Republication of “High-Speed Video Analysis of Syndesmosis Injuries in Soccer—Can It Predict Injury Mechanism and Return to Play? A Pilot Study”

Background: Ankle syndesmosis injuries in professional soccer may lead to an unpredictable and prolonged recovery. This injury has been investigated in anatomical and radiologic studies but the precise mechanism leading to syndesmosis injury is not well understood and remains debated. The 2 goals of this study were to (1) evaluate the relationship between the mechanism of syndesmosis injury as determined by high-speed video analysis and the injured structures identified by clinical and radiologic examination and to (2) investigate the relationship between mechanism of injury and time of return to play. Methods: This pilot study prospectively reviewed high-speed video analysis of 12 professional soccer players who sustained syndesmosis injuries. The mechanism of injury was compared with the clinical and MRI evaluation and the time taken to return to play. Results: Higher-grade syndesmosis injuries occurred during ankle external rotation with dorsiflexion. Supination-inversion injuries with a standard lateral ankle sprain (rupture of the anterior talofibular ligament) may extend proximally, causing a lower-grade syndesmosis injury. These may present with signs of a high ankle sprain but have a quicker return to sport than those following a dorsiflexion-external rotation injury (mean 26 days vs 91 days). Conclusions: Video analysis confirmed that at least 2 mechanisms may result in injury to the ankle syndesmosis. Those “simple” ankle sprains with signs of syndesmosis injury had a quicker return to play. This new finding may be used by club medical teams during their initial assessment and help predict the expected time away from soccer in players with suspected high ankle sprains. Level of Evidence: Level IV, retrospective cohort study.

Ankle syndesmosis injury has been associated with persistent pain and prolonged recovery; however, no predictors of prolonged recovery have been identified. The aims of this study were to establish prognosis for ankle syndesmosis injury compared with a lateral ankle sprain and to explore factors associated with prolonged recovery. Participants (n = 63) age 21 ± 3.2 yr, with acute ankle ligament injuries (diagnosed through magnetic resonance imaging), were recruited from 10 sport clubs and sports medicine and physiotherapy clinics in two Australian cities. Follow-up was until full recovery and with preinjury activity level. Time to return to play was compared between injury types using Kaplan-Meier survival curves. Secondary analysis investigated putative factors that increased risk of prolonged recovery. For this analysis, participants unrecovered at 2 wk completed the following: Fear Avoidance Beliefs Questionnaire (FABQ); Star Excursion Balance Test, weight-bearing lunge, and vertical jump (VJ). These variables were correlated with time to recovery using bivariate Pearson's r correlation coefficient. The median recovery time for conservatively treated ankle syndesmosis injury was 62 and 15 d for lateral sprain. The sport-specific subscale scores of the FABQ were significantly higher (P = 0.017) for the ankle syndesmosis group, whereas vertical jump height was lower for this group, (P = 0.052). No baseline variables were strong predictors (r ≥ 0.6) of recovery. Moderate correlations were found for VJ (r = -0.471, P = 0.004) and the sport-specific subscale of the FABQ (r = 0.463, P = 0.004). Conservatively treated ankle syndesmosis injuries took four times longer to recover than lateral ankle sprain. Tests such as VJ and FABQ may identify individuals at risk of prolonged recovery and allow health professionals to determine realistic and appropriate time to recovery.

An evidence base for the management and prevention of shoulder injuries in soccer is lacking. The aim of this study was to demonstrate the type, mechanism and recovery time after surgery associated with serious shoulder injuries sustained in professional soccer to build an evidence base foundation. Fifty-two professional soccer players underwent shoulder surgery for injuries sustained during match play. Of these, 25 fulfilled the inclusion criteria. Data were collected for injury mechanism and type; clinical, radiological and surgical findings and procedures; and return to full participation. Subjects were all managed by the same surgeon. Labral injuries represented the most common injury type affecting 21 (84 %) subjects; two rotator cuff (8 %) and two combined labral/rotator cuff (8 %) injuries were less common. Fourteen (56 %) subjects sustained a high-energy trauma injury in a combined abduction and external rotation position. Six (24 %) subjects sustained a low-energy trauma mechanism in variable positions, while five (20 %) had a gradual onset of symptoms. Twenty-two (88 %) subjects reported a dislocation as a feature of their presentation. All of the subjects with high- and low-energy trauma mechanisms reported a dislocation occurring at the time of injury. Eight (32 %) subjects had sustained a previous significant shoulder injury to the ipsilateral side. Goalkeepers did not sustain low-energy trauma injuries. Outfield players returned to full participation in a mean time of 11.6 weeks, while goalkeepers did so in 11.1 weeks post-surgery. Return to participation time ranged from 7 to 24 weeks with a median of 11 weeks. Professional soccer players can expect a return to participation within 12 weeks post-surgery. The majority of serious shoulder injuries in soccer occur at a positional extreme of external rotation and abduction in high-energy situations, while a significant number occur in low-energy situations away from this position. Most serious shoulder injuries in professional soccer are dislocations. Previous shoulder injury is considered a risk factor. IV.

