Sports Health-A Multidisciplinary Approach最新文献

Background: Fear of pain and reinjury significantly hinders return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). However, the neural basis of this psychological barrier remains unclear.

Hypothesis: ACLR patients will exhibit structural and functional brain changes in regions related to pain and emotion, influencing their psychological readiness to RTS.

Study design: Cross-sectional study.

Level of evidence: Level 3.

Methods: We recruited 36 ACLR patients and 36 healthy controls, collecting visual analog scale (VAS) scores for knee pain, Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scores, and structural and functional magnetic resonance imaging data.

Results: Significant smaller gray matter (GM) volume was observed in the thalamus (effect size, -0.813), periaqueductal gray (PAG) (effect size, -0.737), and prefrontal cortex (PFC) (effect size, -0.690) in ACLR patients. We also found weakened functional connectivity between the PAG and the anterior cingulate cortex (ACC). GM volume in the thalamus was correlated positively with ACL-RSI scores (r = 0.362). Notably, the effect of VAS scores on ACL-RSI was mediated by the reduced FC between PAG and ACC (direct effect, -2.071, indirect effect, -0.826).

Conclusion: This study reveals that the psychological readiness to RTS after ACLR may be due to peripheral nociceptive input causing changes in pain-related brain structures and functions.

Clinical relevance: Recognizing these neuropsychological changes may guide comprehensive rehabilitation strategies post-ACLR, emphasizing the need for interventions targeting central neural mechanisms alongside physical recovery.

Tenosynovial giant cell tumor (TGCT), formerly pigmented villonodular synovitis (PVNS), may extend into the popliteal fossa and mimic a Baker cyst, complicating diagnosis and operative planning. A 53-year-old former endurance runner presented with posterior knee pain, swelling, intermittent locking, and a palpable popliteal mass. Examination demonstrated effusion and limited range of motion; weightbearing radiographs showed mild osteoarthritic change with effusion, and magnetic resonance imaging (MRI) revealed synovial hypertrophy with low T2 signal suggestive of hemosiderin deposition. Arthroscopic synovectomy via 4 anterior and 2 posterior portals was performed; histology confirmed diffuse, nonmalignant TGCT. Given persistent posterior disease, a staged posterior open approach (lazy-S incision) enabled en bloc excision of the extra-articular component. Adjuvant radiosynoviorthesis (intra-articular yttrium-90) was administered. At 8-year follow-up, there was no clinical or radiographic evidence of disease. This case emphasizes MRI recognition of hemosiderin-related low T2 signal, the value of combining arthroscopic synovectomy with posterior open excision in diffuse disease with popliteal extension, and selective use of adjuvant radiosynoviorthesis for durability.

Background: Researchers have examined associations between sport specialization and injury. However, no studies have investigated associations between sport specialization and health-related quality of life (HRQoL) after injury.

Hypothesis: Among injured youth athletes, level of sport specialization is not associated with differences in HRQoL approximately 1 month after sport-related injury.

Study design: Cross-sectional study.

Level of evidence: Level 4.

Methods: A multicenter, cross-sectional study was performed at 3 primary care sports medicine clinics. Eligible 8- to 18-year-old athletes who presented for musculoskeletal injury or concussion were enrolled. At the initial clinic visit, patients completed the Player Development Survey (PDS) to determine sport specialization level. Approximately 1 month after enrollment, patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) to determine HRQoL measures.

Results: Of 720 athletes invited to participate, 336 (age, 14.2 ± 2.4 years) completed the PDS and PROMIS surveys; 22% were highly specialized, 39% were moderately specialized, and 39% were low specialized athletes. Overall, there were no differences in HRQoL scores across the 3 levels of sport specialization. In subgroup analysis based on sex, female HRQoL scores were worse than male HRQoL scores irrespective of sport specialization level in 3 categories: pain interference (mean difference between female and male scores [± SEM] = 2.3 ± 1.1; P = 0.04), depression/sadness (2.9 ± 1.1; P = 0.01), and anxiety/fear (2.8 ± 1.2; P = 0.02).

