High-impact Athletes Research Articles

Cross-sectional study on the prevalence of post-traumatic osteoarthritis in young athletes

Background. Joint traumas often cause post-traumatic osteoarthritis (PTOA), especially in young high-impact athletes. PTOA is a primary cause of early-onset osteoarthritis, yet this group has a low diagnostic rate. The goal of this cross-sectional study is to investigate how common PTOA is in youth athletes and what risk factors they face. Methods. At Dehradun’s Shri Guru Ram Rai Institute of Medical and Health Sciences, 100 athletes aged 18-35-yearold participated in the study. Sports like athletics, cricket, football, rugby, and basketball added to the participant pool. Included criteria were joint trauma; excluded were congenital joint conditions or no traumatic osteoarthritis. Data collection included clinical exams, imaging (X-rays and MRI), and a detailed questionnaire about the athlete’s past, injuries, and rehabilitation. The main objective was PTOA incidence, while secondary outcomes assessed risk factors such sport, injury severity, and trauma duration. All statistical studies utilize logistic regression and Chi-square testing, with a significance level of p < 0.05. Results. PTOA affected the knee (25%), ankle (18%), and hip (8%), with a total prevalence of 35%. The majority of PTOA patients had ligament tears, mostly ACLs. Football and rugby players had a 2.5-fold increased risk of PTOA. The risk was 3.1% higher for athletes with major injuries including fractures or dislocations. The time after the event also affected PTOA; damage older than five years was more likely. Conclusion. Results demonstrate that youth athletes often have ankle and knee PTOA. Early detection, prevention, and monitoring can reduce PTOA in this group. Identifying specific therapy to reduce joint injuries’ long-term effects requires more research.

The Association Between the Development of Cam Morphology During Skeletal Growth in High-Impact Athletes and the Presence of Cartilage Loss and Labral Damage in Adulthood: A Prospective Cohort Study With a 12-Year Follow-up

Background: Cam morphology develops during skeletal growth, but its influence on cartilage and the labrum in high-impact athletes later in life is unknown. Purpose: To (1) explore the association between the presence and duration of cam morphology during adolescence and the cartilage and labral status 7 to 12 years later and (2) report the prevalence of cartilage loss and labral damage in a population of young male athletes (<32 years old) who played professional soccer during skeletal growth. Study Design: Cohort study (Prognosis); Level of evidence, 2. Methods: A total of 89 healthy male academy soccer players from the Dutch soccer club Feyenoord (aged 12-19 years) were included at baseline. At baseline and 2.5- and 5-year follow-ups, standardized supine anteroposterior pelvis and frog-leg lateral radiographs of each hip were obtained. At 12-year follow-up, magnetic resonance imaging of both hips was performed. Cam morphology was defined by a validated alpha angle ≥60° on radiographs at baseline or 2.5- or 5-year follow-up when the growth plates were closed. Hips with the presence of cam morphology at baseline or at 2.5-year follow-up were classified as having a “longer duration” of cam morphology. Hips with cam morphology only present since 5-year follow-up were classified as having a “shorter duration” of cam morphology. At 12-year follow-up, cartilage loss and labral abnormalities were assessed semiquantitatively. Associations were estimated using logistic regression, adjusted for age and body mass index. Results: Overall, 35 patients (70 hips) with a mean age of 28.0 ± 2.0 years and mean body mass index of 24.1 ± 1.8 participated at 12-year follow-up. Cam morphology was present in 56 of 70 hips (80%). The prevalence of cartilage loss was 52% in hips with cam morphology and 21% in hips without cam morphology (adjusted odds ratio, 4.52 [95% CI, 1.16-17.61]; P = .03). A labral abnormality was present in 77% of hips with cam morphology and in 64% of hips without cam morphology (adjusted odds ratio, 1.99 [95% CI, 0.59-6.73]; P = .27). The duration of cam morphology did not influence these associations. Conclusion: The development of cam morphology during skeletal growth was associated with future magnetic resonance imaging findings consistent with cartilage loss in young adults but not with labral abnormalities.

Screening for pelvic floor symptoms in exercising women: a survey of 636 health and exercise professionals.

