Asymptomatic Athletes Research Articles

Ultrasound feature variants of the adductor longus tendon in asymptomatic sportive subjects: Management implications

ObjectivesThe potential contribution of ultrasound (US) to diagnose adductor longus (AL) tendinopathy in athletic pubalgia requires clarification. We investigate US findings from AL tendons of asymptomatic participants to identify the range and prevalence of common US features not associated with groin pain. MethodsWe consecutively enrolled 45 volunteers physically active participants with no history of groin pain. US features of bilateral AL tendons were investigated and recorded by two experienced musculoskeletal radiologists (MSKR) in accordance with a defined ultrasound protocol. Two other MSKRs retrospectively and independently analyzed all US images. ResultsNinety AL tendons from 45 participants (4/45 women) were imaged (average age: 35 years ±14.6; dominant side: 37/45 (82.2%) right, 8/45 (17.8%) left). Abnormalities on US were found in all 45 (100%) AL tendons, including: abnormal echogenicity (98.9%/100% respectively according to reader), loss of fibrillar structure (92.2%/97.8%), irregularities of the superficial paratendon (23.3%/30%), calcifications (22.2%/25.5%), and cortical erosion (52%/55.5%), with excellent inter-observer assessment. No AL tears or hyperemia at color Doppler were detectable. ConclusionsAL tendon abnormalities were identified via US in 100% of our asymptomatic athletes. The significance of these US findings should be interpreted cautiously with respect to clinical presentation. On the other hand, there is a need for supplemental investigation into the clinical relevance of US AL tendon tears not present in the present asymptomatic athlete population.

Neovascularization in Meniscus and Tendon Pathology as a Potential Mechanism in Regenerative Therapies: Special Reference to Platelet-Rich Plasma Treatment

Neovascularization is a complex, multistep process that includes the activation of endothelial cells, degradation of the basement membrane surrounding the blood vessel, formation of tip cells, the sprouting, migration and proliferation of endothelial cells into the interstitial space, and then the generation of space in the matrix to allow for the formation of a new, proper lumen of a newly formed blood vessel. Abundant neovascularization can be found in tendinous tissue obtained from asymptomatic athletes or the meniscus early after the injury. The concept of neovascularization in musculoskeletal system disorders seems to be mainly associated with pain and poor clinical outcomes. On the one hand, this phenomenon allows for tissue regeneration, but on the other, it is present during the degeneration process in connective tissue. Establishing the current concept on neovascularization is also needed. A narrative review of the current literature was conducted using databases including Embase, PubMed and Cochrane. This review aims to investigate the exact role of the neovascularization process in tendon and meniscus lesions and its role as a potential target in clinics, specifically in platelet-rich plasma (PRP) therapy. The stabilization of the neovessels required to achieve the healed tissue, together with the standardization of the PRP injections, can offer an alternative future therapeutic approach for the treatment of tendinopathy and meniscal injuries.

SARS-CoV2 infection: functional and morphological cardiopulmonary changes in elite handball players

There is increasing evidence of cardiac involvement post-SARS-CoV-2 infections in symptomatic as well as in oligo- and asymptomatic athletes. This study aimed to characterize the possible early effects of SARS-CoV-2 infections on myocardial morphology and cardiopulmonary function in athletes. Eight male elite handball players (27 ± 3.5 y) with past SARS-CoV-2 infection were compared with four uninfected teammates (22 ± 2.6 y). Infected athletes were examined 19 ± 7 days after the first positive PCR test. Echocardiographic assessment of the global longitudinal strain under resting conditions was not significantly changed (− 17.7% vs. − 18.1%). However, magnetic resonance imaging showed minor signs of acute inflammation/oedema in all infected athletes (T2-mapping: + 4.1 ms, p = 0.034) without reaching the Lake-Louis criteria. Spiroergometric analysis showed a significant reduction in VO2max (− 292 ml/min, − 7.0%), oxygen pulse (− 2.4 ml/beat, − 10.4%), and respiratory minute volume (VE) (− 18.9 l/min, − 13.8%) in athletes with a history of SARS-CoV2 infection (p < 0.05, respectively). The parameters were unchanged in the uninfected teammates. SARS-CoV2 infection caused impairment of cardiopulmonary performance during physical effort in elite athletes. It seems reasonable to screen athletes after SARS-CoV2 infection with spiroergometry to identify performance limitations and to guide the return to competition.

