August 2020 Sports Medicine Journal Roundup
The American Journal of Sports Medicine August 2020
Patients allocated to early ACL surgery, performed a mean 5 days after injury, had a lower prevalence of tibiofemoral radiographic OA at 32 to 37 years after injury compared with patients who never had ACL surgery. The prevalences of symptomatic OA, radiographic patellofemoral OA, and knee symptoms were similar irrespective of ACL treatment. Overall, the prevalence of OA after ACL injury was high.
Traumatically torn menisci possess a higher degree of degeneration than intact menisci. Our results suggest that patients with a traumatic meniscal tear may already have had a certain degree of meniscal degeneration. These findings potentially challenge the classic view of traumatic versus degenerative meniscal tears.
Meniscal repair leads to significantly lower rates of reoperation and higher rates of early complications with a higher total cost compared with meniscectomy in a large database study.
Overall, 20.4% (612/2999) of the cohort was documented to have undergone at least 1 subsequent surgery on the ipsilateral knee 6 years after their index ACL reconstruction.
The most common subsequent surgical procedures were related to the meniscus (11.9%), revision ACL reconstruction (7.5%), loss of motion (7.8%), and articular cartilage (6.7%)
Significant risk factors for incurring subsequent meniscus-related surgery were having a medial meniscal repair at the time of index surgery, reconstruction with a hamstring autograft or allograft, higher baseline Marx activity level, younger age, and cessation of smoking.
Significant predictors of undergoing subsequent surgery involving articular cartilage were higher body mass index, higher Marx activity level, reconstruction with a hamstring autograft or allograft, meniscal repair at the time of index surgery, or a grade 3/4 articular cartilage abnormality classified at the time of index ACL reconstruction
Risk factors for incurring subsequent surgery for loss of motion were younger age, female sex, low baseline Knee injury and Osteoarthritis Outcome Score symptom subscore, and reconstruction with a soft tissue allograft.
Complete capsular closure after hip arthroscopy was associated with faster return to play and a higher rate of return compared with that of nonclosure of the capsule in this sample population of high-level athletes. At a minimum 2-year follow-up, complete capsular closure was associated with significantly higher patient-reported outcomes compared with those of nonclosure in athletes who underwent hip arthroscopy.
Younger age, open physes, trochlear dysplasia, elevated TT-TG distance, and patella alta were key risk factors for the recurrence of lateral patellar dislocations. Despite being not infrequently cited as risk factors, patient sex and a history of contralateral dislocations were not found to be significant risk factors. The presence of multiple risk factors increased the risk, and the development of predictive instability scores in large patient cohorts using all established risk factors should be a focus of future studies.
British Journal of Sports Medicine (August 2020)
Concussed players reported more symptoms and recalled fewer words than controls on both the Immediate Memory and Delayed Recall tasks during the acute evaluation.
Concussed players also made more errors than Controls on the mBESS and were more likely to report double vision and exhibit clinician-observed balance problems than controls.
There were no between-group differences on the Concentration component of the SCAT5. Stepwise regression revealed that symptom report and list learning tasks both accounted for independent variance in identifying players diagnosed with concussion.
Eleven randomized controlled trials comprising 1353 patients were included. For pain outcomes at both 2–4 and 6 months, no intervention significantly outperformed placebo IA injection.
For functional outcomes at both 2–4 and 6 months, no intervention significantly outperformed placebo IA injection.
Regarding change from baseline at 2–4 months and 6 months, pooled data demonstrated that all interventions (including placebo), with the exception of HA+PRP, led to a clinically important improvement in both pain, exceeding the minimal clinically important difference.
There were 256 participants (64 treatment per group). Response rates for the primary outcome were 94% at 6 weeks, 88% at 6 months and 80% at 12 months.
Greater improvement in total SPADI score was seen with physiotherapist-led exercise than with the exercise leaflet at 6 months.
There were no significant differences between the injection groups at 6 weeks, 6 months or 12 months.
In patients with SAPS, physiotherapist-led exercise leads to greater improvements in pain and function than an exercise leaflet. Ultrasound guidance confers no additional benefit over unguided corticosteroid injection.
Sports Medicine (August 2020)
Results support CARE-MVP norm use in populations typically underrepresented or not adjusted for in traditional normative reference samples, such as those self-reporting ADHD/LD or black/African American race.
CARE-MVP norms improve upon prior normative methods and may offer a practical, simple alternative for collegiate institutions concerned about logistical and financial burden associated with baseline testing. An automated scoring program is provided.
Resistance training seems to be an effective means to improve Change of direction (CoD) speed in youth and young physically active and athletic adults. The findings indicate that the impact of RT on CoD speed may be more prominent in males than in females and in youth than in adults.
Independently computed single factor analyses for different training variables showed that higher compared with lower RT intensities, frequencies, and volumes appear not to have an advantage on the magnitude of CoD speed improvements. In terms of RT type, similar improvements were observed following machine-based and free weights training.
Twenty-three studies that investigated 3D landing kinematics in subjects with either patellar tendinopathy (PT), patellofemoral pain (PFP), exertional medial tibial pain (EMTP) or groin overuse injury.
Based on this systematic review, there is evidence for decreased knee flexion range of motion (ROM) and increased knee abduction ROM during landing as risk factors for PFP. For PT, risk factors are poorly understood. Furthermore, the meta-analysis demonstrated significantly greater hip adduction at initial contact (IC), greater knee internal rotation at IC, greater peak knee external rotation and less ankle dorsiflexion at peak vertical ground reaction force (vGRF) in subjects with knee overuse injuries compared to healthy controls.
There is evidence of increased trunk, hip and knee transversal ROM as risk factors for EMTP. Groin injuries are associated with greater pelvic and hip frontal and transversal plane ROM in the injured group compared to the healthy controls.
Exercise training showed a small beneficial effect on EF in older adults and the magnitude of the effect was different across some moderators.
Results were significantly moderated by cognitive status, revealing that Effect sizes were larger for participants with cognitively normal as compared to those with mild cognitive impairment.
Sports Health Journal (September/October 2020)
Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. .
Years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence.
As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked.
Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries.
There was no significant difference in ER after throwing at underloaded weights. The overload condition showed a statistically significant increase of 3.3° in external rotation. The extreme overload condition showed a statistically significant increase in ER of 8.4°. There were no differences in internal rotation for any group.
A significant increase in shoulder ER was observed immediately after throwing overload weighted balls. This effect increased as the weights of the balls increased.
Low intensity hand grip exercises (LI-IHE) seem to lower SBP, DBP, and MAP values in prehypertensive and hypertensive adults. It appears that LI-IHE reduces, in greater magnitude, blood pressure levels in hypertensive patients, specifically in patients aged <45 years, those who are overweight, and those on medications.
Substantial heterogeneity in the main results and in the analyses by subgroups generated uncertainty about the real reduction magnitude that LI-IHE can produce on blood pressure.