This study aimed to establish health and exercise professionals' (i) current practice of screening for pelvic floor (PF) symptoms in women within sports/exercise settings (ii) between-professional group differences in screening practice (iii) confidence and attitudes towards screening for PF symptoms and (iv) barrier/enablers towards engagement in future screening practice. Observational, cross-sectional survey. Australian health and exercise professionals (n = 636) working with exercising women participated in a purpose-designed and piloted, online survey about PF symptom screening in professional practice. Data were analysed descriptively and groups compared using Chi-square/Kruskal-Wallis tests. Survey respondents included physiotherapists (39%), personal trainers/fitness instructors (38%) and exercise physiologists (12%), with a mean of 12 years of practice (SD: 9.7, range: 0-46). One in two participants never screened women for PF symptoms; 23% screened when indicated. Pregnant/recently post-natal women (44%) were more commonly screened for PF symptoms than younger women (18-25 years:28%) and those competing in high-impact sports (32%). Reasons for not screening included waiting for patients to disclose symptoms (41%) and an absence of PF questions on screening tools (37%). Most participants were willing to screen PF symptoms but cited a lack of knowledge, training and confidence as barriers. Screening for PF symptoms in exercising women is not common practice, especially in at-risk groups such as young, high-impact athletes. Including PF questions in existing pre-exercise questionnaires and providing professional development to improve knowledge of indications for screening and evidence-based management options may facilitate early symptom identification and prevent secondary exercise cessation.

Significant variations in surgical construct and return to sport protocols with syndesmotic injuries: an ISAKOS global perspective

ObjectivesAlthough the body of literature on syndesmosis injuries is growing with regard to both the biomechanics and clinical outcomes for various fixation constructs, there is little consensus on the optimal treatment and return to sport strategy for these injuries. We endeavoured to assess the current approaches to managing syndesmotic injuries through a Research Electronic Data Capture survey. MethodsThe survey consisted of 27 questions, including respondent demographics, indications for treatment of syndesmotic injuries, preferred treatment and technique, and postoperative management. Responses were generated through six different athlete scenarios: moderate impact, high impact, and very high impact athletes with/without complete deltoid injury. Frequencies and percentages were calculated for all categorical responses. ResultsA total of 742 providers responded to the survey, including 457 American surgeons and 285 members of various international societies. Flexible devices were the preferred fixation construct (47.1%), followed by screws (29.6%), hybrid fixation (e.g. combination of flexible device and screw, 18%), and other (5.3%). Sixty-four percent of respondents noted that their rehabilitation protocols would not change for each athlete scenario. Considerable variability was present in anticipated return to full participation, largely dependent on the presence or absence of a deltoid ligament injury. ConclusionThe most common elements used as surgical indications were syndesmosis widening > 2 mm on x-ray, an anterior inferior talofibular ligament injury in combination with a posterior inferior talofinular ligament or deltoid ligament involvement on magnetic resonance imaging, and widening of the distal tibiofibular joint during arthroscopic evaluation. Overall, flexible fixation (e.g. suture button) was the preferred device choice for the repair of an injured syndesmosis. Most respondents did not alter their rehab protocol or anticipated return to play timeline based on the injury severity. However, there was considerable variability between respondents on the time to weight-bearing, running, and full participation. Further pragmatic outcomes data are necessary to guide safe return to play protocols for syndesmotic injuries. Level of evidenceLevel IV.

The association between statistical shape variations of the hip and the presence of a cartilage defect or labral tear on MRI in high-impact athletes

Purpose: Hip osteoarthritis (OA) is highly prevalent in older people and a leading cause of physical disability worldwide. Although the etiology of hip OA is multifactorial, recent evidence has demonstrated that bony hip morphologies, such as cam morphology and acetabular dysplasia, are associated with an increased risk of developing hip OA in the elderly. Other morphological variants might also pose a risk; statistical shape modeling (SSM) can be used to identify these variants by quantifying the whole radiographic hip shape.

