Clinical Journal of Sport Medicine最新文献

Objective: The purpose of this study was to explore the perceived ability of sports medicine physicians to effectively treat and manage the preventative and rehabilitative care of adaptive athletes.

Design: Exploratory mixed-methods, survey-based study.

Setting: Online, United States.

Participants: The survey was conducted using a sample of 2728 physicians. A total of 286 responded to the invitation and the response rate was 10% (286 of 2728). One hundred thirty (45.5%) of 286 physicians completed the survey.

Interventions: Survey.

Main outcome measures: Knowledge of adaptive athlete care and perceived confidence.

Results: Most respondents were willing to accept adaptive athletes into their clinical practice, and there were no significant associations between their willingness and if (χ 2 = 5.487, P = 0.139) or at what point (χ 2 = 4.463, P = 0.878) they received education about adaptive athletes. Those who received education about adaptive athletes during training reported feeling moderately to very confident in caring for adaptive athletes in an outpatient setting (χ 2 = 36.906, P < 0.001). When considering the areas of knowledge lacking to appropriately manage a competitive adaptive athlete, multiple areas named as deficits were identified. Themes centered on increasing hands-on experience, understanding of the adaptive athlete's disability and its impact on participation in adaptive sports, the physical demand of adaptive sports, and equipment.

Conclusions: Our results indicate that most physicians are willing to accept adaptive athletes into their practice; however, they acknowledge more education and training is needed to feel comfortable and confident when working with this population. Further educational interventions are needed to ensure equitable care for adaptive athletes.

Objective: To determine the inter- and intrarater reliability of physical therapists and athletic trainers to rate the subjective biomechanical and motor control risk factors exhibited by patients undergoing a structured postoperative anterior cruciate ligament (ACL) return-to-sport (RTS) assessment.

Design: Interrater and intrarater reliability.

Setting: University sports medicine clinic.

Patients: Thirty adult patients with ACL reconstruction who underwent a standardized ACL RTS assessment.

Intervention: Video data demonstrating the performance of the ACL RTS assessments were distributed to 4 skilled raters. The limb performance of each test was evaluated for hip/pelvic stability, knee flexion, varus/valgus, shock absorption, trunk stability, power, and body control on a 3-point scale. For each patient, the scores (1-3) for each subjective component were added to attain a total subjective score for each of the 17 tests.

Main outcome measures: Total scores for each of the tests were used to calculate interrater and intrarater reliability for all 4 raters.

Results: Most of the tests demonstrated substantial agreement across the 4 raters with interclass coefficients ranging from 0.61 to 0.77. The posteromedial and posterolateral components of the Y Balance test had lower coefficients (0.57-0.61). Although the leg press had near perfect agreement (0.81-0.86), hamstrings and hip abduction strength had moderate agreement (0.33-0.68).

Conclusions: This study has demonstrated the substantial agreement of a subjective rating system to evaluate the biomechanical and motor control risk patterns of patients after ACL reconstruction undergoing a standardized return-to-sport assessment. Multiple raters were able to substantially agree on the patients' risk profile across 14 of the 17 different tests of physical function. Further work is required to improve the interrater reliability of the Y balance test and hamstrings/hip strength evaluations.

Objective: To identify strength and flexibility measures that are associated with the risk of running-related overuse injuries.

Design: Prospective observational study.

Setting: Secondary analysis of a previously reported cohort of runners.

Participants: Runners registered for the 2019 New York City Marathon.

Independent variables: Participants were asked to complete a baseline strength and flexibility self-assessment 16 weeks before the marathon date.

Main outcome measure: Participants were asked to respond to surveys on running-related injuries occurring within 4-week "training quarters" at 16, 8, 4, and 1 week(s) before the marathon date.

Results: Of the n = 867 runners included in our final analytic sample, 36.1% sustained a running-related overuse injury while preparing for the marathon. The only significant difference in odds and/or hazard of injury was found in the single-leg glute bridge test. Participants who reported that they could hold a single-leg glute bridge on their weaker side for 20 to 29 seconds had 64% lower risk of running-related overuse injury (aHR: 0.36; 95% CI, 0.18-0.72; P = 0.0036) than those who could only hold for 0 to 9 seconds on their weaker side. In addition, participants who reported that they could hold a single-leg glute bridge on their weaker side for 30 seconds or more had 49% lower risk of running-related overuse injury (aHR: 0.51; 95% CI, 0.29-0.92; P = 0.0245).

Conclusions: Strength training programs, particularly targeting hip abductors and related muscle groups, may provide benefits for distance runners, though more rigorous research is needed.

