Clinical Journal of Sport Medicine最新文献

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.

Objective: The purposes of this study were to (1) describe the physical effects (injuries) and associated risk factors during flag football season and (2) evaluate in-season mental health of female flag football athletes.

Design: Prospective cohort study.

Participants: We conducted a 4-month longitudinal pilot study of female adolescents participating in a season of high school flag football and nonathlete controls.

Setting: Preseason/in-season questionnaires.

Interventions: Not applicable.

Main outcome measures: Participants completed preseason and weekly in-season questionnaires assessing physical activity (PA), injuries, stress, mood, and energy. We calculated sport-related injury rates and used a multivariable Cox proportional hazards model to assess factors associated with injuries sustained.

Results: Nintey-eight participants (n = 83 flag football) participated (mean age = 16.3 ± 1.1 years): 23 sport-related injuries were reported. The injury rate was 7.25 injuries/1000 exposure hours. There were no significant predictors of injury risk. Flag football athletes reported significantly greater in-season physical activity than nonathletes (9.6 ± 4.7 vs 4.5 ± 6.4 h/wk; P < 0.001) but physical activity level was not associated with energy level, mood, or stress. After adjusting for physical activity level and school year, flag football participation was associated with significantly higher energy levels during the season relative to nonathletes (β = 0.94; 95% confidence interval, 0.13-1.76; P = 0.02).

Conclusions: The injury rate was 7.25 injuries/1000 exposure hours, and no variables were associated with injury risk. The complex nature of injury makes prediction challenging. Physical activity was not associated with mental health outcomes. Flag football participation was associated with significantly higher energy levels. Flag football may provide some benefit to athlete mental health independent of physical activity.

Abstract: Infections after anterior cruciate ligament (ACL) reconstruction surgery pose a significant challenge in orthopedics, potentially jeopardizing the integrity and function of the graft. Among these, infections caused by Bacillus cereus are exceedingly rare. Bacillus cereus , a Gram-positive, aerobic, and facultative anaerobic bacillus, is predominantly recognized in soil, vegetation, and the gastrointestinal tract of humans and other animals. Despite its ubiquity in the environment, extraintestinal infections due to B. cereus are exceptionally uncommon in individuals with intact immune systems. By detailing our experience with this atypical infection, we aim to provide references to managing rare bacterial complications after ACL reconstruction.

Objective: To investigate the prevalence of low back pain (LBP) and disk degeneration (DD) and the relationship of DD with LBP among elite cross-country skiers.

Design: A cross-sectional study of elite cross-country skiers.

Setting: Study participants were recruited during autumn 2022 among elite cross-country skiers and collegiate skiers who were selected to national teams' training groups.

Participants: The original study group consisted of 44 skiers (16 national team skiers and 28 sports academy skiers).

Interventions: The study protocol included a 1.5T lumbar spine MRI, a clinical examination, and an interview with questions about general health and training as well as selected patient-reported outcomes. The morphology of intervertebral disks from T12/L1 to L5/S1 on sagittal T2-weighted midline images was visually assessed using the Pfirrmann classification with a grade 3 or higher considered degenerated in this age group.

Main outcome measures: Cross-sectional occurrence of DD on MRI and self-reported LBP.

Results: Low back pain was reported by 33 (75%) skiers. Half of the skiers had at least 1 disk of ≥grade 3 in the Pfirrmann classification. At least 1 disk grade ≥3 in the Pfirrmann classification was found in 61% (20 of 33) of skiers with LBP and 18% (2 of 11) of skiers without LBP (P = 0.034).

Conclusions: The most important findings in our study were the high prevalence of self-reported LBP and a statistically significant difference in the occurrence of at least 1 degenerated disk in the Pfirrmann classification between skiers who reported LBP compared with those who did not.

Abstract: The Association of Ringside Physicians (ARP) emphasizes the importance of screening combat sports athletes for blood-borne infections, including hepatitis B, HIV, and hepatitis C, to mitigate transmission risks and ensure participant safety. Although transmission of hepatitis B and C and HIV in combat sports is rare, protecting athletes is of utmost importance. It is the recommendation of the ARP that all fighters participating in combat sports, in which the presence of blood is a common occurrence and is allowed during competition, should undergo testing for HIV, hepatitis B (HBV), and hepatitis C (HCV). Testing should be conducted using serum samples, because rapid tests are not considered acceptable for accurate results. Testing for HBV, HCV, and HIV should optimally be done within 3 months of competition, but within 6 months is acceptable. Athletes whose tests suggest active HBV, HCV, or HIV infection should be disqualified from competition in sports where blood is common and allowed. Athletes with cured prior HCV infection may be cleared for competition in all combat sports. Athletes with prior HBV infection and no detectable HBV DNA in blood can be cleared for competition in all combat sports. Athletes with latent HBV infection with detectable HBV DNA in blood have a small risk of disease reactivation, so they should not be cleared.

Abstract: Adhesive capsulitis (AC) is a pathologic process in which excessive collagen depositions form across a joint leading to stiffness, pain, and limited joint mobility. Our case is a 48-year-old man who presented with right hip pain. Approximately 5 months after arthroscopic labral repair, he reported recurrence of the pain and limited range of motion in the hip. A therapeutic hip hydrodilatation was performed using ultrasound-guidance and an anterior approach. One month after the hydrodilatation, ported resolution of the pain and hip internal rotation was symmetric. Most patients with AC of the hip can be managed nonsurgically with anti-inflammatory drugs, corticosteroid injections, and physical therapy. However, patients with persistent pain and limited range of motion after these treatment options typically are only left with the option of surgery. There is a lack of data on pressure hydrodilatation or distention for AC of the hip. In this case report, the patient developed AC after labral surgery and was successfully treated with pressure hydrodilatation. Resolution of the patient's symptoms suggests that this procedure can potentially be performed in postsurgical AC without adverse events.