PEDI-CHAMP© AGILITY TEST VARIES BY AGE, GENDER AND SPORT SPECIALIZATION IN YOUTH ATHLETES

Background:The Pediatric Comprehensive High-Level Activity Mobility Predictor (Pedi-CHAMP©) is a 4-part agility test aimed to assess functional performance in children with and without sports medicine injuries or orthopedic conditions. The Pedi-CHAMP© assesses bilateral single limb balance, lateral agility, directional changes, and acceleration/deceleration.Hypothesis/Purpose:To determine if the Pedi-CHAMP component (Single-Limb-Stance [SLS], modified Edgren Side Step [mESS], L-Test, Illinois Agility Test [IAT]) and composite scores are stratified based on age, sex, and sport-type/specialization in youth athletes.Methods:Youth athletes were recruited to complete the Pedi-CHAMP© either as an independent test or as part of larger battery of tests (Specialized Athlete Functional Evaluation [SAFE] Program). Completion times for each test component were converted to points using age-sex matched scoring algorithms. Each participant also answered questions to determine specialization in organized sports (defined as competition with a referee, umpire, etc.). Kruskal-Wallis was used to assess differences based on age groups (elementary [E, 5-9yrs], preteen [PT, 10-12yrs], early teen [ET, 13-15yrs], late teen/young adult [LT, 16-22yrs]), with Mann-Whitney U pairwise post-hoc comparisons (α<0.05). Independent Mann-Whitney U tests were used to assess differences based on sex, sport type (low vs high impact) and specialization (single vs multi-sport) within each age group.Results:A total of 251 youth athletes (134 females, age 13.7±3.3yrs; BMI 20.9±5.9) completed Pedi-CHAMP© testing. Significant differences were seen with the Pedi-CHAMP© component and composite scores between all ages (p<0.001, Table 1), however, there were no differences between ET and LT groups for the SLS or mESS. When assessing age and sex, elementary-aged girls demonstrated improved SLS balance (p=0.017), and mESS scores were higher in preteen boys compared to girls (p=0.022). However, all 3 agility components (mESS, L-Test, IAT) and the Pedi-CHAMP© composite scores were significantly higher in boys compared to girls for the ET and LT groups. When accounting for age, there were no differences in single-sport vs. multi-sport athletes. ET and LT low-impact athletes scored lower on the L-test compared to high-impact athletes.Conclusion:The Pedi-CHAMP© was able to detect differences based on age, sex and sport impact-type (low- vs. high-impact). Performance improves with age for the L-Test and IAT, however, no differences in SLS and mESS were seen between younger and older teens which may indicate a ceiling effect for these two components. Further research should focus on correlating the Pedi-CHAMP© to other performance measures in youth athletes.Tables/Figures:

Prevalence of early hip OA features on MRI in high-impact athletes. The femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study

To compare early hip osteoarthritis (OA) features on magnetic resonance imaging (MRI) in high-impact athletes with and without hip and/or groin pain, and to evaluate associations between early hip OA features, the International Hip Outcome Tool (iHOT33) and Copenhagen Hip and Groin Outcome Score (HAGOS). This case-control study evaluated data of the femoroacetabular impingement and hip osteoarthritis cohort (FORCe). One hundred and eighty-two symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 pain-free high-impact athletes (soccer or Australian football (AF)) without definite radiographic hip OA underwent hip MRI. The Scoring Hip Osteoarthritis with MRI (SHOMRI) method quantified and graded the severity of OA features. Each participant completed the iHOT33 and HAGOS. Hip and/or groin pain was associated with higher total SHOMRI (0-96) (mean difference 1.4, 95% CI: 0.7-2.2), labral score (adjusted incidence rate ratio (aIRR) 1.33, 95% CI: 1.1-1.6). Differences in prevalence of cartilage defects, labral tears and paralabral cysts between symptomatic and pain-free participants were inconclusive. There was a lower prevalence of effusion-synovitis in symptomatic participants when compared to pain-free participants (adjusted odds ratio (aOR) 0.46 (95% CI: 0.3-0.8). Early hip OA features were not associated with iHOT33 or HAGOS. A complex and poorly understood relationship exists between hip and/or groin pain and early hip OA features present on MRI in high-impact athletes without radiographic OA. Hip and/or groin pain was associated with higher SHOMRI and labral scores.

Effectiveness of Using Compression Garments in Winter Racing Sports: A Narrative Review.

