Sports Medicine Injuries Research Articles

Groin Injuries in Sports Medicine

Context:An in-season groin injury may be debilitating for the athlete. Proper diagnosis and identification of the pathology are paramount in providing appropriate intervention. Furthermore, an adductor strain that is treated improperly can become chronic and career threatening. Any one of the 6 muscles of the adductor muscle group can be involved. The degree of injury can range from a minor strain (grade 1), where minimal playing time is lost, to a severe strain (grade 3), in which there is complete loss of muscle function. Persistent groin pain and muscle imbalance may lead to athletic pubalgia.Evidence Acquisition:Relevant studies were identified through a literature search of MEDLINE and the Cochrane database from 1990 to 2009, as well as a manual review of reference lists of identified sources.Results:Ice hockey and soccer players seem particularly susceptible to adductor muscle strains. In professional ice hockey and soccer players throughout the world, approximately 10% to 11% of all injuries are groin strains. These injuries have been linked to hip muscle weakness, a previous injury to that area, preseason practice sessions, and level of experience. This injury may be prevented if these risk factors are addressed before each season.Conclusion:Despite the identification of risk factors and strengthening intervention for athletes, adductor strains continue to occur throughout sport. If groin pain persists, the possibility of athletic pubalgia needs to be explored, because of weakening or tears in the abdominal wall muscles. A diagnosis is confirmed by exclusion of other pathology.

Improved Muscle Healing after Contusion Injury by the Inhibitory Effect of Suramin on Myostatin, a Negative Regulator of Muscle Growth

Background Muscle contusions are the most common muscle injuries in sports medicine. Although these injuries are capable of healing, incomplete functional recovery often occurs. Hypothesis Suramin enhances muscle healing by both stimulating muscle regeneration and preventing fibrosis in contused skeletal muscle. Study Design Controlled laboratory study. Methods In vitro: Myoblasts (C2C12 cells) and muscle-derived stem cells (MDSCs) were cultured with suramin, and the potential of suramin to induce their differentiation was evaluated. Furthermore, MDSCs were cocultured with suramin and myostatin (MSTN) to monitor the capability of suramin to neutralize the effect of MSTN. In vivo: Varying concentrations of suramin were injected in the tibialis anterior muscle of mice 2 weeks after muscle contusion injury. Muscle regeneration and scar tissue formation were evaluated by histologic analysis and functional recovery was measured by physiologic testing Results In vitro: Suramin stimulated the differentiation of myoblasts and MDSCs in a dose-dependent manner. Moreover, suramin neutralized the inhibitory effect of MSTN on MDSC differentiation. In vivo: Suramin treatment significantly promoted muscle regeneration, decreased fibrosis formation, reduced myostatin expression in injured muscle, and increased muscle strength after contusion injury. Conclusion Intramuscular injection of suramin after a contusion injury improved overall skeletal muscle healing. Suramin enhanced myoblast and MDSC differentiation and neutralized MSTN's negative effect on myogenic differentiation in vitro, which suggests a possible mechanism for the beneficial effects that this pharmacologic agent exhibits in vivo. Clinical Relevance These findings could contribute to the development of biological treatments to aid in muscle healing after experiencing a muscle injury.

A Systematic Approach to Magnetic Resonance Imaging Interpretation of Sports Medicine Injuries of the Shoulder

A Systematic Approach to Magnetic Resonance Imaging Interpretation of Sports Medicine Injuries of the Shoulder

Influence of Foot Characteristics on the Site of Lower Limb Osteoarthritis

Foot structure and range of motion have been linked to lower limb musculoskeletal injuries in sports medicine,(11,14,41) and recently there have been attempts to establish a connection between the foot and lower limb osteoarthritis (OA)(19,13). Considering the fact that OA of the knee and hip are the most important causes of pain and disability in older people,(12,25) it is surprising that there has been no research comparing the foot types of those with knee OA and those with hip OA. To evaluate an apparent difference in the feet and gaits of patients with hip OA and medial compartment OA of the knee that was noted during routine clinical assessment, a prospective observation study was undertaken. The study included patients with OA either of the hip or the medial compartment of the knee and a control group of healthy subjects. There were 60 in each group determined by sample size calculation. The groups were matched for age and gender. Dorsiflexion and plantarflexion of the ankle, calcaneal angle, and navicular height in both sitting and standing were measured. Results were analyzed by ANOVA and linear regression analysis. There were significant differences among all three groups, particularly in ankle dorsiflexion (p < 0.001) and calcaneal angle (p < 0.001). Differences in foot type between patients with OA of hip and knee were confirmed. These two groups also were different from the control group of healthy subjects. The lack of ankle dorsiflexion and high arches of patients with OA of the hip contrasted with the ample dorsiflexion and flatfeet of patients with OA of the knee.

