Pub Date : 2024-09-09DOI: 10.1136/bjsports-2024-108222
Rintje Agricola, Michiel M A van Buuren, Joanne L Kemp, Harrie Weinans, Jos Runhaar, Sita M A Bierma-Zeinstra
Objective: The objective is to determine the association and absolute risk of femoroacetabular impingement syndrome (FAIS) for the development of radiographic hip osteoarthritis (RHOA).
Methods: This is a nationwide, multicentre prospective cohort study (Cohort Hip and Cohort Knee) with 1002 individuals aged between 45 and 65 years. Hips without definitive RHOA (Kellgren-Lawrence (KL) grade≤1) at baseline and with anteroposterior pelvic radiographs at baseline and 10-year follow-up available (n=1386 hips) were included. FAIS was defined by the baseline presence of a painful hip, limited internal hip rotation≤25° and cam morphology defined by an alpha angle>60°. The outcomes were incident RHOA (KL grade≥2 or total hip replacement (THR)) and incident end-stage RHOA (KL≥3 or THR) within 10 years.
Results: Of the 1386 included hips (80% women; mean age 55.7±5.2 years), 21 hips fulfilled criteria for FAIS and 563 hips did not fulfil any of the FAIS criteria (reference group; no symptoms, no signs, no cam morphology). Within 10-year follow-up, 221 hips (38%) developed incident RHOA and 15 hips (3%) developed end-stage RHOA (including 9 hips with THR). Adjusted for sex, age and body mass index, FAIS with cam morphology resulted in an OR of 6.85 (95% CI 2.10 to 22.35) for incident RHOA and 47.82 (95% CI 12.51 to 182.76) for incident end-stage RHOA, compared with hips not having any FAIS criteria. The absolute risk of FAIS was 81% for incident RHOA and 33% for incident end-stage RHOA.
Conclusion: FAIS was strongly associated with the development of RHOA within 10 years. Although the baseline prevalence of FAIS was low, the high absolute risk of FAIS for RHOA warrants further studies to determine preventive strategies.
{"title":"Femoroacetabular impingement syndrome in middle-aged individuals is strongly associated with the development of hip osteoarthritis within 10-year follow-up: a prospective cohort study (CHECK).","authors":"Rintje Agricola, Michiel M A van Buuren, Joanne L Kemp, Harrie Weinans, Jos Runhaar, Sita M A Bierma-Zeinstra","doi":"10.1136/bjsports-2024-108222","DOIUrl":"10.1136/bjsports-2024-108222","url":null,"abstract":"<p><strong>Objective: </strong>The objective is to determine the association and absolute risk of femoroacetabular impingement syndrome (FAIS) for the development of radiographic hip osteoarthritis (RHOA).</p><p><strong>Methods: </strong>This is a nationwide, multicentre prospective cohort study (Cohort Hip and Cohort Knee) with 1002 individuals aged between 45 and 65 years. Hips without definitive RHOA (Kellgren-Lawrence (KL) grade≤1) at baseline and with anteroposterior pelvic radiographs at baseline and 10-year follow-up available (n=1386 hips) were included. FAIS was defined by the baseline presence of a painful hip, limited internal hip rotation≤25° and cam morphology defined by an alpha angle>60°. The outcomes were incident RHOA (KL grade≥2 or total hip replacement (THR)) and incident end-stage RHOA (KL≥3 or THR) within 10 years.</p><p><strong>Results: </strong>Of the 1386 included hips (80% women; mean age 55.7±5.2 years), 21 hips fulfilled criteria for FAIS and 563 hips did not fulfil any of the FAIS criteria (reference group; no symptoms, no signs, no cam morphology). Within 10-year follow-up, 221 hips (38%) developed incident RHOA and 15 hips (3%) developed end-stage RHOA (including 9 hips with THR). Adjusted for sex, age and body mass index, FAIS with cam morphology resulted in an OR of 6.85 (95% CI 2.10 to 22.35) for incident RHOA and 47.82 (95% CI 12.51 to 182.76) for incident end-stage RHOA, compared with hips not having any FAIS criteria. The absolute risk of FAIS was 81% for incident RHOA and 33% for incident end-stage RHOA.</p><p><strong>Conclusion: </strong>FAIS was strongly associated with the development of RHOA within 10 years. Although the baseline prevalence of FAIS was low, the high absolute risk of FAIS for RHOA warrants further studies to determine preventive strategies.</p>","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":" ","pages":"1061-1067"},"PeriodicalIF":11.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1136/bjsports-2023-107703
Madison Hayes-Lattin, Laura M Krivicich, Jack T Bragg, Ashley Rogerson, Matthew J Salzler
Orthopaedic and sports medicine clinicians can improve outcomes for transgender patients by understanding the physiological effects of gender-affirming hormone therapy (GAHT). This narrative review investigated the role of GAHT on bone mineral density, fracture risk, thromboembolic risk, cardiovascular health and ligament/tendon injury in this population. A search from the PubMed database using relevant terms was performed. Studies were included if they were levels 1-3 evidence. Due to the paucity of studies on ligament and tendon injury risk in transgender patients, levels 1-3 evidence on the effects of sex hormones in cisgender patients as well as basic science studies were included for these two topics. This review found that transgender patients on GAHT have an elevated fracture risk, but GAHT has beneficial effects on bone mineral density in transgender women. Transgender women on GAHT also have an increased risk of venous thromboembolism, stroke and myocardial infarction compared with cisgender women. Despite these elevated risks, studies have found it is safe to continue GAHT perioperatively for both transgender women and men undergoing low-risk operations. Orthopaedic and sports medicine clinicians should understand these unique health considerations for equitable patient care.