Nowadays, compression garments (CGs) are widely used in winter racing sports, such as speed skating, short-track speed skating, alpine skiing, and cross-country skiing. However, the effect of wearing CGs on athletic performance in these specific sports is still not fully examined. Thus, the aim of this narrative review is to summarize the research and application of CGs in winter racing sports and to discuss how the CGs help athletes improve their performance in an integrative manner (i.e., physiology, aerodynamics, and biomechanics). A total of 18 experimental studies dedicated to CGs in winter racing sports were identified from the peer-review scientific literature. The main findings are as follows. (1) Currently, CG studies have mainly focused on drag reduction, metabolism, muscle function, strength performance, and fatigue recovery. (2) The results of most studies conducted in wind tunnels showed that, for cylindrical structures similar to the human body, clothing with rough surfaces can reduce air drag. Notably, the effect of CGs on drag reduction in real competition has not been fully explored in the literature. (3) Compression can reduce muscle vibrations at high impact and help athletes control the center of pressure movement, a function that is important for alpine skiing. Future studies are needed to improve current understanding of the effects of compression clothing microstructure on drag reduction and their stretching in different parts of the body. Furthermore, the design of experimental protocol must be consistent with those during the competition, thus providing a full discussion on energy metabolism, fatigue, and recovery affected by CGs.

Prevalence of osteoarthritis features on MRI in high-impact athletes: the femoroacetabular impingement and hip osteoarthritis cohort study

Purpose: High-impact sporting activity may be associated with the development of hip osteoarthritis (OA). Features of early hip OA on magnetic resonance imaging (MRI) have not been reported in this population. Further, the association between hip-related symptoms and features of early hip OA is unknown. Therefore, we aimed to: 1) compare OA features on MRI in high-impact athletes with and without hip pain; and 2) evaluate associations between the International Hip Outcome Tool (iHOT33), Copenhagen Hip and Groin Outcome Score (HAGOS) and OA features.

Femoroacetabular impingement syndrome is associated with features of early hip osteoarthritis on MRI in high-impact athletes

Purpose: Femoroacetabular impingement syndrome (FAIs) is a triad of symptoms, clinical signs and imaging findings. However, the association between FAIs and early osteoarthritis (OA) features on magnetic resonance imaging (MRI) in active high-impact athletes has yet to be determined. Therefore, we aimed to investigate the association between the specific features of FAIs and early OA features on MRI in high-impact athletes.

La influencia del deporte en la postura del pie

Objetivo: Analizar la postura del pie en una muestra de deportistas federados, en activo durante al menos dos temporadas, que acuden al Centro Andaluz del Medicina del Deporte frente a un grupo de sujetos que no practican deporte. Se pretende valorar si hay diferencias significativas en la postura del pie de ambos grupos y secundariamente, comprobar si los deportes de alto impacto tienen mayor repercusión sobre ella que los de bajo impacto.&#x0D; Método: Se realizó un estudio observacional, analítico y transversal. La muestra incluyó 89 participantes. Se clasificaron en tres subgrupos de estudio: grupo 0, sujetos no deportistas; grupo 1, deportistas de deportes de alto impacto (baloncesto, fútbol y atletismo) y grupo 2, deportistas que realizan deportes de bajo impacto (ciclismo y natación). Se analizó la postura del pie mediante el Navicular Drop Test y el Índice Postural del Pie.&#x0D; Resultados: los valores obtenidos para las variables Navicular Drop Test fueron de 0.65±0.71/0.74±0.70 (Navicular Drop Test izquierdo/derecho) para el grupo 0; 0.37±0.32/0.42±0.37 (Navicular Drop Test izquierdo/derecho) para el grupo 1 y de 0.29±0.28/0.32±0.31(Navicular Drop Test izquierdo/derecho) para el grupo 2. Mientras que para el Índice Postural del Pie fueron de 6.53±0.40/6.75±0.42 (Índice Postural del Pie izquierdo/derecho) en el grupo 0; 3.25±0.34/3’1±0.38 (Índice Postural del Pie izquierdo/derecho) en el grupo 1 y de 3.38±0.48/3.23±0.40 (Índice Postural del Pie izquierdo/derecho) en el grupo 2, mostrando diferencias estadísticamente significativas (p&lt;0.001) entre los grupos 0-1 y 0-2, pero no entre 1-2.&#x0D; Conclusiones: se ha observado que el grupo de deportistas federados durante un periodo in-interrumpido de actividad de dos ó más años presentan una posición del pie más neutra que los sujetos no deportistas, no considerando influyente en dicha posición la tasa de impactos que implique la práctica deportiva.