The use of therapeutic medications for soft‐tissue injuries in sports medicine

The use of therapeutic medications for soft‐tissue injuries in sports medicine

The use of therapeutic medications for soft‐tissue injuries in sports medicine

The use of non-steroidal anti-inflammatory drugs (NSAIDs) to treat most muscle, ligament and tendon injuries should be reassessed. They have, at best, a mild effect on relieving symptoms and are potentially deleterious to tissue healing. Soft-tissue injury associated with definite inflammatory conditions such as bursitis or synovitis or involving nerve impingement does warrant short-term treatment with NSAIDs. Paracetamol has similar efficacy to NSAIDs in soft-tissue injury, is cheaper, and has a lower side-effect profile. It is the analgesic of choice for most soft-tissue injury. Cyclo-oxygenase-2 (COX-2) inhibitors should not be used to treat soft-tissue injuries unless impingement is a major feature and non-selective NSAIDs are contraindicated (eg, coexisting gastric disorder), and the patient is not at cardiovascular risk. Corticosteroid injections for tendon injuries may achieve a mild to moderate reduction in pain for up to 6 weeks. However, they do not promote tendon healing, so should generally be used only when healing is not a critical goal. Promising new therapeutic treatments for soft-tissue injuries include topical glyceryl trinitrate, aprotinin injections, and prolotherapy.

Foreword: A universal language

Exhortations to exercise or engage in some form of sporting activity have been ignited by alarm over the burgeoning epidemics of obesity, heart disease, and type 2 diabetes in affluent nations. But increasingly countries such as China and India are also paying the price of inactivity and overeating. Like it or not, emulating Homer Simpson's couch potato lifestyle and eating habits is not going to lead to optimum health, wellbeing, and a longer life. It is not just at the individual level that exercise and sport are important: sport has much more to offer—to help develop and build upon global partnerships in a world increasingly beset by the effects on health of inequality, poverty, and violence.This year was proclaimed by the United Nations General Assembly as The International Year of Sport and Physical Education (IYSPE 2005) with the aim to promote sport as a way to help reach the Millennium Development Goals. What better topic for this year's special issue, therefore, than Medicine and Sport. In this collection of essays, features, reviews, and profiles we have covered some of the more usual issues associated with sports medicine—injury; the psychology of sport; and issues about disability, enhancement, gender, age, and the elite—as well as the use of sport to promote education, tolerance, and peace. As UN Secretary-General Kofi Annan has said, “Sport is a universal language that can bring people together no matter what their origin, background, religious beliefs or economic status”.We warmly thank the authors, without whom this special issue would not have been possible. Exhortations to exercise or engage in some form of sporting activity have been ignited by alarm over the burgeoning epidemics of obesity, heart disease, and type 2 diabetes in affluent nations. But increasingly countries such as China and India are also paying the price of inactivity and overeating. Like it or not, emulating Homer Simpson's couch potato lifestyle and eating habits is not going to lead to optimum health, wellbeing, and a longer life. It is not just at the individual level that exercise and sport are important: sport has much more to offer—to help develop and build upon global partnerships in a world increasingly beset by the effects on health of inequality, poverty, and violence. This year was proclaimed by the United Nations General Assembly as The International Year of Sport and Physical Education (IYSPE 2005) with the aim to promote sport as a way to help reach the Millennium Development Goals. What better topic for this year's special issue, therefore, than Medicine and Sport. In this collection of essays, features, reviews, and profiles we have covered some of the more usual issues associated with sports medicine—injury; the psychology of sport; and issues about disability, enhancement, gender, age, and the elite—as well as the use of sport to promote education, tolerance, and peace. As UN Secretary-General Kofi Annan has said, “Sport is a universal language that can bring people together no matter what their origin, background, religious beliefs or economic status”. We warmly thank the authors, without whom this special issue would not have been possible.

1. The use of therapeutic medications for soft‐tissue injuries in sports medicine

1. The use of therapeutic medications for soft‐tissue injuries in sports medicine

A Systematic Approach to Magnetic Resonance Imaging Interpretation of Sports Medicine Injuries of the Knee

Magnetic resonance imaging is performed more commonly on the knee than on any other joint, and it is an excellent diagnostic tool that can aid in the evaluation of a host of sports-related injuries involving the ligaments, tendons, menisci, osseous structures, and articular surfaces. A thorough evaluation of the images, however, can be a daunting task, as the study often contains dozens of images obtained with multiple pulse sequences and in several imaging planes. A systematic approach will facilitate an accurate and timely evaluation of this complex examination and will ensure that all of the clinically relevant structures are adequately assessed. This article will provide a systematic approach to the interpretation of a magnetic resonance examination of the knee. The normal imaging appearance of each anatomical structure will be described, and the optimal pulse sequence and imaging plane for the evaluation of each structure will be discussed. Finally, the signs of injury will be described and illustrated.

