Sports Health-A Multidisciplinary Approach最新文献

Background: Foot strike type affects running mechanics and may influence overuse injury occurrence. Measuring the interaction between cumulative load and foot strike type may provide additional information that could increase understanding of injury mechanisms.

Hypothesis: There will be no differences in cumulative loading between runners using rearfoot strike (RFS) and nonrearfoot strike (NRFS) patterns. NRFS runners will have a greater stride rate. There will be differences in per stride metrics of select lower extremity mechanics.

Study design: Observational laboratory study.

Level of evidence: Level 3.

Methods: Thirty male participants (age, 22.7 ± 2.9 years; height, 1.79 ± 0.07 m; mass, 70.7 ± 7.86 kg; mean ± SD) ran on an instrumented treadmill for 5 km at 3.15 m/s with their preferred foot strike type (14 RFS, 16 NRFS). Stride rate, foot strike angle, loading rate (LR), per stride and per kilometer (cumulative) vertical ground-reaction force (VGRF) impulse, impact peak, absolute peak, knee negative work, and ankle negative work were calculated and compared across time and between groups.

Results: Per stride differences were seen for stance time, foot strike angle, and LR (greater for RFS runners, P = 0.003). Per stride and cumulative ankle and knee negative work showed significant differences (greater ankle negative work for NRFS runners, P < 0.001 [per stride and cumulative], greater knee negative work for RFS runners, P = 0.01 per stride, P = 0.008 cumulative).

Conclusion: Ankle and knee loading metrics showed differences in per stride and cumulative metrics between foot strike groups. Individual variability in VGRF loading patterns was more apparent than group distinctions. The common perception that NRFS runners have a higher stride rate was not supported.

Clinical relevance: Individual loading patterns, not just foot strike type, and training session characteristics related to cumulative load should be considered when assessing injury risk.

Background: Arthroscopic hip surgery for femoroacetabular impingement syndrome (FAIS) has high rates of return to sport; however, patient return to long-distance running is unclear.

Hypotheses: (1) Long-distance runners undergoing arthroscopic hip surgery for FAIS are a distinctive subgroup in terms of demographics, hip injury characteristics, and running metrics. (2) Most patients will return to general running but a lower proportion return to long-distance running after arthroscopic hip surgery.

Study design: Case series.

Level of evidence: Level 4.

Methods: An institutional hip preservation registry was reviewed retrospectively for long-distance runners (half marathons, marathons) who underwent primary hip arthroscopies for FAIS between March 2008 and January 2018. Patient demographics, injury characteristics, and clinical and radiographic findings were recorded. Multivariable logistic regression analysis identified potential risk factors for not returning to long-distance running.

Results: Sixty-eight (78 hips) long-distance runners (mean patient age, 37.8 ± 8.9 years; 38 (56%) female; mean weekly running mileage before injury, 34.5 ± 16.9 miles) were included. Overall, 50 runners (74%) returned to any running, of which 25 (50%) returned to long-distance running, completing half/full marathons races after surgery. Most common reasons for not returning to running were pain or discomfort (50%) followed by fear of reinjury (22%), and additional different injuries (22%). Multivariable logistic regression analysis revealed female runners (odds ratio, 0.2; CI, 0.0-0.9; P = 0.03) were less likely to return to long-distance running.

Conclusion: Most (74%) long distance runners returned to running after hip arthroscopic treatment for FAIS; however, only 37% returned to long-distance running. Satisfaction from surgery was not necessarily associated with return to running. Female long-distance runners were less likely to return to long-distance running after surgery.

Clinical relevance: Study findings provide helpful context for clinicians counseling patients with symptomatic FAIS who are considering hip arthroscopy and are concerned about return to long-distance running.

Background: People suffering anterior cruciate ligament (ACL) injuries are at increased risk for development of osteoarthritis (OA). This study investigated associations between daily step count, cartilage degeneration and patient-reported outcomes 2 years after ACL reconstruction (ACLR).

Hypothesis: Daily step count is associated with cartilage health and patient-reported knee symptoms and function 2 years after ACLR.

Study design: Cross-sectional.

Level of evidence: Level 4.

Methods: We analyzed data from 34 patients (18 female), aged 33.4 ± 10.8 years with stable knees recruited from the community 2 years after primary ACLR. Mean daily step count was measured using an activity tracker (FitBit) over a 7-day collection period. Cartilage morphology on magnetic resonance imaging (MRI) was graded across multiple joint areas. Knee symptoms and function were assessed by the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales pain, symptoms, activity of daily living (ADL), sport/recreation (sport/rec), and knee-related quality of life (QoL) using published thresholds for patient acceptable symptom state (PASS). Analyses were adjusted for age, sex, and body mass index.

