Level Of Sport Research Articles

Estimation of Body Composition and Health Status in Women, PE Students, on-site of Outdoor Activities on Gazivode Lake – A Case Study Report

This paper is based on the results of the cross-sectional experiment that was implemented in the school year 2021/2022 among women students in the first year of bachelor studies at the Faculty of Sport and Physical Education (FSPE) in Leposavić, University of Priština (temporarily allocated in Kosovska Mitrovica). The study design model was implemented during the obligatory course Outdoor activities (2nd semester, weekly classes 1 + 4, and 15 + 60 classes per semester) for the first time. Body composition assessment was realized along with the pedagogical practice of summer outdoor activities camp on Gazivode Lake in Kosovo (as a practical exam study curriculum requirement). The sample includes seven women FSPE students. Based on the body composition and health status assessment, students’ results are presented in figures (for the evaluation of measured variables) and diagrams for estimating the individual student’s results. Comparative analysis of results within the group was used, considering the differences among examined students regarding calculated mean values, recorded min and max results, and confidence interval. The student profile model scores were selected according to the best results achieved in general placement in most variables and evaluated regarding the case study report. The results were evaluated based on the digital system for the assessment of body composition (Omron BF511) and the interpretation of results for the following variables: Body Fat (BF%), Visceral Fat (VF), Skeletal Muscles Percentage (SM%), Body Mass Index (BMI), and Resting Metabolic Rate (RMR). Health status assessments were performed by an electronic digital blood pressure monitor (Prizma YE660E) for the measurement of Systolic (SYS), Diastolic Blood Pressure (DIA), and Resting Heart Rate (RHR). The results show the expected intra-group differences in body composition parameters, which are not inherited conditionally, for all selected body parameters (except for BMI). However, most of the values are in the recommended range, especially those with small percentages of high BF% and BMI, as well as SM% values, indicating the heterogeneity of the participants, their sports orientation, health status, and level of physical activity.

Poster 342: Anterior Cruciate Ligament Reconstruction in Recreational Athletes Aged 40 and Older: Activity Level as an Indication

Objectives: The number of patients that are continuing to be active is extending into middle age. Many in this population report consistent participation in recreational sports. Anterior cruciate ligament reconstruction (ACLR) is the gold standard for treatment among young athletic patients, but nonoperative treatment has historically been utilized more often in older patient populations. It has been traditionally thought that older adult patients do not share the same activity level as younger patients and thus are not in need of surgical treatment of an ACL injury. There is some hesitancy to treat older patients if they have mild to moderate pre-existing arthritis, but in recent years the literature has demonstrated good outcomes in this population. The type of graft used in older patients is another source of controversy, with many surgeons opting to use allograft rather than a patient’s native tissue for ACLR. Factors that can inform decision-making such as pre-injury activity level and employment have not been thoroughly assessed for these patients. The purpose of this study was to better understand indications for ACLR in patients aged 40 and older by characterizing their activity level, mechanisms of injury, employment status, demographics, surgical characteristics, and patient reported outcomes (PROs). Methods: A registry of prospectively-collected PROs from a single metropolitan ambulatory surgical center was retrospectively reviewed for patients that received an ACLR from 2009-2016. Patients younger than 40 years old, revision procedures, and concomitant ligament repairs or reconstructions were excluded. Demographic, employment, activity, injury, and surgical characteristics were extracted via chart review. The level of strength required by the patient’s occupation was stratified by the definitions from the United States Department of Labor Occupation Requirements Survey (graded as “sedentary”, “light work”, “medium work”, “heavy work”, “very heavy work”). Surgical outcomes include ACLR failure or re-rupture, ipsilateral knee re-operations, and complications. PROs utilized were the Single Assessment Numeric Evaluation (SANE) and Knee Injury & Osteoarthritis Outcome Score (KOOS) collected pre-operatively and at two years post-operatively. Results: A total of 141 patients were identified. More than half the patients were female (n=81, 58%) and the average age was 47 years old (range: 40-66). Approximately 87% (n=124) of patients had PRO data. The average KOOS and SANE at two-year follow-up were 80.0 ± 15.9 and 85.3 ± 22.0, respectively. The average change from baseline score were 20.8 ± 20.2 and 24.1 ± 30.3 for KOOS and SANE, respectively. Pre-existing arthritis was found in the majority of patients (n=88, 62%). The most common graft type used for ACLR in this group was allograft (n=95, 67%). Injured menisci were typically treated with meniscectomy vs repair (n=65, 56%). The majority of patients (n=104, 77%) were engaged in a sport when they sustained an ACL injury, with 96% being engaged in a sport that requires running, jumping, and other high-impact activity. Those injured while involved in a sport on average demonstrated higher KOOS scores at baseline and at two-year follow up compared to those that were not involved in a sport (61.5 ± 18.0 vs 51.6 ± 18.0 at baseline, p=0.045; 82.8 ± 13.7 vs 70.8 ± 19.5 at two years, p=0.0048). A total of 27 of the sporting-related injuries occurred in patients age 50 or older (60% of n=45 patients age 50 years or older). All of these patients expressed a desire to return to sport and pre-injury activity. Skiing was the most frequently cited sport (n=41, 29%). Most ACL injuries were acute, with just 10% found to be chronic. The mechanism of injury varied by activity, but non-contact type ACL injuries were the most prevalent (n=66, 49%). Although most patients worked in a sedentary or desk job environment (n=87, 65%), some worked in very heavy-duty jobs (n=18, 14%). There was a low incidence of re-ruptures and re-operations (4.5% and 8.7%, respectively). Conclusions: The majority of patients aged 40 and over sustained ACL injuries while engaging in sports, with all of these patients citing a desire to return to sport and pre-injury activity level as their reason for wanting an ACLR. Patients were mostly treated with allograft compared to autograft, and meniscal injuries were most frequently treated through meniscectomy instead of repair. Many of these patients had some form of pre-existing arthritis and still went on to have surgery with excellent outcomes. PROs were also found to be higher initially and at two-year follow-up in the more active adult group, suggesting that pre-injury and post-injury activity level is associated with improved outcomes. When an older adult patient presents with an ACL tear, surgeons should consider the activity level and desires of the patient as they determine the appropriate avenue of treatment. There is certainly a role for conducting ACLR in patients aged 40 or older. [Table: see text][Table: see text][Table: see text]

