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Rock, paper, scissors: Resolving the conflicting results of randomized trials involving corticosteroid, platelet rich plasma (PRP) and placebo injections 石头、剪刀、布：解决涉及皮质类固醇、富血小板血浆（PRP）和安慰剂注射的随机试验中相互矛盾的结果

JSAMS plus

Pub Date : 2025-01-02 DOI: 10.1016/j.jsampl.2024.100081

John W. Orchard

Objective

To explore whether there is evidence of a rock-paper-scissors phenomenon in injections for various musculoskeletal conditions whereby platelet rich plasma (PRP) injections outperform corticosteroid injections (CSI) in randomized trials, corticosteroid outperforms placebo whereas PRP does not outperform placebo.

Methods

Narrative review searching for examples of musculoskeletal conditions which have high level evidence of this proposed rock-paper-scissors phenomenon.

Results

High quality studies or reviews could be found for lateral epicondylitis (tennis elbow), knee osteoarthritis, rotator cuff tendinopathy and plantar fasciitis suggestive of a rock-paper-scissors phenomenon. This was consistently in the direction of PRP injections having superior results to corticosteroid injections, corticosteroid injections having superior results to placebo, but then evidence that PRP injections were not superior to placebo. The most consistent result of the triumvirate was that PRP injections consistently outperformed corticosteroid injections in the medium-term (4 to 12 months).

Discussion

There appears to be somewhat of a rock-paper-scissors phenomenon for four common musculoskeletal conditions, with the significant limitation that this was a finding of a narrative review, limited by a non-systematic search protocol. The underlying explanation is that PRP is superior to corticosteroid in the medium-term (but not the short-term), corticosteroid is superior to placebo in the short-term (only) with PRP not being superior to placebo in either short- or medium-term in well-blinded trials. The most likely explanation for this phenomenon is that corticosteroid injections are helpful for musculoskeletal conditions in the short term (≤8 weeks) but are actually harmful in the medium-term (3 months and beyond). Systematic reviews which further explore this phenomenon are justified to help provide practical evidence-based advice on when to, if ever, use PRP and corticosteroid injections for musculoskeletal conditions.

目的探讨在各种肌肉骨骼疾病的注射中是否存在石头剪刀布现象的证据，即在随机试验中富血小板血浆（PRP）注射剂优于皮质类固醇注射剂（CSI），皮质类固醇优于安慰剂，而PRP不优于安慰剂。方法通过叙述性综述，寻找具有高水平证据的肌肉骨骼疾病的例子，证明这种提出的石头剪刀布现象。结果对网球肘外上髁炎、膝骨性关节炎、肩袖肌腱病变、足底筋膜炎等提示“石头剪刀布”现象的病例进行了高质量的研究或综述。这与PRP注射的结果优于皮质类固醇注射的结果一致，皮质类固醇注射的结果优于安慰剂，但有证据表明PRP注射并不优于安慰剂。三组最一致的结果是PRP注射在中期（4至12个月）的表现始终优于皮质类固醇注射。讨论对于四种常见的肌肉骨骼疾病，似乎存在某种石头剪刀布现象，但有一个显著的局限性，即这是一项叙述性综述的发现，受非系统搜索协议的限制。潜在的解释是，PRP在中期（但不是短期）优于皮质类固醇，皮质类固醇在短期（仅）优于安慰剂，而PRP在短期或中期盲法试验中都不优于安慰剂。对这一现象最可能的解释是，皮质类固醇注射在短期内（≤8周）对肌肉骨骼疾病有帮助，但在中期（3个月及以上）实际上是有害的。进一步探讨这一现象的系统评价是合理的，有助于提供实用的循证建议，说明何时（如果有的话）使用PRP和皮质类固醇注射治疗肌肉骨骼疾病。

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引用次数: 0

Exploring different interventions for Relative Energy Deficiency in Sport (REDs): A systematic review 探索运动中相对能量缺乏（red）的不同干预措施：一项系统综述

JSAMS plus

Pub Date : 2025-01-02 DOI: 10.1016/j.jsampl.2024.100085

Rosie Rudin , Louisa Harris , Hollie White, Lucy Hammond

Objectives and design

Relative Energy Deficiency in Sport (REDs) is caused by an imbalance in energy intake and expenditure through exercise, which leads to low energy availability. Although awareness of REDs is improving, a synthesis into the available literature to determine the efficacy of different interventions in athletes with REDs is needed. Subsequently, this may inform clinicians and athletes of the most appropriate interventions.