MALDI-ToF protein profiling as a potential rapid diagnostic platform for COVID-19

More than a year after the COVID-19 pandemic was declared, the need still exists for accurate, rapid, inexpensive and non-invasive diagnostic methods that yield high specificity and sensitivity towards the current and newly emerging SARS-CoV-2 strains. Compared to the nasopharyngeal swabs, several studies have established saliva as a more amenable specimen type for early detection of SARS-CoV-2. Considering the limitations and high demand for COVID-19 testing, we employed MALDI-ToF mass spectrometry in the analysis of 60 gargle samples from human donors and compared the resultant spectra against COVID-19 status. Several standards, including isolated human serum immunoglobulins, and controls, such as pre-COVID-19 saliva and heat inactivated SARS-CoV-2 virus, were simultaneously analyzed to provide a relative view of the saliva and viral proteome as they would appear in this workflow. Five potential biomarker peaks were established that demonstrated high concordance with COVID-19 positive individuals. Overall, the agreement of these results with RT-qPCR testing on nasopharyngeal swabs was ≥90% for the studied cohort, which consisted of young and largely asymptomatic student athletes. From a clinical standpoint, the results from this pilot study suggest that MALDI-ToF could be used to develop a relatively rapid and inexpensive COVID-19 assay.

Primary cam morphology; bump, burden or bog-standard? A concept analysis

BackgroundCam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or...

Performance of the BD Veritor system SARS-CoV-2 antigen test among asymptomatic collegiate athletes: A diagnostic accuracy study

BackgroundCOVID-19 testing strategies and determining the accuracy of tests is crucial for the prevention of disease in asymptomatic communities. ObjectiveTo determine the positive predictive value for the BD Veritor System for rapid detection of SARS-CoV-2 (BD Veritor System) among asymptomatic athletes and athletic staff in a University setting. Secondarily, a cost savings analysis was conducted to evaluate the benefits of a rapid antigen testing strategy over a universal PCR-based strategy. MethodsAsymptomatic athletic personnel at Ferris State University tested using the BD Veritor System from November 4, 2020-February 15, 2021. Individuals whose antigen test was positive immediately had specimen collected for confirmatory PCR testing. These results were used to determine the positive predictive value (PPV) for the BD Veritor System. A cost-savings analysis was conducted from the University's perspective to determine the value of this rapid antigen testing strategy over a universal PCR-based strategy. ResultsA total of 3352 antigen tests were performed on 359 individuals during the study period. During this period, 21 positive antigen tests were obtained of which 5 individuals had a positive reflex PCR result. The calculated PPV of the BD Veritor System among asymptomatic individuals was 25%. According to the mandated athletics testing schedule, the University spent $67,475.76 on BD Veritor System tests and $1785 on confirmatory PCR tests. In contrast, if a solely PCR-based approach had been continued, the same testing strategy would have cost the University $284,920. By employing a 2-tiered testing strategy with the BD Veritor System with reflex PCR testing, the University realized a cost savings of $215,659.24 during the 3-month period. ConclusionsDespite sub-optimal PPV associated with the BD Veritor System among asymptomatic athletes, the University was able to effectively use an antigen-based testing program to comply with collegiate testing requirements and realize $215,659.24 cost savings per quarter over a PCR-based strategy.

Assessing the utility of screening electrocardiograms in paediatric patients following COVID-19.