Poster 333: Outcomes of Anterior Closing Wedge High Tibial Osteotomy in Patients Undergoing ACL Revision Reconstruction

Objectives: Graft failure rates following anterior cruciate ligament (ACL) reconstruction have been reported up to 30%. According to the literature, one anatomic variant linked to graft reinjury is a high posterior tibial slope. As a result, surgeons are exploring the effectiveness of slope reducing high tibial osteotomy (HTO) to reduce the subsequent reinjury risk. While cadaveric models indicate that this procedure decreases the forces across the ACL graft, there is limited evidence demonstrating its efficacy in clinical trials. Therefore, the purpose of this study was to compare self-reported patient outcomes between patients undergoing ACL revision surgery with a slope reducing high tibial osteotomy (ACL+HTO) and matched controls undergoing revision ACL reconstruction without slope reducing HTO. We hypothesized that patients undergoing ACL+HTO would exhibit similar outcomes with a low failure rate when compared to their matched counterparts. Methods: A retrospective matched-case control study was conducted for patients undergoing ACL revision reconstruction from 2018 to 2021, utilizing a single surgeon database (n = 1,781). Patients in the HTO group were included if they were at least one year out from surgical ACL reconstruction and slope reducing osteotomy. Patients were excluded if they had a primary ACL reconstruction or no concomitant ACL reconstruction with an HTO. Patients in the ACL+HTO group were age, gender, and setting-matched to a control group of patients undergoing revision ACL reconstruction. Descriptive patient demographic and surgical data were obtained, including pre/postoperative posterior tibial slope (o) for the HTO group. Complications and injury surveillance was conducted throughout the postoperative follow-up period. Primary outcome measures included the Single Assessment Numeric Scale (SANE), and graft failure rates at 24 months. Secondary outcomes included return to sport rate and level, and postoperative complications (infection, loss of motion, deep vein thrombosis, etc). Generalized linear models were conducted using parametric and nonparametric equivalents to compare baseline and outcome measures between groups with an a-priori alpha level of .05. Results: From a group of 364 revision ACL reconstructions, 9 patients met the inclusion criteria for the ACL+HTO group (Table 1). This group was age, gender and revision matched to 30 patients in the control group. Baseline comparisons revealed that the ACL control group weighed more than the experimental group (198.2 ±26.4 vs 183.7 ±21.7, P <.001), however all other comparisons were not statistically different. The mean pre op posterior tibial slope was 19.2o ±4.1o and 7.7o ±2.3o following HTO (mean diff: -11.5o, P <.001). Mean time to follow-up was 1.82 ±0.3 years. At follow-up, there were no statistical differences in self-reported knee function (SANE score), graft reinjury rate, rate of return to sport, or level of return to sport between groups (Table 2). There were no graft reinjuries reported in the ACL+HTO group, and approximately 85.8% returned to some level of sporting activity with 42% returning to a level I or II cutting and pivoting sport. Conclusions: Preliminary evidence provided in the current study suggests that slope reducing HTO in the setting of revision ACL reconstruction for large posterior tibial slope deformities is effective at correcting malalignment and avoiding graft failure out to 2 years. This procedure also holds promise to allow a majority of patients to return to various levels of sporting activities. To our knowledge, this is the first comparative study comparing the intermediate outcomes of this subpopulation to a matched revision ACL cohort. While these data do provide evidence for ongoing investigation, it is important to note that this pilot study is underpowered and we strongly recommend the performance of larger clinical trials to confirm these results. [Table: see text][Table: see text]

Arthroscopic Repair of an Anteroinferior Capsular Tear in the Shoulder of a Throwing Athlete

Background: Anterior capsular tears are often associated with traumatic glenohumeral instability episodes; however, there are not many previous descriptions in the literature without occurrence of frank dislocation. This video will discuss the presentation of a throwing athlete with an anteroinferior capsular tear in his dominant shoulder who underwent successful arthroscopic repair. Indications: Based on the patient's clinical symptoms, magnetic resonance imaging arthrogram findings, and failure to return to play despite attempts at conservative management, he was determined to be a candidate for arthroscopic repair. Technique Description: Arthroscopic repair consisted of reapproximation of the avulsed capsular tissue to its attachment point medially using suture anchors in the glenoid and a side-to-side repair of the mid-substance extension of the capsular split. Results: Arthroscopic repair of the anteroinferior capsular tear allowed the patient to return to his previous level of sport. Discussion/Conclusion: In the present case and a previous case series, surgical repair of anterior capsular tears, whether arthroscopic or open, can yield good results in throwing athletes aiming to return to prior levels of performance. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Poster 339: Long-Term Outcomes of Multiligament Knee Injuries in American Football Players from a Single Institution

