Open Access Journal of Sports Medicine最新文献

Lateral epicondylitis (LE) is a significant source of pain and dysfunction resulting from repetitive gripping or wrist extension, radial deviation, and/or forearm supination. Although most cases are self-limiting over several years, controversy exists regarding the best treatment strategy for chronic LE. Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), shockwave therapy, and injections with corticosteroids or biologics are all conservative treatment options for LE. For refractory cases, surgical options include open, arthroscopic, and percutaneous techniques. In this review, the current evidence behind these treatment strategies is presented. The data demonstrate that NSAIDs, PT, bracing, and shockwave therapy provide limited benefit for treating LE. Biologics such as platelet-rich plasma and autologous whole-blood injections may be superior to steroid injections in the long-term management of LE. Although the initial results are promising, larger comparative studies on stem cell injections are needed. For refractory LE, open, arthroscopic, and percutaneous techniques are all highly effective, with no method seemingly superior over another. Arthroscopic and percutaneous approaches may result in faster recovery and earlier return to work.

Purpose: The aim of this study was to investigate the prevalence of overuse injuries in non-elite netballers and whether these increase over a typical competitive season and to establish if player age, experience, training, and use of bracing are related to overuse injuries.

Patients and methods: A prospective study was conducted over a 12-week period, using a recently developed questionnaire. Data were collected on overuse injuries in the knee, ankle, and shoulder areas every week.

Results: Thirty-seven players responded to the questionnaire, with an average response rate of 65%. The total prevalence of overuse injuries identified was 52.7%, with ankle problems accounting for 26% (75 cases), knee problems accounting for 21.2% (61 cases), and shoulder problems accounting for 5.5% (16 cases). Ankle injuries increased over the study period, while knee and shoulder problems decreased. Injuries were more common in players over 36 years old or those with less than 5 years of playing experience. Players who used a brace were more likely to have an overuse complaint. Training volume was not associated with increased risk.

Conclusion: Overuse injuries are common in netballers, particularly of the knee and ankle. Shoulder overuse complaints are higher than previously reported. Risk factors for injury include older age and less playing experience, and these should be considered when planning injury prevention programs for this sport.

Snowboarding has seen a continuous increase in popularity, leading to an increase in the number of snowboarding injuries seen in orthopedic practice. Upper-extremity injuries are more common than lower-extremity, spine, and pelvis injuries. In this review, we focus on the most common snowboarding injuries of the extremities, spine, and pelvis and provide an overview of their respective rehabilitation and return-to-sport protocols. Despite many of the injuries seen in snowboarding also occurring in other sports, objective data about rehabilitation and return to sport are lacking for many injuries. This provides an opportunity for research in the area with regard to many sports and many different injuries.

Purpose: The purpose of this case report is to present the successful management of symptomatic bilateral femoroacetabular impingement (FAI) syndrome in a patient who underwent surgical treatment on one side and non-surgical treatment on the other side.

Methods: We evaluated the treatment outcome of a young female presenting with bilateral FAI syndrome of cam morphology. A follow-up was performed at 5 years following surgical treatment on the right hip and 2 years following non-surgical treatment on the left hip. The evaluation included a clinical examination, patient-reported outcome measurements (PROM), plain radiographs, and magnetic resonance imaging (MRI).

Results: The patient experienced subjective improvements bilaterally. The clinical examination revealed differences in range of motion between the surgically treated and the non-surgically treated sides, with internal rotation differing the most (20° vs almost 0°). Flexion was, however, the same on both sides (125°). The PROM results were satisfactory on both sides, with slightly better results for the surgically treated side (the short version of the International Hip Outcome Tool [iHOT-12]: 96.9 vs 90, the Copenhagen Hip and Groin Outcome Score [HAGOS]: 90-100 vs 65-100). On the surgically treated side, the alpha angle decreased by 19° postoperatively. An MRI did not reveal any injury to the cartilage or labrum on either side.