To determine the utility of screening electrocardiograms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children in detecting myocarditis related to coronavirus disease 2019 (COVID-19). A retrospective chart review was performed at a large paediatric academic institution to identify patients with prior SARS-CoV-2 infection who received a screening electrocardiogram by their primary care providers and were subsequently referred for outpatient cardiology consultation due to an abnormal electrocardiogram. The outcomes were the results from their cardiology evaluations, including testing and final diagnoses. Among 46 patients, during their preceding COVID-19 illness, the majority had mild symptoms, 4 were asymptomatic, and 1 had moderate symptoms. The median length of time from positive SARS-CoV-2 test to screening electrocardiogram was 22 days, and many electrocardiogram findings that prompted cardiology consultation were normal variants in asymptomatic adolescent athletes. Patients underwent frequent additional testing at their cardiology appointments: repeat electrocardiogram (72%), echocardiogram (59%), Holter monitor (11%), exercise stress test (7%), and cardiac MRI (2%). Five patients were incidentally diagnosed with CHD or structural cardiac abnormalities, and three patients had conduction abnormalities (pre-mature atrial contractions, pre-mature ventricular contractions, borderline prolonged QTc), although potentially incidental to COVID-19. No patients were diagnosed with myocarditis or ventricular dysfunction. In a small cohort of children with prior COVID-19, who were primarily either asymptomatic or mildly symptomatic, subsequent screening electrocardiograms identified various potential abnormalities prompting cardiology consultation, but no patient was diagnosed with myocarditis. Larger multi-centre studies are necessary to confirm these results and to evaluate those with more severe disease.

Psycho-affective health, cognition, and neurophysiological functioning following sports-related concussion in symptomatic and asymptomatic athletes, and control athletes

Little is known about the neuropsychiatric and neurophysiological differences that characterize abnormal recovery following a concussion. The present study aimed to investigate the psycho-affective, cognitive, and neurophysiological profiles of symptomatic, slow-to-recover, concussed athletes, asymptomatic concussed athletes, and control athletes. Seventy-eight athletes (26 symptomatic, 26 asymptomatic, 26 control) completed the Beck Depression Inventory-II, Profile of Mood States, and 2-Back task. Additionally, event-related brain potentials were recorded during an experimental three-stimulus visual Oddball paradigm. Compared to asymptomatic and control groups, the symptomatic group reported greater depression symptoms and negatively altered mood states. Symptomatic athletes also exhibited poorer cognitive performance on the 2-Back task, indicated by more errors and slower reaction time. ERP analyses indicated prolonged P3b latency for both symptomatic and asymptomatic groups, but symptomatic athletes also exhibited reduced P3b amplitude compared to both asymptomatic and control groups. For the asymptomatic group, correlations were observed between time since last concussion and functioning, but no relations were observed within the symptomatic group for any measure. The current findings provide valuable information regarding the psycho-affective, cognitive, and neurophysiological profiles of athletes with and without persistent symptoms following a concussion and highlight the need to assess and treat symptomatic, slow-to-recover athletes from a multidimensional and integrative perspective.

Evaluation of Shoulder and Knee Isokinetic Strength Profile Among Elite Adolescent Badminton Players.

Badminton continues to be a highly competitive sport where training is introduced at an early age and load has intensified. This exposes players to a greater risk of injuries, in particular when assessing related training outcomes such as strength, agonist-antagonist ratio, and bilateral deficit among adolescents where age- and sex-associated growth and development should be considered. To evaluate strength profile of the upper and lower limbs among adolescent elite Malaysian badminton players. Cross-sectional study. Laboratory. Forty-eight asymptomatic athletes (24 males and 24 females) were grouped into early and late adolescence (13-14 y old and 15-17 y old, respectively). Strength (absolute and normalized) of the external/internal rotators of the shoulder and flexor/extensor of the knee and strength derivatives, conventional strength ratio (CSR), dynamic control ratio (DCR), and bilateral deficits were measured. Males showed greater strength in all strength indices (P < .05). The older group had greater strength compared to younger for most of the upper and lower limb indices (P < .05); these effects diminished when using normalized data. For females, there was no age group effect in the shoulder and knee strength. All players displayed lower shoulder and knee normative values for CSR and DCR. Dominant and non-dominant knee strength were comparable between sex and age groups. For males, growth and maturation had a greater contribution to strength gained compared to training, whereas for females, growth, maturation, and training did not improve strength. The normalized data indicated that training did not improve all indices measured apart from external rotator strength in females. All players also displayed lower normative values of CSR and DCR. These results suggest that training in elite adolescent Malaysian badminton players lacks consideration of strength gain and injury risk factors.