Objectives: Multiligament knee injuries (MLKIs) can be devastating to an athlete’s career but can also negatively affect participation in recreational activities and daily tasks. A subset of athletes at significant risk of MLKIs are American football players. MLKIs with an associated anterior cruciate ligament tear (ACL-MLKI) are almost always surgically treated to restore stability to the athlete’s knee and to preserve knee-related function and joint health later in life. However, currently, there is a paucity of mid- and long-term outcomes data related to MLKIs and their surgical management. The objective of this study was to investigate >2-year outcomes in American football players who had reconstruction of the anterior cruciate ligament (ACL) alongside any combination of additional knee ligament tears treated with repair or reconstructive surgery, constituting an ACL-MLKI, at a single institution. We hypothesized that greater than half of American football players who underwent surgical management for an ACL- MLKI would meet the International Knee Documentation Committee subjective knee form Patient Acceptable Symptomatic State (IKDC-PASS) cutoff, would be able to return to their pre-injury level of sport, and would be satisfied with their surgical treatment outcome. Methods: We utilized a single institution’s prospectively collected data repository to retrospectively- identify patients from 2001-2019 who were American football players, underwent surgical management for an ACL-MLKI, and were at least 2 years post-operative. We included patients with ACL reconstruction plus any additional combination of repair or reconstruction of the posterior cruciate ligament, medial or lateral collateral ligaments, or posterolateral corner. We excluded those with advanced osteoarthritis at the time of injury or morbid obesity. Follow-up for assessing patient-reported outcomes was performed using a web-based platform or via phone calls using 3 questionnaires: the IKDC, an institutionally developed surgical satisfaction questionnaire, and an institutionally-developed return-to-sport questionnaire. We calculated the proportions of patients meeting a previously published IKDC-PASS cutoff specific to isolated ACL reconstruction (IKDC³75.9) and calculated summary statistics for all outcomes data. As secondary analyses, we compared IKDC scores between 2-ligament and >2-ligament groups using independent t-tests and evaluated the association between age at surgery and IKDC scores using linear regression (alpha<0.05). Results: Outcomes data were successfully collected for 50 of 72 eligible patients (69%; mean follow-up time=7.9±4.0 years; Table 2). Of the 72 eligible patients, 55 (76%) had 2 ligaments surgically-treated, 16 (22%) had 3 ligaments surgically-treated, and 1 (2%) had 4 ligaments surgically-treated (Table 1). Among those with outcomes data (n=50), the mean IKDC score was 83.7, with 78% meeting the IKDC-PASS cutoff (Table 2). Only 7 patients (14%) did not return to sports participation due to limitations from their ACL-MLKI surgery, and 94% were either satisfied or very satisfied with their surgical outcome (Table 2). The 2-ligament and >2-ligament groups did not differ in IKDC scores at follow-up (2-ligament: 84.0±15.4; >2-ligament: 82.9±16.5; p=0.83). Age at surgery was not associated with IKDC score at follow-up (p=0.64). Conclusions: This study represents the largest cohort of American football players evaluated for mid- to long-term outcomes following ACL-MLKI surgery at a single institution. A high proportion of these athletes met the IKDC-PASS, successfully returned to sport, and were satisfied with their ACL-MLKI surgical treatment. [Table: see text][Table: see text]

Poster 205: Performance and Return to Sport Following Medial Ulnar Collateral Ligament Repair with Internal Brace Augmentation in Professional Baseball Players

Objectives: Medial ulnar collateral ligament (UCL) reconstruction (UCLR) has been the gold standard treatment for symptomatic UCL injuries in throwing athletes. Recently, a novel technique of UCL repair with suture augmentation has been described and shown promising biomechanical as well as clinical results in a few small series of nonprofessional athletes. An added advantage of this technique over UCLR is that it affords the potential ability to return to competitive throwing with an accelerated timeline of 6-7 months as opposed to 12-18 months. No prior work has described the outcomes of this technique in professional athletes. This study aimed to evaluate the frequency and rate of return to prior level of sport as well as athletic performance of professional baseball players following UCL repair with Internal Brace augmentation. Methods: This study included all professional Major League Baseball (MLB) and Minor League Baseball (MiLB) players who underwent primary UCL repair with Internal Brace from January 2016 to June 2021. Demographic and performance data were recorded for each player. Performance metrics were then compared from one year preinjury against one year postoperative metrics. The return to play date was recorded. Univariate statistical analysis was performed to compare preinjury to postoperative performance (p< 0.05 considered statistically significant). Results: Fifteen players met inclusion criteria (8 MLB and 7 MiLB). Mean age was 28.2 +/- 4.06 years at time of surgery. There were 10 pitchers and 5 position players. All injuries were to the dominant extremity. No players underwent revision surgery during the study period. 93.3% (14/15) of players returned to sport and eventually prior level of competition. Average time to return to sport was 11.5 +/- 4.27 months and average time to prior level of competition was 12.1 +/- 4.61 months. When comparing competitive performance of players that returned successfully, one year preinjury to one year postoperatively, there was no statistically significant difference observed in performance [Table 1]. Conclusions: This study demonstrates promising early results of UCL repair with Internal Brace augmentation in professional baseball players. 93.3% of players were able to return to sport in under 12 months. All players, pitcher and position, that returned to sport were able to return to their prior level of play. No statistically significant drop in performance was observed in players that were able to return to play. Further clinical evaluation of UCL repair with Internal Brace augmentation and direct comparison of this procedure with UCL reconstruction is warranted. [Table: see text]

Poster 251: Patients who Undergo Bilateral Medial Patellofemoral Ligament Reconstruction Return to Sport at a Similar Rate to Unilaterals: A Matched Cohort Study

