Clinical Journal of Sport Medicine最新文献

Objective: This study explores the functional recovery and rates return to play (RTP) of professional jockeys following midshaft clavicle fractures, which have been managed conservatively. The high incidence of these fractures in horse racing underscores the importance of evaluating nonsurgical recovery paths for effective RTP.

Design: We used a retrospective cohort study to assess treatment outcomes.

Setting: The research is set in the professional horse racing scene of Ireland.

Participants: Sixteen professional Irish jockeys with conservatively managed midshaft clavicular fractures were examined. Jockeys who underwent surgery or were inactive at injury time were excluded.

Interventions: The study involved no direct interventions.

Main outcome measures: Recovery was assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and Patient-Reported Outcome Measures, alongside racing records to track RTP.

Results: The all-male cohort had an average age of 27 years. Results showed an average 67.1-day absence from racing, with 94% returning to preinjury competition levels. Complications were minimal, and patient outcomes were positive, as indicated by a mean QuickDASH score of 2.58, suggesting minimal residual disability.

Conclusions: Findings highlight the success of conservative management for midshaft clavicle fractures in professional jockeys, enabling them to return to prior competitive levels with few complications and excellent functional recovery.

Objective: To compare physical contacts (PCs), including head contacts (HCs), suspected concussion, and nonconcussion injury incidence rates between youth ringette and female ice hockey.

Design: Cross-sectional.

Setting: Alberta ice arenas.

Participants: Players participating in 8 U16AA (ages 14-15 years) ringette and 8 U15AA (ages 13-14 years) female ice hockey games during the 2021 to 2022 season.

Assessment of risk factors: Dartfish video-analysis software was used to analyze video recordings.

Main outcome measures: Univariate Poisson regression analyses (adjusted for cluster by team-game, offset by game minutes) were used to estimate PCs (including HCs) and suspected injury (concussion and nonconcussion) and concussion-specific IRs and incidence rate ratios (IRRs) to compare sports. Proportions of all PCs that were body checks (level 4-5 trunk PC) and direct HCs (HC1) penalized were reported.

Results: Ringette had a 2.6-fold higher rate of body checking compared with hockey (IRR = 2.63, 95% CI: 1.59-4.37). Ringette also had a 2-fold higher rate of HC1 compared with hockey (IRR = 2.08, 95% CI: 1.37-3.16). A 3.4-fold higher rate of suspected injury was found in ringette (IRR = 3.37, 95% CI: 1.40-8.15). There was no significant difference in suspected concussion IRs in ringette compared with hockey (IRR = 1.93, 95% CI: 0.43-8.74). Despite being prohibited in both sports, only a small proportion of body checks (Ringette = 18%; Hockey = 17%) and HC1 (Ringette = 6%; Hockey = 6%) were penalized.

Conclusions: Higher rates of body checking, HC1, and suspected injuries were found in ringette compared with female ice hockey. Body checking and HC1 were rarely penalized, despite rules disallowing them in both sports. Future research should consider other youth age groups.

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.

Level of evidence: Level IV.

Objective: This study aimed to explore associations and trends for athletes experiencing exercise-associated muscle cramps (EAMC) in ultraendurance competitions.

Design: Retrospective analysis of prospectively collected data.

Setting: Medical tent data were collected from annual IRONMAN World Championship events.

Participants: In total, 10 533 medical records were reviewed among 49 530 race participants from 1989 to 2019.

Assessment of risk factors: Athlete demographics data, performance data, and additional medical conditions were examined.

Main outcome measures: Primary outcome of interest was to compare triathletes with and without EAMC. Secondary outcome was to analyze triathletes with subsequent EAMC.

Results: EAMC (N = 2863) occurred in 57.8 per 1000 participants (95% confidence interval = 55.7 to 60.0). The incidence of EAMC did not differ between athlete sex. Athletes with EAMC had greater weight loss but did not differ in serum sodium and serum potassium compared with those without EAMC. Further analysis with a logistic regression analysis revealed that dehydration, exhaustion, hypotension, abdominal pain, headaches, and a previous evaluation for cramping were strongly associated with muscle cramping. The most common treatment for EAMC was intravenous fluids.

Conclusions: Findings from the current study support previous reports that electrolyte abnormalities are not associated with cramping. However, our finding that dehydration is associated with muscle cramping contradicts current literature.