Arthroscopically assisted acromioclavicular joint stabilization leads to significant clavicular tunnel widening in the early post-operative period.

Arthroscopically assisted acromioclavicular joint (ACJ) stabilization techniques use bone tunnels in the clavicle and coracoid process. The tunnel size has been shown to have an impact on the fracture risk of clavicle and coracoid. The aim of the present study was to radiographically evaluate the alterations of the clavicular tunnel size in the early post-operative period. It was hypothesized that there would be a significant increase of tunnel size. Twenty consecutive patients with acute high-grade ACJ (Rockwood type IV-V) injury underwent arthroscopic-assisted ACJ stabilization. The median age of the patients was 40 (26-66) years. For all patients, a single tunnel button-tape construct was used along with an additional ACJ tape cerclage. Radiologic measurements were undertaken on standardized Zanca films at two separate time points, immediate post-operative examination (IPO) and at late post-operative examination (> 4months; LPO). The LPO radiographs were taken at a median follow-up period of 4.5 (3-6) months. Clavicular tunnel width (CT) and coracoclavicular distance (CCD) were measured using digital calipers by two independent examiners and the results are presented as median, range, and percentage. The median CCD increased significantly from 9.5 (8-13) mm at IPO to 12 (7-20) mm at LPO (p < 0.05). Median tunnel size showed significant difference from 3 (3-4) mm at IPO to 5 (4-7) mm at LPO (p < 0.05). Despite a significant increase of 2mm (66.6%) of the initial tunnel size, there was no correlation between tunnel widening and loss of reduction. Arthroscopic ACJ stabilization with the use of bone tunnels led to a significant increase of clavicular tunnel size in the early post-operative period. This phenomenon carries a higher fracture risk, especially in high-impact athletes, which needs to be considered preoperatively. IV.

Do female elite athletes experience more complicated childbirth than non-athletes? A case–control study

ObjectivePrevious studies have suggested that female athletes might be at higher risk of experiencing complications such as caesarean sections and perineal tears during labour than non-athletes. Our aim was to...

Prevalence of urinary incontinence in high-impact sports athletes and their association with knowledge, attitude and practice about this dysfunction

ABSTRACTObjective: To evaluate the prevalence of urinary incontinence (UI) in female athletes practising high-impact sports and its association with knowledge, attitude and practice (KAP).Design: Observational study.Methods: A semi-structured evaluation form, KAP survey and the International Consultation on Incontinence Questionnaire – Short Form were used. Univariate and multivariate analyses were performed to verify the association of UI with KAP, sociodemographic, gynaecological and sports-related variables, with significant variables remaining in the model (p < .05), through a stepwise strategy.Results: The prevalence of UI in 118 athletes was 82 (70%), of which 19 (23%) had pure stress UI, 19 (23%) had pure urgency UI and 44 (54%) had mixed UI; with 50 (61%) athletes losing urine during training and 37 (45%) during competitions. Regarding the KAP survey, 37 athletes (31%) demonstrated adequate knowledge, 63 (53%) adequate attitude and zero adequate practice. In the multivariate analysis, a sports practice time of over 8 years and dyspareunia presented significant values, with odds ratios (OR) of 2.66 and 2.99, respectively. Knowledge was significantly associated with UI (OR 0.43). UI had a slight impact on QOL.Conclusions: There is a high prevalence of UI yet low levels of adequate knowledge and practice regarding the occurrence of UI in sports, with sports practice time over 8 years and dyspareunia factors predisposing female athletes to UI by 2.7 and 3 times, respectively. Athletes with adequate knowledge were 57% less likely to develop UI.