Objectives: Lateral patellar instability is a debilitating condition not only to athletes, but also a broad range of highly active individuals. Many of these patients experience instability symptoms bilaterally. Medial patellofemoral ligament reconstruction (MPFLR) is indicated to prevent future recurrence and ideally facilitate a complete return to sports (RTS). While RTS has been examined following MPFLR, the rate and timing of RTS in patients that undergo MPFLR bilaterally is unknown. The purpose of this study is to compare patients who have received bilateral MPFLR to a matched unilateral cohort, to elucidate potential differences and eventually allow better prognostication of this unique population’s ability to return to sports. Methods: Patients who underwent primary MPFL reconstructions with minimum 12-months clinical follow-up were identified from a single institution from the years 2011 to 2021. Those who underwent non-simultaneous primary MPFL reconstruction of bilateral knees were identified, as well as cohort of unilateral MPFLR. Surveys were then disseminated, including the Visual Analog Scale (VAS) for pain and satisfaction, the Kujala Anterior Knee Pain Scale, the Tegner Activity Scale, and the MPFL-RSI assessing psychological readiness to RTS. Detailed baseline sport activity and RTS information was collected, which was modified for bilateral patients to report on each procedure. For analysis, bilateral and unilateral MPFLRs were matched in a 1:2 ratio based on age, sex, BMI, and status of concomitant tibial tubercle osteotomy (TTO). A sub-analysis was performed comparing patients who underwent concomitant TTO compared to isolated MPFLR. Outcomes were compared between cohorts using T-tests and Chi-square analyses when required. Bivariate linear regression and logistic regression were performed to assess correlation between RTS and outcome scores, as well as psychological readiness. Results: Surveys were completed by 24 patients who underwent bilateral MPFL reconstruction and 105 unilateral patients with a total mean follow-up time of 4.2 ± 2.4 years. Among the bilateral patients, average time between MPFL procedures was 19.3 ± 16.9 months; notably, 71.4% of patients had symptoms in the contralateral knee at the time of index procedure. Three bilateral patients were unable to be matched, resulting in a 21:42 match with respective bilateral and unilateral cohorts having a mean age (22.5 ± 5.7 vs 23.3 ± 6.6 years; p = 0.65), sex (males 9/21 vs 18/42; p = 1.00), BMI (25.87 ± 6.39 vs 25.21 ± 4.78 kg/m2; p = 0.65), and concomitant TTO (9/18 vs 18/42; p = 1.00) that did not significantly differ, indicating successful matching. When comparing matched cohorts, bilateral MPFLR patients returned-to-sport at a similar rate to unilaterals following both their first (61.1% vs 63.2%; p = 0.98) and second MPFLR (72.7% vs 63.2%; p = 0.82). After undergoing both procedures, 33.3% of the bilateral cohort was able to return to their preinjury level of sport, compared to 26.3% of unilaterals (p = 0.82). The mean time for bilateral patient to RTS following their first procedure was 24.3 ± 7.5 weeks and 22.5 ± 12.9 weeks after their second, compared to the unilateral time-to-return taking 38.5 ± 23.0 weeks, though this difference at each time point (bilateral index vs unilateral; bilateral contralateral vs unilateral) did not reach significance (p = 0.06; p = 0.08). All patients scored highly with respect to VAS surgery satisfaction (85.4 vs 82.8; p = 0.44). There were no significant differences found between bilateral and unilateral cohorts for the Kulaja score (79.0 vs 86.1; p = 0.14) or in psychological readiness to RTS as indicated by the MPFL-RSI (49.7 ± 24.2 vs 58.8 ± 26.7; p = 0.24). Regression analysis found both the Kujala score (β = 0.06, p = 0.01) and MPFL-RSI (β = 0.06, p < 0.01) to be weakly, but significantly associated with rate of RTS. Sub-analysis of MPFLR with and without concomitant TTO did not demonstrate any significant differences with respect to RTS, psychological readiness, or any other outcome score (p > 0.05). Conclusions: The results of this study suggest that patients who undergo MPFLR bilaterally are able to return to sports at a similar rate and to a similar level compared to a matched unilateral comparison group with equivalent satisfaction and functional outcome scores. These findings are particularly important due to the high prevalence of simultaneous bilateral symptomatic patellar instability. With no demonstrable differences in rate and timing of return-to-sport, knee function, and psychological readiness between patients who have undergone unilateral versus bilateral MPFLR, surgeons can more confidently report equivalent outcomes to patients particularly with respect to RTS rates.

Poster 267: Psychological Readiness and Return to Sport and Work Following Autologous Chondrocyte Implantation