MR Imaging Evaluation of the Postoperative Knee

The increased number of patients undergoing arthroscopy or surgery of the knee for sports medicine injuries is leading to increased numbers of patients who require imaging after surgery because of failure to improve, recurrent symptoms, or new injury. As in preoperative patients, magnetic resonance (MR) imaging is the most valuable imaging method for postoperative evaluation of the knee. Surgical changes increase the difficulty of diagnosis of abnormalities in the knee with MR imaging. MR arthrography with direct intraarticular injection of contrast material can help improve evaluation of the postoperative meniscus and possibly help improve evaluation of anterior cruciate ligament grafts in patients after surgery. Recognition of the normal postoperative MR imaging appearance of the structures in the knee and of abnormalities is essential to accurate MR imaging evaluation of these patients.

Prior Injuries &amp; Future Participation in National Football League (NFL) Prospects

2215 PURPOSE & METHODS: To analyze sports medicine injuries and to predict future participation in the National Football League, we evaluated medical, physical, and performance variables in 384 (196 Offense, 149 Defense, and 39 Undefined) top US college football players who were tested at the 2000 Indianapolis NFL Combine. We then tracked these players' participation in the NFL over the next two consecutive years by using NFL consolidated summaries collected after each pro game. RESULTS: Within the previous 5 yr, 58% (n = 223) of players accounted for 524 significant injuries and 257 surgeries or 1.4 injuries and 0.7 surgeries per player for the entire group. 17% (n = 64) had 1 injury, 18% (n = 70) had 2 injuries, 15% (n = 58) had 3 injuries, and 8% (n = 31) had 4 or more injuries within the past 5 yr. The most recent, primary sites of injury were the knee (20%, n = 77), shoulder (11%, n = 42), ankle (7%, n = 26), lower back (5%, n = 19) and hand (3%, n = 13). The top primary diagnoses were tear (18%, n = 70), dislocation/subluxation (9%, n = 36), fracture (7%, n = 28), and repetitive trauma/loose bodies (7%, n = 26). 14% of players (n = 54) had significant degenerative joint diseases or arthritis as documented by comprehensive orthopedic analyses and imaging. The highest body mass indices (BMI) were in offensive lineman and defensive tackles (both 38), while the lowest were in defensive backs (27) and wide receivers (26). For all player classifications, average BMI were higher than national recommendations (< 25) predicting relatively higher disease risk and a shortened life span. Though there was wide variability, offensive lineman (yr 1: 16%, yr 2: 21%), wide receivers (yr 1: 14%, yr 2: 18%), defensive ends (yr 1: 17%, yr 2: 27%) and linebackers (yr 1: 15%, yr 2: 29%) had the highest participation. 61% of players (n = 235) were classified as minimal participants (<10% of plays for both yr). For offense, orthopedic grade was a significant predictor of participation in running backs (8% of variance) and wide receivers (10% of variance) for the 1st year (both P<0.05). For defense, the total number of injuries (11%) and total number of surgeries (11%) were significant predictors of participation in linebackers only (both P<0.05). CONCLUSIONS: While predicting participation may be crucial from an owner and coach perspective, we are concerned more with the health and well-being of these athletes well into the future. Our data imply that many players who report to the Combine have significant injuries prior to entering the NFL, that a vast majority subsequently drafted have very little impact in the 1st and 2nd yr, and that BMI, preexisting injuries and arthritis predict significant future health consequences.

Prior Injuries &amp; Future Participation in National Football League (NFL) Prospects