Ulnar-Sided Wrist Pain in the Athlete: Sport-Specific Demands, Clinical Presentation, and Management Options.

Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.

Prevention of strain-induced impairments of patellar tendon micromorphology in adolescent athletes.

High-level patellar tendon strain may cause impairments of the tendon's micromorphological integrity in growing athletes and increase the risk for tendinopathy. This study investigated if an evidence-based tendon exercise intervention prevents high-level patellar tendon strain, impairments of micromorphology and pain in adolescent basketball players (male, 13-15years). At three time points over a season (M1-3), tendon mechanical properties were measured using ultrasound and dynamometry, proximal tendon micromorphology with a spatial frequency analysis and pain and disability using VISA-P scores. The control group (CON, n=19) followed the usual strength training plan, including sprint and change-of-direction drills. In the intervention group (INT, n=14), three sessions per week with functional exercises were integrated into the training, providing repetitive high-magnitude tendon loading for at least 3s per repetition. The frequency of high-level strain (ie, ≥9%) continuously decreased in INT, while tending to increase in CON since tendon force increased in both (p<0.001), yet tendon stiffness only in INT (p=0.004). In CON, tendon strain was inversely associated with tendon peak spatial frequency at all time points (p<0.05), indicating impairments of tendon micromorphological integrity with higher strain, but not at M2 and M3 in INT. Descriptively, the fraction of asymptomatic athletes at baseline was similar in both groups (~70%) and increased to 100% in M3 in INT, while remaining unchanged in CON. We suggest that functional high-load tendon exercises could reduce the prevalence of high-level patellar tendon strain and associated impairments of its micromorphology in adolescent athletes, providing new opportunities for tendinopathy prevention.

Application of visual methods in the diagnosis of tendinopathy of athletes

This article presents an analysis of the problem of diagnosis of tendinopathy in athletes according to scientific research of domestic and foreign scientists. The advantages and disadvantages of visual diagnostic methods (ultrasound, MRI) are considered. The article clarifies the advantages and disadvantages of adequate diagnostic methods of tendinopathy of the lower extremities based on the analysis of domestic and foreign scientific sources, as well as a plan for treatment and physical rehabilitation of tendon pain based on evidence: clinical doctor's opinion, patient complaints and data regarding motor dysfunctions. It is concluded that the possibility of diagnosing tendinopathy by functional tests presented in a review published in January 2012, which proposed three functional tests to detect tendinopathy of the upper tendon of the biceps femoris. It should be noted that severe tendinopathy may be asymptomatic (without pain and manifestations of motor dysfunction) for a long period before the onset of clinical signs. Studies have shown ultrasound anomalies of the patellar tendon among asymptomatic athletes of game sports, as well as athletes. There is an assumption that by means of ultrasonic inspection of sinews of athletes who did not have a pain syndrome - it is possible to predict group of risk of development of a tendinopathy. These diagnostic methods can be useful to confirm the diagnosis where it is doubtful. Diagnosis of tendinopathy in athletes by visual methods should be carried out in case of difficulty in diagnosis. If there are clinical signs of tendinopathy, it is sufficient to perform a series of functional tests to confirm (histological changes in the tendons will be present) or to refute the diagnosis.

Editors' Note: Longitudinal Changes of Brain Microstructure and Function in Nonconcussed Female Rugby Players