Results: The mean (SD) daily step count was 9276 (3199). At least 1 cartilage abnormality was present on morphological MRI in 20% of ACLR knees. The mean (SD) KOOS values were: pain 94 (7), symptoms 92 (8), ADL 91 (10), function in sport/rec 85 (14), and knee-related QoL 56 (22). Failure to achieve PASS rates were 76% for ADL; 59% for QoL, 18% for pain, 35% for sport/rec, and 0% for symptoms.

Conclusion: Daily step count was not associated with cartilage health or knee symptoms and function 2 years after ACLR. However, a high proportion of participants with reported unacceptable ADL and QoL 2 years after ACLR.

Clinical relevance: The proportion with unacceptable PASS for ADL and QoL in participants with stable knees after ACLR indicates a need to optimize rehabilitation and improve post-ACLR recovery.

Context: Lateral extra-articular tenodesis (LET) and anterolateral ligament (ALL) reconstruction have been adopted by some surgeons as augmentations during anterior cruciate ligament reconstruction (ACLR) to improve anterolateral rotatory instability.

Objective: The objective of this study was to assess the statistical robustness of outcomes reported in randomized controlled trials (RCTs) assessing the clinical significance of LET and ALL reconstruction in ACLR.

Methods: PubMed, Embase, and MEDLINE were systematically searched. RCTs published January 1, 2010 to December 31, 2024 assessing LET and ALL reconstruction during ACLR were included. Fragility index (FI) or reverse FI (rFI) was calculated for each outcome, representing the number of event reversals required to alter statistical significance for significant and nonsignificant outcomes, respectively. The fragility quotient (FQ) was determined by dividing the FI or rFI by sample size.

Level of evidence: Level 1.

Results: Of 112 RCTs screened for inclusion, 17 were included for analysis, resulting in 51 total outcomes. The median FI across the 51 outcomes was 4 [interquartile range (IQR), 2-7] with an associated median FQ of 0.031 (IQR, 0.014-0.049). Statistically significant outcomes were more fragile (median FI, 3.5; median FQ, 0.015) than statistically nonsignificant outcomes (median rFI, 5; median FQ, 0.038). In 60.8% of all outcomes (31 of 51), the number of patients lost to follow-up was greater than the outcome's respective FI or rFI. In the 7 RCTs assessing LET, the median FQ was 0.015 (IQR, 0.012-0.042) across 23 outcomes. In the 10 RCTs assessing ALL, the median FQ was 0.035 (IQR, 0.019-0.051) across 28 outcomes. Graft failure, pivot shift, and Lachman/anterior laxity were the most common outcome categories reported, with median FQs of 0.017, 0.035, and 0.048, respectively.

Conclusion: Outcomes reported in RCTs for LET and ALL reconstruction as augments of ACLR are statistically fragile, emphasizing the need for additional robust and adequately powered RCTs to better understand the impact of anterolateral augmentation on ACLR outcomes.

Background: Tennis players frequently use motor imagery (MI) to improve serve accuracy and efficiency. Moreover, breathing, such as forced expiration, can improve serving speed.

Hypothesis: A combination of MI before action and breathing during movement would increase serve performance in skilled tennis players.

Study design: Nonrandomized, repeated-measures design.

Level of evidence: Level 3.

Methods: A total of 20 tennis players (mean age, 24.2 years; SD = 5.9), with between 9 and 18 years of regular practice, completed 4 experimental counterbalanced sessions: Control (no instruction), Breathing (inhalation while throwing the ball and forced expiration while hitting), Imagery (external visual mental simulation before serving), and Imagery + Breathing (combination of both). Each session included the completion of 10 first-serves in an actual match condition. The speed, percentage of success, accuracy, and efficiency scores served as performance indicators and dependent variables.

Results: Compared with the Control condition, Imagery significantly improved accuracy and percentage of success, and Breathing increased speed of the serves. Participants had significantly better performances in the Imagery + Breathing condition than in the Control condition; better serving speed than in the Imagery condition; and higher accuracy, efficiency, and percentage of success than in the Breathing condition.

Conclusion: The combination of MI plus breathing resulted in an overall improvement in serve performance.

