Sports Health-A Multidisciplinary Approach最新文献

Background: Large language model (LLM)-based artificial intelligence (AI) chatbots, such as ChatGPT and Gemini, have become widespread sources of information. Few studies have evaluated LLM responses to questions about orthopaedic conditions, especially osteochondritis dissecans (OCD).

Hypothesis: ChatGPT and Gemini will generate accurate responses that align with American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines.

Study design: Cohort study.

Level of evidence: Level 2.

Methods: LLM prompts were created based on AAOS clinical guidelines on OCD diagnosis and treatment, and responses from ChatGPT and Gemini were collected. Seven fellowship-trained orthopaedic surgeons evaluated LLM responses on a 5-point Likert scale, based on 6 categories: relevance, accuracy, clarity, completeness, evidence-based, and consistency.

Results: ChatGPT and Gemini exhibited strong performance across all criteria. ChatGPT mean scores were highest for clarity (4.771 ± 0.141 [mean ± SD]). Gemini scored highest for relevance and accuracy (4.286 ± 0.296, 4.286 ± 0.273). For both LLMs, the lowest scores were for evidence-based responses (ChatGPT, 3.857 ± 0.352; Gemini, 3.743 ± 0.353). For all other categories, ChatGPT mean scores were higher than Gemini scores. The consistency of responses between the 2 LLMs was rated at an overall mean of 3.486 ± 0.371. Inter-rater reliability ranged from 0.4 to 0.67 (mean, 0.59) and was highest (0.67) in the accuracy category and lowest (0.4) in the consistency category.

Conclusion: LLM performance emphasizes the potential for gathering clinically relevant and accurate answers to questions regarding the diagnosis and treatment of OCD and suggests that ChatGPT may be a better model for this purpose than the Gemini model. Further evaluation of LLM information regarding other orthopaedic procedures and conditions may be necessary before LLMs can be recommended as an accurate source of orthopaedic information.

Clinical relevance: Little is known about the ability of AI to provide answers regarding OCD.

Background: Lateral epicondylitis is caused by overuse and manifests as pain, weakness, and difficulty with object manipulation. Platelet-rich plasma (PRP) and dextrose injections have shown promise in reducing pain and improving function.

Hypothesis: PRP is more effective for force precision control of the extensor carpi radialis brevis (ECRB) muscle than dextrose injection for patients with chronic lateral epicondylitis (CLE).

Study design: Randomized, double-blinded clinical trial.

Level of evidence: Level 1.

Methods: A total of 62 participants (25 healthy subjects and 37 CLE patients) were assigned randomly to either PRP (19) or dextrose (18) groups. Assessments included maximal voluntary contraction (MVC), wrist extension force, questionnaires, sonography, and electromyography assessments.

Results: PRP and dextrose had similar effects on clinical questionnaire scores. Compared with pre-test values, only PRP demonstrated a significant increase in MVC (PRP, 75.3 ± 107.7%; P < 0.01; dextrose, 34.0 ± 66.1%; P = 0.08), and greater reduction in force fluctuations (PRP, -27.4 ± 13.3%; P < 0.01; dextrose, -5.4 ± 33.2%; P = 0.22) during post-test wrist extension. After treatment, the PRP group experienced a roughly 41.7% increase in motor units (MUs) with recruitment thresholds (Rec_TH) (pre-test, 3.67 ± 6.15% MVC; post-test, 5.20 ± 8.02% MVC; P < 0.01). The dextrose group showed no significant change (-3.74%) in MU Rec_THs (pre-test, 3.48 ± 6.80% MVC; post-test, 3.35 ± 6.62% MVC; P = 0.75). PRP increased the MU discharge rate with Rec_THs at <30% MVC, whereas dextrose administration elevated MU discharge rate with Rec_THs >20% MVC.

Conclusion: PRP may be more effective than dextrose in improving neuromuscular control of the ECRB muscle, particularly for enhancing the scaling of force during wrist extension, attributed to distinct MU activation strategies.

Clinical relevance: Detailed comparison and head-to-head analysis of PRP and dextrose injections offers more options for patients considering injections.

Background: There is growing awareness that back pain in adolescent soccer (European football) players is not always related to local tissue damage. Approaches taking into consideration lifestyle factors are needed. This study aimed to investigate the association between psychological distress, skipped meals, and insufficient sleep, and the occurrence of back pain among adolescent female soccer players.

Hypothesis: Psychological distress, skipped meals, and insufficient sleep are associated with the occurrence of back pain.