Objectives: Return to preinjury function in work and sport is dependent on both postoperative physical function and psychological readiness. Kinesiophobia has been studied following various orthopedic surgeries, but data remains scant in patients undergoing cartilage restoration procedures. The purpose of our investigation is to evaluate the effect of fear of reinjury on return to sport (RTS), return to work (RTW), and clinical outcomes following autologous chondrocyte implantation. Methods: A retrospective review of patients who underwent autologous chondrocyte implantation (ACI) and matrix-associated autologous chondrocyte implantation (MACI) at a single institution between 2012 – 2020 with a minimum of 2 year clinical follow-up was conducted. Patient-reported outcomes were measured using the Visual Analog Scale (VAS) for pain and satisfaction and the Knee Injury and Osteoarthritis Outcome Score (KOOS; subscores: symptoms, pain, sport, and quality of life (QOL)). Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia-11 (TSK-11). The Pain Catastrophizing Scale (PCS) was used to analyze individuals’ response to pain. T-tests or non-parametric tests and Chi-squared tests were used to analyze continuous variables and categorical variables, respectively. A one-way ANOVA was used to compare outcomes based on RTS status, using a post-hoc Tukey’s HSD test for multiple comparisons. Logistic regression controlling for age, sex, and BMI was used to determine if TSK-11 scores is predictive of RTS. Results: Forty-nine patients, mainly male (55.1%) aged 29.35 (± 6.28) with a mean follow-up of 5.7 ± 3.2 years were included in our analysis. Sixteen patients (32.7%) did not RTS. Of the 33 patients (67.3%) who returned to sport, 16 (32.7%) returned at their preoperative level or higher, and 17 (34.7%) returned at a lower level. TSK-11 scores (26.44 vs. 20.62, p=0.019) and VAS pain scores (47.94 vs. 6.88, p<0.001) were significantly greater in patients that that did not return to sport compared to those who return at the same level or higher. All KOOS subscores (Symptom: 59.69 vs. 85.62, Pain: 71.35 vs. 94.97, Sports: 37.19 vs. 86.56, QOL: 29.69 vs. 82.42, p <0.001) were significantly lower in patients who did not RTS compared to those who returned at the same level or higher. Patients who returned to sport, but at a lower level, had significantly greater KOOS-QOL (58.82 vs. 29.69, p<0.001) and KOOS-pain subscores (89.22 vs. 71.35, p<0.001) compared to patients who did not RTS. There were no significant differences in PCS scores between all three groups (p = 0.08). Increasing TSK-11 scores were inversely related to probability of RTS (OR [95% CI]; -0.19 [0.36 to 0.06], p=0.01). Of the 40 (81.6%) patients employed prior to injury, 100% (n=40) returned to work. Thirty-six (90%) patients returned to modified work within six months of surgery and had significantly lower TSK-11 scores (23.00 vs. 30.50, p=0.01) compared to patients who returned to work >6 months postoperatively. Conclusions: Fear of reinjury decreases the likelihood that patients will return to preinjury level of sport or higher after autologous chondrocyte implantation. Those who did not return to work had significantly worse KOOS scores. [Table: see text]

Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction Using a Calcium Phosphate-Hybridized Tendon Graft with More than an Average of 5 Years of Follow-Up: A Follow-Up Study of a Randomized Controlled Trial.

Calcium phosphate (CaP)-hybridized tendon grafting using an alternate soaking process improves tendon-to-bone healing in anterior cruciate ligament (ACL) reconstructions. This study aimed to compare bone tunnel enlargement, knee osteoarthritis, and clinical results between CaP-hybridized tendon grafting and conventional grafting in anatomical single-bundle ACL reconstruction. This study was a follow-up of a randomized controlled trial. Between July 2011 and December 2015, 90 patients underwent unilateral anatomical single-bundle ACL reconstructions and were randomly assigned to the CaP-hybridized tendon grafting (CaP group, n = 45; age, 27.1 [14-54] years; sex, 21 males and 24 females) or conventional grafting (control group, n = 45; age, 22.9 [13-58] years; sex, 26 males and 19 females). The randomization was performed according to the days of the week when the patients first visited the outpatient. The CaP-hybridized tendon grafting was created intraoperatively. The tendon grafts were soaked in a calcium solution for 30 s. After that, the tendon grafts were soaked in a NaHPO4 solution for 30 s. This soaking cycle between the calcium solution and the NaHPO4 solution was repeated 10 times. The bone tunnel enlargement, osteoarthritis grade, clinical score, and sports level were evaluated in patients who could be followed up for >3 years (CaP group, n = 20, average follow-up period 6.0 [5.1-6.9] years; control group, n = 15, average follow-up period 5.6 [4.3-6.9] years). Clinical scores, sports levels, and osteoarthritis grades were analyzed using a generalized linear mixed model (GLMM) based on repeated measurement data from preoperative and final observations, with time, group, sex, age, and BMI as fixed effects and the effect of individual differences as variable effects. In addition, bone-tunnel enlargements were analyzed using generalized linear models (GLM) with group, sex, age, and BMI as the main effects. Compared with the control group, the CaP group exhibited significantly reduced bone-tunnel enlargement on the femoral side (anteroposterior diameter; CaP group, 7.9% [-1.1-16.8] vs. control group, 29.2% [17.9-40.5], p = 0.004, MCID 16.05, proximal-distal diameter; CaP group, 7.9% [-1.9-17.8] vs. control group, 22.8% [10.9-34.7], p = 0.062, MCID 15.00). The osteoarthritis grades progressed in both groups (p < 0.001). The clinical scores and sports levels were not significantly different between the groups. This study suggests that the calcium phosphate-hybridized tendon graft reduces femoral bone-tunnel enlargement after anatomical single-bundle anterior cruciate ligament reconstruction in an average >5-year follow-up period. A longer follow-up period is necessary to reveal the clinical effects of the calcium phosphate-hybridized tendon grafts in anterior cruciate ligament reconstruction.

Aspects regarding the development of basic motor skills in 10- 12 year old children in football. Perspectives of the coach

The 10-12 years age category is one of the most important periods in the training of young footballers, especially from the perspective of motor skills. Psycho-physical development allows the expansion of gestural accumulations, the rapid assimilation of new motor skills and the formation of a culture of movement. At this age, there is an increase in motor guidance capacity, temporal differentiation, rhythm and reaction. By merging the new skills with the ones already learned, in an integrative way, the prerequisites for the consolidation of a multilateral motor baggage are ensured. The role of the coach in the football game is to ensure the development of the children on a sporting, social, psychological and educational level. The coach, in order to succeed in these things, must know the child, know the particularities of age and, last but not least, take into account his abilities. Thus, this study proposes the application of a questionnaire to the coaches from Bihor County, regarding their vision on the development of motor skills in 10-12 year-old children in the game of football. Analyzing the responses of the coaches, we can affirm the fact that most of the respondents are very well prepared from a theoretical point of view.