Clinical relevance: Tennis coaches and practitioners should integrate MI interventions and breathing practice during training and matches.

Background: Sleep is vital for an athlete's recovery, physical and mental health, and athletic performance. The impact on circadian rhythm from long-distance travel across multiple time zones has not been studied using wearable technology in female professional tennis players.

Hypothesis: Travel between time zones in female professional tennis players leads to circadian desynchronization, causing disruption in sleep patterns, changes in physiologic parameters, and decreased athletic performance.

Study design: Retrospective cohort study.

Level of evidence: Level 3.

Methods: A total of 52 female professional tennis players consented to wear, and share the data of, WHOOP 3.0 while traveling and competing on the Women's Tennis Association (WTA) Tour. Linear mixed models examined the relationship between (1) travel and sleep/recovery and (2) sleep/recovery and match performance.

Results: Sleep duration without travel averaged 437 minutes (436.8 ± 2.8). On the first night after travel, for every hour time zone difference (TZD) traveled regardless of direction, players slept 11 minutes less (-11.3 ± 0.96; P < 0.05). Eastward travel further reduced sleep (-24.5 ± 4.2; P < 0.05), while westward travel increased sleep duration (+30.0 ± 4.2; P < 0.05). These effects were reduced on the subsequent 2 nights.

Conclusion: Sleep duration reduction was most prominent on the first night after travel, particularly with eastward travel, but improved on subsequent nights. The number of time zones crossed predictably increases the vulnerability for insufficient sleep duration, whereby a 2-hour TZD easterly, and 4-hour TZD westerly, reduces sleep duration <7 hours on the first night. No significant correlation was found between sleep disruption and competition performance in our female professional tennis population.

Clinical relevance: The findings suggest that professional tennis players should, and generally do, arrive at competition locations with enough time to resynchronize their circadian rhythm to the destination time zone; particularly if traveling eastward.

Background: Upper extremity physical performance tests are used frequently to assess upper limb performance in overhead athletes such as tennis players. Recently, it has been suggested that a test battery rather than individual tests should be used to increase construct validity. So far, no test battery consisting of analytical tests, as well as physical performance tests, has been validated in a population of adult tennis players, correlating results with serve performance.

Hypothesis: The test battery will show a strong correlation with serve velocity and a limited correlation with serve accuracy.

Study design: Cross-sectional study.

Level of evidence: Level 3.

Methods: A total of 69 tennis players underwent a serve performance test, including velocity and accuracy measurements. They next completed a test battery consisting of strength tests (hand grip and shoulder strength), shoulder range of motion (ROM) tests and upper extremity physical performance tests. The physical performance test assessment included the closed kinetic chain upper extremity stability test, seated single-arm shot-put test, upper limb rotation test, and shoulder endurance test. The correlation between the test battery and serve velocity and accuracy was assessed through linear regression. Backward regression was used to identify the most significant variables.

Results: A strong correlation was found between the test battery and serve velocity. The test battery explained 58.5% of the variance in serve velocity. Exploratory backward regression showed that the closed kinetic chain upper extremity stability test and shoulder internal rotation strength explained 59.3% of the variance. There was no significant correlation between the test battery and serve accuracy.

Conclusion: The test battery, including physical performance tests, strength, and ROM measurements, demonstrates strong construct validity for serve velocity.

Clinical relevance: This test battery provides an on-field, easy, and efficient method of assessing athletes. Clinicians may use this test battery to evaluate healthy adult tennis players.

Background: Horizontal hop testing is a reliable measure included in test batteries after anterior cruciate ligament (ACL) reconstruction (ACLR). Hop test results are typically expressed as limb symmetry indexes (LSIs) comparing the involved limb with the uninvolved limb. Using the uninvolved limb as a comparative measure has been questioned due to concerns that performance may be reduced in this limb also and may not be a stable comparison across time, leading to a falsely inflated LSI. Here, we report changes in uninvolved limb hop scores over 5 timepoints after ACLR.

Hypothesis: Uninvolved limb hop scores would be similar between preoperative rehabilitation and 2 years after ACLR.

Study design: Cohort study.

Level of evidence: Level III.

Methods: Level I and II athletes were enrolled after isolated ACL injury. Participants completed a preoperative hop testing battery after impairment resolution, preoperative rehabilitation, and 6 months, 1 year, and 2 years after ACLR. Linear mixed-effects models were performed separately for each hop and each limb to characterize change in scores over time. Pairwise comparisons for fixed effects of timepoint and estimated marginal means are reported.