Objective: To evaluate the profile of foot and ankle injuries in professional soccer. Methods: Data were collected prospectively during the 2016 São Paulo Soccer Championship using two electronic forms: an initial form (10 variables) and a follow-up form (6 variables). The results were standardized and evaluated in SPSS 23.0. Results: A total of 259 injuries were reported: 106 to the thigh (40.9%), 42 to the foot and ankle (16.2%), 39 to the knee (15.1%), 39 to the head or face (15.1%) and 33 in other locations (12.7%). Of the 42 foot and ankle injuries, 20 were lateral ankle sprains (47.6%), 5 were medial ankle sprains (11.9%), 3 were to the triceps surae (7.1%), 3 were leg contusions (7.1%), 3 were foot contusions (7.1%), 2 were myalgias (4.8%), in addition to 5 other types (11.9%). There was physical contact in 73.8% of the injuries (p <0.001), and six injuries (14.3%) were considered severe, i.e., involving a time loss of at least one month. Of the severe injuries, four were treated surgically (three by osteosynthesis and one by tenorrhaphy). The mean time loss due to injury was 19.7 days, and the overall incidence rate was 3.5 injuries per 1000 hours of exposure, with 2.1 ligament injuries per 1000 hours. X-rays and magnetic resonance imaging were the most requested tests in the follow-up of these patients. Conclusion: Foot and ankle injuries were the second most frequent injury in Brazilian professional soccer, 73.8% of which resulted from physical contact (p<0.001). Lateral ankle sprains accounted for 47.6% of these injuries, which reaffirms their high prevalence and importance for sports medicine. Level of Evidence III; Prognostic Studies; Prospective Study.

O 032 - Investigating the gender-related response of muscle fatigue of the medial longitudinal arch height in healthy young

Magnetic resonance imaging of midtarsal sprain: Prevalence and impact on the time of return to play in professional soccer players

BackgroundRisk for injury in professional soccer is one of the largest in sports. Next to negative aspects for players' health, in professional soccer the absence of players due to injury...

BackgroundAnkle syndesmosis injury is a common condition, and the injury mechanism can be sorted into pure syndesmosis injury, Weber-B, and Weber-C type fractures. This study aims to evaluate the treatment outcomes and stability of suture-button fixation for syndesmosis injury with different injury mechanisms. We hypothesized that injury mechanisms would alter the stability of suture-button fixation.MethodsWe retrospectively reviewed 63 patients with ankle syndesmosis injury who underwent surgery with TightRope (Arthrex, Naples, FL, USA) from April 2014 to February 2019. The stability of suture-button fixation with TightRope was evaluated by comparing the preoperative, postoperative, and final follow-up measurements of tibiofibular clear space (TFCS), tibiofibular overlap (TFO), and medial clear space (MCS). A subgroup analysis for each demographic group and injury type including pure syndesmosis injury, Weber-B, and Weber-C type fractures were performed.ResultsSyndesmosis was effectively reduced using TightRope. After the index surgery, the tibiofibular clear space was reduced from 7.73 to 4.04 mm, the tibiofibular overlap was increased from 3.05 to 6.44 mm, and the medial clear space was reduced from 8.12 to 3.54 mm. However, syndesmosis widening was noted at the final follow-up, especially in Weber-C type fractures (TFCS 3.82 to 4.45 mm, p < 0.01 and TFO 6.86 to 6.29 mm, p = 0.04). Though widened, the final follow-up values of tibiofibular clear space and tibiofibular overlap were in the acceptable range. Postoperatively and at the final follow-up, medial clear space was found to be significantly larger in the Weber-C group than in the pure syndesmosis and Weber-B groups (p < 0.05).ConclusionsSuture-button fixation can offer anatomic reduction and dynamic fixation in syndesmosis injuries. However, when using this modality for Weber-C type fractures, more attention should be focused on the accuracy of reduction, especially of medial clear space, and rediastasis should be carefully monitored.Trial registrationThis trial was retrospectively approved by TMU-JIRB. Registration number N202004122, and the date of approval was May 06, 2020.Level of evidenceIII