{"title":"Considerations for the care of transgender patients in orthopaedics and sports medicine: a narrative review.","authors":"Madison Hayes-Lattin, Laura M Krivicich, Jack T Bragg, Ashley Rogerson, Matthew J Salzler","doi":"10.1136/bjsports-2023-107703","DOIUrl":"10.1136/bjsports-2023-107703","url":null,"abstract":"<p><p>Orthopaedic and sports medicine clinicians can improve outcomes for transgender patients by understanding the physiological effects of gender-affirming hormone therapy (GAHT). This narrative review investigated the role of GAHT on bone mineral density, fracture risk, thromboembolic risk, cardiovascular health and ligament/tendon injury in this population. A search from the PubMed database using relevant terms was performed. Studies were included if they were levels 1-3 evidence. Due to the paucity of studies on ligament and tendon injury risk in transgender patients, levels 1-3 evidence on the effects of sex hormones in cisgender patients as well as basic science studies were included for these two topics. This review found that transgender patients on GAHT have an elevated fracture risk, but GAHT has beneficial effects on bone mineral density in transgender women. Transgender women on GAHT also have an increased risk of venous thromboembolism, stroke and myocardial infarction compared with cisgender women. Despite these elevated risks, studies have found it is safe to continue GAHT perioperatively for both transgender women and men undergoing low-risk operations. Orthopaedic and sports medicine clinicians should understand these unique health considerations for equitable patient care.</p>","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":" ","pages":"1075-1082"},"PeriodicalIF":11.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141598526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1136/bjsports-2023-107716
Kristin L Popp, Brittany N Bozzini, Marinaliz Reynoso, Jennifer Coulombe, Katelyn I Guerriere, Susan P Proctor, Colleen M Castellani, Leila A Walker, Nicholas Zurinaga, Katherine Kuhn, Stephen A Foulis, Mary L Bouxsein, Julie M Hughes, Nanette Santoro
Objective: Less than half of servicewomen report loss of menses during initial military training. However, self-reported menstrual status may not accurately reflect hypothalamic-pituitary-ovarian (HPO) axis suppression and may underestimate reproductive health consequences of military training. Our aim was to characterise HPO axis function during US Army Basic Combat Training (BCT) in non-hormonal contraceptive-using women and explore potential contributors to HPO axis suppression.
Methods: In this 10-week prospective observational study, we enrolled multi-ethnic women entering BCT. Trainees provided daily first-morning voided urine, and weekly blood samples during BCT. Urinary luteinising hormone, follicle stimulating hormone, and metabolites of estradiol and progesterone were measured by chemiluminescent assays (Siemens Centaur XP) to determine hormone patterns and luteal activity. We measured body composition, via dual-energy X-ray absorptiometry, at the beginning and end of BCT.
Results: Trainees (n=55) were young (mean (95% CI): 22 (22, 23) years) with average body mass index (23.9 (23.1, 24.7) kg/m2). Most trainees (78%) reported regular menstrual cycles before BCT. During BCT, 23 (42%) trainees reported regular menses. However, only seven trainees (12.5%) had menstrual cycles with evidence of luteal activity (ELA) (ie, presumed ovulation), all with shortened luteal phases. 41 trainees (75%) showed no ELA (NELA), and 7 (12.5%) were categorised as indeterminant. Overall, women gained body mass and lean mass, but lost fat mass during BCT. Changes in body mass and composition appear unrelated to luteal activity.
Conclusions: Our findings reveal profound HPO axis suppression with NELA in the majority of women during BCT. This HPO axis suppression occurs among women who report normal menstrual cycles.