Conclusion: Higher level of sport specialization is not associated with worse HRQoL approximately 1 month after sport-related injury. Female athletes have worse short-term HRQoL after an injury irrespective of sport specialization level. While sex differences were statistically significant, the magnitude of differences was small.

Clinical relevance: Sport specialization is not associated with differences in HRQoL after injury. Injured female athletes may need closer monitoring due to possibly worse short-term HRQoL, but further investigation is needed.

Context: Testosterone is a steroid hormone produced primarily in the testes in men and ovaries in women, playing crucial roles in androgenic, anabolic, and psychological functions, including muscle growth, bone formation, erythropoiesis, risk-taking, and aggression, making it important for athletes. Sports performance is linked closely to testosterone level, prompting athletes to explore legal and illegal ways to boost testosterone. This review examines testosterone physiology and legal strategies for optimizing testosterone levels in athletes, as well as their practical applications.

Evidence acquisition: Database search.

Study design: Narrative review.

Level of evidence: Level 5.

Results: Maintaining healthy testosterone levels requires energy balance and optimal nutrition with adequate macronutrients and micronutrients, especially for athletes prone to dieting and food restriction. Testosterone boosters are marketed widely but lack strong evidence for efficacy and may pose risks. While some substances show promise, further research is needed. Sleep is critical as testosterone secretion is linked to the rapid eye movement phase, highlighting the need for proper sleep hygiene and addressing sleep disorders. Moderate-to-high intensity free-weight resistance exercises are most effective for increasing testosterone, while the effects of sexual activity remain unclear. Endocrine-disrupting chemicals can lower testosterone levels and should be avoided. While cold-water immersion may decrease testosterone, sauna bathing appears to be neutral. Radiofrequency electromagnetic radiation from modern electronic devices may harm the hypothalamic-pituitary-gonadal axis, warranting limited use. Over-the-counter analgesics, such as nonsteroidal anti-inflammatory drugs and acetaminophen, may decrease testosterone levels, suggesting cautious use. Seasonal changes in testosterone levels require further study. Testosterone-optimizing strategies excluding banned substances may aid in treating functional low testosterone or reducing harm in anabolic-androgenic steroid users.

Conclusion: Educating athletes on safe and effective strategies to increase testosterone is crucial, with ongoing research needed to explore additional methods.Strength-of-Recommendation Taxonomy:B.

Context: Ankle injuries are common in athletes and can significantly impair postural stability. Balance deficits may vary with the type of injury and the specific biomechanical demands of the sport.

Objective: To evaluate systematically how different types of ankle injuries affect postural stability in athletes by classifying and comparing findings across distinct sport archetypes (eg, multidirectional, linear, balance-focused) to identify sport-specific impairments.

Data sources: A search was conducted in PubMed, Scopus, Embase, and Web of Science from inception up to August 31, 2025, for observational studies assessing postural stability in athletes with ankle injuries.

Study selection: Studies published in any language were included if they assessed postural stability in athletes with ankle injuries. Data were extracted independently by 2 authors, and any disagreements were resolved through discussion. Study quality was assessed using Joanna Briggs Institute checklists (cross-sectional: 8-item; cohort: 11-item; case-control: 10-item). Reporting quality was evaluated using the STROBE checklist.

Study design: Systematic review.

Level of evidence: Level 1.

Data extraction: Data were extracted on static and dynamic balance (DB), including postural sway, center of pressure, stabilization times, and reach distances in the Star Excursion Balance Test (SEBT) and Y Balance Test (YBT).

Results: A total of 59 studies involving 4848 participants were included. Most participants were youth (61%, aged 19-29 years) and adolescent (32%, aged 12-18 years) athletes, with a limited focus on female-only cohorts (6.7% of studies). Athletes with ankle injuries showed deficits in static and DB, with chronic ankle instability (CAI) causing persistent impairments in stabilization times and reduced reach in the SEBT/YBT. Pivoting sports (eg, soccer, basketball) exhibited greater balance deficits than endurance or balance-focused sports.