Conclusion: This patient with bilateral FAI syndrome treated with arthroscopic surgery on one side and physiotherapy together with reduced physical activity on the other side, presented with good results bilaterally at follow-up.

Purpose: This study compared the accessory anteromedial portal (AAMP) and the modified transtibial technique (MTTT)" for single-bundle anterior cruciate ligament (ACL) reconstruction.

Patients and methods: Sixty active adult patients with ACL tear were randomly assigned into two equal groups who were treated surgically. One group was operated on using AAMP and the other group through MTTT. Both the groups had the same postoperative course and were followed for 1 year after surgery. The follow-up included Lysholm and International Knee Documentation Committee (IKDC) subjective knee evaluation forms, IKDC objective knee examination form, and radiological evaluation. Results were evaluated and compared with each other.

Results: There was no significant difference in subjective effects or clinical examination between the two groups. Regarding radiological angles, the AAMP had more oblique graft orientation in the coronal plane than the MTTT, but both were found to be more slanted than native ACL. Also, the MTTT had succeeded to place the graft and tunnel more obliquity than the traditional non-anatomic TTT and better than the anatomic ranges despite having the graft inclination of the AAMP higher than the MTTT. The complaints from the patients and subjective scoring were found to be positively related to graft stability. Patients with healthier preoperative subjective state had a smoother postoperative period and better outcome.

Conclusion: This study offers simple modifications to the transtibial technique to allow near anatomic ACL reconstruction with similar results comparable to the AAMP and with fewer complications.

Purpose: The purpose of this study was to determine the clinical success rate of nonoperative treatment of partial-thickness rotator cuff tears (PT-RCTs), to determine baseline clinical factors predictive of outcome of nonoperative treatment of PT-RCTs, and to determine the imaging outcome of nonoperative treatment of PT-RCTs.

Patients and methods: All patients with a primary diagnosis of a PT-RCT were eligible for inclusion. Seventy-six patients (48 males, 28 females) with an average age of 52±10 years were included in the study. Patients were evaluated using a standardized format including clinical, imaging, and shoulder specific quality-of-life outcomes. Patients were assessed and treated either successfully nonoperatively or consented to undergo surgical intervention of their PT-RCT. Patients treated nonoperatively underwent follow-up by MRI arthrogram.

Results: Thirty-seven patients (49%) underwent nonoperative treatment. Logistic regression analysis indicated that the baseline variables of side (dominant or nondominant side involved), onset (traumatic or atraumatic), and thickness of tendon tear (<50% or >50%) were significant predictors of outcome. At a mean 46±7 months of follow-up, nonoperatively treated patients demonstrated a mean American Shoulder and Elbow Surgeons score of 85.1±16.0, and a Simple Shoulder Test score of 10.0±2.5. Overall, 76% of tears treated nonoperatively did not show a tear progression on anatomic imaging. Nine patients (24%) demonstrated tear progression, of which three patients (8%) demonstrated full-thickness tearing.

Conclusion: Nonoperative treatment was utilized in ~50% of the patients and resulted in improved clinical outcomes. Onset, shoulder involved, and thickness of the tear were predictive of the success of nonoperative treatment.

The Functional Movement Screen (FMS) is a popular movement screen used by rehabilitation, as well as strength and conditioning, professionals. The FMS, like other movement screens, identifies movement dysfunction in those at risk of, but not currently experiencing, signs or symptoms of a musculoskeletal injury. Seven movement patterns comprise the FMS, which was designed to screen fundamental movement requiring a balance between stability and mobility. The 7 movement patterns are summed to a composite FMS score. For an instrument to have wide applicability and acceptability, there must be high levels of reliability, validity, and accuracy. The FMS is certainly a reliable tool, and can be consistently scored within and between raters. Although the FMS has high face and content validity, the criterion validity (discriminant and convergent) is low. Additionally, the FMS does not appear to be studying a single construct, challenging the use of the summed composite FMS score. The accuracy of the FMS in screening for injury is also suspect, with low sensitivity in almost all studies, although specificity is higher. Finally, within the FMS literature, the concepts of prediction and association are conflated, combined with flawed cohort studies, leading to questions about the efficacy of the FMS to screen for injury. Future research on the use of the FMS, either the composite score or the individual movement patterns, to screen for injury or injury risk in adequately powered, well-designed studies are required to determine if the FMS is appropriate for use as a movement screen.

