november 2020 sports medicine journal roundup
The American journal of sports medicine (nov 2020)
The objective was to analyze and measure microvascular anatomy of the meniscus in adult cadavers less than 35. The maximal depth of vascular penetration into the periphery of the medial and lateral menisci ranged from 0% to 42% and 0% to 48%, respectively.
The vascular supply of the medial and lateral menisci in specimens from adults <35 years of age extended farther than what was reported in specimens from older individuals; however, median values remained consistent. Gene expression of the angiogenic marker VEGF was low throughout all regions of uninjured menisci from young adults, which is consistent with reports in older specimens
Merkely G, Ackermann J, Farina EM, VanArsdale C, Lattermann C, Gomoll AH. Shorter Storage Time Is Strongly Associated With Improved Graft Survivorship at 5 Years After Osteochondral Allograft Transplantation. The American Journal of Sports Medicine. 2020;48(13):3170-3176.
A limited time of 14 (to complete infectious disease screening) to 28 days is the window for the use of osteochondral allografts. THe rates of graft survival is unknown.
In total, 56 patients received early transplant grafts (storage time, 19-24 days), and 55 received late transplant grafts (storage time, 25-27 days). Patients in the late transplant group had a significantly lower rate of graft survival at 5 years postoperatively (70.4%) as compared with patients in the early transplant group.
OCA transplantation is a safe and successful treatment option for large osteochondral defects of the knee, with excellent rates of in situ graft survival at 5 years. Prioritizing early transplantation of OCAs to <25 days in storage improves rates of graft survival.
Sobrado MF, Giglio PN, Bonadio MB, et al. Outcomes After Isolated Acute Anterior Cruciate Ligament Reconstruction Are Inferior in Patients With an Associated Anterolateral Ligament Injury. The American Journal of Sports Medicine. 2020;48(13):3177-3182.
Two groups (182 total patients) were separated based on the presence (ALL group) or absence (no-ALL group) of ALL injury on preoperative magnetic resonance imaging scans. Both groups underwent anatomic reconstruction of the ACL with autologous hamstring tendon grafts.
Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 2 years after ACL reconstruction. Patients with concomitant ALL injury showed a higher rerupture rate and worse functional scores.
Andrews JR, Venkateswaran V, Christensen KD, et al. Outcomes After Ulnar Collateral Ligament Revision Reconstruction in Baseball Players. The American Journal of Sports Medicine. 2020;48(13):3359-3364.
Sixty-five baseball players who underwent UCL reconstructions, 40 (62%) were contacted at a minimum 22 months after surgery. Of these, 38 (95%) were pitchers and 2 (5%) were position players. Time to return was 6.2 months.
Fifty percent had an excellent result (Conway score) returning to previous level of play within one year. Thirty percent had a good result, indicating a return to a lower level for at least 1 year. For those who were able to return to competition, it took 12.7 ± 3.6 months.
Only half of baseball players undergoing UCL revision reconstruction were able to return to their previous levels of competition. Outcomes for revision reconstructions are not as promising as primary procedures. Baseball players should be cautioned that they may not return to their previous levels of play after a revision reconstruction.
british journal of sports medicine (nov 2020)
Journath G, Hammar N, Vikström M, et alA Swedish primary healthcare prevention programme focusing on promotion of physical activity and a healthy lifestyle reduced cardiovascular events and mortality: 22-year follow-up of 5761 study participants and a reference groupBritish Journal of Sports Medicine 2020;54:1294-1299.
Individuals with at least one CV risk factor but no prior MI were followed from 1988 to 1993 were followed. They received support to increase physical activity using the program Physical Activity on Prescription and to adopt health-promoting behaviours including cooking classes, weight reduction, smoking cessation and stress management. Participants (n=5761) were compared with a randomly selected, propensity score-matched reference group from the general population in Stockholm County (n=34 556). All individuals were followed in Swedish registers until December 2011.
Participation in a CVD prevention programme in primary healthcare focusing on promotion of physical activity and healthy lifestyle was associated with lower risk of CV events (12%), CV deaths (21%) and all-cause deaths (17%) after two decades. Promoting physical activity and healthy living in the primary healthcare setting may prevent CVD.
Kroshus E, Cameron KL, Coatsworth JD, et alImproving concussion education: consensus from the NCAA-Department of Defense Mind Matters Research & Education Grand ChallengeBritish Journal of Sports Medicine 2020;54:1314-1320.
The objective of the consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting.
The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and military service academy settings with a priori thresholds for retaining, discarding and revising statements.
A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and military service academy cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes and (5) organisational processes.
Sihvonen R, Paavola M, Malmivaara A for the FIDELITY (Finnish Degenerative Meniscus Lesion Study) Investigators, et alArthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trialBritish Journal of Sports Medicine 2020;54:1332-1339.
One hundred and forty six adults with the mean age 52 years with knee symptoms consistent with degenerative medial meniscus tear and verified by MRI scan and arthroscopically were followed for 5 years.
