Sports Medicine and Arthroscopy Review最新文献

Osteoarthritis of the knee generally affects individuals from the fifth decade, the typical age of middle-age athletes. In the early stages, management is conservative and multidisciplinary. It is advisable to avoid sports with high risk of trauma, but it is important that patients continue to be physically active. Conservative management offers several options; however, it is unclear which ones are really useful. This narrative review briefly reports the conservative options for which there is no evidence of effectiveness, or there is only evidence of short-term effectiveness.

Introduction: Joint overload and sport-related injuries may accelerate the development of osteoarthritis (OA). A systematic review of the literature was performed to establish the risk of athletes to develop premature OA compared with nonathletes.

Materials and methods: This systematic review was conducted according to the PRISMA guidelines. PubMed, Google scholar, Embase, and Web of Science databases were accessed in June 2021. All the published clinical studies investigating OA onset in athletes versus nonathletes were considered. Studies reporting data on secondary and/or post-traumatic OA were excluded.

Results: Data from 32 articles (20,288 patients) were retrieved. The mean age was 67.8±10.0 years and the mean body mass index was 25.0±2.5 kg/m2. 74% (6859 patients) of the athletes suffered from premature OA. Of them, 21% were active in soccer, 11% in handball, 11% in ice-hockey, 3% in football, and 0.3% in rugby. 26% of the athletes reported no significant differences in OA progression compared with healthy controls. Of these athletes, 47% were runners, 5% dancers, and 1% triathletes.

Conclusion: Certain sports, such as soccer, handball, ice-hockey, and rugby are more likely to be associated with premature knee and hip OA. Conversely, runners and ballet dancers do not evidence significant increase in OA. Moderate and recreational exposure to aerobic sports does not accelerate the development of OA.

Purpose: The present study investigated the type of sport and activity level of athletes before they underwent knee and/or hip arthroplasty for osteoarthritis (OA), and compared them with a control group of subjects who did not undergo knee and hip arthroplasty. We hypothesed athletes exposed to high physical loads during sports had the highest risk of developing OA requiring arthroplasty.

Materials and methods: This systematic review was conducted according to the PRISMA guidelines. All the comparative clinical trials to August 2021 investigating the sport activity level between subjects who underwent arthroplasty versus those who did not undergo arthroplasty for OA were considered.

Results: Data from 5 studies and 3638 patients were collected. The mean age for both groups was 47.61±15.5 years, and the mean body mass index was 24.6±2.1 kg/m2 17.6% were women. The Newcastle-Ottawa scale attested good quality of the methodology of the investigations included in the present study.

Conclusion: Intense physical exercise, implying a high cumulative number of hours of exercise which can lead to excessive joint overload, in both sexes is associated with greater likelihood of early knee and hip OA which may lead to prosthetic surgery. Moderate and recreational exposure to sport has minor degenerative effects, and is not associated with early onset OA requiring arthroplasty.

Purpose: Intense sporting activity and certain types of work increase the risk of early osteoarthritis (OA). OA can be idiopathic or associated to certain predisposing factors: female sex, obesity, history of joint injury, and joint overuse. The role of gender among the active population as a predisposing factor for OA is not well clear. This study investigated whether the risk of OA changes with age in both sexes in physically active individuals.

Materials and methods: This systematic review was conducted according to the PRISMA guidelines 2020. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in April 2021. No time constrains were used for the search. All the published clinical studies reporting data about relationship between physical activity and OA were included.

Results: Data from 7 articles were retrieved including 360,053 patients (271,903 males; 88,150 females). The mean age was 48.2±16.7 years. Males, under the age of 60 had a higher risk of developing OA. People undertaking intense physical activity, such as professional athletes or heavy workers, are more prone to develop early OA.

Conclusion: Physically active males demonstrated a higher risk of developing OA.

Arthrofibrosis (AF) is an exaggerated immune response to a proinflammatory insult leading to pathologic periarticular fibrosis and symptomatic joint stiffness. The knee, elbow, and shoulder are particularly susceptible to AF, often in the setting of trauma, surgery, or adhesive capsulitis. Prevention through early physiotherapeutic interventions and anti-inflammatory medications remain fundamental to avoiding motion loss. Reliable nonoperative modalities exist and outcomes are improved when etiology, joint involved, and level of dysfunction are considered in the clinical decision making process. Surgical procedures should be reserved for cases recalcitrant to nonoperative measures. The purpose of this review is to provide an overview of the current understanding of AF pathophysiology, identify common risk factors, describe prevention strategies, and outline both nonoperative and surgical treatment options. This manuscript will focus specifically on sterile AF of the knee, elbow, and shoulder.

Despite advances in techniques designed to make arthroscopic sports medicine procedures simple, complications still arise in the operating room; even in the most trained hands. However, what marks a skilled surgeon is not just the ability to steer the ship amidst smooth seas, but a knack for getting out of trouble once things deviate from the set course. Each surgical case presents a unique challenge, and no 2 are the same. For this reason, a true expert surgeon must know how to deal with "complications" ranging from a mild swell to a raging storm. In this review we present strategies to prevent and navigate some of the most common, and fearsome complications a sports medicine surgeon may face during surgery. A great surgeon is one that acknowledges that throughout their career it is not a question of "if" these situations will arise, but "when"; and preparation is the key to success.

Orthopedic sports surgery of the knee and shoulder is generally considered to be safe and effective. Vascular complications can occur during or after arthroscopy of either joint. A thorough understanding of anatomy, particularly when placing portals in non-routine locations, is extremely important. Prompt recognition of any vascular complication is of significant importance. This review will discuss the potential vascular complications for both knee and shoulder sports surgery, review the relevant anatomy, and discuss the treatment and expected outcome of each.

Postoperative infection remains a potentially devastating complication facing the sports medicine surgeon. Infection prevention begins with a thorough history and physical examination to identify patient specific risk factors and aid in risk stratification. Perioperative steroid injections should be used cautiously, with increased time prior to or following surgery being associated with lower infection risk. Sterile preparation with an alcohol containing solution is typically preferred, though there is limited evidence to identify which product is superior. Diagnosis can be challenging with a high index of suspicion needed to identify and appropriately manage patients. Treatment involves prompt irrigation and debridement with deep cultures. Antibiotic coverage should begin with empiric broad treatment and be tailored based on culture results. Early consultation with an infectious disease specialist is recommended to ensure appropriate antibiotic coverage and duration of treatment.