Conclusion: Ankle injuries, particularly CAI, result in significant balance impairments, necessitating sport-specific rehabilitation addressing both distal and proximal neuromuscular control. Static tests may underestimate functional deficits.

This infographic summarizes the first prospective injury and illness surveillance study in Sail Grand Prix (SailGP) during Season 4 (2023-2024). Monitoring 100 professional athletes across 4919.84 sailing hours, the study found an overall injury rate of 9.96 per 1000 hours-higher during racing (11.89) and particularly during foiling activities (26.52). Lower limb injuries, especially to the ankle and knee, were most common, with grinders showing the highest positional injury incidence. Illness, mainly respiratory in nature, occurred at 5.14 per 1000 hours. These findings highlight the physical demands and health risks of elite foiling, informing targeted prevention, conditioning, and safety strategies in SailGP.

Background: Structural abnormalities assessed with conventional ultrasound (US) or magnetic resonance imaging (MRI) are associated with the risk of developing patellar tendinopathy (PT). However, their prognostic value for athletes with PT performing exercise therapy remains unclear.

Hypothesis: Baseline imaging features could be associated with changes in pain and disability over 24 weeks in athletes with PT after exercise treatment.

Study design: Cohort study.

Level of evidence: Level II.

Methods: Athletes with PT were randomly allocated to 2 different programs of exercise therapy for 24 weeks. Imaging features at baseline included patellar tendon thickness, intratendinous calcifications, patellar erosions, and Doppler flow on US, as well as tendon fiber disruption, infrapatellar fat pad (IFP) edema, bone marrow edema, and deep infrapatellar bursitis on MRI scan. Clinical outcomes were measured at baseline, and at 12- and 24-week follow-up, using the visual analog scale after single-leg squat (VAS-SLDS) for pain on loading, and Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire for disability. Linear mixed-effects models, incorporating interaction terms tested using likelihood ratio tests, evaluated the prognostic value of baseline imaging features.

Results: Of 76 included athletes (58 male, 18 female; average age, 24 ± 4 years), abnormal US features were identified in 26% to 78% of cases. Among 72 MRI scans analyzed, abnormal features were demonstrated in 43% to 81% of cases. No significant associations were identified between individual imaging features and 24-week changes in VAS-SLDS or VISA-P scores (all P_interaction > 0.10), or between the total number of imaging abnormalities and clinical outcomes (all P_interaction > 0.50).

Conclusion: There was no evidence of an association between baseline abnormalities assessed using conventional US or MRI and 24-week changes in pain or disability among athletes with PT undergoing exercise therapy.

Clinical relevance: Healthcare professionals should avoid relying on conventional imaging findings to predict prognosis.

Context: It is estimated that only 50% of athletes who sustain pectoralis major tendon injuries return to sport (RTS) despite successful treatment. This limited RTS rate may be due to absence of standardized RTS criteria for such patients. Evidence suggests a significant heterogeneity in RTS guidance across various studies, leading to inconsistency in clinical advice.

Objective: To examine the existing RTS criteria used in pectoralis major tendon injury in different sporting populations.

Data sources: A comprehensive literature search with defined keywords was conducted in electronic databases including PubMed, Scopus, EBSCO (via CINAHL complete), Web of Science, Embase, and grey literature (e.g., Opengrey.com) to include studies published from inception until May 2024.

Study selection: Studies investigating the RTS outcome after pectoralis major injury managed surgically and/or conservatively in various sporting athletes were included. All studies included were in English language.

Study design: Scoping review.

Level of evidence: Level 4.

Data extraction: Details of population age, sex, type of sports, injury mechanism (contact/noncontact), management technique, rehabilitation protocol, outcomes assessed, RTS criteria used, mean RTS duration, number of athletes returned to play, athletes reaching preinjury performance level, and re-injury rate were extracted.

Results: The literature search identified 1707 studies; 39 studies were included for the final review. A total of 1129 injured athletes (1 female were recorded from the included studies with a mean age of 30.1 years. Regarding RTS criteria, no established criterion for this injury exists in the literature. Strength assessment, range of motion, functional outcomes, and pain were the measures used most in clearing the athlete to continue sport.