There was a consistent, slightly greater risk for progression of radiographic knee osteoarthritis in the partial meniscectomy group as compared with the placebo surgery group. There were no relevant between-group differences in the three patient-reported outcomes: adjusted absolute mean differences (APM vs placebo surgery).
This reiterates the limited use of arthroscopy with degenerative meniscus tears.
sports medicine (nov 2020)
Fourteen meta-analyses were included in the review of resistance training in healthy children and adolescents. Eleven of these meta-analyses reported between-subject effect sizes which are important to eliminate bias due to growth and maturation. RT produced medium-to-large effects on muscle strength, small-to-large effects on muscle power, small-to-medium effects on linear sprint, a medium effect on agility/change-of-direction speed, small-to-large effects on throwing performance, and a medium effect on sport-specific enhancement.
The magnitude of effects varies according to the respective outcome measure and it appears to follow the principle of training specificity. Larger effect sizes were found for strength-related outcome measures.
Mason, B., McKune, A., Pumpa, K. et al. The Use of Acute Exercise Interventions as Game Day Priming Strategies to Improve Physical Performance and Athlete Readiness in Team-Sport Athletes: A Systematic Review. Sports Med 50, 1943–1962 (2020).
Twenty nine studies were evaluated to review acute exercise interventions as game day priming strategies. Resistance training using heavy loads at low volumes increased strength and power measures following a 4–6 h recovery, with limited improvements observed following shorter (1–3 h) and longer (6–12 h) recovery periods. Running-based sprint priming led to improvements in subsequent sprint and repeat sprint performance following a 5–6 h recovery, whereas cycling improved counter-movement jump height in a single study only.
High-intensity low-volume resistance training leads to a greater physiological and performance response than high-volume resistance training. Maximal running sprints may be more effective than maximal cycling sprints due to an increased physiological demand; however, loading protocols must also be considered in conjunction with exercise volume and movement specificity to achieve a beneficial response for subsequent performance.
sports health journal (nov 2020)
Most studies centered around the football athlete, either professional or collegiate. Professional football game day use of intramuscular ketorolac declined from 93.3% in 2002 to 48% in 2016. Collegiate football game day use of intramuscular ketorolac declined from 62% in 2008 to 26% in 2016. Game day corticosteroid injection was far lower than ketorolac usage. Both medications were reported to be effective with few adverse events.
Greenberg EM, Dyke J, Leung A, Karl M, Lawrence JT, Ganley T. Uninjured Youth Athlete Performance on Single-Leg Hop Testing: How Many Can Achieve Recommended Return-to-Sport Criterion? Sports Health. 2020;12(6):552-558.
A total of 340 participants were included and the mean LSI (limb symmetry index was >95% for each single leg hop test (SLHT). When analyzed as a test battery, only 45% of participants achieved this standard. Significantly weak to moderate correlations existed among hop tests
Participant performance across all SLHT components varied, such that less than half of healthy athletes could achieve ≥90% LSI across all hops. Current guidelines require ≥90% LSI on SLHTs. The majority of healthy youth athletes could not achieve this standard, which questions the validity of this LSI threshold in youth athletes after ACLR.
current sports medicine reports (nov 2020)
Dasburg, Kathryn Anne MD1; Vincent, Kevin R. MD, PhD, FACSM, CAQSM2 Use of Point of Care Ultrasound during Shoulder Reduction, Current Sports Medicine Reports: November 2020 – Volume 19 – Issue 11 – p 449-450
Describes technique used with Ultrasound to aid in shoulder reduction.
Kraeutler, Matthew J. MD1; Belk, John Wilson BA2; Carver, Trevor J. BA2; McCarty, Eric C. MD2; Khodaee, Morteza MD, MPH, FACSM3 Traumatic Primary Anterior Glenohumeral Joint Dislocation in Sports: A Systematic Review of Operative versus Nonoperative Management, Current Sports Medicine Reports: November 2020 – Volume 19 – Issue 11 – p 468-478
In many studies, younger age (between 21 and 30 years) was associated with greater risk for recurrence of GHJ dislocations. Twelve studies (total N = 753) directly compared outcomes of operative versus nonoperative management.
It seems that operative management significantly reduces recurrence rates with patients treated operatively among the young and active population.
Operative management should be considered as a treatment option for young and athletic patients presenting with a first-time anterior GHJ dislocation.
journal of science in sports medicine (nov 2020)
Knowledge of and attitudes towards concussion were positive.
However, there were knowledge gaps and discrepancies between some attitudes and behaviour on some aspects of concussion.
Targeted campaigns to promote awareness of concussion and improve recognition and onward management are needed.
Education related to equestrian activities such as helmet use and injury mechanisms is needed to change behaviour and minimise the risk of injury.
In conclusion, this study shows that physical fatigue can potentially affect rugby union players’ tackling technique.
Therefore, players should develop technical capacity to resist the effects of physical fatigue during the tackle.
current reviews in musculoskeletal medicine (nov/dec 2020)