JANUARY 2021 SPORTS MEDICINE JOURNAL ROUNDUP
This month, we review all of January’s Sports Medicine Journals all in one place here on the sports medicine review.
The American journal of sports medicine (JAN 2021)
- At 12 months, there was no difference in pain (VAS) between the groups with 88.3% of participants having a labral tear and 60 % of those being repaired.
- Both the osteochondroplasty and the lavage groups with or without labral repair for FAI had significantly improved pain or function significantly at 1 year.
- At 2 years, the reoperation rate was significantly lower in the osteochondroplasty group.
Maldonado DR, Diulus SC, Shapira J, et al. Hip Arthroscopic Surgery in the Context of Femoroacetabular Impingement Syndrome, Labral Tear, and Acetabular Overcoverage: Minimum 5-Year Outcomes With a Subanalysis Against Patients Without Overcoverage. The American Journal of Sports Medicine. 2021;49(1):55-65.
- In the context of femoroacetabular impingement syndrome (FAIS), labral tears, and acetabular overcoverage, patients who underwent hip arthroscopy reported significant improvement in several PROs at minimum 5-year follow-up
- Outcomes were comparable with those of a propensity-matched control group without acetabular overcoverage. Furthermore, the rate of achieving the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the Hip Outcome Score–Sports-Specific Subscale (HOS-SSS) was similar between these groups.
- This study included 25 patients (22 male and 3 female) who underwent surgical repair versus 30 patients (26 male and 4 female) who received primary tenodesis for proximal rectus femoris avulsion injuries.
- All patients returned to their preinjury levels of sporting activity. Primary tenodesis was associated with earlier return to preinjury level of sporting function as compared with surgical repair. At 1-year follow-up, there was no difference in surgical repair versus primary tenodesis relating to patient satisfaction scores, isometric quadriceps strength, Tegner scores and lower extremity functional scores
- High patient satisfaction, quadriceps muscle strength, and functional outcome scores were maintained and remained comparable between treatment groups at 2-year follow-up.
- A total of 18 studies including 811 patients undergoing intra-articular injection with platelet rich plasma (PRP) (mean age, 57.6 years) and 797 patients with hyaluronic acid (HA) (mean age, 59.3 years) were compared and there was a mean follow-up was 11.1 months.
- Patients undergoing treatment for knee OA with PRP can be expected to experience improved clinical outcomes when compared with HA. Additionally, leukocyte-poor PRP may be a superior line of treatment for knee OA over leukocyte-rich PRP, although further studies are needed that directly compare leukocyte content in PRP injections for treatment of knee OA.
British Journal of sports medicine (JAN 2021)
- 480 participants completed the trial with a total of 151 lateral ankle sprains being reported. All outcomes favored Spraino with incidence rate ratios of 0.87 for all lateral ankle sprains; 0.64 for non-contact lateral ankle sprains; and 0.47 for severe lateral ankle sprains. Time loss per injury was also lower in the Spraino group (1.8 vs 2.8 weeks.) Six participants reported minor harms because of Spraino.
- Compared with usual care, athletes allocated to Spraino had a lower risk of lateral ankle sprains and less time loss, with only few reported minor harms.
Paavola M, Kanto K, Ranstam J For the Finnish Shoulder Impingement Arthroscopy Controlled Trial (FIMPACT) Investigators, et alSubacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial. British Journal of Sports Medicine 2021;55:99-107.
- In the primary intention to treat analysis for arthroscopic subacromial decompression versus a diagnostic arthroscopy, there were no between-group differences that exceeded the minimally important difference (MID) for the primary outcomes at 5 years. There were no between-group differences in the secondary outcomes or adverse events that exceeded the MID. There were no significant between-group differences for the secondary outcomes or adverse events.
- Arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy (or exercise therapy) at 5 years for patients with shoulder impingement syndrome.
- Thirty four elite youth football teams were compared with one group using load management principles for a ten month season. The between-group difference in health problem prevalence (primary outcome) was 1.8%-points with no reduction in the likelihood of reporting a health problem in the intervention group compared with the control group.
- There was no between-group difference, suggesting that this specific load management intervention was not successful in preventing health problems in elite youth footballers
Sports Medicine (JAN 2021)
- Fourty-four moderate-to-high quality studies were included in this review with up to 59,000 individuals. Seven factors were identified as independently increasing the odds of sustaining a C-ACL injury (in order of highest to lowest): (1) returning to a high activity level; (2) Body Mass Index < 25; (3) age ≤ 18 years; (4) family history of ACL injury; (5) primary ACL reconstruction performed ≤ 3 months post injury; (6) female sex ; and (7) concomitant meniscal injury.
- Given the lack of studies related to neuromuscular factors that may be modifiable by training, future studies are warranted that investigate the possible role of factors such as dynamic knee stability and alignment, muscle activation and/or strength and proprioception as well as sport-specific training prior to return-to-sport for C-ACL injuries.
- Fourty-nine articles were included in the review. Across all measures, ACL deficient limbs showed lesser quadriceps femoris muscle size, whereas ACL reconstructed limbs showed lesser muscle size in the quadriceps femoris, vastus medialis, vastus lateralis, hamstrings, semitendinosus and gracilis when compared to uninjured limbs.
- When undertaking reconstructive surgery with a semitendinosus/gracilis tendon graft, the harvested muscle shows lesser muscle size compared to the uninjured limb.
Sports Health Journal (jan/feb 2021)
- There was no statistical difference in nonoperative success rates between the braced and nonbraced athletes (P = 0.33). Braced athletes (n = 20) returned to play 80% of the time, while nonbraced athletes (n = 77) returned at a rate of 88%. Of the braced athletes, 85% were football players (n = 17). A football-only comparison demonstrated no difference between braced failures (26%) and nonbraced failures (16%) (P = 0.47).
- In adolescent athletes with shoulder instability treated nonoperatively, functional bracing did not result in increased success rates when compared with no bracing.
- The special test combination of the bear hug and belly press demonstrated the highest positive likelihood ratio (18.29). Overall, 3 special test combinations in series demonstrated a significant impact on posttest probabilities.
- With parallel testing, the combination of bear hug and belly press had the highest sensitivity (84%) and lowest calculated negative likelihood ratio (0.21).
- Running with RFS imposed higher biomechanical loads on overall ground impact and knee and patellofemoral joints, whereas FFS imposed higher biomechanical loads on the ankle joint and Achilles tendon. The modification of strike techniques may affect the specific biomechanical loads experienced on relevant structures or tissues during running.
- In patients with PFP who have inflexible hamstrings, dynamic hamstring stretching with strengthening exercises was superior for improving muscle activation time and clinical outcomes compared with static hamstring stretching with strengthening exercises.
Current Sports Medicine Reports (Jan 2021)
- Exercise has been shown to decrease seizure frequency and has even been assessed as a means to prevent epilepsy.
- The risk of injury is a commonly cited reason for restricting physical activity although the majority of these injuries are soft tissue injuries.
- Literature has shown that the benefits of sports participation for persons with epilepsy far outweigh the risk to the participant.
- While there are recommended contraindications to a small number of sports, persons with epilepsy can safely participate in the majority of sports with correct counseling and observation.
- At 1–4 h, 5/10 males and 5/14 females who completed the PCSS had elevated symptom severity scores compared to pre-exertion. Only 24.2% (3/17 males and 5/16 females) of participants completing the PCSS at 6–12 h reported increased symptom severity scores.
- This study provides evidence to suggest individuals who experience an exacerbation of concussion-associated symptoms after exertion are likely to return to pre-exertion levels within the same day.