{"title":"Hypothalamic-pituitary-ovarian axis suppression is common among women during US Army Basic Combat Training.","authors":"Kristin L Popp, Brittany N Bozzini, Marinaliz Reynoso, Jennifer Coulombe, Katelyn I Guerriere, Susan P Proctor, Colleen M Castellani, Leila A Walker, Nicholas Zurinaga, Katherine Kuhn, Stephen A Foulis, Mary L Bouxsein, Julie M Hughes, Nanette Santoro","doi":"10.1136/bjsports-2023-107716","DOIUrl":"10.1136/bjsports-2023-107716","url":null,"abstract":"<p><strong>Objective: </strong>Less than half of servicewomen report loss of menses during initial military training. However, self-reported menstrual status may not accurately reflect hypothalamic-pituitary-ovarian (HPO) axis suppression and may underestimate reproductive health consequences of military training. Our aim was to characterise HPO axis function during US Army Basic Combat Training (BCT) in non-hormonal contraceptive-using women and explore potential contributors to HPO axis suppression.</p><p><strong>Methods: </strong>In this 10-week prospective observational study, we enrolled multi-ethnic women entering BCT. Trainees provided daily first-morning voided urine, and weekly blood samples during BCT. Urinary luteinising hormone, follicle stimulating hormone, and metabolites of estradiol and progesterone were measured by chemiluminescent assays (Siemens Centaur XP) to determine hormone patterns and luteal activity. We measured body composition, via dual-energy X-ray absorptiometry, at the beginning and end of BCT.</p><p><strong>Results: </strong>Trainees (n=55) were young (mean (95% CI): 22 (22, 23) years) with average body mass index (23.9 (23.1, 24.7) kg/m<sup>2</sup>). Most trainees (78%) reported regular menstrual cycles before BCT. During BCT, 23 (42%) trainees reported regular menses. However, only seven trainees (12.5%) had menstrual cycles with evidence of luteal activity (ELA) (ie, presumed ovulation), all with shortened luteal phases. 41 trainees (75%) showed no ELA (NELA), and 7 (12.5%) were categorised as indeterminant. Overall, women gained body mass and lean mass, but lost fat mass during BCT. Changes in body mass and composition appear unrelated to luteal activity.</p><p><strong>Conclusions: </strong>Our findings reveal profound HPO axis suppression with NELA in the majority of women during BCT. This HPO axis suppression occurs among women who report normal menstrual cycles.</p>","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":" ","pages":"1052-1060"},"PeriodicalIF":11.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1136/bjsports-2024-108408
Sara Lynn Terrell, James Lynch
{"title":"Mission impossible-maybe not? Preventing hip osteoarthritis in athletes.","authors":"Sara Lynn Terrell, James Lynch","doi":"10.1136/bjsports-2024-108408","DOIUrl":"10.1136/bjsports-2024-108408","url":null,"abstract":"","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":" ","pages":"1087-1088"},"PeriodicalIF":11.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141589673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1136/bjsports-2024-108731
Aminah Amer
{"title":"Rehabilitation from the perspective of a hijabi: a tale of finding myself while navigating unchartered territory-Dr Aminah Amer.","authors":"Aminah Amer","doi":"10.1136/bjsports-2024-108731","DOIUrl":"10.1136/bjsports-2024-108731","url":null,"abstract":"","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":" ","pages":"1091-1092"},"PeriodicalIF":11.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141533600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1136/bjsports-2024-108127
Tong Zhao, Qize Yang, Joshua F Feuerbacher, Bizhu Yu, Christian Brinkmann, Sulin Cheng, Wilhelm Bloch, Moritz Schumann
Objective To compare the efficacy of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control. Design Systematic review and network meta-analysis. Data sources Embase, Web of Science, PubMed/MEDLINE and SPORTDiscus. Eligibility criteria Randomised controlled trials involving exercise, metformin or their combined treatments in individuals with prediabetes or type 2 diabetes mellitus (T2DM) were included. Outcomes included haemoglobin A1c (HbA1c), 2-hour glucose during oral glucose tolerance test, fasting glucose, fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR). Results 407 articles with 410 randomised controlled trials (n=33 802) were included. In prediabetes, the exercise showed greater efficacy than metformin on HbA1c levels (mean difference −0.16%, 95% CI (−0.23 to −0.09) vs −0.10%, 95% CI (−0.21 to 0.02)), 2-hour glucose (−0.68 mmol/L, 95% CI (−0.97 to −0.39) vs 0.01 mmol/L, 95% CI (−0.38 to 0.41)) and HOMA-IR (−0.54, 95% CI (−0.71 to −0.36) vs −0.23, 95% CI (−0.55 to 0.10)), while the efficacy on fasting glucose was comparable (−0.26 mmol/L, 95% CI (−0.32 to −0.19) vs −0.33 mmol/L, 95% CI (−0.45 to −0.21)). In T2DM, metformin was more efficacious than exercise on HbA1c (−0.88%, 95% CI (−1.07 to −0.69) vs −0.48%, 95% CI (−0.58 to −0.38)), 2-hour glucose (−2.55 mmol/L, 95% CI (−3.24 to −1.86) vs −0.97 mmol/L, 95% CI (−1.52 to −0.42)) and fasting glucose (−1.52 mmol/L, 95% CI (−1.73 to −1.31) vs −0.85 mmol/L, 95% CI (−0.96 to −0.74)); exercise+metformin also showed greater efficacy in improving HbA1c (−1.23%, 95% CI (−2.41 to –0.05)) and fasting glucose (−2.02 mmol/L, 95% CI (−3.31 to –0.74)) than each treatment alone. However, the efficacies were modified by exercise modality and metformin dosage. Conclusion Exercise, metformin and their combination are efficacious in improving glucose metabolism in both prediabetes and T2DM. The efficacy of exercise appears to be superior to metformin in prediabetes, but metformin appears to be superior to exercise in patients with T2DM. PROSPERO registration number CRD42023400622. Data are available upon reasonable request. Data are available on reasonable request by contacting the corresponding author.