Introduction: Elbow ulnar collateral ligament (UCL) injuries in gymnastics have not been well documented in the literature, in comparison to UCL injuries in baseball. Few studies have examined the mechanism and nonoperative management of this injury, and no studies to date have been published on incidence of injury and return to play recommendations in gymnastics.

Patient case review: A literature search was performed using PubMed to review articles from 1980 to 2016 that addressed the biomechanics of UCL injury in baseball and gymnastics, the anatomy of the elbow, injury rates, surgical vs non-surgical management, rehabilitation, and return to play recommendations for the sport of gymnastics. Five female collegiate gymnasts sustained UCL injury over a 3-year period. Electronic medical records for each case were thoroughly reviewed including imaging, surgical and non-surgical management, rehabilitation, and the progressive return to gymnastics.

Discussion: Four UCL injuries were confirmed by MRI to be avulsions at the distal insertion of the UCL and one was an avulsion at the proximal origin. While less than half of baseball players can return to competition with conservative management of these types of injuries, four out of five gymnasts were able to return to competition with nonoperative management. One gymnast opted to have reconstruction after a successful competition season. Time to return to play varied seemingly dependent on the severity of UCL injury and event.

Conclusion: In our case series, collegiate female gymnasts were able to return to participation with nonoperative treatment of the UCL. Their success in returning to competitive gymnastics may also depend on the event(s) in which they are trying to participate.

Strength of recommendation taxonomy: C.

Treatment of symptomatic meniscal tears continues to evolve as we improve our understanding of the biomechanical role of the meniscus and its long-term importance to the health of the knee joint. Suture repair of meniscal tears is challenging and continues to rise as we aim to preserve meniscal tissue. Outside-in meniscal suture techniques may involve using expensive equipment that is not readily available for immediate use in most operating rooms. Aware of the different techniques available, the authors describe a fast and reproducible technique that does not require the use of specific material or equipment.

Introduction: The stability of hematological status indices is a key determinant of optimal sport performance. The capacity to monitor hematological behaviors of elite soccer players may better explain the stresses placed upon physiological systems and the potential decrements in performance and physical capacity. The primary aim of this investigation was to examine the post-seasonal hematological status of professional top-level soccer players in response to seasonal match-play and training demands, in terms of the training practices, intensity, and loadings that they experience before, during, and after each season.

Methods: Seventeen male elite European soccer players participated in the study (mean±SD: age 26.8±4.6 years, weight 78.1±5.7 kg, height 182.4±4.8 cm, body fat 9.8%±2.9%, and maximal aerobic capacity 56.5±4.2 mL kg^-1 min^-1). The season culminated in 74 competitive matches including domestic, Champions League, and UEFA Cup matches. Blood samples were collected between 9:00 and 10:30 am after an overnight fast (~10 hours), 72 hours post conclusion of the final match of the competitive season.

Results: Near-perfect correlations between white blood cells, neutrophils, the period of season, training availability, and total competitive minutes were found. When adjusting for all the confounding variables, a stability of the hematological profile was noticed. Only mean cell volume and mean cell hemoglobin values were associated with the requirement for elite European soccer teams to fulfill excessive competitive loadings. The reported lower mean cell volume and mean cell hemoglobin values may highlight the accumulative effects of seasonal training and match-play demands.

Conclusion: Regular blood testing could identify the need for both squad rotation and the implementation of interventions to assist in stabilizing transient hematological behaviors in order to optimize performance and sports output.