Objective: The objective of this study was to evaluate whether percussive massage reduces the intensity of quadriceps pain and perceived fatigue and improves perceived recovery and vertical jump after habitual running.

Design: Randomized clinical trial.

Settings: Road race.

Participants: Eighty-four runners aged 18 to 60 years, 1-year experience in running and a training frequency of twice a week, were included (experimental group: n = 39, 34.33 ± 1.61 years, 61% M, 5.68 ± 1.16 years of running experience; control group: n = 45; 34.51 ± 1.50 years; 71% M; 6.01 ± 1.02 years of running experience).

Interventions: The experimental group received 10 minutes of percussive massage on the quadriceps, and the control group received sham hip and knee joint mobilization.

Main outcome measures: Quadriceps pain intensity and fatigue (visual analog scale), perceived recovery (perceived global effect scale), and vertical jump after habitual running.

Results: The experimental group showed better results for quadriceps pain intensity (0.98; 95% confidence interval [CI], -1.63 to -0.34), fatigue (0.7; 95% CI, -1.45 to -0.05) and perceived recovery (0.54; 95% CI, 0.02-1.07), but not for vertical jump performance (0.95; 95% CI, -1.57-3.47).

Conclusions: Percussive massage improved pain intensity, fatigue, and perceived recovery after running but had no effect on vertical jump.

Abstract: A 49-year-old short-board goofy-stance competitive surfer presented with a 3-month history of bilateral, left foot pain associated with tender soft tissue plantar nodules. Magnetic resonance imaging of the left foot revealed foci of fibrotic tissue within the subcutaneous tissue adjacent to the first and fifth metatarsophalangeal joints compatible with surfers' knots. The patient underwent conservative treatment with oral ibuprofen as needed before competitions, topical diclofenac gel, wide toe box shoes, and use of a double-thick traction pad on his surfboard to alleviate the friction between the metatarsophalangeal joints of his left foot and the surfboard. He reported improvement of symptoms and full return to surfing at 8-month follow-up. We present a case of surfers' knots overlying the left first and fifth metatarsophalangeal joints of a male competitive surfer and highlight recommendations for successful conservative treatment options for symptomatic athletes.

Objective: Low back pain (LBP) is a prevalent musculoskeletal condition, often mechanical in nature, affecting millions globally. Mechanical LBP originating from sacroiliac joint (SIJ) discomfort is common but underappreciated. Determining sacroiliac joint pain or dysfunction (SIJP/D) prevalence poses challenges because of varied diagnostic criteria and characteristics. This systematic review aims to explore SIJP/D risk factors, biomechanics, and prevalence, in athletic populations, to inform preventive strategies.

Data sources: We conducted a systematic review following PRISMA guidelines. Searches were performed in Web of Science, Embase, MEDLINE, and Scopus databases up to February 2024. Eligible studies reported sacroiliac joint pain or dysfunction in athletes in English. Data extraction included prevalence and risk factors. NIH quality assessment tool was used for bias assessment. Proportional meta-analysis was used, and forest plots were generated using STATA 18 and SPSS-25.

Main results: A systematic review identified 1515 studies, of which 913 were excluded after screening titles and abstracts. Full-text evaluation led to the inclusion of 13 studies. These studies involved 2842 athletes from various sports, predominantly males. The prevalence of SIJP/D varied widely across studies, with mean prevalence of 10.72% among all athletes, 5.61% among injured athletes, 32.39% among athletes with low back pain, and 35.99% among those with pelvic or pubis pain. Risk factors for SIJP/D included stress injuries, biomechanical movements, and years of experience, with exercise showing potential for prevention. Methodological quality ranged from low to moderate, with bias mainly due to lack of exposure confirmation and sample size justification.

Conclusions: Based on the current literature assessed in this review, we cannot report an accurate prevalence of SIJ pain or dysfunction in athletes. Owing to heterogeneity of the available data, further evaluation is necessary.

Objectives: (1) To estimate adherence to brace wearing for medial collateral ligament (MCL) injuries across 3 phases of conventional treatment and (2) to explore predictors of adherence for each phase.

Design: Exploratory cohort study.

Setting: Primary care center.

Patients: Fifty-nine patients aged 18 to 65 (27 men, 32 women) from a randomized clinical trial examined the effectiveness of 2 bracing techniques (0-90 degrees or 30-90 degrees) for acute isolated MCL or combined anterior cruciate ligament injuries. Patients were prescribed a 6-week bracing protocol and were followed for 12 weeks.

Interventions: Patients were prescribed constant brace wearing for 4 weeks (∼23 h/d), then daytime wear only (∼15 h/d) until brace discontinuation at 6 weeks. Rehabilitation exercises were prescribed from 2 weeks onward. Adherence to the protocol was assessed through daily self-reported logs. Clinical and patient-reported outcomes were collected throughout the randomized clinical trial (baseline, 2, 4, and 6 weeks). This study interpreted them as predictor variables of treatment adherence alongside patient and treatment characteristics.

Main outcome measures: Adherence to each 2-week phase, interpreted dichotomously (adherer or nonadherer). Adherers were identified as those who wore their brace according to the protocol.

Results: Adherence and pain decreased, while overall knee ratings improved throughout the treatment. Pain, affected knee, and brace range-of-motion settings were significant predictors of adherence in the exploratory logistic regressions.

Conclusions: Pain, affected knee, and brace range-of-motion settings were the primary predictors of brace wearing in the first 4 weeks of treatment. This study is the first to provide insight into MCL bracing adherence, potentially aiding clinicians in treatment management.