Methods

Medline, Embase and Web of Science databases were searched using keywords and their combinations. Two independent reviewers screened the retrieved studies by title, abstract and full text. The Joanna Briggs Institute critical appraisal tool was used to assess risk of bias. Data were extracted into an excel spreadsheet and a narrative synthesis performed.

Results

The search retrieved 982 papers, and after screening, 11 were eligible for inclusion, including increase in energy intake (n = 3), increase in energy intake and decrease in energy expenditure (n = 1), dietary approaches (n = 1), education and counselling (n = 5) and hormonal intervention (n = 1). Increasing energy intake enabled return of menses, yet did not significantly increase bone mineral density. Dietary approaches significantly improved body image, tension, vigour and depression. Nutrition education improved bone health, energy availability, and eating behaviours in athletes, while hormonal interventions had limited effects on bone mineral density.

Conclusion

Increasing energy intake is essential in the management of REDs and may be more effective when used alongside education and hormonal treatment. Future research is needed to allow better analysis of the efficacy of interventions due to the limited research available.

运动中相对能量不足（relative Energy Deficiency in Sport, red）是由于运动中能量摄入和消耗的不平衡，导致能量可用性低而引起的。虽然对红血球的认识正在提高，但需要综合现有文献来确定不同干预措施对红血球运动员的疗效。随后，这可能会告诉临床医生和运动员最合适的干预措施。方法采用关键词及其组合对medline、Embase和Web of Science数据库进行检索。两名独立审稿人按标题、摘要和全文筛选检索到的研究。使用乔安娜布里格斯研究所的关键评估工具来评估偏倚风险。将数据提取到excel电子表格中，并进行叙事合成。结果共检索到982篇论文，经筛选，纳入11篇，包括能量摄入增加（n = 3）、能量摄入增加和能量消耗减少（n = 1）、饮食方式（n = 1）、教育和咨询（n = 5）和激素干预（n = 1）。增加能量摄入使月经恢复，但骨密度没有显著增加。饮食方法显著改善了身体形象、紧张、活力和抑郁。营养教育改善了运动员的骨骼健康、能量供应和饮食行为，而激素干预对骨密度的影响有限。结论增加能量摄入对红血病的治疗至关重要，与教育和激素治疗相结合可能更有效。由于现有的研究有限，需要进一步的研究来更好地分析干预措施的效果。

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引用次数: 0

Injuries in German national short-track speed skating athletes 德国国家短道速滑运动员的受伤情况

JSAMS plus

Pub Date : 2025-01-02 DOI: 10.1016/j.jsampl.2024.100080

Jan Ziegler , Heidrun Beck , Roland L. Bell , Dominik Matzner , Xinggui Tian , Stefan Zwingenberger

Objectives

Short-Track Speed Skating (STSS) is a high-intensity ice sport characterized by fast-paced races and proximity among athletes, which inherently poses a risk for falls and injuries. This paper presents a comprehensive analysis of orthopedic-traumatological injuries in German national STSS athletes with comparisons to previous studies.

Design

Retrospective analysis.

Methods

Medical records of 69 athletes (30 females, 39 males) who were part of the German national team between 2009 and 2020 were analyzed retrospectively based on a new standardized injury surveillance system published by the International Olympic Committee in 2020.

Results

The average career duration of athletes on the German STSS national team was 10.9 ± 4.4 years, with each athlete accumulating 10,116 ± 4326 h of exposure to risk during training. A total of 371 orthopedic-traumatological injuries requiring medical consultation (IRMCs) were recorded, with an estimated incidence of 0.53 per 1000 h of exposure. 69.8 % of the observed injuries affected the lower extremities, primarily involving the knee and ankle. Joint injuries were the leading cause of IRMCs, accounting for 16.3 % of cases. The majority of IRMCs occurred during on-ice training (45.0 %), followed by off-ice training (30.0 %), and competitions (25.0 %).

Conclusion

This was the first implementation based on a standardized injury surveillance system in STSS. Important information about career-related injuries and injury patterns resulted from the analyses. However, further prospective research is needed to support the prevention of health issues in STSS.

