Ligament Sprains Research Articles

Knee Trauma.

Knee Trauma.

Retracted] Athletes’ Ankle Injury Features and Rehabilitation Methods Based on Internet Big Data

With the development of science and technology and the improvement of living standards, people are paying more and more attention to sports and health. However, the foot joints are very important joints in the human body and are one of the most vulnerable parts in sports. Foot joint sprain is a common clinical disease in orthopedics, accounting for the first place of joint ligament sprain. If the treatment is not timely or appropriate, it often leaves pain and joint instability, followed by osteoarthritis. The rate of repeated injuries after the first injury is very high. Due to the rapid development of visual sensing technology, computer technology, and image processing technology, Internet big data has been widely used in food, medical treatment, construction, chemical industry, electronics, packaging, automobile, and other fields. This article mainly studies the characteristics and rehabilitation methods of athletes’ ankle injuries based on Internet big data. Based on Internet big data, this paper studies the function and structural stability of the foot joints and analyzes the causes of gymnast foot joint injuries. On this basis, this paper puts forward the treatment method of ankle joint injury. In this paper, 20 male competitive bodybuilders with ankle joint injury on one side were randomly divided into experimental group and control group. The experimental group received proprioception recovery training, and the control group received normal functional recovery training. Experimental results show that the proprioception training of foot joint can improve the dynamic balance ability of gymnasts and effectively prevent the occurrence of foot joint injury. In this paper, the stability of the anterior and posterior foot joints was measured by comparing the control group with the experimental group. After 6 weeks of proprioception training, there was no significant difference between the static balance ability of one foot and the healthy part of the injured side foot joints (P > 0.05).

Return to Play after Low-Energy Lisfranc Injuries in High Demand Individuals: A Systematic Review and Meta-Analysis of Athletes and Active Military Personnel

Category:Sports; Midfoot/ForefootIntroduction/Purpose:Low-energy Lisfranc injury is increasingly reported in the literature. While there is a relatively large body of studies discussing the high energy Lisfranc injuries, the evidence available on this low-energy injury in active individuals with high demand remains scarce and mostly retrospective. The injury can range from a non-displaced ligamentous sprain to fracture-dislocations, and management varies from non-operative management to primary arthrodesis with a multitude of variables potentially affecting the return to play (RTP) and return to duty (RTD). This study aims to report on return to play (RTP) rate and time with regard to the type of the injury, whether bony or ligamentous, management whether non-operative, open reduction and internal fixation (ORIF) or the increasingly debated primary arthrodesis (PA).Methods:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant studies in English literature were identified between database inceptions to June 2019. Electronic based search on MEDLINE (PubMed), EMBASE, Google Scholar, and Cochrane databases using the following keywords with their synonyms: ('Lisfranc' AND 'athlete' AND 'midfoot sprain'). In addition, the reference lists from previous review articles were searched manually to check for eligible studies. Two investigators (AA, KM) independently reviewed all titles, abstracts, and the full text of articles that were potentially eligible based on the abstract review. The eligible studies were selected according to the inclusion and exclusion criteria. Any disagreement was resolved by the senior author (DF). The primary outcomes were (1) return to play rate and (2) time to return to play, whereas the secondary outcomes were (1) games missed, (2) time out of practice, (3) midfoot arthritis, and reoperation.Results:15 studies were eligible for meta-analysis with a total of 441 subjects. Out of 441 subjects, a total of 380 (86.16%) were able to return to play and duty. There were no statistically significant difference in RTP comparing op vs. non-op [OR=0.714, CI: 0.17-2.88,I2=0%] nor ORIF vs. PA [OR=0.780, CI: 0.310-1.963, I2=0%]. The overall RTP in bony and ligamentous injuries were 82.1% [CI:70.9-93.4%, I2=0%] and 95.8% [CI:92.6-99.1%, I2=0%], respectively with no statistically significant differences [OR=1.909, CI=0.64- 5.64, I2=37%]. The mean time out in non-op and op. groups were 58.01 [CI:13.6-102.4, I2=98.03%] and 116.4 [CI:62.4-170.4; I2=99.45%] days, respectively. The mean time out in bony and ligamentous injury groups were 98.8 [CI:6.1- 191.6, I2=99.82%] and 76.4 [CI:37.9-115.02; I2=99.83%] days, respectively with statistically significant differences [SMD:3.621, CI:- 5.7-13, I2=83.17%].Conclusion:Our meta-analysis on low-energy Lisfranc injuries in high demand individuals found an overall excellent RTP/RTD rate. The time out was not affected by the management, bony or ligamentous nature of the injury nor players' position. However, the low level of evidence and significant heterogeneity of the included studies precludes making conclusions regarding the exact time out or optimal management. Superior quality studies on low energy Lisfranc are needed.