2215 PURPOSE & METHODS: To analyze sports medicine injuries and to predict future participation in the National Football League, we evaluated medical, physical, and performance variables in 384 (196 Offense, 149 Defense, and 39 Undefined) top US college football players who were tested at the 2000 Indianapolis NFL Combine. We then tracked these players' participation in the NFL over the next two consecutive years by using NFL consolidated summaries collected after each pro game. RESULTS: Within the previous 5 yr, 58% (n = 223) of players accounted for 524 significant injuries and 257 surgeries or 1.4 injuries and 0.7 surgeries per player for the entire group. 17% (n = 64) had 1 injury, 18% (n = 70) had 2 injuries, 15% (n = 58) had 3 injuries, and 8% (n = 31) had 4 or more injuries within the past 5 yr. The most recent, primary sites of injury were the knee (20%, n = 77), shoulder (11%, n = 42), ankle (7%, n = 26), lower back (5%, n = 19) and hand (3%, n = 13). The top primary diagnoses were tear (18%, n = 70), dislocation/subluxation (9%, n = 36), fracture (7%, n = 28), and repetitive trauma/loose bodies (7%, n = 26). 14% of players (n = 54) had significant degenerative joint diseases or arthritis as documented by comprehensive orthopedic analyses and imaging. The highest body mass indices (BMI) were in offensive lineman and defensive tackles (both 38), while the lowest were in defensive backs (27) and wide receivers (26). For all player classifications, average BMI were higher than national recommendations (< 25) predicting relatively higher disease risk and a shortened life span. Though there was wide variability, offensive lineman (yr 1: 16%, yr 2: 21%), wide receivers (yr 1: 14%, yr 2: 18%), defensive ends (yr 1: 17%, yr 2: 27%) and linebackers (yr 1: 15%, yr 2: 29%) had the highest participation. 61% of players (n = 235) were classified as minimal participants (<10% of plays for both yr). For offense, orthopedic grade was a significant predictor of participation in running backs (8% of variance) and wide receivers (10% of variance) for the 1st year (both P<0.05). For defense, the total number of injuries (11%) and total number of surgeries (11%) were significant predictors of participation in linebackers only (both P<0.05). CONCLUSIONS: While predicting participation may be crucial from an owner and coach perspective, we are concerned more with the health and well-being of these athletes well into the future. Our data imply that many players who report to the Combine have significant injuries prior to entering the NFL, that a vast majority subsequently drafted have very little impact in the 1st and 2nd yr, and that BMI, preexisting injuries and arthritis predict significant future health consequences.

Protected Research: Sports Medicine and Rugby Injuries

(2004). Protected Research: Sports Medicine and Rugby Injuries. Sport in Society: Vol. 7, No. 1, pp. 95-108.

A comparison of two injury surveillance systems within sports medicine clinics

This study compares a comprehensive method of collecting injury data from sports medicine clinics, with a more simplified method of injury surveillance. The sports medicine injury surveillance (SMIS) project was implemented in a group of five allied sports medicine clinics in Melbourne. over two consecutive years. The injury surveillance method used in the second year (SMIS2) was a simplified version of that used in the first year (SMIS1). Methodological differences in the injury surveillance systems included form design, staff commitment and training, auditing process, financial incentives offered and employment of a project officer. Data were collected on 6479 new sports injury patients during SMIS1 and on 1682 patients during SMIS2. Comparative data from the two years of injury surveillance included patient profile (gender. age. days from injury to treatment, sport and context of injury) and injury information (site, cause and nature of injury). The SMIS2 methodology was associated with a lower sensitivity (p < 0.001) and a higher proportion of missing information (p < 0.001) than the SMIS1 methodology. There was also a significant difference in the nature and cause of injury variables (p < 0.001) between SMIS1 and SMIS2 and this was associated with coding changes. This study shows that the method of data collection influences both the proportion of missing information and the sensitivity of the system. A comprehensive method of injury surveillance will lead to a more complete data collection process. Methodological differences, however, do not appear to substantially alter conclusions about general patient characteristics, but do have some influence on the accuracy with which broad injury data are identified. Notwithstanding these comments, this study shows that injury surveillance activities can be successfully implemented in sports medicine clinics.

Editorial Comment

The articles in this symposium represent the state of science in the field of sports medicine for the treatment of lower extremity injuries. This symposium represents an evidence-based approach for the physician evaluating and treating lower extremity injuries in sports medicine. Each manuscript’s focus is to review the best clinical scientific studies with emphasis on prospective and randomized controlled trials. For example, graft choice for anterior cruciate ligament reconstruction is reviewed by Fox et al and Graham and Parker. A rational approach to rehabilitation after anterior cruciate ligament reconstruction is provided by Beynnon et al. Injuries and treatment to the articular cartilage (Buckwalter) and meniscus (McCarty et al) provide insight into the relative deficiencies in the understanding of the treatment of two of the most important risk factors for osteoarthrosis. Finally, methods for providing validated measure of outcomes of treatment (Irrgang and Anderson) and techniques for prevention of anterior cruciate ligament injuries focusing on proprioception and neuromuscular exercises (Hewett et al) complete the symposium. Hopefully, this symposium will assist the reader in reevaluating treatment strategies based on available evidence-based research and possibly stimulate clinicians to consider future research contributions.