Combining age, sex, body mass index, sport level, and preoperative quadriceps strength improves the predictive ability of quadriceps strength recovery after anterior cruciate ligament reconstruction

PurposeThis study compared the predictive ability of each independent predictor with that of a combination of predictors for quadriceps strength recovery one year after anterior cruciate ligament (ACL) reconstruction.MethodsPatients who underwent primary ACL reconstruction using hamstring autografts were enrolled. Quadriceps strength, hamstring strength, and anterior tibial translation were measured, and the limb symmetry index (LSI) of the quadriceps and the hamstrings was calculated preoperatively and one year after surgery. Patients were classified into two groups according to the LSI of the quadriceps strength at one year postoperatively (≥ 80% or < 80%). Multivariate logistic regression analysis identified the independent predictors of quadriceps strength recovery, and the cut-off value was calculated using the receiver operating characteristic curve. A model assessing predictive ability of the combination of independent predictors was created, and the area under the curve (AUC) for each independent predictor was calculated by using the receiver-operating characteristic curves and the DeLong method.ResultsOf the 646 patients, 414 (64.1%) had an LSI of at least 80% for quadriceps strength one year after surgery, and 232 patients (35.9%) had an LSI of < 80%. Age, sex, body mass index (BMI), preinjury sport level, and LSI of preoperative quadriceps strength were independently associated with quadriceps strength recovery one year after ACL reconstruction. The cut-off values were age: 22.5 years; sex: female; BMI: 24.3 kg/m2; preinjury sport level: no sport; and LSI of preoperative quadriceps strength: 63.3%. The AUC of the model assessing the predictive ability of the combination of age, sex, BMI, preinjury sport level, and LSI of preoperative quadriceps strength was significantly higher (0.73) than that of similar factors of preoperative quadriceps strength (AUC: 0.63, 0.53, 0.56, 0.61, and 0.68, p < 0.01, respectively).ConclusionThe combination of age, sex, BMI, preinjury sport level, and LSI of preoperative quadriceps strength had a superior predictive ability for quadriceps strength recovery at one year after ACL reconstruction than these predictors alone. Multiple factors, including patient characteristics and preoperative quadriceps strength, should be considered when planning rehabilitation programs to improve quadriceps strength recovery after ACL reconstruction.Level of evidenceIII.

Open Reduction and Internal Fixation of Purely Ligamentous Lisfranc Injury in a Rugby Player: A Case Report

Objective: Lisfranc injuries are found in various injury patterns, especially in athletes. These injuries are the second most common type of foot injuries in athletes. However, the treatment decision differs and is essential in athletes for a good outcome. The main controversies in surgical management include whether to execute open or close reduction, fixation technique, and arthrodesis’ role in athletes. Case Report: A previously healthy 21 Years Old Malay gentleman sustained a sports injury diagnosed with pure ligamentous Lisfranc injury with an incomplete, partial lateral dislocation. The patient was treated with Open Reduction and Internal Fixation (ORIF) using a dorsal bridge Lisfranc locking plate. Conclusion: Early diagnosis and appropriate treatment are crucial to achieving stability in unstable Lisfranc injuries. Anatomical reduction and Lisfranc joint restoration are the keys to a good outcome. Open reduction and internal fixation are preferred methods where most athletes can return to their previous level of sports.

Comparison of Primary Repair of the Anterior Cruciate Ligament and Anterolateral Structures to Reconstruction and Lateral Extra-articular Tenodesis at 2-Year Follow-up

Background: Lateral extra-articular procedures have been effective in reducing graft rupture rates after anterior cruciate ligament (ACL) reconstruction (ACLR), but the evidence supporting their role in ACL repair is sparse. Purpose/Hypothesis: The purpose was to compare clinical and radiological outcomes of ACLR and lateral extra-articular tenodesis (LET) (ACLR+LET) against combined repair of the ACL and anterolateral (AL) structures (ACL+AL Repair). It was hypothesized that patients undergoing ACL+AL Repair would have noninferior clinical and radiological outcomes with respect to International Knee Documentation Committee (IKDC) scores, knee laxity parameters, and magnetic resonance imaging (MRI) characteristics. Furthermore, it was hypothesized that patients undergoing repair would have significantly better Forgotten Joint Score–12 (FJS-12) values and shorter times to return to the preinjury level of sport, without any increase in the rate of ipsilateral second ACL injury. Study Design: Cohort study; Level of evidence, 2. Methods: Consecutive patients evaluated with an acute ACL tear were considered for study eligibility. ACLR+LET was only performed when intraoperative tear characteristics contraindicated ACL repair. Patient-reported outcome measures such as the IKDC score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS); reinjury rates; anteroposterior side-to-side laxity difference; and MRI characteristics were reported at a minimum follow-up of 2 years. The noninferiority study was based on the IKDC subjective score; side-to-side anteroposterior laxity difference; and signal-to-noise quotient (SNQ). The noninferiority margins were defined using the existing literature. An a priori sample size calculation was performed using the IKDC subjective score as the primary outcome measure. Results: A total of 100 patients (47 ACLR+LET, 53 ACL+AL Repair) with a mean follow-up of 25.2 months (range, 24-31 months) were enrolled and underwent surgery within 15 days of injury. At the final follow-up, the differences between groups with respect to the IKDC score, anteroposterior side-to-side laxity difference, and SNQ did not exceed noninferiority thresholds. ACL+AL Repair was associated with a shorter time to return to the preinjury level of sport (ACL+AL Repair: mean, 6.4 months; ACLR+LET: mean, 9.5 months; P < .01), better FJS-12 values (ACL+AL Repair: mean, 91.4; ACLR+LET: mean, 97.4; P = .04), and a higher proportion of patients achieving the Patient Acceptable Symptom State (PASS) for the KOOS subdomains studied (Symptoms: 90.2% vs 67.4%, P = .005; Sport and Recreation: 94.1% vs 67.4%, P < .001; Quality of Life: 92.2% vs 73.9%, P = .01). There were no significant differences between groups with respect to ipsilateral second ACL injury rates (ACL+AL Repair group, 3.8% and ACLR+LET group, 2.1% [n = 1]; P = .63). Conclusion: ACL+AL Repair yielded clinical outcomes that were noninferior to (or not significantly different from) ACLR+LET with respect to IKDC subjective, Tegner activity level, and Lysholm scores; knee laxity parameters; graft maturity; and rates of failure and reoperation. However, there were significant advantages of ACL+AL Repair, including a shorter duration of time to return to the preinjury level of sport, better FJS-12 values, and a higher proportion of patients achieving PASS for KOOS subdomains studied (Symptoms, Sport and Recreation, Quality of Life).

