be managed correctly to eradicate infection effectively. In addition, the increased prevalence of tinea incognito and terbinafine-resistant Trichophyton tonsurans makes dermatophyte infections difficult to handle. Limited studies provide evidence for a nuanced approach when treating athletes who engage in weight cycling or rapid weight loss, but adjusted dosing and treatment guidelines remain important.

Objective: To describe 3.0-Tesla (T) magnetic resonance imaging (MRI) findings of hamstring muscles in clinically recovered athletes who were cleared for return to play (RTP).

Design: Prospective observational study.

Setting: Hospital.

Participants: Athletes (amateur and professional) who were cleared for RTP after hamstring injury. Fifty-eight participants were included in the analysis.

Independent variables: 3-T MRI at baseline (within 7 days from initial injury) and MRI at RTP (within 10 days of RTP).

Main outcome measures: Injury location, grade of injury (modified Peetrons and British Athletics Muscle Injury Classification/BAMIC), presence and the extent of intramuscular signal abnormality, intramuscular tendon disruption, and thickness. Reinjuries within 1 year of RTP were recorded.

Results: Magnetic resonance images at RTP showed that 55 (95%) participants had intramuscular increased signal intensity (edema) and 44 (76%) participants had intramuscular abnormal low-signal intensity (suggesting fibrosis) on MRI. There was an overall reduction of injury grades according to the modified Peetrons and BAMIC classification at initial injury to RTP. Three (5%) participants had no abnormal signal intensities (grade 0 or grade 0A) on MRI at RTP. Intramuscular tendon disruption, waviness, and tendon thickening were present at RTP in, respectively, 22 (38%), 15 (26%), and 36 (62%). We recorded 3 (5%) reinjuries.

Conclusions: At RTP, 3.0-T MRI shows high percentages of MRI abnormalities (edema, fibrosis, and intramuscular tendon disruption and thickening). We conclude that complete normalization of 3.0-T MRI is not expected for RTP decision after a hamstring injury. Its possible association with reinjury risk has to be determined in larger cohorts.

Objective: To compare soreness location and intensity between male and female soccer athletes across 2 competitive seasons.

Design: Descriptive Cohort Study.

Setting: Collegiate Sports Medicine Facility.

Participants: Forty male and 42 female collegiate soccer athletes.

Intervention: Season-long soccer trainings and games.

Main outcome measures: Athletes reported perceived soreness location and intensity daily. χ2 analysis and linear mixed effect models were used to compare soreness locations and intensities by sex.

Results: Male and female soccer athletes reported similar number of soreness instances, but male soccer athletes reported soreness more frequently at the ankle, foot, hip, pelvis, and posterior thigh. Female soccer athletes reported soreness more frequently at the anterior leg, anterior thigh, and knee. There was no significant difference in soreness intensity between sexes at any body location (P = 0.86). When collapsed across sex, the frequency of anterior thigh soreness was higher at preseason (7.49%, CI: 5.46-9.52) than at midseason (4.55%, CI: 2.52-6.57; t = -2.94, P = 0.023) and at postseason (3.00%, CI: 0.76-5.23; t = -3.74, P < 0.001). There was also a significant difference in hip soreness frequency between the preseason (2.35%, CI: 1.32-3.33) and the postseason time points (0.52%, CI: -0.73% to 1.67%; t = -2.68, P = 0.023).

Conclusions: Male and female athletes differ in the locations of their lower extremity soreness. However, lower extremity soreness intensity does not differ between sexes. Soccer athletes report soreness more frequently during the preseason and midseason than during the postseason. With tools to measure daily soreness location and intensity, clinicians could create targeted interventions to reduce soreness and limit its negative affect.

Objective: To investigate the associations between clinical risk factors, social demographic and time to concussion clinic presentation after sports-related concussion in young athletes.

Design: Retrospective cohort study.

Setting: Multidisciplinary regional concussion center.

Patients: Athletes ages 12 to 18 years who sustained a SRC from November 2017 to April 2022.

Independent variables: Independent variables included social demographic factors (ie, race, ethnicity, public vs private school, public vs private insurance), patient medical history, family medical history, acute concussion characteristics, and initial presentation elsewhere.

Main outcome measures: Descriptive statistics were employed to assess for group differences. Mann-Whitney U tests, Spearman rank order correlations, and linear regressions were performed to explore associations between each independent variable and the main outcome, days to concussion clinic presentation.

Results: A total of 945 athletes we included (age 15.8 ± 1.61, 33.7% female). Hispanic/Latino background, (P = 0.009), public insurance status (U = 47 377.0, P = 0.002), amnesia (U = 57 738.0, P = 0.002) at time of injury, family psychiatric (U = 35 091.0, P < 0.001) or migraine (U = 59 594.5, P < 0.001) histories, and personal psychiatric (U = 30 798.0, P = 0.004) or migraine (U = 34 133.5, P = 0.011) histories were associated with longer time to concussion clinic presentation. A multivariable linear regression found that initial presentation elsewhere (β = 0.37, P < 0.001), family migraine history (β = 0.18, P < 0.001), public insurance status (β = 0.09, P = 0.024), and history of learning disability (β = 0.09, P = 0.032) were the only predictors of longer time to concussion clinic presentation.

Conclusions: Variables that predicted longer time to concussion clinic presentation included initial presentation elsewhere, public insurance status, positive family migraine history, and history of learning disability. Further research is needed to elucidate these findings and determine how they impact concussion seeking behavior.

Objective: To evaluate the effect of the Nordic hamstring exercise on normalized muscle activity and relative contribution of the biceps femoris long head, semitendinosus, and semimembranosus through multichannel electromyography in the late-swing phase of high-speed running.

Design: A pragmatic, 2-arm, single-center randomized controlled trial. Participants were randomly assigned to a Nordic group or control group.

Setting: Dutch male basketball.

Participants: Twenty injury-free players (mean age 18 ± 3 years).

Intervention: A 12-week Nordic hamstring exercise intervention.

Main outcome measures: Level of normalized muscle activity (percentage maximal voluntary isometric contraction [%MVIC]) and relative contribution (%con) of hamstring muscles for 12 weeks.

Results: The Nordic hamstring exercise intervention did not result in significant changes for 12 weeks. For normalized muscle activity, between-group differences (compared with the control group) for 12 weeks were 11.4 %MVIC (95% confidence interval [95% CI]: -11.0, 33.8) for the biceps femoris long head, -9.4 %MVIC (95% CI: -23.3, 5.2) for the semitendinosus, and -2.7 %MVIC (95% CI: -15.8, 10.3) for the semimembranosus, P = 0.151. For relative contribution, between-group differences for 12 weeks were -6.1 %con (95% CI: -2.4, 14.6) for the biceps femoris long head, -7.0 %con (95% CI: -13.6, -0.4) for the semitendinosus, and 0.9 %con (95% CI: -9.2, 11.0) for the semimembranosus P = 0.187. Positive values are in favor of the Nordic group.

Conclusions: A 12-week Nordic hamstring exercise intervention did not affect the level of muscle activity and relative contribution of hamstring muscles in the late-swing phase of high-speed running. Because of the low amount of data sets, results should be interpreted cautiously.