LCL INJURY WITH A BICEPS FEMORIS RUPTURE?

HISTORY: A 20 year old female college freshman soccer forward sustained a right knee injury after a one-on-one breakaway. She was dribbling into the penalty box to shoot with her left foot when the keeper slid out onto her planted right leg hyperextending her knee. She felt a stretching and a “snap”. She was examined on the field by the trainer, ice was applied, and she was then sent to the emergency department. In the emergency department, she complained of numbness and tingling in her leg, foot, and toes. X-rays were completed and were negative, she was placed in a knee immobilizer and she was instructed to follow up Sunday morning in the Sports Medicine Injury Clinic for further evaluation at which point I became involved in the case. PHYSICAL EXAMINATION: Inspection at the Injury Clinic revealed varus malalignment of the bilateral lower extremities. 1+ effusion of the left knee with general swelling in the posterior aspect of the knee and at the proximal head of the fibula. Ecchymosis was noted along the posterior lateral aspect of the knee. There was tenderness along the lateral joint line, over the head of the fibula, and posteriorly. Her ROM was diminished to 75 degrees of flexion due to swelling and tenderness. She had a positive anterior drawer, negative posterior drawer, and a 2+ Lachmans without a discernible endpoint. Varus stressing revealed 30 degrees of opening with no end point. Valgus stress of the knee was intact. McMurray's and Apley's testing were not performed due to patients discomfort. She had 2+ dorsalis pedis and posterior tibialis pulses with decreased sensation along the anterior tibia and dorsum of the foot(photos will be presented). DIFFERENTIAL DIAGNOSIS: Traumatic rupture of the ACL and LCL with a lateral meniscal tear Occult Fibular head fracture and superficial peroneal nerve injury TESTS AND RESULTS: Right Knee Complete Series Radiographs: Negative with no evidence of fracture. Right Knee Magnetic Resonance Imaging: Grade III LCL tear, Grade I MCL sprain, severe interstitial or complete disruption of the ACL, partial tear of the PCL, no medial or lateral tear of the meniscus identified, bone contusion of the medial femoral condyle, and possible biceps femoris tendon disruption (photos will be presented). FINAL WORKING DIAGNOSIS: Rupture of the ACL and LCL with biceps femoris tendon rupture Partial PCL tear with a MCL grade I sprain Superficial peroneal nerve injury. TREATMENT AND OUTCOMES: Passive ROM with a hinge brace and non-weight bearing prior to surgery Surgical repair of the lateral complex with a arthroscopic repair of the ACL and surgical release of the impinged peroneal nerve (intraoperative photos will be presented).

A profile of Australian football injuries presenting to sports medicine clinics

Most of the published data describing Australian football injuries is from hospital emergency departments and elite injury surveillance studies. There is a lack of good information about injuries to players at the lower levels of participation and those not severe enough to warrant hospital treatment. This study describes the profile of Australian football injuries that present to sports medicine clinics for treatment. New sports injury cases, presenting to five metropolitan Melbourne sports medicine clinics during a 12 month period in 1996-1997, were recorded through the Sports Medicine Injury Surveillance project. Both the patient and treating health professional provided personal and injury details. Australian football accounted for 29% of the 6479 recorded injury cases. The majority of injured players were male (99%) and from adult, community leagues (78%); the mean age was 23 years. Competition accounted for 78% of injuries and 72% of injured players presented for treatment to a sports physician/medical practitioner. Body contact accounted for half of all injuries and the most common injuries were medial ligament sprains of the knee (7%), lateral ligament sprains of the ankle (6%) and anterior cruciate ligament injuries (4%). In conclusion, sports medicine clinics treat a wide variety of football injuries and appear to be a good source of data about injuries to non-elite participants.

Potential Applications of Gene Therapy in Sports Medicine

Gene therapy has the potential to improve greatly the management of sports medicine injuries. By the expeditious introduction of the appropriate genes to sites of injury, it should prove possible to initiate healing responses in those tissues that normally fail to heal, to accelerate healing in tissues which do naturally heal, and to improve the quality of the repair tissue. In addition, genes with anti-inflammatory properties offer novel possibilities for the control of chronic, sports related inflammation. None of these applications of gene therapy in sports medicine is yet in the clinic. It would seem, however, only a matter of time before the first clinical trials emerge. Their acceptance will be facilitated by the two human protocols that are presently underway for the treatment of rheumatoid arthritis. The present status of sports medicine gene therapy is summarized in Table 3.

Common Pediatric Sports Medicine Injuries

Common Pediatric Sports Medicine Injuries

Common Pediatric Sports Medicine Injuries

Common Pediatric Sports Medicine Injuries