目的短道速滑（STSS）是一项高强度的冰上运动，其特点是比赛节奏快，运动员之间的距离近，这本身就存在摔倒和受伤的风险。本文对德国国家STSS运动员的骨科创伤损伤进行了全面分析，并与以往的研究进行了比较。DesignRetrospective分析。方法基于国际奥委会2020年发布的新的标准化损伤监测系统，对2009 - 2020年德国国家队69名运动员（女30名，男39名）的医疗记录进行回顾性分析。结果德国STSS国家队运动员平均职业生涯时间为10.9±4.4年，每位运动员在训练过程中累积风险暴露时间为10,116±4326小时。总共记录了371例需要医疗咨询的骨科创伤损伤（irmc），估计每1000小时暴露的发生率为0.53。69.8%的损伤发生在下肢，主要是膝关节和踝关节。关节损伤是irmc的主要原因，占16.3%。大多数irmc发生在冰上训练（45.0%），其次是场外训练（30.0%）和比赛（25.0%）。结论这是第一次在STSS中实施标准化的损伤监测系统。从分析中得到了与职业相关的伤害和伤害模式的重要信息。然而，需要进一步的前瞻性研究来支持对STSS健康问题的预防。

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引用次数: 0

Examining concussions in adult male, senior-grade semi-elite rugby league in Australia: A retrospective observational video review case series 检查成年男性脑震荡，高级别半精英橄榄球联赛在澳大利亚：回顾性观察视频回顾病例系列

JSAMS plus

Pub Date : 2025-01-02 DOI: 10.1016/j.jsampl.2024.100086

Martin A. Lang , Grant L. Iverson , Suzi Edwards , Ben Jones , Douglas P. Terry , Andrew J. Gardner

Background

The risk of concussion at the elite level of rugby league has been extensively evaluated. However, there has been very little concussion research conducted at the semi-elite level.

Purpose

To examine cases of medically diagnosed concussion from a single season of adult men's semi-elite rugby league.

Methods

A retrospective review of the 2019 Queensland Cup season head injury assessment surveillance program was completed. All Head Injury Assessment (HIA) cases, including cases of medically diagnosed concussion were retrospectively video reviewed and game play characteristic variables along with video signs of concussion were coded. This data was combined with the return to play data to form the research database.

Results

There were 132 players removed for HIAs in 170 games. There were 36 players medically diagnosed with concussions, which equates to an incidence rate was 6.11 concussions per 1000 player match hours, or one concussion every 4.7 matches. All concussions occurred in a tackle event, where the player was struck in the head/face. Possible balance disturbance was the most commonly observed video sign (97.2 %; 35/36), with slow to stand also commonly observed in concussed players (91.7 %; 33/36). Most concussed players (63.9 %; 23/36) did not miss a game following the concussion.

Conclusion

This is one of the first studies to review video footage of concussions in sub-elite rugby league. These findings build on the growing body of video analysis research in rugby league and suggest that the retrospective review of the video of incidents may offer insights into modifiable risk factors that may help reduce concussion in rugby league.

在橄榄球精英联赛中，脑震荡的风险已被广泛评估。然而，在半精英水平上进行的脑震荡研究很少。目的对成年男子半精英橄榄球联赛单赛季医学诊断的脑震荡病例进行研究。方法对2019年昆士兰杯赛季头部损伤评估监测方案进行回顾性分析。所有脑损伤评估（HIA）病例，包括医学诊断为脑震荡的病例，回顾性地进行视频回顾，并对游戏特征变量以及脑震荡的视频体征进行编码。该数据与回归数据相结合，形成研究数据库。结果在170场比赛中，有132名球员因HIAs被淘汰。有36名球员被医学诊断为脑震荡，相当于每1000名球员比赛小时发生6.11次脑震荡，或每4.7场比赛发生一次脑震荡。所有脑震荡都发生在铲球事件中，球员的头部或面部被击中。可能的平衡障碍是最常见的视频信号(97.2%；35/36)，在脑震荡球员中站立缓慢也很常见(91.7%；33/36)。大多数脑震荡球员(63.9%；23/36)在脑震荡后没有错过任何一场比赛。结论本研究是首次对橄榄球亚精英联赛中脑震荡的录像资料进行回顾研究。这些发现建立在橄榄球联盟中越来越多的视频分析研究的基础上，并表明对事件视频的回顾性审查可能会对有助于减少橄榄球联盟脑震荡的可修改风险因素提供见解。

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