Clinical Journal of Sport Medicine最新文献

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.

Objective: To compare game events, head contact (HC) rates, and suspected concussion incidence rates (IRs) in boys' and girls' youth basketball.

Design: Cross-sectional.

Setting: Canadian club basketball teams (U16-U18).

Participants: Players from 24 boys' and 24 girls' Canadian club basketball teams during the 2022 season.

Assessment of risk factors: Recorded games were analyzed using Dartfish video analysis software to compare sexes.

Main outcome measures: Poisson regression analyses were used to estimate HCs [direct (HC1) and indirect (HC2)], suspected concussion IRs, and IR ratios (IRRs). Game event, court location, and HC1 fouls were reported.

Results: Division 1 HC rates did not differ between boys (n = 238; IR = 0.50/10 player-minutes; 95% confidence interval [CI], 0.43-0.56) and girls (n = 220; IR = 0.46/10 player-minutes; 95% CI, 0.40-0.52). Division 2 boys experienced 252 HCs (IR = 0.53/10 player-minutes; 95% CI, 0.46-0.59); girls experienced 192 HCs (IR = 0.40/10 player-minutes; 95% CI, 0.35-0.46). Division 2 boys sustained higher HC1 IRs compared with Division 2 girls (IRR = 1.42; 95% CI, 1.15-1.74). Head contacts, rates did not differ between boys and girls in either Division. Suspected concussion IRs were not significantly different for boys and girls in each Division. Head contacts occurred mostly in the key for boys and girls in each Division. Despite illegality, HC1 penalization ranged from 3.9% to 19.7%. Head contact mechanisms varied across Divisions and sexes.

Conclusions: Despite current safety measures, both HCs and suspected concussions occur in boys' and girls' basketball. Despite the illegality and potential danger associated with HC, only a small proportion of direct HCs were penalized and therefore targeting greater enforcement of these contacts may be a promising prevention target.

Objective: This study characterizes Vermont City Marathon (VCM) exertional heat stroke (EHS) cases to better understand current EHS trends in US marathon runners.

Design: Retrospective review.

Setting: VCM medical tent for 10 years: 2012 to 2019 and 2022 to 2023.

Patients or participants: In total, 22 224 marathon runners, including 26 patients with EHS.

Independent variables: Demographic, treatment, and environmental data.

Main outcome measures: To characterize patients with EHS and incidence at VCM and compare with other marathons.

Results: Of 22 224 marathon starters, 26 patients with EHS yielded an incidence of EHS of 12/10 000 (0.12%). Compared with all VCM marathon starters, patients with EHS were younger (mean 33 vs 39 years, P = 0.01), but sex did not differ (62% vs 54% male, P = 0.44). All patients with EHS were treated with cold water immersion (CWI) with 100% survival. Cooling rate during CWI was 0.17°C/min and CWI time averaged 16 minutes. Since protocol updates in 2016, only 23% of patients with EHS have required hospital transport. For every 1°C of increasing wet bulb globe temperature (WBGT), EHS incidence at VCM increased by 1.2 cases per 10 000 runners (P = 0.04). Exertional heat stroke at VCM was more frequent than at the Boston Marathon (12 vs 3.7/10 000, P < 0.001), consistent with higher mean WBGT at VCM (20°C vs 14°C, P = 0.04).

Conclusions: This study is the first to characterize patients with EHS at VCM and compare these data to other US marathons. A linear correlation was established between WBGT and EHS incidence. Despite the early season and northerly setting of VCM, EHS was prevalent and important for medical tent preparation. Appropriate EHS treatment was life-saving.

Objectives: (1) Assess medial collateral ligament (MCL) laxity differences in nonoperatively treated acute MCL and anterior cruciate ligament (ACL)-MCL injuries with 2 range of motion (ROM) knee brace settings. (2) Describe knee ROM, brace satisfaction, overall knee score, adherence, pain, quality of life, and knee function. (3) Assess feasibility of larger trial.

Design: Prospective, randomized, single-blinded feasibility clinical trial.

Participants: Sixty-four adults with acute moderate-to-severe isolated MCL or combined ACL-MCL injuries at the University of Calgary Sport Medicine Centre.

Intervention: Random assignment to the protected (0-90 degrees) or restricted (30-90 degrees) brace group. Four weeks of constant brace wearing, followed by daytime wear until 6 weeks. Rehabilitation exercises prescribed from 2 weeks onward. Follow-up for 12 weeks.

Main outcome measures: Clinical outcomes included side-to-side difference (SSD) MCL laxity (mm) at 30 degrees knee flexion and 0 degree, ROM, patient-reported pain, overall knee ratings, brace satisfaction, daily adherence, international knee documentation committee subjective, and ACL-quality of life (QOL) collected throughout 12 weeks (baseline, 2, 4, 6, 8, and 12 weeks). The outcome assessor was masked to treatment group allocation.

Results: At 12 weeks, 73% had <1 mm SSD valgus laxity at 30 degrees knee flexion, with 82% in the restricted group and 67% in the protected group. All patients reported improved pain; none suffered a loss of knee ROM by 12 weeks. The 30 to 90 degrees brace group trended toward better adherence, satisfaction, function, overall knee scores, and QOL. A larger RCT would be feasible but challenging because of sample size needs and slow recruitment.

Conclusions: Favorable outcomes for bracing moderate-to-severe MCL injuries at 30 to 90 degrees for 6 weeks were observed in this feasibility trial.