Homolateral Lisfranc Fracture/Dislocation of 1st - 5th Metatarsals in a Collegiate Quarterback: A Case Study

Category:Sports; Midfoot/ForefootIntroduction/Purpose:Lisfranc injuries encompass a spectrum of injuries to the tarsometatarsal (TMT) joint complex from ligamentous sprains to fractures with dislocation. While studies have shown it is possible to return to sport (RTS) after low- energy injuries, no literature exists demonstrating RTS after homolateral fracture/dislocation of all 5 metatarsals. We present a novel surgical technique for repair of homolateral Lisfranc fracture/dislocation of the 1st-5th metatarsals. Fusion of the 2nd and 3rd TMT joints provides stability of the middle column. Internal bracing of the 1st TMT joint gives stability while preserving greater physiologic motion in a high-level athlete.Methods:A dorsal approach is used for fusion of the 2nd and 3rd TMT joints with medial approach for internal bracing of the 1st TMT joint. 2nd and 3rd metatarsals were denuded of cartilage, and the fusion site was fully prepared. Rigid fixation was applied to the fusion sites. Guidewire for the cannulated Internal Brace system is inserted into the base of the 1st metatarsal. Fluoroscopic imaging confirmed positioning and the 3.4mm drill is passed over the wire, followed by the cannulated tap. A 4.75mm Swivelock anchor with Fibertape suture is inserted into the metatarsal base. The guidewire is placed in a reciprocating position on the medial cuneiform. The 2.7 mm drill is passed over the wire, followed by the 3.5 mm tap. A 3.5 mm Swivelock is then loaded with the Fiberwire from the 1st metatarsal. Tensioning is performed, and the 3.5 mm Swivelock is inserted into the medial cuneiform.Results:The athlete was cleared to return to full competition 9 months following surgery with physical exam demonstrating stability in both dorsiflexion and abduction. Weight bearing x-rays showed no evidence of hardware failure and no instability in the 1st TMT joint. CT scan demonstrated solid fusion of 2nd and 3rd TMT joints and maintained anatomic reduction of the 1st TMT joint. At 1-year post-op, patient was having pain over the 4th TMT joint. He had a second surgery to remove an exostosis at the 4th TMT joint as well as remove the screw from the 3rd metatarsal to the middle cuneiform. His pain had resolved at most recent follow up. He returned to game action in the final game of his senior season.Conclusion:The literature demonstrates return to sport is possible for athletes with Lisfranc injuries though the data focuses on either purely ligamentous injuries or Myerson type B and C fractures. This case study demonstrates a novel surgical approach to homolateral fracture/dislocation. While return to sport in this athlete took longer than lower-energy injuries, it is possible for athletes with homolateral displacement to return to full competition.

Calcaneal Intraosseous Lipoma: A Case Report

Background: This case report is presented to increase awareness among clinicians about the existence of this rare cause of calcaneal pain. Intraosseous lipoma is a rare, benign primary tumour occurring in the bone We report a 40-year-old lady who presented with the history of one week old trauma with pain in the lateral aspect of right ankle which was clinically diagnosed to be right lateral collateral ligament sprain. The radiographs of the right ankle and heel incidentally revealed a lytic lesion. The patient had no symptoms persisting to foot and heel. MRI of right foot was suggestive of calcaneal stage 2 intra osseous lipoma. In view of the subchondral location of the lesion, prophylactically the lesion was treated with curettage and bone grafting to prevent the pathological fracture. The post-operative radiographs demonstrated continued remodelling and healing of the graft site. The patient was followed up on an OPD basis and made a full recovery with good patient compliance. Even though this tumour is rare, there is a need for physicians to recognize its radiological findings and offer the appropriate treatment options. It is also important for primary care physicians to be aware that there are other causes of heel pain than the common suspects. Keywords: Intraosseous lipoma, Heel pain, Lytic lesion, Benign primary tumour

Approach and considerations for surgery in subaxial cervical spine injury: A narrative review