Study design: Cohort study.

Level of evidence: Level 3.

Methods: Swedish adolescent female soccer players aged 12 to 17 years, without back pain at baseline, were included. The exposures psychological distress, skipped meals, and insufficient sleep were assessed at baseline. The players were followed for 1 year with a weekly web-based survey, where back pain intensity was measured on a numeric rating scale (NRS) ranging from 0 to 10. The outcome back pain was defined as reporting low back pain and/or upper back/neck pain intensity of ≥4 on the NRS. Multivariable Cox proportional hazard regression analyses were performed to estimate the hazard rate ratio (HRR) with 95% CI for the association between each exposure and the outcome back pain, adjusted for age at baseline and parents' education.

Results: In total, 351 players were included, and 141 players reported back pain at some point during the 1-year follow-up. The adjusted HRR for back pain was 1.79 (95% CI, 1.11-2.91) for insufficient sleep, 1.45 (95% CI, 0.97-2.17) for psychological distress, and 0.98 (95% CI, 0.61-1.59) for skipped meals.

Conclusion: Insufficient sleep and psychological distress are associated with the occurrence of back pain among female adolescent soccer players.

Clinical relevance: Our results contribute to the understanding of what may influence the occurrence of back pain in adolescence, offering potential strategies for the prevention of back pain in adolescent female soccer players.

Background: Achilles tendinopathy (AT) is a prevalent musculoskeletal injury among runners, accounting for approximately 10% of all running-related injuries. AT can result in persistent symptoms and impact the quality of life of runners. The Victorian Institute of Sport Assessment questionnaire (VISA-A) is a widely used self-reported tool for assessing severity of AT. However, the anatomic, biomechanical, psychological, and social factors that influence its score are still poorly understood. The aim of this study is to identify the factors that explain the severity of AT based on the VISA-A score in runners experiencing acute AT.

Hypothesis: The VISA-A score will be explained by both biological and psychosocial factors.

Study design: Cross-sectional study.

Level of evidence: Level 4.

Methods: Runners with AT were assessed within 3 months of symptoms onset. The potential explanatory factors assessed included sociodemographic characteristics and medical history, as well as psychosocial, physical, and anatomic (ultrasound imaging) variables.

Results: Participants with AT (n = 84) demonstrated moderate impairments, with a mean VISA-A score of 62.8 (SD, 15.1). Three variables emerged as significant factors explaining AT severity: higher level of kinesiophobia and pain catastrophizing, pain during single-leg jumps, and increased cross-sectional Achilles tendon area on ultrasound imaging. These 3 variables had a moderate capacity (R² = 0.47) to explain the VISA-A score.

Conclusion: Pain during single-leg jumps, an increased cross-sectional tendon area assessed by ultrasound, and a high score on kinesiophobia and pain catastrophizing questions are associated with higher VISA scores.

Clinical relevance: These findings provide the basis for the development of more tailored interventions to improve the quality of life and function of runners with acute AT.

Context: There is need for an up-to-date comprehensive review of baseball interval throwing programs in the literature.

Objective: To (1) understand the origin and basis of interval throwing programs; (2) evaluate the content of programs in the peer-reviewed literature including target audience, initiation criteria, throwing specifics, arm care, and performance evaluation metrics; (3) classify these variables as well defined, ambiguous, or missing; and (4) analyze variability in key aspects including starting criteria, length, progression, and completion criteria.

Data sources: Medline, Embase, Cochrane Reviews, Web of Science, and ScopusStudy Selection:The full text of studies, in English, had to be available. Included studies had to contain a complete interval throwing program designed for baseball players.

Study design: Systematic review.

Level of evidence: Level 4.

Data extraction: Initial screening was conducted based on article title and abstract. Full text of the remaining articles was evaluated for fulfillment of inclusion criteria.

Results: Nine studies initially met inclusion criteria. The programs' comprehensiveness was poor, with a mean Interval Throwing Program Checklist score of 20 (range 14-23) on a scale of 0 to 30. There were a variety of components, including progressive long toss, weighted ball, and throwing mechanics exercises. The programs identified had significant heterogeneity in duration, intensity, progression, and focus. Overall, there was a significant lack of attempts at validation or formal study of efficacy for published throwing programs.

Conclusion: Current published interval throwing programs are mostly variations of an original program published many years ago and were based on principles of progressive loading with pain as sign of injury that should be monitored carefully. However, these programs have minimal clinical validation and objective measures to quantify their effectiveness. This work identifies several limitations in the current literature and can serve as a foundation for future development of evidence-based interval throwing programs.