Dr. Manning et al. found cross-sectional and longitudinal changes in the white matter diffusion measures and resting-state functional MRI network connectivity in 73 concussion-free female rugby players compared with 31 age-matched female swimmers and rowers. They concluded that longitudinal changes occur in the microstructure and function of the brain in otherwise healthy, asymptomatic athletes participating in contact sport and that further research is needed to understand the long-term brain health and biological implications of these changes. In response, Drs. Shahim and Diaz-Arrastia note that repetitive head impacts over decades have been associated with late-life dementia in previous studies of professional contact-sport athletes, but that it is less clear whether participation in such sports at the amateur level poses similar risks. They note that the finding of white matter microstructural disruption seen in the study by Dr. Manning et al. is also seen as a consequence of more severe traumatic brain injuries. While commending the longitudinal data provided by the study, they caution that imaging techniques such as diffusion tensor imaging and rsfMRI may detect small degrees of disruption that are not functionally limiting and also have limited availability and cumbersome processing needs that preclude their use for routine assessment of athletes. They call for further studies of more inexpensive blood-based biomarkers and their correlation with imaging markers of axonal disruption after concussive and subconcussive head impacts. Responding to these comments, the authors agree that cognitive reserve in the individuals studies may be sufficiently high that they are functionally unaffected by the identified MRI markers of tissue and network disruption but argue that they may eventually affect the brain's response to other insults later in life. They agree that these MRI approaches are presently intended for research purposes. Noting that they have undertaken further work on blood-based markers on this cohort, they comment that metabolomic signatures may be more relevant than classical markers of injury while acknowledging the need for better correlation with imaging results and cognitive testing. This exchange underscores our evolving, but incomplete, understanding of the clinical significance of imaging and blood-based markers of axonal injury in otherwise healthy athletes engaged in contact sports. Dr. Manning et al. found cross-sectional and longitudinal changes in the white matter diffusion measures and resting-state functional MRI network connectivity in 73 concussion-free female rugby players compared with 31 age-matched female swimmers and rowers. They concluded that longitudinal changes occur in the microstructure and function of the brain in otherwise healthy, asymptomatic athletes participating in contact sport and that further research is needed to understand the long-term brain health and biological implications of these changes. In response, Drs. Shahim and Diaz-Arrastia note that repetitive head impacts over decades have been associated with late-life dementia in previous studies of professional contact-sport athletes, but that it is less clear whether participation in such sports at the amateur level poses similar risks. They note that the finding of white matter microstructural disruption seen in the study by Dr. Manning et al. is also seen as a consequence of more severe traumatic brain injuries. While commending the longitudinal data provided by the study, they caution that imaging techniques such as diffusion tensor imaging and rsfMRI may detect small degrees of disruption that are not functionally limiting and also have limited availability and cumbersome processing needs that preclude their use for routine assessment of athletes. They call for further studies of more inexpensive blood-based biomarkers and their correlation with imaging markers of axonal disruption after concussive and subconcussive head impacts. Responding to these comments, the authors agree that cognitive reserve in the individuals studies may be sufficiently high that they are functionally unaffected by the identified MRI markers of tissue and network disruption but argue that they may eventually affect the brain's response to other insults later in life. They agree that these MRI approaches are presently intended for research purposes. Noting that they have undertaken further work on blood-based markers on this cohort, they comment that metabolomic signatures may be more relevant than classical markers of injury while acknowledging the need for better correlation with imaging results and cognitive testing. This exchange underscores our evolving, but incomplete, understanding of the clinical significance of imaging and blood-based markers of axonal injury in otherwise healthy athletes engaged in contact sports.

Absence of cardiac damage induced by long-term intensive endurance exercise training: A cardiac magnetic resonance and exercise echocardiography analysis in masters athletes

ObjectivesIt is under debate whether the long-term practice of intensive endurance exercise induces chronic cardiac damage such as myocardial fibrosis and ventricle contractile dysfunction. Multimodality analysis was performed to evaluate myocardial damage induced by long term intensive endurance training in master athletes. MethodsThirty-three asymptomatic endurance master athletes (47 ± 6 year-old, 9,6 ± 1,7 h training/week for 26 ± 6 years), were compared to 18 sedentary controls (49 ± 7 year-old). They underwent a CMR protocol including 4 chambers morphological and late gadolinium-enhancement (LGE) analysis, left (LV) and right ventricular (RV) T1 mapping and calculation of cardiac extracellular volume (ECV). A maximal exercise echocardiography with left and right ventricular longitudinal global strain (LGS) analysis was performed. Cardiac biomarkers of fibrosis (high sensitive cardiac Troponin T, N-Terminal pro brain natriuretic peptide, N-terminal propeptide of procollagen type I and N-terminal propeptide of procollagen type III) were analysed. ResultsAthletes had larger left and right atrial volume, LV and RV end diastolic volume and increased LV and RV mass compared to controls. LGE was not found in athletes. Native T1 values of LV and RV were not significantly different in athletes compared with controls. ECV was normal in both groups (21,5%± 1,6% [18.3 – 23%] in athletes, 22%± 2,2% [18.5 – 27%] in controls). LV and RV peak exercise LGS values were higher in athletes. Cardiac biomarkers levels were normal. ConclusionDespite significant physiological cardiac remodelling, consistent with previous descriptions of athlete's heart, there was no evidence of myocardial fibrosis or exercise left or right ventricular dysfunction or cardiac fibrosis in endurance athletes. Our results are not supporting the hypothesis of deleterious cardiac effects induced by long term and intensive endurance exercise training.