Objective: This study aimed to evaluate the long-term effectiveness of different surgical techniques for discoid meniscus in athletes.

Design: This retrospective cohort study included 44 athletes (51 knees) who underwent arthroscopic surgery for symptomatic discoid meniscus between 1996 and 2019.

Setting: The study was conducted at a tertiary-level sports medicine center.

Patients: Athletes aged 15 to 35 years with symptomatic discoid meniscus confirmed by magnetic resonance imaging and requiring surgical treatment were included. Exclusion criteria were cartilage injuries (Outerbridge grades 3-4), concomitant ligament injuries requiring surgery, osteochondritis dissecans, and prior knee surgery.

Interventions: Patients underwent arthroscopic partial, subtotal, or total meniscectomy, with or without meniscus repair.

Main outcome measures: Functional outcomes were assessed using Visual Analog Scale (VAS), International Knee Documentation Committee (IKDC), and Lysholm scores. Osteoarthritis progression was evaluated using the Kellgren-Lawrence classification. Return to sports time and total career duration were also recorded and compared between the surgical groups.

Results: The mean follow-up was 13.5 ± 6.2 years (range: 5-27 years). At the final follow-up, 72% of the meniscus-preserving group (partial meniscectomy and repair) had KL grade 0 osteoarthritis, whereas 38% of the subtotal/total meniscectomy group developed KL grades 3 to 4 osteoarthritis (P < 0.001). All groups showed significant postoperative functional improvements (P < 0.001), but career duration and return to play time were significantly longer in the meniscus-preserving group (P = 0.004, P < 0.001, respectively).

Conclusions: Subtotal/total meniscectomy significantly accelerates osteoarthritis progression. Meniscus-preserving techniques provide better long-term outcomes.

Objective: Femoroacetabular impingement syndrome (FAIS) is a prevalent cause of hip pain, characterized by distinctive motion patterns. However, the impact of surgical intervention on squatting biomechanics remains underexplored. This review aims to evaluate the effects of surgical treatment on biomechanical outcomes during squatting in patients with FAIS.

Data sources: A comprehensive search was conducted across multiple databases following PRISMA guidelines (Prospero registration number CRD42023473974). Data of longitudinal, prospective/retrospective cohorts, case-control, and clinical trial studies with 3-dimensional motion analysis describing kinematics and/or kinetics for any joint during squatting in patients with FAIS comparing presurgical to postsurgical biomechanical data on the same patients were included. Quality assessment was performed using MINORS criteria. Both qualitative and quantitative analyses were performed.

Main results: Six studies met the inclusion criteria for qualitative review and 5 were suitable for meta-analysis. The overall quality of the studies was moderate based on MINORS criteria. The postsurgical motion analysis was performed between 6 and 32 months postoperatively. Although most studies reported no significant changes in kinematic or kinetic variables postsurgery, individual studies reported specific increases in squat depth, pelvic sagittal range of motion, anterior pelvic tilt, hip and knee flexion, and ankle dorsiflexion angles. Meta-analysis revealed no significant differences in the kinematic parameters analyzed.

Conclusions: These findings underscore the multifaceted nature of FAIS, suggesting that bone deformities alone do not account for the biomechanical limitations observed during squatting in these patients. This highlights the need for further biomechanical investigations.

Level of evidence: Systematic Review of Level II-III studies.

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 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 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: The objective of this descriptive study was to evaluate spondylolysis in adolescent athletes, including age at time of injury, sport associated with injury, examination findings, site of injury, studies used for diagnosis, treatments, duration of treatment, and outcomes.

Design: This was a retrospective chart review of patients who presented with a diagnosis of spondylolysis over a 17-year period.

Setting: Community primary care sports medicine practice.

Patients: All patients between 10 and 20 years of age diagnosed with spondylolysis.

Interventions: There was no set intervention protocol. A variety of interventions and combination of interventions were used and determined by the treating physician on a case-by-case basis.

Main outcome measures: Clearance for return to sport activity.

Results: Males comprised 317 of the 533 patients. Soccer, gymnastics/cheer, football, and basketball were the most common sports associated with spondylolysis. Bilateral injuries were most common. L5 was the most common level for injury. Bracing and formal physical therapy as treatments were associated with longer duration of care. Most patients were treated successfully with nonoperative treatment. Recurrence of injury was rare.

Conclusions: Spondylolysis is a common cause of back pain in adolescent athletes. Males are more likely to experience these injuries and are older at presentation compared than females. Spondylosis may be encountered in many sports. Nonoperative treatment leads to successful outcomes in most patients.