Background: Elite gymnasts are exposed to high levels of physical stress, during both childhood and adolescence, with significantly late maturation and high injury prevalence. Here, we compare the physiological characteristics of female gymnasts in 2 age groups: young (9-12 years) and adolescent (≥13 years) in 3 disciplines of competitive gymnastics.

Hypothesis: Participants' physiological characteristics will differ by age group and by gymnastic discipline.

Study design: Cohort study.

Level of evidence: Level 2.

Methods: The study included 274 gymnasts, aged 11.8 ± 1.9 years. Data collection included anthropometric measures, Tanner stage, and menarche age; ultrasound assessments were used to assess bone properties, including bone strength, skeletal age, and final-height prediction.

Results: Univariate analysis of variance showed age × discipline interactions for body mass index (BMI) percentiles (F_{(2, 266)} = 4.379; P = 0.01), skeletal age (F_{(2, 241)} = 3.808; P = 0.02), and final-height prediction (F_{(2, 240)} = 3.377, P = 0.04). Moreover, in both age groups, artistic gymnasts exhibited significantly higher BMI percentiles than rhythmic gymnasts (P < 0.05). In the adolescent group, final-height prediction for rhythmic gymnasts was significantly greater than that of artistic gymnasts (P < 0.05). Finally, in adolescent gymnasts, regression lines showed that skeletal age was lower than chronological age (P < 0.05).

Conclusion: Artistic gymnasts were shorter than rhythmic and acrobatic gymnasts. Despite similar BMI and body fat, maturity patterns, and training-volume history, artistic gymnasts had lower bone-strength than rhythmic and acrobatic gymnasts. Combined with their high-impact and intensive training, this could increase their risk of musculoskeletal injuries.

Clinical relevance: The current study may help athletic trainers and medical teams define "norms" for different age groups and gymnastic disciplines, based on what may be expected during the athletes' early and late maturation. This knowledge can be used to modify, individualize, and optimize training programs.

Background: Engaging in physical exercise is recommended to enhance cardiovascular health and manage blood sugar levels in people with type 1 diabetes (T1D).

Hypothesis: The impact of high-intensity interval exercise with elastic bands (EB-HIIE) versus continuous moderate-intensity aerobic exercise (CONT) on glycemic control is different in men with T1D.

Study design: Crossover study design.

Level of evidence: Level 3.

Methods: Participants (39 men with T1D) underwent either an EB-HIIE or a CONT session in randomized order, with a separation of ≥72 hours to avoid carry-over effects. Changes in glucose values during exercise were measured simultaneously from venous blood (YSI) and interstitial fluid (Dexcom G6 glucose sensor). Subsequent 24-hour glucose was monitored using the glucose sensor.

Results: Blood glucose was lower in CONT vs EB-HIIE (P < .01). Post hoc analysis revealed clinically relevant differences during exercise (-35.1 mg/dl; P = .02), at its end (-49.5 mg/dl; P < .01), and at 10 and 20 minutes after completion (-51.2 mg/dl; P < .01 and -45.9 mg/dl; P < .01, respectively). Time-in-range 24 hours after exercise completion was significantly higher with EB-HIIE than with CONT (66.5% vs 59.3%), although both were significantly better than the previous 24 hours before exercise (50%).

Conclusion: Results suggest that EB-HIIE is a safe training method for male adults with diabetes, resulting in euglycemia during and immediately after exercise and improving glucose outcomes in the subsequent 24 hours.

Clinical relevance: This study provides new evidence and practical information on how to implement safe physical activity in daily life of patients with diabetes. EB-HIIT exhibited lower hypoglycemia risk during exercise and better glycemic control in the subsequent 24 hours. In contrast, practicing CONT exercise is associated with higher risk of hypoglycemia. Healthcare providers should take this information into account when prescribing exercise.

Background: Lower extremity muscle tears are common sports injuries. The British Athletics Muscle Injury Classification (BAMIC) may provide clinical guidance for tears although its value in American football and college athletes is unknown.

Hypothesis: Clinical outcomes, specifically time to return to play (RTP) (TRTP), in college American football athletes with activity-related hamstring (HS) and quadriceps (QD) tears will be associated with BAMIC.

Study design: Retrospective cohort study.

Level of evidence: Level 3.