Shear wave elastography assessment and comparison study of the Achilles tendons in optimally conditioned asymptomatic young collegiate athletes.

To assess the functional parameters of the Achilles tendons among asymptomatic college level athletes using shear wave elastography (SWE) and to describe the relationship to athlete demographics and anthropometric lower extremity measurements. Sixty-five athletes were included in this IRB-approved study. SWE measurements were made on two tendon positions (neutral state and active maximum dorsiflexion) with two different probe orientations (longitudinal and transverse). Associations were assessed with BMI, tibial/foot length, type of sports, and resting/maximal dorsiflexion-plantar flexion angles. Thirty-five (53.8%) males and 30 (46.2%) females with an overall mean age of 20.9years (± 2.8), mean height of 176 cm (± 0.11), and mean weight of 74.1 kg (± 12) were studied. In the neutral state, the mean wave velocity of 7.5m sec-1 and the mean elastic modulus of 176.8kPa were recorded. In active maximum dorsiflexion, the mean velocity was 8.3m sec-1 and mean elastic modulus was 199kPa. On the transverse view, the mean velocity and elastic measurements were significantly lower (p = 0.0001). No significant differences in SWE parameters were seen between male and female athletes regardless of probe orientation (p < 0.05) with SWE values being higher in the running group vs non-running group (p < 0.05). In neutral state, longitudinal SWE measurements correlated with the tibia-foot length whereas transverse measurements correlated with the tendon diameter and ankle resting angle (ARA) (p < 0.005). SWE can distinguish functional differences in Achilles tendon stiffness between athletes engaged in running-intensive sports compared with other athletes.

Differences in Biomechanical Loading Magnitude During a Landing Task in Male Athletes with and without Patellar Tendinopathy.

Prior research has not established if overloading or underloading movement profiles are present in symptomatic and asymptomatic athletes with patellar tendon structural abnormality (PTA) compared to healthy athletes. The purpose was to compare involved limb landing biomechanics between male athletes with and without patellar tendinopathy. Cross-sectional study Setting: Laboratory Patients or Other Participants: 43 males were grouped based on patellar tendon pain & ultrasound imaging of the proximal patellar tendon: symptomatic with PTA (SYM-PTA; n=13; 20±2yrs; 1.8±0.1m; 84±5kg), asymptomatic with PTA (ASYM-PTA; n=15; 21±2yrs; 1.8±0.1m; 82±13kg), and healthy control (CON; n=15; 20±2yrs; 1.8±0.1m; 79±12kg). 3D biomechanics were collected during double-limb jump-landing. Kinematic (knee flexion angle (KF)) and kinetic (vertical ground reaction force (VGRF); internal knee extension moment (KEM); patellar tendon force (FPT)) variables were analyzed as continuous waveforms during the stance phase for the involved limb. Mean values were calculated for each 1% of stance, normalized over 202 data points (0-100%), and plotted with 95% confidence intervals. Statistical significance was defined as a lack of 95% CI overlap for ≥ 6 consecutive data points. SYM-PTA had lesser KF than CON throughout the stance phase. ASYM-PTA had lesser KF than CON in the early and late stance phase. SYM-PTA group had lesser KEM and FPT than CON in early stance, as well as ASYM-PTA in mid-stance. Male athletes with SYM-PTA demonstrated a patellar tendon load-avoidance profile compared to ASYM-PTA and CON athletes. ASYM-PTA did not show evidence of overloading compared to CON. Our findings support the need for individualized treatments for athletes with tendinopathy to maximize load-capacity. ClinicalTrials.gov (#XXX).