Return to play (RTP) decision making in professional soccer is crucial for minimising re-injury risk, reducing financial burdens on clubs, and optimising player performance. Despite its significance, there is a lack of objective criteria and consensus on RTP for adductor longus injuries, one of the most common muscle injuries in soccer. The aim of the present consensus was to validate an RTP protocol based on clinical, functional, and performance criteria through expert evaluation. This study hypothesises that a validated RTP protocol for adductor longus injuries will enhance decision making, reduce re-injury rates, and improve player performance upon return. An observational survey was designed to validate an RTP protocol through an expert panel. A total of 63 injury-management professionals (strength and conditioning coaches, physiotherapists, doctors, and rehabilitation fitness coaches) with an average experience of 12.02 ± 6.87 years participated in validating a 20-criteria RTP protocol. The protocol, divided into clinical, functional, and performance criteria, was assessed using a 5-point Likert scale. Aiken's V coefficient was calculated for content validity, with criteria validated if Aiken's V ≥ 0.75. Out of 20 initial RTP criteria, 14 were validated by the expert panel, with Aiken's V ranging from 0.77 to 0.94 (overall range: 0.61-0.98). Key validated criteria included pain on palpation, flexibility, imaging, athlete feedback, strength assessments, movement quality, pre-injury GPS data, and performance under simulated match conditions. Criteria such as the Copenhagen adduction exercise and specific agility tests were not validated. The expert-validated RTP protocol for adductor longus injuries provides a structured approach to decision making, potentially reducing re-injury risk, improving rehabilitation strategies, and enhancing player performance. These findings could be integrated into clinical sports-medicine practices to enhance rehabilitation effectiveness and RTP decisions in professional soccer.

Background: Muscle injury is the most common injury type in professional soccer players. Despite this, risk factors for common lower extremity injuries remain elusive. Purpose: To evaluate the effects of various player- and match-related risk factors on the occurrence of lower extremity muscle injury in male professional soccer. Study Design: Cohort study; Level of evidence, 2. Methods: Between 2001 and 2010, 26 soccer clubs (1401 players) from 10 European countries participated in the study. Individual player exposure and time loss muscle injuries in the lower extremity were registered prospectively by the club medical staffs during 9 consecutive seasons. Hazard ratios (HRs) were calculated for player-related factors from simple and multiple Cox regression, and odds ratios (ORs) were calculated for match-related variables from simple and multiple logistic regression, presented with 95% confidence intervals (CIs). Results: There were 2123 muscle injuries documented in the major lower extremity muscle groups: adductors (n = 523), hamstrings (n = 900), quadriceps (n = 394), and calf (n = 306). Injuries to the adductors (56%; P = .015) and quadriceps (63%; P< .001) were more frequent in the kicking leg. Multiple analysis indicated that having a previous identical injury in the preceding season increased injury rates significantly for adductor (HR, 1.40; 95% CI, 1.00-1.96), hamstring (HR, 1.40; 95% CI, 1.12-1.75), quadriceps (HR, 3.10; 95% CI, 2.21-4.36), and calf injuries (HR, 2.33; 95% CI, 1.52-3.57). Older players (above mean age) had an almost 2-fold increased rate of calf injury (HR, 1.93; 95% CI, 1.38-2.71), but no association was found in other muscle groups. Goalkeepers had reduced injury rates in all 4 muscle groups. Match play on away ground was associated with reduced rates of adductor (OR, 0.56; 95% CI, 0.43-0.73) and hamstring injuries (OR, 0.76; 95% CI, 0.63-0.92). Quadriceps injuries were more frequent during preseason, whereas adductor, hamstring, and calf injury rates increased during the competitive season. Conclusion: Intrinsic factors found to increase muscle injury rates in professional soccer were previous injury, older age, and kicking leg. Injury rates varied during different parts of the season and also depending on match location.

Purpose: The purpose of this systematic review was (I) to determine the quality of evidence from studies evaluating the effects of strength training on the incidence of ankle injuries in soccer and (II) to determine the effectiveness of strength training on the incidence of ankle injuries in soccer. Methods: Preferred Reporting Items for Systematic Reviews (PRISMA) statements were considered using keywords associated with ankle injuries, strength training, and soccer. The following four databases were used: PubMed, Web of Science, Scopus, and SPORTDiscus. The quality of evidence for the articles included in this review was assessed using the PEDro scale. Results: Of the 721 articles retrieved, two were included in this study. The total population included in the review was 132 male participants, including professional soccer players and youth players. Strength training in young soccer players could reduce the risk of injury and improve parameters related to sports performance; however, the two articles included in this review found no statistically significant differences in injury incidence between the proprioceptive training and control groups. Conclusions: The articles included in this review had a high risk of bias, indicating low quality of evidence. In addition, it was impossible to determine whether strength training effectively reduced ankle injuries in the soccer players. Keywords: Sports, ankle sprains, athletic injuries, resistance training