Subaxial cervical spine injuries are common and encompass a spectrum of injuries ranging from a minor ligamentous sprain to fracture dislocation with spinal cord injury. These injuries are often missed in the initial evaluation, and a high index of suspicion is needed to evaluate and diagnose these injuries, which otherwise could lead to spinal cord injury. Computed tomography scans are the gold standard in the evaluation of fractures as plain radiographs have limited sensitivity. Magnetic resonance imaging (MRI) is necessary to identify injury to the disco-ligamentous complex and to assess cord injury. The principles of the treatment of cervical spine injuries include early immobilization to prevent secondary neurological injury, achieving alignment by reduction and stabilization of the unstable injured segment and decompression of the cord in the presence of cord injury. Owing to a broad spectrum of injuries, there is no unified approach, and the management plan depends on the morphology of injury, the extent of structures damaged, and the presence of neurological impairment. Various classifications grade and help assess the severity of the injury. Minor injuries are conservatively managed with cervical orthoses, and unstable injuries require stabilization either anterior, posterior, or combined approaches, depending on the injury morphology. Controversy exists over the safety of closed reduction in facetal subluxations, need for pre-reduction MRI, and the ideal approach for each injury. This review presents the current evidence and guidelines on the management of subaxial cervical spine injuries.

Homolateral Lisfranc Dislocation 1-5 in a Collegiate Quarterback: A Case Study

Background: Lisfranc injuries encompass a spectrum of injuries to the tarsometatarsal (TMT) joint complex from ligamentous sprains to fractures with dislocation. While studies have shown it is possible to return to sport (RTS) after low-energy injuries, no literature exists demonstrating RTS after homolateral fracture/dislocation of all 5 metatarsals. Indications: We present a novel technique for repair of homolateral Lisfranc fracture/dislocation of metatarsals 1-5 which may be used in high-level athletes attempting to return to competition. Technique Description: A dual approach is utilized, with a dorsal approach to allow for fusion of the 2nd and 3rd TMT joints and medial approach for internal bracing of the 1st TMT joint. The 2nd and 3rd metatarsals were denuded of all cartilage and the fusion site was fully prepared. Rigid fixation was applied to the fusion sites and then stability of the 1st TMT was reassessed. A guidewire for the cannulated InternalBrace (Arthrex; Naples, FL) system is initially inserted into the base of the 1st metatarsal. Positioning is confirmed with fluoroscopic imaging and the 3.4 mm drill is passed over the wire, followed by the cannulated tap. A 4.75 mm SwiveLock anchor (Arthrex; Naples, FL) with FiberTape suture (Arthrex; Naples, FL) is then inserted into the metatarsal base. The guidewire is placed in a reciprocating position on the medial cuneiform. The 2.7 mm drill is passed over the wire, followed by the 3.5 mm tap. A 3.5 mm SwiveLock anchor is then loaded with the FiberTape suture from the 1st metatarsal. Tensioning is performed, and the 3.5 mm SwiveLock anchor is inserted into the medial cuneiform. Results: The athlete was cleared to return to full competition 9 months following surgery. Physical examination demonstrated stability in dorsiflexion and abduction. Both weight-bearing x-rays and computed tomography scans showed no evidence of hardware failure, no instability of the 1st TMT joint, and solid fusion of the 2nd and 3rd TMT joints. Discussion/Conclusion: Current literature demonstrates that RTS is possible for athletes suffering from low-energy Lisfranc injuries. This novel surgical technique is the first to demonstrate return to sport of a high-level athlete from homolateral fracture/dislocation of all 5 metatarsals.

Risk factors for ACL, hamstring strain, and hip/groin injuries in elite Australian female footballers: A prospective study.

Introduction: Female footballers are at high risk of sustaining lower limb injuries, with some of the most prevalent and severe injuries being hamstring strains, hip/groin pain, and knee ligament sprains. However, there is currently limited evidence to guide injury prevention strategies and injury risk assessment testing in female footballers. The aim of this study was to assess risk factors for ACL, hamstring, and hip/groin injuries in elite female footballers. Methods: Data were collected from 321 elite female Australian Football, soccer, and Rugby League players during pre-season. Players underwent field-based assessments of isometric hip adductor and abductor strength (ForceFrame), eccentric knee flexor strength during the Nordic hamstring exercise (NordBord), countermovement jump (CMJ) on dual forceplates (ForceDecks), and a single-leg triple vertical hop (TVH) using a makerless motion capture system (HumanTrak). Players were subsequently followed for injuries for 18 months. Risk factors were identified prospectively using simple and multiple logistic regression and decision tree learning. Results: A total of 12 anterior cruciate ligament (ACL) ruptures, 17 hamstring strains, and 12 hip/groin injuries were recorded. Risk factors for ACL injury included prior ACL injury (standardised odds ratio [OR]=12.3, P<.001), lower body weight normalised adductor torque (OR=2.1, P=.028), greater body weight normalised CMJ peak force (OR=1.9, P=.013), lower CMJ impulse (OR=2.0, P=.037), greater triple vertical hop knee frontal plane projection angle (OR=2.3, P=.014), and greater triple vertical hop lateral trunk flexion (OR=1.7, P=.038). Multiple logistic regression and decision tree models classified ACL injured players with high accuracy (sensitivity=67% and 75% respectively, and specificity=88% and 100% respectively). Risk factors for time-loss hamstring injury included smaller stature (OR=1.8, P=.030), greater between-leg asymmetry in CMJ peak force (OR=2.0, P=.011) and eccentric impulse (OR=1.9, P=.016). There were no statistically significant risk factors for hip/groin injury. Discussion: This is the first study to explore risk factors for lower limb injury in elite female Australian football codes. These results provide insight into the potential modifiable factors associated with subsequent injury in elite female footballers, which may inform player testing batteries and the design of targeted injury risk reduction strategies. Conflict of interest statement: Funding for travel was provided by Vald Performance (Brisbane, Australia) and SMA Research Foundation. My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