目的 比较运动、二甲双胍及其联合用药对血糖控制异常者糖代谢的疗效。设计 系统综述和网络荟萃分析。数据来源：Embase、Web of Science、PubMed/MEDLINE 和 SPORTDiscus。资格标准 纳入对糖尿病前期或 2 型糖尿病 (T2DM) 患者进行运动、二甲双胍或其联合治疗的随机对照试验。结果包括血红蛋白 A1c (HbA1c)、口服葡萄糖耐量试验中的 2 小时血糖、空腹血糖、空腹胰岛素和胰岛素抵抗稳态模型评估 (HOMA-IR)。结果 共纳入 407 篇文章，410 项随机对照试验（n=33 802）。在糖尿病前期，运动对 HbA1c 水平（平均差 -0.16%，95% CI (-0.23 to -0.09)对 -0.10%，95% CI (-0.21 to 0.02)）、2 小时血糖（-0.68 mmol/L，95% CI (-0.97 to -0.39)对 0.01 mmol/L，95% CI (-0. 38 to 0.41)和胰岛素抵抗（HOMA-IR）的疗效高于二甲双胍。38至0.41））和HOMA-IR（-0.54，95% CI（-0.71至-0.36） vs -0.23，95% CI（-0.55至0.10）），而对空腹血糖的疗效相当（-0.26 mmol/L，95% CI（-0.32至-0.19） vs -0.33 mmol/L，95% CI（-0.45至-0.21））。在 T2DM 患者中，二甲双胍对 HbA1c（-0.88%，95% CI（-1.07 至 -0.69） vs -0.48%，95% CI（-0.58 至 -0.38））、2 小时血糖（-2.55 mmol/L，95% CI（-3.24 至 -1.86） vs -0.97 mmol/L，95% CI（-1.52 至 -0.42））和空腹血糖（-1.52 mmol/L，95% CI (-1.73 to -1.31) vs -0.85 mmol/L，95% CI (-0.96 to -0.74)）；运动+二甲双胍在改善 HbA1c（-1.23%，95% CI (-2.41 to -0.05)）和空腹血糖（-2.02 mmol/L，95% CI (-3.31 to -0.74)）方面的疗效也优于单独使用每种治疗方法。然而，运动方式和二甲双胍剂量会影响疗效。结论 运动、二甲双胍和它们的组合对改善糖尿病前期和 T2DM 患者的糖代谢都有疗效。对于糖尿病前期患者，运动的疗效似乎优于二甲双胍，但对于 T2DM 患者，二甲双胍的疗效似乎优于运动。PROSPERO 注册号为 CRD42023400622。如有合理要求，可提供数据。如需数据，请联系通讯作者。
{"title":"Effects of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control: a systematic review and network meta-analysis","authors":"Tong Zhao, Qize Yang, Joshua F Feuerbacher, Bizhu Yu, Christian Brinkmann, Sulin Cheng, Wilhelm Bloch, Moritz Schumann","doi":"10.1136/bjsports-2024-108127","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108127","url":null,"abstract":"Objective To compare the efficacy of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control. Design Systematic review and network meta-analysis. Data sources Embase, Web of Science, PubMed/MEDLINE and SPORTDiscus. Eligibility criteria Randomised controlled trials involving exercise, metformin or their combined treatments in individuals with prediabetes or type 2 diabetes mellitus (T2DM) were included. Outcomes included haemoglobin A1c (HbA1c), 2-hour glucose during oral glucose tolerance test, fasting glucose, fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR). Results 407 articles with 410 randomised controlled trials (n=33 802) were included. In prediabetes, the exercise showed greater efficacy than metformin on HbA1c levels (mean difference −0.16%, 95% CI (−0.23 to −0.09) vs −0.10%, 95% CI (−0.21 to 0.02)), 2-hour glucose (−0.68 mmol/L, 95% CI (−0.97 to −0.39) vs 0.01 mmol/L, 95% CI (−0.38 to 0.41)) and HOMA-IR (−0.54, 95% CI (−0.71 to −0.36) vs −0.23, 95% CI (−0.55 to 0.10)), while the efficacy on fasting glucose was comparable (−0.26 mmol/L, 95% CI (−0.32 to −0.19) vs −0.33 mmol/L, 95% CI (−0.45 to −0.21)). In T2DM, metformin was more efficacious than exercise on HbA1c (−0.88%, 95% CI (−1.07 to −0.69) vs −0.48%, 95% CI (−0.58 to −0.38)), 2-hour glucose (−2.55 mmol/L, 95% CI (−3.24 to −1.86) vs −0.97 mmol/L, 95% CI (−1.52 to −0.42)) and fasting glucose (−1.52 mmol/L, 95% CI (−1.73 to −1.31) vs −0.85 mmol/L, 95% CI (−0.96 to −0.74)); exercise+metformin also showed greater efficacy in improving HbA1c (−1.23%, 95% CI (−2.41 to –0.05)) and fasting glucose (−2.02 mmol/L, 95% CI (−3.31 to –0.74)) than