Methods: American football college athletes who sustained a HS or QD tear and underwent magnetic resonance imaging within 7 days at 1 institution during the 2023 season were included. TRTP and reinjury rate (RIR) for HS and QD tears classified by BAMIC and injury characteristics were evaluated.

Results: Of the 24 HS and 10 QD tears in 21 (17.3%) of 121 athletes (20 ± 1.2 years; 100.0% male), most (60.0%) were BAMIC 2a-3b. Most (89.3%) injuries occurred before the season, and all occurred in practice. Overall median TRTP was 26 days (interquartile range, 17.8-33.0), translating to about 4 weeks missed play. The RIR was 19.0% (4/21). Most (75.0%) reinjuries occurred before RTP. There was no significant relationship between BAMIC and TRTP, although TRTP was less for grade 0 injuries and greater TRTP for injury site "c," albeit with small effect sizes.

Conclusion: Activity-related HS and QD tears are common in American football college athletes, particularly in preseason and practice. Injured athletes missed about 3 to 4 games, regardless of BAMIC, with 1 in 5 athletes suffering a reinjury. There was no relationship between BAMIC or muscle group and TRTP.

Clinical relevance: This appraisal of BAMIC in college and American football athletes highlights the prevalence of muscle tears and the need for prevention. Although BAMIC lacked value in this study, larger studies are needed to evaluate BAMIC in this population.

BackgroundThe elderly US population is growing quickly and staying active longer. However, there is limited information on sports-related injuries in older adults.Hypotheses(1) National estimate and incidence of sports-related orthopaedic injuries in the US elderly population have increased over the last 10 years, (2) types and causes of sports-related injuries in the elderly have changed, and (3) elderly sports-related injuries will increase more than the number of treating physicians by 2040.Study DesignDescriptive epidemiology study.Level of EvidenceLevel 4.Methods:The National Electronic Injury Surveillance System database was used to identify all patients aged ≥65 years with sports-related orthopaedic injuries in US emergency departments from 2012 to 2021. Surgeon and physician estimates were calculated using the Physician Compare database. Population data were obtained from US Census estimates and used to calculate annual incidence rates of injuries and to project total injuries through 2040. Injury characteristics were analyzed using Wilcoxon Rank-Sum tests and Chi-square or Fisher exact tests.ResultsAn estimated 444,078 sports-related orthopaedic injuries occurred in the elderly from 2012 to 2021. There were significant increases in injuries (from 32,573 in 2012 to 50,909 in 2021; P < 0.01) and in the national incidence of injuries (from 78 per 100,000 in 2012 to 91 per 100,000 in 2021; P = 0.01). The number of sports-related injuries in the elderly is projected to reach 111,245 by 2040, an increase of 119% from 2021. The number of orthopaedic surgeons and sports medicine physicians is projected to increase by only 19.7% over the same timeperiod.Conclusion:Sports-related orthopaedic injuries in the elderly are increasing in both number and incidence.Clinical RelevanceOrthopaedic surgeons and other practitioners should be prepared to treat an increasing number of active elderly patients.

Background: Premier Rugby Sevens (PR7S) is a new professional rugby league. Our study aims to examine injury data from PR7S over the last 3 years to clarify the incidence of injury per event and determine any trends within injuries to specific body regions related to both sex and year of competition. Understanding these injury patterns will assure relevant player education campaigns related to injury awareness, inform sex-specific injury prevention strategies, and help medical professionals care for athletes more effectively in future competitions.

Hypothesis: There will be a difference in injury patterns and data between men and women throughout the last 3 years of data.

Study design: Cohort study.

Level of evidence: Level 3.

Methods: This is a cohort study including the whole population of athletes from PR7S from 2021 to 2023. After each of the 9 events, athletes filled out a postevent injury form in Health Insurance Portability and Accountability Act compliant electronic health record with their team athletic trainer which included name, date of birth, event, injury type, and location of injury.

Results: When comparing injury rates year to year, there was a statistically significant increase from 7 to 62 injuries among female athletes (P = 0.004). The number of injuries in male athletes stayed relatively the same. Despite having 432 athletes for both sexes, lower extremity injuries in female athletes have increased each year, whereas male athlete lower extremity injuries have stayed roughly the same throughout the study.

Conclusion: There were statistically more injuries in female athletes compared with male athletes.

Clinical relevance: These results are similar to other studies including other sports showing increased lower extremity injuries among female athletes compared with male athletes. More research needs to be done to evaluate the causes of increased injuries into to develop prevention strategies in rugby and in other sports.