ObjectivesSyndesmosis injuries are common and increasing in contact sports with a marked impact on players and teams alike. They can result in an unpredictable and often prolonged return to pre-injury level. We aim to evaluate the time to return to play (RTP) after syndesmosis injuries in professional male rugby players. MethodsA cohort study including all professional rugby players with syndesmosis injuries, treated both operatively and non-operatively by the senior author was performed. The follow up period was a minimum of 12 months or until RTP. Players with previous ankle injuries or associated ankle fractures were excluded. Outcome measures included players age, body mass index (BMI), field position, seven-a-side or 15-a-side match, mechanism of injury, clinical findings, radiological findings, return to training (RTT), and RTP dates. ResultsFor the period July 2015 to July 2019, a total of 13 professional male rugby players were included in the study. The leading mechanism of syndesmosis injury was in contact during a tackle. Six players had a grade 3 injury (40%), 4 players had a grade 2B injury (27%), 2 players had a grade 2A injury (13%) and 3 players had a grade 1 injury (20%). Two of the aforementioned players presented with new contralateral syndesmosis injuries during the study period. The median time for RTT and RTP was 97 days (IQR: 36) and 112 days (IQR: 54), respectively. All players with syndesmosis injuries were able to return to play. No discrepancy was found between seven-a-side and 15-a-side players regarding injury mechanism, injury severity, and RTP. ConclusionMost syndesmosis injuries in professional rugby players are acquired during a tackle. These injuries are often unstable, requiring surgical intervention, with an unpredictable recovery period. Injury severity, surgical complications, delayed diagnosis, and associated injuries can prolong this period. The subtype of rugby (seven-a-side and 15-a-side) does not affect the injury severity or return to play. Level of evidenceLevel 4

Study DesignSecondary analysis of pooled data from 3 cohort and 2 randomised controlled studies.ObjectivesTo evaluate risk factors for ankle sprain injury (ASI) in youth soccer and basketball.BackgroundASI is the most...

Syndesmosis injuries are rare, but very debilitating and frequently misdiagnosed. The purpose of this clinical commentary is to review the mechanisms of syndesmotic injuries, clinical examination methods, diagnosis, and management of the injuries. Cadaveric studies of the syndesmosis and deltoid ligaments are also reviewed for further understanding of stress transmission and the roles of different structures in stabilizing the distal syndesmosis. External rotation and excessive dorsiflexion of the foot on the leg have been reported as the most common mechanisms of injury. The injury is most often incurred by individuals who participate in skiing, football, soccer, and other sport activities played on turf. The external rotation and squeeze tests are reliable tests to detect this injury. The ability of imaging studies to assist in an accurate diagnosis may depend on the severity of the injury. The results of cadaveric studies indicate the importance of the deltoid ligament in maintaining stability of the distal tibiofibular syndesmosis and the congruency of the ankle mortise. Intervention programs with early rigid immobilization and pain relief strategies, followed by strengthening and balance training are recommended. Heel lift and posterior splint intervention can be used to avoid separation of the distal syndesmosis induced by excessive dorsiflexion of the ankle joint. Application of a rigid external device should be used with caution to prevent medial-lateral compression of the leg superior to the ankle mortise, thereby inducing separation of the distal syndesmosis articulation. Surgical intervention is an option when a complete tear of the syndesmotic ligaments is present or when fractures are observed.

Despite the presence of various injury prevention programs, the rate of hamstring injuries and reinjuries is increasing in soccer, warranting the need for a soccer-specific rehabilitation program. To develop and validate a new, functional on-field program for the rehabilitation and readaptation of soccer players after a hamstring strain injury through a panel of experts; and determine the usefulness of the program through its application in professional soccer players. A 13-item program was developed, which was validated by a panel of experts and later applied to professional soccer players. Soccer training ground. Fifteen strength and conditioning and rehabilitation fitness coaches with a professional experience of 15.40 (1.57) years in elite clubs and national teams in Europe validated the program. The program was later applied to 19 professional soccer players of the Spanish First Division (La Liga). Once a player sustained a clinically diagnosed injury, the player would first be subject to mobilization and strengthening exercises in the gym after undergoing treatment by percutaneous needle electrolysis. The player would then complete an on-field readaptation program consisting of 13 drills arranged in a progressive manner in terms of complexity. The drills integrated various aspects of repeated sprint abilities, retraining and reeducation of biomechanical patterns, and neuromuscular control of the core and lower limbs. Aiken's V for each item of the program and number of days taken by the players to return to play. The experts evaluated all items of the program very highly, as seen from Aiken's V values between 0.78 and 0.98 (0.63-0.99) for all drills, while the return to play was in 22.42 (2.32) days. This program has the potential to help a player suffering from a hamstring strain injury to adapt to real-match conditions in the readaptation phase through the application of sports-specific drills that were very similar to the different injury mechanisms.