July 5, 2020

June 2020 Sports Medicine Journal Roundup

The American Journal of Sports Medicine (June 2020)

  • The ABOS database revealed significantly reduced rates of SLAP repairs performed in recent times.

  • Trends with age remained consistent over time, in that SLAP repairs were predominantly performed in younger patients.

  • Open biceps tenodesis was performed more frequently overall, but with an increased proportion of arthroscopic biceps tenodesis occurring with rotator cuff repair.

  • Arthroscopic biceps tenodesis was performed much more frequently with rotator cuff repair than without.

  • Pitch velocity was significantly associated with abnormality of the medial epicondyle and elbow pain.

  • A 10-km/h increase in pitch velocity would increase the risk of medial epicondyle abnormality and medial elbow pain by 3 times.

  • Cartilage from the impingement zone in FAI is associated with a high expression of inflammatory markers, extending throughout all cartilage zones

  • This includes IL-1β, MMP-13, ADAMTS-4, and COL2

  • Nonoperative treatment of ACL injuries failed in 60% of patients and was highly correlated with age and activity level.

  • In patients aged 25 years or younger or participating in higher-impact sports, early ACL reconstruction should be considered to prevent longer delay between injury and surgery, as well as new meniscal injuries.

  • Our data showed that use of a sciatic nerve block with anterior cruciate ligament reconstruction in patients with hamstring and bone-patellar-bone grafts influences persistent knee flexor strength deficits at time of return to sports.

  • Although the cause of postoperative muscular weakness is multifactorial, this study adds to the growing body of evidence suggesting that perioperative nerve blocks affect muscle strength and functional rehabilitation after anterior cruciate ligament reconstruction.

  • Blood flow restriction training appears to be a safe strengthening approach for knee-related musculoskeletal disorders, but further research is needed to make definitive conclusions and to evaluate the safety in other musculoskeletal conditions.

  • Improved definitions of adverse events related to blood flow restriction training are needed to include clear criteria for differentiating among common, uncommon, and rare adverse events.

  • Finally, further research is needed to effectively screen who might be at risk for rare adverse events.

British Journal of Sports Medicine (June 54-11, June 54-12)

  • One in four patients who presented to primary care with LBP received imaging as did one in three who presented to the emergency department.

  • The rate of complex imaging appears to have increased over 21 years despite guideline advice and education campaigns.

  • Performing arthroscopic partial meniscectomy (APM) in all patients with knee pain and a meniscal tear is not appropriate, and surgical treatment should not be considered the first-line intervention.

  • There may, however, be a small-to-moderate benefit from APM compared with physiotherapy for patients without osteoarthritis.

  • No trial has been limited to patients failing non-operative treatment or patients with an unstable meniscal tear in a non-arthritic joint; research is needed to establish the value of APM in this population.

  • This review identified trends of higher harms rates and higher percentages of severe harms in opioid arms for the management of subacute and chronic low back pain (LBP).

  • The majority of trials that demonstrated benefits with opioids also had potential conflicts of interest.

  • Lastly, non-opioid medications demonstrated statistically significant pain improvement compared with opioids.

  • We feel that the results of the trial are supportive of current LBP guidelines and do not condone the initial use of opioids in management of subacute or chronic LBP.

  • Subacromial decompression surgery provided no important benefit compared with placebo surgery or exercise therapy, and probably carries a small risk of serious harms

  • Early controlled motion (ECM) revealed no benefit compared with immobilisation in any of the investigated outcomes

Sports Medicine (June 2020)

  • Although activity level could not be assessed, there are increased odds of ACL injury after concussion in a general population.

  • Based on the evidence of increased odds of musculoskeletal injury after concussion, standard clinical assessments should consider concussion symptom resolution as well as assessment of neuromuscular factors associated with risk of injuries.

  • Being female, reporting a higher Positive Symptom Total at initial assessment, and being less likely to have a physiological predominant symptom cluster at initial assessment predicted > 14 versus ≤ 14-day SR-mTBI symptom resolution with a high level of accuracy.

  • Long-term exercise training does not overall influence the risk of dropouts due to health issues or mortality in older adults, and results in a reduced mortality risk in clinical populations.

  • Moreover, exercise reduces the number of falls and fall-associated injuries, and improves physical function and cognition in this population.

  • Resistance training elicits large improvements in muscular strength and hypertrophy in healthy adult females.

  • Training volume and frequency appear to be important variables that influence muscular strength.

Sports Health Journal (May/June 2020)

  • Opioids are being overprescribed for arthroscopic procedures of the shoulder, knee, and hip, with more than one-third of prescribed opioids remaining postoperatively.

  • The majority of patients are unaware of the appropriate disposal techniques for surplus opioids.

  • Appropriate risk stratification tools and evidence-based recommendations regarding pain management strategies after arthroscopic procedures are needed to help curb the growing opioid crisis.

  • The incidence of death associated with sickle cell trait in DI football athletes has decreased significantly since legislation was enacted.

  • Cases of death associated with sickle cell trait outside of football are rare.

  • It is unclear whether the decrease is related to screening for sickle cell trait, education, or both.

  • It appears that isometric resistance training reduces SBP, DBP, and MAP in normotensive young adults in a statistically significant and clinically relevant manner. This type of exercise could be considered effective in preventing arterial hypertension

  • In this study, intended to construct an intervention for people with chronic LBP, the primary aims were to help individuals “make sense of their pain,” develop effective pain control strategies via body relaxation and extinction of safety behaviors, and adopt healthy lifestyle behaviors to affect cognitive factors known to affect pain sensitivity and disability.

  • These primary aims were achieved through an emphasis on factors such as development of positive beliefs, reduced fear, increased awareness, enhanced understanding and control of pain, adaptive coping, enhanced self-efficacy, confidence, and improved mood through the class-based intervention.