each treatment alone. However, the efficacies were modified by exercise modality and metformin dosage. Conclusion Exercise, metformin and their combination are efficacious in improving glucose metabolism in both prediabetes and T2DM. The efficacy of exercise appears to be superior to metformin in prediabetes, but metformin appears to be superior to exercise in patients with T2DM. PROSPERO registration number CRD42023400622. Data are available upon reasonable request. Data are available on reasonable request by contacting the corresponding author.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"9 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142144266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1136/bjsports-2023-106722
Robin Vermeulen, Nicol van Dyk, Rod Whiteley, Karim Chamari, Warren Gregson, Lorenzo Lolli, Roald Bahr, Johannes L Tol, Andreas Serner
Objective To describe and categorise the injury-inciting circumstances of sudden-onset hamstring match injuries in professional football players using systematic video analysis. Methods Using a prospective injury surveillance database, all sudden-onset hamstring match injuries in male football players (18 years and older) from the Qatar Stars League between September 2013 and August 2020 were reviewed and cross-referenced with broadcasted match footage. Videos with a clear observable painful event (ie, a player grabbing their posterior thigh) were included. Nine investigators independently analysed all videos to describe and categorise injury-inciting circumstances. We used three main categories: playing situation (eg, time of injury), player action(s) (eg, running) and other considerations (eg, contact). Player action(s) and other considerations were not mutually exclusive. Results We included 63 sudden-onset hamstring match injuries out of 295 registered injuries between 2013 and 2020. Running was involved in 86% of injuries. Hamstring injuries occurred primarily during acceleration of 0–10 m (24% of all injuries) and in general at different running distances (0–50 m) and speeds (slow to fast). At 0–10 m distance, indirect player-to-player contact and inadequate balance were involved in 53% and 67% of the cases, respectively. Pressing occurred in 46% of all injuries (injured player pressing opponent: 25%; being pressed by opponent: 21%) and frequently involved player-to-player contact (69% of the cases when the injured player was pressing vs 15% of the cases when the opponent was pressing) and inadequate balance (82% vs 50%, respectively). Other player actions that did not involve running (n=9, 14% of all injuries) were kicking (n=6) and jumping (n=3). Conclusion The injury-inciting circumstances of sudden-onset hamstring match injuries in football varied. The most common single-player action (24%) was acceleration over a distance of <10 m. Pressing, inadequate balance and indirect contact were frequently seen player actions. Injury prevention research in football should look beyond high-speed running as the leading risk factor for sudden-onset hamstring injuries. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Not applicable.