Objective: Despite excellent functional outcomes after shoulder stabilization surgery, a substantial number of patients fail to return to sports (RTS) at the preinjury level. The psychological factors affecting RTS postsurgery have been underexplored. This scoping review aimed to identify and analyze potential psychological factors influencing the decision to RTS after shoulder stabilization surgery.

Data sources: We reviewed the EBSCOhost/SPORTDiscus, PubMed/Medline, Scopus, EMBASE, and Cochrane Library databases for studies on patients with anterior glenohumeral instability who underwent stabilization surgery. We included studies that reported on RTS and considered the psychological factors influencing the decision to return.

Main results: Our analysis comprised 21 articles involving 2073 patients. Psychological factors influencing RTS after surgery were categorized within the framework of transactional stress and coping model. Primary appraisal factors, such as fear of reinjury, kinesiophobia, and anxiety, emerged as significant influencers. In addition, we explored factors related to social support, self-determination, motivation, competing interests, and advanced age. Assessment tools were used to evaluate the psychological readiness for RTS.

Conclusions: This scoping review identified fear of reinjury and kinesiophobia as important psychological barriers to returning to sports after shoulder stabilization surgery. The limited use of psychological assessment tools and lack of comparative studies have restricted robust conclusions.

Level of evidence: Level IV, Scoping review.

Objective: To evaluate the trabecular bone score (TBS) Z scores in long-distance runners with bone stress injuries (BSIs) in whom the bone mineral density (BMD) Z score is more than -1.0 (Aim 1) and whether the number of runners with abnormal TBS Z scores would be higher in those with BSI in trabecular-rich sites as compared with cortical-rich sites (Aim 2).

Design: Retrospective cohort study.

Setting: Institutional sports medicine center.

Patients: We analyzed Z scores derived from the TBS and BMD in 44 long-distance runners aged 18 to 40 years who had sustained BSIs between 2017 and 2023 and undergone a dual-energy x-ray absorptiometry scan with reported TBS measurements within 1 year before or 2 years after their injuries.

Independent variables: Bone mineral density and TBS Z scores.

Main outcome measures: Evaluation of BMD and TBS Z scores in long-distance runners with BSIs, further stratified according to cortical-rich and trabecular-rich BSIs.

Results: Bone mineral density assessments revealed an average Z score of -0.96 ± 0.99. In this cohort of 44 runners, 55% (n = 24) of runners were reported to have BMD Z score more than -1.0. Within this subgroup, 54% (n = 13) displayed abnormal TBS. Stratifying BSIs by trabecular- (n = 23) and cortical-rich (n = 19) sites, we found no significant difference in sex, mean BMD, or the number of runners with abnormal TBS between the 2 groups.

Conclusions: Trabecular bone score Z scores in sports medicine may provide complementary information to BMD in long-distance runners with BSI, particularly when the BMD Z scores are more than -1.0. However, further research is needed to validate the usefulness of TBS Z scores in this context.

Study design: Cohort study.

Level of evidence: Retrospective Case Series, IV.

Objective: To examine differences in the presentation and management of concussion in younger children (aged 4-8 years) versus preadolescents (9-12 years) and identify factors that influence recovery time.

Design: Retrospective analysis of prospectively collected data.

Setting: Pediatric sports medicine and orthopedics clinic.

Patients: Three hundred seventy-five patients aged 4 to 12 years diagnosed with concussion between 2020 and 2022.

Independent variables: Age, gender, race/ethnicity, mechanism of injury (sport vs nonsport related), neurodevelopmental or psychiatric diagnosis, concussion history, Post-Concussion Symptom Scale (PCSS) score, and Vestibular Ocular Motor Screening (VOMS) overall change scores.

Main outcome measures: Days since injury (DSI) to initial visit, total number of visits, recovery time (days).

Results: Groups significantly differed in DSI (P = 0.01) and overall VOMS change score (P = 0.03). No differences were observed between groups on total number of visits or recovery time. Patients with fewer DSI [odds ratio (OR) = 1.15], less change in overall VOMS score (OR = 1.02), lower PCSS scores (OR = 1.02), and who were injured in sport were less likely to experience a protracted recovery.

Conclusions: Younger children with concussion may be appropriately treated with a similar approach to preadolescent patients despite greater DSI and differences in VOMS change scores, without sacrificing overall recovery time. Consistent with research in older cohorts, protracted recovery was seen in nonsport patients, and patients seen sooner at a specialty concussion clinic were less likely to experience a protracted recovery, endorsed lower PCSS scores, and had lower overall VOMS change scores. Further research is needed to solidify a child-specific paradigm to concussion management.