Epidemiology of Musculoskeletal Injuries in Adult Athletes: A Scoping Review.

Background and Objectives: Sport-related musculoskeletal injuries (MSK-Is) are a common health issue in athletes that can lead to reduced performance. The aim of this scoping review was to synthetize available evidence on injury incidence rates (IIRs), types, and sites that affect the musculoskeletal (MSK) system of adult athletes. Materials and Methods: We performed a scoping review on the Pubmed database limiting our search to 33 Olympic sports. Results: We identified a total of 1022 papers, and of these 162 were examined in full for the purpose of this review. Archery was the sport with the highest risk of injuries to the upper extremities, marathons for the lower extremities, and triathlon and weightlifting for the body bust. In the majority of the sports examined, muscle/tendon strain and ligament sprain were the most common MSK-Is diagnoses, while athletics, karate, and football were the sports with the highest IIRs, depending on the methods used for their calculations. Conclusions: Our scoping review highlighted the general lack and dishomogeneity in the collection of data on MSK-Is in athletes.

Traumatic Hip Dislocation in an NCAA DI Football Player with Occult Sequelae: A Case Report.

Background and PurposeAmerican football generates the most sports-related injuries in the United States, with tackling as the leading injury mechanism. Overall injury rate at the collegiate level has been reported as 8.61 per 1,000 athlete exposures (AEs) – twice the rate of high school levels; competition injury rates are reported as high as 36.94/1000 AEs. Traumatic hip dislocation is an uncommon injury typically arising from high-energy axial impact with only 2-5.5% occurring during sports activities.Case DescriptionA 22-year-old NCAA Division I football defensive back who experienced extreme left hip pain following contact with another player with his hip flexed during a game was diagnosed with a type 1 posterior hip dislocation, a grade 1 medial collateral ligament sprain with concomitant posterior thigh and hip muscle strains. Key impairments were limited left lower extremity motor performance, range of motion deficits, left hip pain, and diminished function and weight-bearing ability.OutcomesThe athlete reintegrated into typical defensive back off-season training approximately four to five months post injury without restrictions, however presented with new anterior hip pain seven months post injury revealing occult sequelae requiring surgical intervention. He was able to return to full play the following football season.DiscussionThis case report describes the successful return to sport of a Division I football player who sustained a traumatic posterior hip dislocation and complicated course including surgical intervention secondary to associated sequelae.Level of Evidence5

Knee pain: Ultrasound and MRI correlation

Abstract Background Knee pain incidence is increasing among the community which has different multiple pathologies. Magnetic Resonance Imaging (MRI) is considered the gold standard imaging modality in diagnosing knee soft tissue injury. Ultrasound (US) is another modality which can be used in diagnosing soft tissue injury. Aim of the Work is to detect the reliability of US in diagnosing cases with knee pain as compared to MRI. Patients and Methods A prospective study was conducted on 20 patients with knee pain. They were referred from the Orthopedic and/or Rheumatology Department to Radiology department at Ain Shams University hospitals for MRI and US examination of the knee.The age group were from 19 to 59 years. Results In this study, 20 patients were examined with majority being males (75%). US was tested against MRI for different soft tissue pathologies.including knee effusion, meniscal pathology (tear, degeneration and extrusion), medial collateral ligament sprain, lateral collateral ligament sprain and Baker’s cyst. There was good agreement between US and MRI in most of these pathologies. US showed an overall sensitivity of 61.7% and specificity of 92.7% with accuracy of 86.9%. The overall PPV and NPV were 66.1% and 91.3% respectively. Conclusion Ultrasound can be considered a reliable screening imaging modality in cases of knee pain.

Approach to Suspected Physeal Fractures in the Emergency Department.