Conclusion: Despite the increasing number of athletes sustaining this injury, current evidence reports marked variability in RTS recommendations, with no universally accepted or validated criteria identified. Therefore, for now, both objective and subjective parameters should be used to aid RTS decision making.

Background: Physical performance tests (PPTs) require athletes to complete a physical activity essential to their sports performance. Evaluating associated electromyographical requirements enables clinicians to select appropriate tests for their athletes' specific needs.

Hypothesis: Shoulder muscle activity differs between tests.

Study design: Descriptive laboratory study.

Level of evidence: Level 4.

Methods: Thirty asymptomatic overhead athletes (17 women, 13 men; mean age, 20.3 ± 1.7 years) performed 4 upper-extremity PPTs: Y-balance test-upper quarter (YBT-UQ), closed kinetic chain upper extremity stability test (CKCUEST), upper limb rotation test (ULRT), and shoulder endurance test (SET). Surface electromyography, expressed as a percentage of the maximal isometric voluntary contraction, was used to measure muscle activity in upper, middle, and lower trapezius, serratus anterior, infraspinatus, and posterior deltoid on both sides. Only the supporting arm (ie, in closed chain) was considered for analysis.

Results: During the YBT-UQ, serratus anterior and infraspinatus activity was highest during all reach directions. Serratus anterior showed the highest activity when supporting the medial and inferolateral reach (range, 72.7-95%). The infraspinatus was most active when supporting the superolateral reach (range, 92-129.2%). During the CKCUEST, all muscles were moderate to highly active, with the serratus anterior (range, 77.5-78.8%) and infraspinatus (range, 64.1-64.7%) being most active. All muscles demonstrated moderate-to-high activity during the ULRT, with the highest activity in posterior deltoid, infraspinatus, and serratus anterior. For the SET, muscle activity progressively increased with increasing speed.

Conclusion: Serratus anterior and infraspinatus activity was high across all tests, with the greatest activity during the YBT-UQ and CKCUEST. The ULRT elicited the highest posterior deltoid activity.

Clinical relevance: Our findings offer clinicians specific electromyographical insights, facilitating appropriate test selection for screening and return to sport.

Background: Despite advancements in preparticipation physical examinations and cardiovascular evaluations, sport-related mortality persists. This study assesses athlete mortality over 25 years, stratifying data by sport, state, cause of death, socioeconomic factors, and age.

Hypothesis: Most athlete mortality would be due to sudden cardiac death (SCD) and occurred in contact sports in low-resource communities.

Study design: Descriptive epidemiology study.

Level of evidence: Level 3.

Methods: A retrospective search of athlete deaths occurring during games or practice from 1999 to 2024 was conducted using an online search engine (https://www.google.com/). Inclusion criteria required deaths to be related directly to athletic activity. Unrelated cases were excluded. The socioeconomic status of athletes was determined through the area deprivation index (ADI). Poisson regression was used to compare mortality rates with respect to sport type and region.

Results: A total of 593 athlete deaths were recorded, with a mean age of 16.2 years (range, 5-43). Most deaths occurred in male athletes (92%), at the high school level (70%), and during football participation (65%). Cardiovascular events were the leading cause of death (51%), followed by neurological causes (18%), and exertional heat stroke (11%). Mortality was highest during practice (69%) and was significantly more frequent in rural areas (P < 0.001). States with the highest mortality rates had an average national ADI of 67.8, indicating moderate socioeconomic deprivation, while states with the lowest mortality rates had an average ADI of 43.8. Exertional heat stroke accounted for 87.5% of deaths in football and was most prevalent in the South Atlantic region (P < 0.001).

Conclusion: Football had the highest rate of all-cause athlete mortality, driven by cardiovascular events, traumatic brain injuries, and exertional heat stroke. Mortality was disproportionately higher in rural areas during practice.

Clinical relevance: Higher mortality rates correlated positively with greater socioeconomic deprivation, as indicated by ADI values.