Results: A total of 182 athletes (25.0 ± 8.8 years, 44% female) were enrolled a mean of 54 days from ACL injury. For each hop, the uninvolved limb hop distance was statistically different from the impairment resolution timepoint only to various follow-up timepoints (P ≤ 0.009). If athletes underwent preoperative rehabilitation, uninvolved limb hop distance was stable throughout the duration of rehabilitation until 2 years, apart from timed hop from 6 months to 2 years (P = 0.04).

Conclusion: The uninvolved limb is a stable comparison for calculating hop test LSIs as part of return-to-sport decisions.

Clinical relevance: These results increase confidence in using symmetry as an outcome and are important for clinicians lacking preinjury hop testing data.

Background: Lateral epicondylitis (LE), or tennis elbow, severely affects elbow mobility due to degeneration of and injury to the extensor carpi radialis brevis (ECRB) tendon. Conventional magnetic resonance imaging (MRI), although relied upon to determine LE severity, is a qualitative measure of tendon degeneration. Novel quantitative T2*-mapping using ultrashort time-to-echo (UTE) assesses the collagen component of the tendon and could provide a more objective assessment of tendon pathology.

Hypothesis: UTE T2* values differentiate LE severity grades and correlate with conventional MRI signal.

Study design: Prospective and cross-sectional.

Level of evidence: Level 3.

Methods: UTE T2* MRI was acquired in 30 patients (11 female/19 male; age, 48.7 ± 13.8 years) with elbow pain at a field strength of 3 T. The ECRB tendon and muscle were segmented to obtain mean T2* values and conventional proton-density MRI signal. Elbows were grouped by a qualitative radiologic grading scale of increasing LE severity (0, no degeneration; 1, degeneration; 2, partial tear; 3, full-thickness tear). T2* and PD values were compared between groups using Wilcoxon rank-sum tests and against each other with Spearman's rank correlation.

Results: Mean T2* was significantly higher in partially torn tendon (15.3 ms) versus normal and degenerated tendon (7.70 ms, P < 0.01). Mean T2* was also higher in partially torn tendon (15.3 ms) versus degenerated tendon (8.32 ms, P = 0.04). The correlation coefficient between T2* and PD was moderate at r = 0.624 (P < 0.01).

Conclusion: T2* differentiates between tendon severity grades and may provide additional information to conventional MRI scan assessment for increased sensitivity to tendon changes in LE.

Clinical relevance: T2* UTE may detect early changes in LE as a quantitative basis for making objective return-to-play or treatment decisions.

Background: For competitive adolescent athletes, injury avoidance is a challenge, and causes of injury are complex and multifactorial. Despite an incidence of 8.2 shoulder injuries per 1,000 hours of tennis played, few studies have investigated the association between shoulder strength, range of motion (ROM), and injury.

Hypothesis: Eccentric and isometric shoulder muscle strength and/or shoulder ROM are associated with new shoulder complaints and/or injuries.

Study design: Cohort study.

Level of evidence: Level 3.

Methods: At baseline 301 adolescent competitive tennis players aged 13 to 19 years completed a questionnaire, were assessed with a shoulder protocol for strength and ROM and followed weekly (for shoulder complaint/injury) for 52 consecutive weeks. Outcomes were a first incidence of a tennis-related shoulder complaint or injury in the dominant arm, defined as a sum score of ≥20 or ≥40, respectively, on the Oslo Overuse Injury Questionnaire. Two cohorts were created for Cox regression analyses, adjusted for age, sex, and playing level: (1) shoulder complaints (n = 204), and (2) shoulder injuries (n = 252).

Results: The most definitive adjusted associations were a hazard rate ratio (HRR) of 1.3 (95% CI 1.0-1.8) for a shoulder complaint in eccentric external rotation (eccER) strength, and a HRR for shoulder injuries of 1.4 (95% CI 1.0-1.9) in isometric internal rotation (IIR) strength in the 90-90 position, and 1.5 (95% CI 1.1-2.0) in eccER normalized to body mass.

Conclusion: Higher values of eccER shoulder strength, IIR strength at the 90-90 position, and eccER shoulder strength normalized to body mass, were associated with shoulder complaints/injuries in adolescent competitive tennis players.

Clinical relevance: Incorporating a training program that takes volume and intensity into account in the daily oncourt sessions, to build resilience through a well-planned, long-term training and competition plan to minimize shoulder injury risk may be of importance.