{"title":"Injury-inciting circumstances of sudden-onset hamstring injuries: video analyses of 63 match injuries in male professional football players in the Qatar Stars League (2013–2020)","authors":"Robin Vermeulen, Nicol van Dyk, Rod Whiteley, Karim Chamari, Warren Gregson, Lorenzo Lolli, Roald Bahr, Johannes L Tol, Andreas Serner","doi":"10.1136/bjsports-2023-106722","DOIUrl":"https://doi.org/10.1136/bjsports-2023-106722","url":null,"abstract":"Objective To describe and categorise the injury-inciting circumstances of sudden-onset hamstring match injuries in professional football players using systematic video analysis. Methods Using a prospective injury surveillance database, all sudden-onset hamstring match injuries in male football players (18 years and older) from the Qatar Stars League between September 2013 and August 2020 were reviewed and cross-referenced with broadcasted match footage. Videos with a clear observable painful event (ie, a player grabbing their posterior thigh) were included. Nine investigators independently analysed all videos to describe and categorise injury-inciting circumstances. We used three main categories: playing situation (eg, time of injury), player action(s) (eg, running) and other considerations (eg, contact). Player action(s) and other considerations were not mutually exclusive. Results We included 63 sudden-onset hamstring match injuries out of 295 registered injuries between 2013 and 2020. Running was involved in 86% of injuries. Hamstring injuries occurred primarily during acceleration of 0–10 m (24% of all injuries) and in general at different running distances (0–50 m) and speeds (slow to fast). At 0–10 m distance, indirect player-to-player contact and inadequate balance were involved in 53% and 67% of the cases, respectively. Pressing occurred in 46% of all injuries (injured player pressing opponent: 25%; being pressed by opponent: 21%) and frequently involved player-to-player contact (69% of the cases when the injured player was pressing vs 15% of the cases when the opponent was pressing) and inadequate balance (82% vs 50%, respectively). Other player actions that did not involve running (n=9, 14% of all injuries) were kicking (n=6) and jumping (n=3). Conclusion The injury-inciting circumstances of sudden-onset hamstring match injuries in football varied. The most common single-player action (24%) was acceleration over a distance of <10 m. Pressing, inadequate balance and indirect contact were frequently seen player actions. Injury prevention research in football should look beyond high-speed running as the leading risk factor for sudden-onset hamstring injuries. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Not applicable.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"48 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142144267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1136/bjsports-2024-108260
Branimir Ivanic, Anna Cronström, Kajsa Johansson, Eva Ageberg
Objective To review the efficacy of exercise interventions on sport-related concussion (SRC) incidence, as well as on linear and rotational head accelerations, and isometric neck strength and to assess reporting completeness of exercise interventions using the Consensus on Exercise Reporting Template (CERT). Design Systematic review and meta-analysis, according to the Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science guidelines. Data sources Six databases (MEDLINE, Embase, CINAHL, Scopus, Web of Science CC and SPORTDiscus) were searched up to 26 June 2023. Eligibility criteria for selecting studies Randomised controlled trials (RCTs), cluster RCTs or quasi-experimental studies, evaluating exercise interventions on SRC incidence, linear and rotational head accelerations, and/or isometric neck strength in male and/or female athletes of any age, and/or in a healthy general population. Results A total of 26 articles were included. A large effect size was observed for resistance training (RT) on isometric neck strength (standardised mean difference (SMD) 0.85; 95% CI 0.57 to 1.13; high-quality evidence). Non-significant effect sizes were observed for neuromuscular warm-up programmes on SRC incidence (risk ratio 0.69; 95% CI 0.39 to 1.23; low-quality evidence), or for RT on linear head acceleration (SMD −0.43; 95% CI −1.26 to 0.40; very low-quality evidence) or rotational head acceleration (SMD 0.08; 95% CI −0.61 to 0.77; low-quality evidence). No studies assessed the impact of RT on SRC incidence. CERT scores ranged from 4 to 16 (out of 19) with median score of 11.5 (IQR 9–13). Conclusion RT increases isometric neck strength, but the effect on SRC incidence is unknown. More adequately powered and rigorous trials are needed to evaluate the effect of exercise interventions on SRC incidence, and on linear and rotational head accelerations. Future studies should follow CERT guidelines, as the included interventions were generally not reported in sufficient detail for accurate replication. PROSPERO registration number CRD42023435033. All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.