Evolving and Innovative Treatments for Syndesmosis Injuries

Category: Sports Introduction/Purpose: Despite extensive research of syndesmotic fixation techniques, there is little consensus regarding optimal treatment and return to play protocols for isolated syndesmotic injuries. As competing treatment goals may exist, orthopedic clinicians have resorted to a wide variety of treatment strategies, ranging from screw fixation to suture fixation in various constructs. Given the myriad techniques and constructs, it is increasingly important to understand the rationale and intended patient setting for selecting particular implants and constructs. Undoubtedly, a multitude of factors contribute to the range of outcomes following syndesmotic fixation. While there are various theoretical arguments made for selecting one construct over another, this study seeks to assess the distribution of current practice approaches to syndesmotic injuries by foot and ankle orthopaedic surgeons at large. Methods: This cross-sectional study collected data from trained, licensed orthopedic surgeons (i.e. MD, DO, etc.) practicing in North America that treat isolated syndesmotic injuries. A one-time online survey was disseminated to the AOFAS membership. The survey contained questions regarding participant demographics, indications for treating syndesmotic injuries, preferred technique for repairing the syndesmosis and post-operative management, as applied to six athlete scenarios (moderate, high, and very high impact athletes with complete syndesmosis injury, with and without complete deltoid injury), and post-operative return to play protocols. Frequencies and percentages were calculated for all categorical responses using STATA 14.2. Free text responses were analyzed for common themes by fellowship trained, licensed orthopedic surgeons. Results: 273 of 337 responses were complete. Radiographic widening of greater than 2 mm at the syndesmosis was a sole indication for surgery for 83% of respondents, and arthroscopic widening of the syndesmosis was a sole indication for 75%. No clinical exam or MRI finding reached a threshold of 50% as a sole indication. In moderate and high-impact athletes with complete syndesmotic injury, the majority of respondents use one or two flexible fixation devices (61.5% and 50.5%, respectively), 25% use screws only, and 23.7% use a combination. More than 70% do not change their treatment construct choice in the presence of a complete deltoid injury. There was considerable variability in anticipated return to sport amongst respondents for all injury scenarios, ranging from 2 weeks to 6 months. Conclusion: There is a wide variety of indications and treatment constructs employed by orthopaedic surgeons for athletes with ligamentous syndesmotic injuries requiring fixation. Despite absent consensus, several trends were evident. Flexible devices were utilized by a majority of respondents in all scenarios, even with ‘very high impact’ scenarios. Hybrid constructs are also common. The presence of a complete deltoid injury impacted fixation constructs for very few respondents. There is substantial variability in expected return to play for all athlete and injury scenarios. The diversity of approaches highlights the need for evidence-based guidelines regarding management of syndesmotic injuries.

The Effect of Drop-Landing Height on Tibia Bone Strain

Athletes and military recruits are often afflicted by stress fractures. Rigorous training programs consisting of increased repetitive mechanical loading may contribute to the high incidence of tibia stress fracture in the athletic and army populations. The purpose of this study was to assess the effect of incremented height on tibia bone strains and strain rates during landing. Seven healthy college males performed drop-landing tasks from 26 cm, 39 cm, and 52 cm, respectively. Tibia bone strains and strain rates were obtained through subject-specific multi-body dynamic computer simulations and finite element analyses. One-way repeated measures ANOVAs were conducted. Both 39 cm and 52 cm conditions resulted in larger tibia bone strains and strain rates than the 26 cm condition. The 52 cm condition also resulted in greater bone strains and strain rates than the 39 cm condition. A dose-response relationship exists between incremented landing height and bone strains and strain rates. Activities consisting of high impact landings are associated with increased risk of developing tibia stress fracture. When designing training programs involved high impact activities, athletes and military recruits should consider the effect of impact loading on tibia bone health and giving enough time for bones to adapt to new trainings.

The Effect of Swimming During Childhood and Adolescence on Bone Mineral Density: A Systematic Review and Meta-Analysis.

The effects of swimming on bone mineral density (BMD) have been studied by several researchers, with inconsistent results. This meta-analysis aims to determine whether systematic swimming training may influence BMD during childhood and adolescence. A systematic search was performed in PubMed, SPORTDiscus and ClinicalTrials.gov from the earliest possible year to March 2015, with data extraction and quality assessment performed independently by two researchers following the PRISMA methodology. Swimmers were compared to sedentary controls and to athletes performing highly osteogenic sports. Therefore, a total of two meta-analyses were developed. Fourteen studies met the inclusion criteria and were included in the meta-analyses. Swimmers presented similar BMD values to sedentary controls and lower than other high-impact athletes. Femoral neck and lumbar spine BMD differences between swimmers and sedentary controls and between swimmers and athletes practicing osteogenic sports appeared to increase with age and favored the non-swimming groups. There were no differences by sex. While swimming is associated with several health benefits, it does not appear to be an effective sport for improving BMD. Swimmers might be in need of additional osteogenic exercises for increasing BMD values.

