MARCH 2021 SPORTS MEDICINE JOURNAL ROUNDUP
THE AMERICAN JOURNAL OF SPORTS MEDICINE (APR 2021)
Walker CM, Genuario JW, Houck DA, Murayama S, Mendez H, Noonan TJ. Return-to-Play Outcomes in Professional Baseball Players After Nonoperative Treatment of Incomplete Medial Ulnar Collateral Ligament Injuries: A Long-Term Follow-up Study. The American Journal of Sports Medicine. 2021;49(5):1137-1144.
- There was a high rate of RTP for professional baseball players treated nonoperatively for incomplete UCL injuries.
- Compared with a matched cohort with no history of UCL injury, professional baseball pitchers treated nonoperatively had similar performance metrics.
- Reinjury rates were low, and no player had reinjury requiring UCL reconstruction.
- Nonoperative treatment of incomplete UCL injuries in professional baseball players, specifically pitchers, is a viable treatment option in the long term.
- In patients older than 40 years with limited osteoarthritis, arthroscopic acetabular labral repair with postoperative physical therapy led to better outcomes than physical therapy alone.
- Thus, age over 40 years should not be considered a contraindication to arthroscopic acetabular labral repair.
- A low Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale and age were predictors of 2-year RTS, while functional tests were not informative.
- Another main finding was that none of the patients who passed the 85% RTS criteria sustained another knee injury.
- In young active patients, the 10-year incidence of clinical radiographic PTOA after ACLR was 37% as defined by osteophytes and 23% as defined by joint space narrowing.
- The mean difference in the degree of osteophyte formation (≤1 grade in 85%) and joint space narrowing (≤1 grade in 96%) between the ACL-reconstructed and contralateral knees was small.
- Clinicians should be judicious regarding the use of intra-articular bupivacaine in the setting of articular cartilage repair.
- The findings of this systematic review revealed that adolescent patients are generally able to return to their preinjury level of performance or higher with limited complications.
- Further investigation is necessary to determine long-term outcomes for return to play after UCL reconstruction of the elbow in adolescent throwing athletes.
- The results of this systematic review and meta-analysis suggest that PRP is superior to corticosteroid injections for pain control at 3 months and lasts up to 1 year.
- In the short term, there is no advantage of corticosteroid infiltration.
- However, the low study quality, high risk of bias, and different protocols for PRP preparation reduce the internal and external validity of these findings, and these results must be viewed with caution.
BRITISH JOURNAL OF SPORTS MEDICINE (APR 2021)
- Education combined with a physical treatment (exercise, orthoses or patellar taping/mobilisation) is most likely to be effective at 3 months.
- At 12 months, education appears comparable to education with a physical treatment. There was insufficient evidence to recommend a specific type of physical treatment over another.
- All treatments in our NMA were superior to wait and see at 3 months, and we recommend avoiding a wait-and-see approach.
- The genetic contribution to ACL rupture of ~69% is high and suggests strong familial clustering.
- If clinicians recognise the high genetic risk of such injury, they may be better able to counsel athletes whose near relatives have had ACL rupture.
- Interventions using apps or trackers seem to be effective in promoting physical activity.
- Longer studies are needed to assess the impact of different intervention components on long-term engagement and effectiveness.
- Menstrual cycle symptoms are very common in exercising women, and women report that these symptoms compromise their exercise participation and work capacity.
- The MSi needs to be formally validated (psychometrics); at present, it provides an easy way to quantify the frequency of menstrual cycle symptoms.
SPORTS MEDICINE (APR 2021)
- The results of eight studies showed that lower limb kinematics, kicking accuracy or ball velocity were improved following warm-ups involving dynamic but not static stretching.
- The current evidence does not support poor sleep as an independent risk factor for increased risk of sport or physical training-related injuries in adult athletic populations.
- Given the methodological heterogeneity and limitations across previous studies, more prospective studies are required to determine the association between sleep and injury in this population.
SPORTS HEALTH JOURNAL (MAR/APR 2021)
- Because of inconsistent evidence among studies, grade B evidence exists to support the use of NMES to aid in the recovery of quadriceps strength after knee surgery.
- Based on the parameters utilized by studies demonstrating optimal treatment effects, it is recommended to implement NMES treatment during the first 2 postoperative weeks at a frequency of ≥50 Hz, at maximum tolerable intensity, with a biphasic current, with large electrodes and a duty cycle ratio of 1:2 to 1:3 (2- to 3-second ramp).
- A 15-year-old male patient volunteered for an 8-week intervention where he performed 30 minutes of treadmill walking, 3 times per week, while wearing a custom-designed knee brace that provided resistance to the thigh muscles of his ACLR leg.
- A full 8 weeks of FRT that targeted both quadriceps and hamstring muscles lead to improvements in strength and gait, suggesting that FRT may constitute a promising and practical alternative to traditional methods of resistance training.
- Myocarditis is a known cause of sudden cardiac death in athletes.
- The currently reported rates of cardiac involvement of COVID-19 makes myocarditis a risk, and physicians who clear athletes for participation in sport as well as sideline personnel should be versed with the diagnosis, management, and clearance of athletes with suspected myocarditis.
- Given the potentially increased risk of arrhythmias, sideline personnel should practice their emergency action plans and be comfortable using an automated external defibrillator.