{"title":"Efficacy of exercise interventions on prevention of sport-related concussion and related outcomes: a systematic review and meta-analysis","authors":"Branimir Ivanic, Anna Cronström, Kajsa Johansson, Eva Ageberg","doi":"10.1136/bjsports-2024-108260","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108260","url":null,"abstract":"Objective To review the efficacy of exercise interventions on sport-related concussion (SRC) incidence, as well as on linear and rotational head accelerations, and isometric neck strength and to assess reporting completeness of exercise interventions using the Consensus on Exercise Reporting Template (CERT). Design Systematic review and meta-analysis, according to the Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science guidelines. Data sources Six databases (MEDLINE, Embase, CINAHL, Scopus, Web of Science CC and SPORTDiscus) were searched up to 26 June 2023. Eligibility criteria for selecting studies Randomised controlled trials (RCTs), cluster RCTs or quasi-experimental studies, evaluating exercise interventions on SRC incidence, linear and rotational head accelerations, and/or isometric neck strength in male and/or female athletes of any age, and/or in a healthy general population. Results A total of 26 articles were included. A large effect size was observed for resistance training (RT) on isometric neck strength (standardised mean difference (SMD) 0.85; 95% CI 0.57 to 1.13; high-quality evidence). Non-significant effect sizes were observed for neuromuscular warm-up programmes on SRC incidence (risk ratio 0.69; 95% CI 0.39 to 1.23; low-quality evidence), or for RT on linear head acceleration (SMD −0.43; 95% CI −1.26 to 0.40; very low-quality evidence) or rotational head acceleration (SMD 0.08; 95% CI −0.61 to 0.77; low-quality evidence). No studies assessed the impact of RT on SRC incidence. CERT scores ranged from 4 to 16 (out of 19) with median score of 11.5 (IQR 9–13). Conclusion RT increases isometric neck strength, but the effect on SRC incidence is unknown. More adequately powered and rigorous trials are needed to evaluate the effect of exercise interventions on SRC incidence, and on linear and rotational head accelerations. Future studies should follow CERT guidelines, as the included interventions were generally not reported in sufficient detail for accurate replication. PROSPERO registration number CRD42023435033. All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"9 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142144240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1136/bjsports-2024-108089
Iain Robert Murray, Navnit S Makaram, Andrew G Geeslin, Jorge Chahla, Gilbert Moatshe, Kay Crossley, Michelle E Kew, Aileen Davis, Maria Tuca, Hollis Potter, Dina C Janse van Rensburg, Carolyn A Emery, SeungPyo Eun, Hege Grindem, Frank R Noyes, Robert G Marx, Chris Harner, Bruce A Levy, Enda King, James L Cook, Daniel B Whelan, George F Hatch, Christopher J Wahl, Kristian Thorborg, James J Irrgang, Nicolas Pujol, Michael J Medvecky, Michael J Stuart, Aaron J Krych, Lars Engebretsen, James P Stannard, Peter MacDonald, Romain Seil, Gregory C Fanelli, Travis G Maak, K Donald Shelbourne, Evert Verhagen, Volker Musahl, Michael T Hirschmann, Mark D Miller, Robert C Schenck, Robert F LaPrade
Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study. An international consensus process was conducted using validated Delphi methodology in line with British Journal of Sports Medicine guidelines. A multidisciplinary panel of 39 members from 14 countries, completed 3 rounds of online surveys exploring aspects of nomenclature, diagnosis, treatment, rehabilitation and future research priorities. Levels of agreement (LoA) with each statement were rated anonymously on a 5-point Likert scale, with experts encouraged to suggest modifications or additional statements. LoA for consensus in the final round were defined ‘a priori’ if >75% of respondents agreed and fewer than 10% disagreed, and dissenting viewpoints were recorded and discussed. After three Delphi rounds, 50 items (92.6%) reached consensus. Key statements that reached consensus within nomenclature included a clear definition for MLKI (LoA 97.4%) and the need for an updated MLKI classification system that classifies injury mechanism, extent of non-ligamentous structures injured and the presence or absence of dislocation. Within diagnosis, consensus was reached that there should be a low threshold for assessment with CT angiography for MLKI within a high-energy context and for certain injury patterns including bicruciate and PLC injuries (LoA 89.7%). The value of stress radiography or intraoperative fluoroscopy also reached consensus (LoA 89.7%). Within treatment, it was generally agreed that existing literature generally favours operative management of MLKI, particularly for young patients (LoA 100%), and that single-stage surgery should be performed whenever possible (LoA 92.3%). This consensus statement will facilitate clinical communication in MLKI, the care of these patients and future research within MLKI.