Outcomes of Microfracture in Professional Skiers (SS-34)

Introduction Symptomatic chondral defects in the knee can be devastating injuries to the competitive skier. Outcomes after microfracture in these high-impact athletes have not been previously reported. The purpose of this study was to evaluate results of microfracture in the professional skier. Methods Twenty active elite skiers having undergone knee microfracture surgery performed by two surgeons at our institution between 1986 and 2008 were included in this study. Demographic data were obtained for each patient, along with outcome scores and objective performance data. Results Twenty patients (23 knees) with an average age of 23.1 years (range: 15-29) were studied (16 female, 4 male). Follow-up information was available on 20 knees with a minimum follow-up of 2 years (87%). Average time from microfracture surgery to final follow-up was 77 months (range: 24-255). Mean lesion size was 155 mm2 (range: 5-450 mm2). One knee underwent microfracture of a bipolar lesion. Twenty-two of 23 knees (96%) returned to competitive skiing. Average return to competition was 13.4 months (range: 0.5-25.3). Mean patient satisfaction scores were 9.8 (range: 6-10). Mean Tegner and Lysholm scores were 8 (range: 3-10) and 86 (range: 41-100), respectively. Conclusion Patients with symptomatic chondral lesions of the knee can return to a high level of competition following microfracture surgery. Ultimately, 22 of 23 (96%) knees were able to return to ski racing. Microfracture is a reliable method of treating chondral lesions in these high-impact athletes. Symptomatic chondral defects in the knee can be devastating injuries to the competitive skier. Outcomes after microfracture in these high-impact athletes have not been previously reported. The purpose of this study was to evaluate results of microfracture in the professional skier. Twenty active elite skiers having undergone knee microfracture surgery performed by two surgeons at our institution between 1986 and 2008 were included in this study. Demographic data were obtained for each patient, along with outcome scores and objective performance data. Twenty patients (23 knees) with an average age of 23.1 years (range: 15-29) were studied (16 female, 4 male). Follow-up information was available on 20 knees with a minimum follow-up of 2 years (87%). Average time from microfracture surgery to final follow-up was 77 months (range: 24-255). Mean lesion size was 155 mm2 (range: 5-450 mm2). One knee underwent microfracture of a bipolar lesion. Twenty-two of 23 knees (96%) returned to competitive skiing. Average return to competition was 13.4 months (range: 0.5-25.3). Mean patient satisfaction scores were 9.8 (range: 6-10). Mean Tegner and Lysholm scores were 8 (range: 3-10) and 86 (range: 41-100), respectively. Patients with symptomatic chondral lesions of the knee can return to a high level of competition following microfracture surgery. Ultimately, 22 of 23 (96%) knees were able to return to ski racing. Microfracture is a reliable method of treating chondral lesions in these high-impact athletes.

Re-defining normal: bone mineral density in elite female athletes

BackgroundCollege age female athletes are susceptible to decreased bone mineral density (BMD) which puts them at an elevated risk for poor bone health in the future.ObjectiveThe primary purpose of this...

Exercise Dependent Pleurisy in a Soccer Athlete

Except for traumatic or spontaneous pneumothorax, little information is known about exercise associated pleural pathologies. We present the case of a 22-year-old athlete with symptoms of musculoskeletal disorders of his upper back after a first league soccer match. Clinical examination initially showed a blockage of the costotransversal joints six and seven with subsequent muscular tension representing an interscapulovertebral pain syndrom. Temporary complete pain relief with following severe reoccurrence of symptomes led to further diagnostic procedures after 3 days. Contrast Enhanced Magnetic Resonance Images (CE-MRI) surprisingly revealed an intrathoracic tumenescence in front of the cardiac apex with surrounding pleural effusion. After excluding all alternative diagnosis for unclear pleurisy we assumed an exercise dependent local pleurisy with subsequent pleural effusion due to local friction by a posttraumatic intrathoracic hematoma. Several invasive and non-invasive therapeutical options were discussed in this rare case with a final decision for a conservative strategy. Seven weeks after injury the player was able to return to play. Even if musculoskeletal problems are most likely in high impact athletes, referred pain due to less common disorders has always to be kept in mind.