Surveillance Testing for SARS-CoV-2 Infection in an Asymptomatic Athlete Population; The Experience of 123,362 Tests and 23,463 Paired RT-PCR/Antigen Samples

Background: This study assesses the diagnostic accuracy of antigen testing compared to RT-PCR in asymptomatic collegiate athletes and describes outcomes of a surveillance testing program.Methods: Quidel Sofia-2 SARS-CoV-2 Antigen Tests were performed daily prior to sport participation for high-risk of transmission (HROT) sports from September 29, 2020-February 28, 2021. Paired RT-PCR and antigen tests were performed at least once a week. Positive antigen tests were reflexed to RT-PCR.Findings: There were 1,931 athletes in 6 HROT sports. A total of 81,175 antigen and 42,187 RT-PCR tests were performed (including 23,463 paired antigen/RT-PCR surveillance tests). There were 346 athletes (17·9%) with a positive RT-PCR test during the study period. Of the positive RT-PCRs, 83 (4·4%) occurred on paired testing days. The clinical sensitivity of antigen tests varied with the frequency of RT-PCR testing and prevalence of COVID-19. With once-a-week PCR testing, the clinical sensitivity of antigen testing was 35·7% (95% CI: 17%, 60%) and specificity 99·8% (95% CI: 99·7%, 99·9%), after adjusting for school prevalence. Daily antigen testing was similar to PCR testing 2-3 times a week in identifying infection, however, antigen testing identified infection prior to the next scheduled PCR on 89 occasions. This resulted in a 234 days where potentially infectious athletes were isolated prior to when they would have been isolated with RT-PCR testing alone. Among athletes who had RT-PCR testing 4 times a week, daily antigen testing did not increase sensitivity. Two (14%) athletic-related outbreaks occurred but 86% of infections were community-acquired.Interpretation: Screening for asymptomatic SARS-CoV-2 can be successful using different strategies. Physical mitigation is important even with frequent screening.Funding Statement: This study was funded by Quidel Corporation. Declaration of Interests: Kimberly G. Harmon declares grants from American Medical Society for Sports Medicine for Outcomes Registry for Cardiac Outcomes in Athletes; grants from Pac-12 Conference as Research Development Director, she is also the President of the American Medical Society for Sports Medicine Foundation Board. All other authors have nothing to declare. Ethics Approval Statement: The study was considered exempt by the University of Washington Institutional Review Board. Data sharing agreements for data in the Pac 12 HAP were in place for all institutions.

Return-to-Play Outcomes in Elite Athletes After Cervical Spine Surgery: A Systematic Review.

Return-to-play (RTP) outcomes in elite athletes after cervical spine surgery are currently unknown. To systematically review RTP outcomes in elite athletes after anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), or posterior foraminotomy (PF) surgery. EMBASE, PubMed, Cochrane, and Medline databases from inception until April 2020. Keywords included elite athletes, return to play, ACDF, foraminotomy, and cervical disc replacement. Eligible studies included those that reported RTP outcomes in elite athletes after cervical spine surgery. Systematic review. Level 4. Data were extracted by 2 independent reviewers. The primary outcomes of interest were rates and timing of RTP. Secondary outcomes included performance on RTP. A total of 1720 studies were initially screened. After inclusion criteria were applied, 13 studies with a total of 349 patients were included. A total of 262 (75%) played football, 37 (11%) played baseball, 19 (5%) played rugby, 10 (3%) played basketball, 10 (3%) played hockey, 9 (3%) were wresters, and 2 (1%) played soccer. ACDF was reported in 13 studies, PF in 3 studies, and CDR in 2 studies. The majority of studies suggest that RTP after surgical management is safe in elite athletes who are asymptomatic after their procedure and may lead to higher rates and earlier times of RTP. There is limited evidence regarding RTP or outcomes after CDR or multilevel surgery. The management and RTP in elite athletes after cervical spine injury is a highly complex and multifactorial topic. The overall evidence in this review suggests that RTP in asymptomatic athletes after both ACDF and PF is safe, and there is little evidence for decreased performance postoperatively. Surgical management results in a higher RTP rate compared with athletes managed conservatively.