{"title":"Multiligament knee injury (MLKI): an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation","authors":"Iain Robert Murray, Navnit S Makaram, Andrew G Geeslin, Jorge Chahla, Gilbert Moatshe, Kay Crossley, Michelle E Kew, Aileen Davis, Maria Tuca, Hollis Potter, Dina C Janse van Rensburg, Carolyn A Emery, SeungPyo Eun, Hege Grindem, Frank R Noyes, Robert G Marx, Chris Harner, Bruce A Levy, Enda King, James L Cook, Daniel B Whelan, George F Hatch, Christopher J Wahl, Kristian Thorborg, James J Irrgang, Nicolas Pujol, Michael J Medvecky, Michael J Stuart, Aaron J Krych, Lars Engebretsen, James P Stannard, Peter MacDonald, Romain Seil, Gregory C Fanelli, Travis G Maak, K Donald Shelbourne, Evert Verhagen, Volker Musahl, Michael T Hirschmann, Mark D Miller, Robert C Schenck, Robert F LaPrade","doi":"10.1136/bjsports-2024-108089","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108089","url":null,"abstract":"Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study. An international consensus process was conducted using validated Delphi methodology in line with British Journal of Sports Medicine guidelines. A multidisciplinary panel of 39 members from 14 countries, completed 3 rounds of online surveys exploring aspects of nomenclature, diagnosis, treatment, rehabilitation and future research priorities. Levels of agreement (LoA) with each statement were rated anonymously on a 5-point Likert scale, with experts encouraged to suggest modifications or additional statements. LoA for consensus in the final round were defined ‘a priori’ if >75% of respondents agreed and fewer than 10% disagreed, and dissenting viewpoints were recorded and discussed. After three Delphi rounds, 50 items (92.6%) reached consensus. Key statements that reached consensus within nomenclature included a clear definition for MLKI (LoA 97.4%) and the need for an updated MLKI classification system that classifies injury mechanism, extent of non-ligamentous structures injured and the presence or absence of dislocation. Within diagnosis, consensus was reached that there should be a low threshold for assessment with CT angiography for MLKI within a high-energy context and for certain injury patterns including bicruciate and PLC injuries (LoA 89.7%). The value of stress radiography or intraoperative fluoroscopy also reached consensus (LoA 89.7%). Within treatment, it was generally agreed that existing literature generally favours operative management of MLKI, particularly for young patients (LoA 100%), and that single-stage surgery should be performed whenever possible (LoA 92.3%). This consensus statement will facilitate clinical communication in MLKI, the care of these patients and future research within MLKI.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"150 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1136/bjsports-2024-108304
Sebastien Racinais, Valentin Dablainville, Yohan Rousse, Mohammed Ihsan, Marie-Elaine Grant, Wolfgang Schobersberger, Richard Budgett, Lars Engebretsen
Sports medicine physicians and physiotherapists commonly use cryotherapy (eg, ice application) postinjury to decrease tissue temperature with the objective of reducing pain, limiting secondary injury and inflammation, and supporting healing. However, besides the analgesic effect of cryotherapy, a literature search revealed no evidence from human studies that cryotherapy limits secondary injury or has positive effects on tissue regeneration. Thus, our current understanding of the potential mechanisms and applications of cryotherapy largely relies on the results from animal studies. Importantly, treatment should not aim at obliterating the inflammatory and regeneration processes but instead aim to restore an adapted/normal regulation of these processes to improve function and recovery. However, some animal studies suggest that cryotherapy may delay or impair tissue regeneration. With the translation of laboratory animal studies to human sport medicine being limited by different injury and muscle characteristics, the effect of cryotherapy in patients with musculoskeletal injuries is uncertain. Thus, pending the results of human studies, cryotherapy may be recommended in the first 6 hours following an injury to reduce pain (and possibly haematoma), but it should be used with caution beyond 12 hours postinjury as animal studies suggest it may interfere with tissue healing and regeneration.
{"title":"Cryotherapy for treating soft tissue injuries in sport medicine: a critical review","authors":"Sebastien Racinais, Valentin Dablainville, Yohan Rousse, Mohammed Ihsan, Marie-Elaine Grant, Wolfgang Schobersberger, Richard Budgett, Lars Engebretsen","doi":"10.1136/bjsports-2024-108304","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108304","url":null,"abstract":"Sports medicine physicians and physiotherapists commonly use cryotherapy (eg, ice application) postinjury to decrease tissue temperature with the objective of reducing pain, limiting secondary injury and inflammation, and supporting healing. However, besides the analgesic effect of cryotherapy, a literature search revealed no evidence from human studies that cryotherapy limits secondary injury or has positive effects on tissue regeneration. Thus, our current understanding of the potential mechanisms and applications of cryotherapy largely relies on the results from animal studies. Importantly, treatment should not aim at obliterating the inflammatory and regeneration processes but instead aim to restore an adapted/normal regulation of these processes to improve function and recovery. However, some animal studies suggest that cryotherapy may delay or impair tissue regeneration. With the translation of laboratory animal studies to human sport medicine being limited by different injury and muscle characteristics, the effect of cryotherapy in patients with musculoskeletal injuries is uncertain. Thus, pending the results of human studies, cryotherapy may be recommended in the first 6 hours following an injury to reduce pain (and possibly haematoma), but it should be used with caution beyond 12 hours postinjury as animal studies suggest it may interfere with tissue healing and regeneration.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"44 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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