Match-Fixing in European Sports: Attitudes and Experiences

ABSTRACT Over the past years, the scholarly interest in match-fixing has grown. Although several empirical studies have tried to map the prevalence of match-fixing, the scope has often been limited to a given country, sports discipline, level of sports, and/or type of match-fixing. Moreover, match-fixing is often stereotyped as a problem caused by external criminals, while match-fixing by internal stakeholders occurs on a larger scale. When it comes to internal stakeholders, research to date has mainly focused on the vulnerability of athletes and referees to match-fixing. Nevertheless, other internal stakeholders in sports can also be the instigators of match-fixing, and may have different attitudes toward match-fixing. This study aims to fill these gaps by examining match-fixing among various internal stakeholders (n = 4958) involved in different sports across Europe. The results showed that internal stakeholders’ attitudes toward match-fixing were not uniform. Additionally, almost one fifth of the respondents indicated (in)direct match-fixing incidents in the questionnaire. The majority of the cases concerned sporting-related match-fixing, while our results also revealed that sporting- and betting-related match-fixing can happen together. By examining various internal stakeholders’ attitudes toward and experiences with match-fixing in European sports, this study could navigate future match-fixing prevention initiatives.

Return to Play After Surgical Treatment for Acromioclavicular Joint Dislocation: A Systematic Review

Background: Acromioclavicular (AC) joint dislocation is a common clinical problem among young and athletic populations. Surgical management is widely used for high-grade dislocations (Rockwood III-VI) and in high-demand athletes at high risk of recurrence. Purpose: To systematically review the evidence in the literature to ascertain the rate and timing of return to play (RTP) and the availability of specific criteria for safe RTP after surgical treatment for AC joint dislocation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted in the PubMed database. Clinical studies were eligible for inclusion if they reported on RTP after surgical treatment for AC joint dislocation. Statistical analysis was performed with SPSS. Results: We found 120 studies including 4327 cases meeting our inclusion criteria. The majority of patients were male (80.2%), with a mean age of 37.2 years (range, 15-85) and a mean follow-up of 34.5 months. Most were recreational athletes (79%), and the most common sport was cycling. The overall rate of RTP was 91.5%, with 85.6% returning to the same level of play. Among collision athletes, the rate of RTP was 97.3%, with 97.2% returning to the same level of play. In overhead athletes, the rate of RTP was 97.1%, with 79.2% returning to the same level of play. The mean time to RTP was 5.7 months (range, 1.5-15). Specific RTP criteria were reported in the majority of the studies (83.3%); time to return to play was the most commonly reported item (83.3%). Type III Rockwood injuries had the highest RTP rate at 98.7% and the earliest RTP at 4.9 months. Among the different surgical techniques, Kirschner wire fixation had the highest rate of RTP at 98.5%, while isolated graft reconstruction had the earliest RTP at 3.6 months. Conclusion: The overall rate of RTP was reportedly high after surgical treatment for AC joint dislocation, with the majority of patients returning to their preinjury levels of sport. There is a lack of consensus in the literature for what constitutes a safe RTP, with further focus on this topic required in future studies.

Implication of COVID-19 pandemic and lockdown on sport activities

Background: The world witnessed a sudden outbreak of a new strand of a deadly disease that rapidly spread throughout the globe. The spread of coronavirus (COVID-19) first originated in Wuhan, Hubei province of China in December 2019. This virus strain extended quickly throughout China and became a pandemic in the country. On March 11, 2020, the World Health Organisation (WHO) confirmed the COVID-19 novel coronavirus as a universal pandemic. Methods: Appropriate keywords were included in Scopus, PubMed, and Google Scholar to identify the available data. Result: Due to the rapid spread and fatality of the COVID-19, the 2020 Olympic Games formally slated for July 24 until August 9, 2020, will commence on July 23 to August 8, 2021. In March 2020, most of the European professional sports leagues, including football, were discontinued for the predictable future. Conclusion: Football resumption after the lockdown was challenging because of the inability to affirm the health status of the players when they return to their clubs. Every measure must be clear to reduce the risk of the disease and to clarify the response strategy about self-protection to the public. The sport organizing-bodies control-outlines for sports events should be strategized based on the laydown sports rules and quarantine protocols. National public health organizations and sports associations should work together to protect every level of human health and sport all over the world.