Study on the cross-sectional area of the multifidus muscle at the L4-L5 level on ultrasound images of Olympic-style weightlifting and judo athletes

The multifidus muscle is located near the spine and controls the erection of the spine and stabilization during movements of the spine and extremities, and assists in all other spinal movements. Differences in paraspinal muscles between sides and levels, particularly in he multifidus, have been proposed as possible indicators of low back pain or spinal pathology. This study aims to examine the cross-sectional area of the lumbar multifidus muscle at L4-L5 vertebral levels on ultrasound images of athletes in Olympic-style weightlifting, judo athletes and sedentary individuals. This study included asymptomatic male athletes (athletes in Olympic-style weightlifting, n= 17, age: 19.24 ±1.88, judo athletes, n= 17, age: 19.18 ± 1.23) and sedentary individuals (n= 17, age: 19.88 ± 1.31). The cross-sectional area of lumbar multifidus muscles was assessed bilaterally at the L4-L5 segments level in prone and using ultrasound imaging. Lumbar multifidus muscle cross-sectional areas of athletes in Olympic-style weightlifting and judo athletes were larger than those of sedentary individuals (p< 0.004). No asymmetric development was observed in cross-sectional areas of right-left lumbar multifidus muscle at L4-L5 levels of athletes in Olympic-style weightlifting and sedentary individuals (p>0.008). The cross-sectional areas of the right and left lumbar multifidus muscle at L5 segment of individuals in judo athletes was found to be asymmetrical (p< 0.008). Our study shows that the cross-sectional areas of athletes in Olympic-style weightlifting and judo athletes are larger than that of sedentary individuals. The difference in the cross-sectional area of the lumbar multifidus muscle of athlete and sedentary groups might be said to result from hypertrophic effect of trainings of these athletes on the cross-sectional area of the lumbar multifidus muscle.

Heart rate monitors used by athletes — from gadget to medical equipment. A decade of own observations

Introduction: For many years, many athletes have reported to the Centre for Sports Cardiology in Pułtusk that during endurance training, mainly running and cycling, they found unexpected increases in heart rate (HR) values observed on sports heart rate monitors (HRMs), in the vast majority of cases without the accompanying clinical symptoms. The authors have attempted to answer the question of whether the “arrhythmia” observed on HRMs is a rhythm disturbance or a mere technical artefact. The aim of the study: This article aimed to summarize the authors’ observations in the field of the usefulness of HRMs for the assessment of cardiac arrhythmias in the situation of introducing new technological solutions in the modernized and enriched ones with new functions HRMs. Material and methods: Over ten years, numerous studies have been carried out and the world literature has been also analysed many times, finally describing the authors’ study results and observations in numerous types of English-language articles published between 2017 and 2021. In this review article, the authors focused only on their publications from the Centre for Sports Cardiology in Pułtusk on the issues of heart rhythm disturbances observed on HRMs by endurance athletes, and on publications in which researchers from CKS participated and the articles themselves were related with the use of HRMs. Only a few references have been cited from other sources. Conclusions: The HRMs used in the past years were not significant for the treatment of asymptomatic exercise-stimulated arrhythmias. These HRMs, however, in a symptomatic arrhythmia situation, became an effective diagnostic tool confirming its occurrence. The analysis of cases and literature shows that modern sports heart rate monitors used by athletes of endurance disciplines (especially with the possibility of ECG recording) are becoming a useful, important and more and more effective diagnostic tool in the detection and final diagnosis of cardiac arrhythmias stimulated by exercise, both symptomatic and asymptomatic athletes and can significantly contribute to the increase of safety during training. It can be assumed that future HRMs will have comparable diagnostic value in detecting cardiac arrhythmias as the Holter ECG, surpassing them with the possibility of constant data transmission, ease of use and affordable price.