Rupture of the gastrocnemius muscle at its distal musculotendinous junction: conservative treatment and outcomes in 11 dogs

ABSTRACT Case history Medical records from three veterinary referral centres and a university veterinary teaching hospital in Australia and the USA were reviewed to identify dogs with a diagnosis of distal gastrocnemius musculotendinous junction rupture (DGMJR) that were treated without surgery between 2007 and 2020. Clinical and imaging findings All dogs (n = 11) presented with unilateral, pelvic limb lameness and bruising, swelling or pain on palpation at the distal musculotendinous junction. The diagnosis was confirmed with ultrasound or MRI in six dogs; radiographs were used to excluded stifle and tarsus pathology in four dogs; and five dogs were diagnosed on physical examination findings. Treatment and outcome All dogs were managed conservatively, either with complete confinement alone (n = 10; median 9 weeks), external coaptation alone (n = 1), or a combination of both (n = 4). Sporting dogs (n = 7) were completely confined (median 22 weeks) for longer periods than companion dogs (n = 3; median 5 weeks). A good to excellent outcome was achieved for all cases in this cohort. The seven sporting dogs achieved an excellent outcome; returning to their previous level of sport, with complete resolution of lameness and recovery of a normal tibiotarsal stance. The four companion dogs achieved a good outcome; returning to their previous level of activity but with persistently increased tibiotarsal standing angle compared to the contralateral limb. Clinical relevance Conservative treatment represents a viable treatment option for dogs with a rupture of the gastrocnemius muscle at its distal musculotendinous junction.

The Pressure Is Rising: Evaluation and Treatment of Chronic Exertional Compartment Syndrome.

Chronic exertional compartment syndrome is a condition that typically affects athletic/active individuals. Chronic exertional compartment syndrome predominantly affects the lower leg; however, there are cases involving the hand, forearm, foot, and thigh. The signs and symptoms of chronic exertional compartment syndrome are severe pain, tightness, cramping, muscle weakness, and paresthesias during participation in exercise. Dynamic intramuscular compartmental pressure (preexertion and postexertion) is the standard diagnostic test. Although other imaging modalities, such as radiography, ultrasound, and magnetic resonance imaging are typically incorporated to rule out other pathologies. In addition, these modalities are being utilized to limit invasiveness of the diagnostic experience. Initial care commonly involves conservative treatment, such as physical therapy, modifications of patient's exercise technique, foot orthoses, and various procedures over a period of 3 to 6 months. Recalcitrant cases may be referred for surgical intervention (fasciotomy), which has inconclusive head-to-head data with conservative management with regard to return to prior sport and specific activity level.

Long-term Outcomes of Tibial Spine Avulsion Fractures After Open Reduction With Osteosuturing Versus Arthroscopic Screw Fixation: A Multicenter Comparative Study

Background: More information is needed regarding return to preinjury sport levels and patient-reported outcomes after tibial spine avulsion (TSA) fracture, which is most common in children aged 8 to 12 years. Purpose: To analyze return to play/sport (RTP), subjective knee-specific recovery, and quality of life in patients after TSA fracture treated with open reduction with osteosuturing versus arthroscopic reduction with internal screw fixation. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 61 patients &lt;16 years old with TSA fracture treated via open reduction with osteosuturing (n = 32) or arthroscopic reduction with screw fixation (n = 29) at 4 institutions between 2000 and 2018; all patients had at least 24 months of follow-up (mean ± SD, 87.0 ± 47.1 months; range, 24-189 months). The patients completed questionnaires regarding ability to return to preinjury-level sports, subjective knee-specific recovery, and health-related quality of life, and results were compared between treatment groups. Univariate and multivariate logistic regression analyses were conducted to determine variables associated with failure to return to preinjury level of sport. Results: The mean patient age was 11 years, with a slight male predominance (57%). Open reduction with osteosuturing was associated with a quicker RTP time than arthroscopy with screw implantation (median, 8.0 vs 21.0 weeks; P &lt; .001). Open reduction with osteosuturing was also associated with a lower risk of failure to RTP at preinjury level (adjusted odds ratio, 6.4; 95% CI, 1.1-36.0; P = .035). Postoperative displacement &gt;3 mm increased the risk of failure to RTP at preinjury level regardless of treatment group (adjusted odds ratio, 15.2; 95% CI, 1.2-194.9; P = .037). There was no difference in knee-specific recovery or quality of life between the treatment groups. Conclusion: Open surgery with osteosuturing was a more viable option for treating TSA fractures because it resulted in a quicker RTP time and a lower rate of failure to RTP as compared with arthroscopic screw fixation. Precise reduction contributed to improved RTP.

Epidemiology of Patellar Tendinopathy in Athletes and the General Population: A Systematic Review and Meta-analysis.

Patellar tendinopathy (PT) mainly affects athletes who use the tendon for repeated energy storage and release activities. It can have a striking impact on athletes' careers, although data on its real prevalence and incidence are sparse. Research efforts should start from the results of reliable and updated epidemiological research to help better understand the impact of PT and underpin preventative measures. To determine the prevalence and incidence of PT in athletes and the general population. Systematic review; Level of evidence, 3. A systematic review of the literature was performed on January 17, 2022, and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Web of Science, and Wiley Cochrane Library databases were searched for epidemiological reports of any evidence level and clinical studies reporting data on the incidence or prevalence of PT for the 11,488 retrieved records. The primary endpoint was the prevalence and incidence of PT in sport-active patients. The secondary endpoints were PT prevalence and incidence in subgroups of athletes based on sex, age, sport type, and sport level played, as well as the same epidemiological measures in the general population. A total of 28 studies, with 28,171 participants, were selected and used for the qualitative and quantitative analysis. The general and athletes' populations reported an overall PT prevalence of 0.1% and 18.3%, respectively. In athletes, the prevalence of PT was 11.2% in women and 17% in men (P = .070). The prevalence of PT in athletes <18 years was 10.1%, while it was 21.3% in athletes ≥18 years (P = .004). The prevalence of PT was 6.1% in soccer players, 20.8% in basketball players, and 24.8% in volleyball players. Heterogeneous PT diagnostic approaches were observed. Higher prevalence values were found when PT diagnoses were made using patient-reported outcomes versus clinical evaluations (P = .004). This review demonstrated that PT is a common problem in the male and female sport-active populations. There are twice as many athletes aged ≥18 years than there are <18 years. Volleyball and basketball players are most affected by PT.