Growth plate (physeal) fractures are defined as a disruption in the cartilaginous physis of bone with or without the involvement of epiphysis or metaphysis. These represent around 15-18% of all pediatric fractures. It is important to diagnose physeal injury as early as possible, as misdiagnosis or delay in diagnosis may result in long term complications. Physeal injuries may not be initially obvious in children who present with periarticular trauma, and a high index of suspicion is important for diagnosis. Differential diagnosis for a Salter-Harris fracture includes a ligamentous sprain, acute osteomyelitis, or an extraphyseal fracture such as a Torus fracture. Salter-Harris I & Salter-Harris II growth plate fractures commonly are commonly managed by closed manipulation, reduction & immobilization. These are relatively stable injuries and can be retained by adequate plaster. Salter-Harris III & Salter-Harris IV fractures require anatomical reduction with the maintenance of congruity of joint. Physeal fractures can have many complications such as malunion, bar formation, acceleration of growth of physis, posttraumatic arthritis, ligament laxity and shortening of the bone. The key to well-healing fractures is successful anatomic reduction and patients must have regular follow-up for these injuries.

An epidemiologic comparison of acute and overuse injuries in high school sports

BackgroundAcute and overuse injuries affect millions of high school athletes annually and a better understanding of differences between these injuries is needed to help guide prevention, treatment, and rehabilitation strategies. This study compares acute and overuse injuries using a nationally representative sample of high school athletes.MethodsInjuries among United States high school athletes participating in 5 boys’ sports (football, soccer, basketball, wrestling, baseball) and 4 girls’ sports (soccer, volleyball, basketball, softball) reported in the High School RIO™ surveillance system during the 2006-07 through 2018-19 school years were classified as acute or overuse. National estimates and injury rates were calculated.ResultsOf 17 434 646 estimated injuries, 92.0 % were acute and 8.0 % were overuse. The acute injury rate was higher than the overuse injury rate among both male (Rate Ratio [RR] 16.38, 95 % CI: 15.70–17.10) and female (RR 8.14, 95 % CI: 7.71–8.60) athletes. The overuse injury rate per 10,000 athlete exposures among female athletes (1.8) was slightly higher than among males (1.4). The rate of acute injury compared with the rate of overuse injury was higher during competition (RR 32.00, 95 % CI: 29.93–34.22) than practice (RR 7.19, 95 % CI: 6.91–7.47). Boys’ football contributed the most acute (42.1 %) and overuse (23.7 %) injuries among the 9 sports. Among female sports, girls’ soccer contributed the most acute (15.6 % of all acute injuries) and overuse (19.4 % of all overuse injuries) injuries. The lower extremity was most commonly injured in acute (48.9 %) and overuse (65.9 %) injuries. Ligament sprain (31.7 %) and concussion (21.0 %) were the most common acute injury diagnoses, while muscle strain (23.3 %) and tendonitis (23.2 %) were the most common overuse injury diagnoses. Compared with acute injuries, overuse injuries were more likely to result in time loss from sports participation of < 1 week among both boys and girls and across most sports. Acute injuries were more likely than overuse injuries to cause a time loss of 1–3 weeks or medical disqualification from sports participation.ConclusionsAcute and overuse injuries display many differences that provide opportunities for data-informed athlete preparation, treatment, and rehabilitation, which may reduce injuries and improve injury outcomes in high school athletics.

Evaluation of the Effects of Tecar Therapy on Acute Symptoms of Athletes Following Lateral Ankle Ligament Sprain

Background and Objectives: Tecar therapy as a modality has been considered due to its reported effects on reducing pain and swelling and finally increasing range of motion and improving function. The aim of this study was to evaluate the effects of tecar therapy on acute symptoms of athletes following lateral ankle ligament sprain in the treatment and control groups between pre-treatment periods, after 6 sessions, and after 12 sessions of treatment. Methods: In this study, 23 patients in each group including athletes with an acute lateral ankle ligament sprain in the acute stage in Tehran. The participant of this study were divided into 2 groups of control with normal treatment and the second group with normal treatment + tecar treatment. Participants were homogenized in terms of age, height, weight, and level of exercise. To evaluate the pain intensity of patients in the two groups and to measure the swelling of the ankle joint, a tape measure (mm) was used. A goniometer was used to measure the degree of ankle motions. The Foot and Ankle Ability Measure (FAAM) questionnaire was also used to collect data. Results: Statistical analyzes showed that the mean numerical visual criterion of pain in both groups was significantly lower after 6 and 12 sessions of treatment (P&lt;0.001). The results of the analysis of variance showed that the mean swelling in the treatment group and in the control group after 6 and 12 sessions of treatment (P&lt;0.001) was significantly lower than the mean swelling before treatment. Also, the mean swelling after 12 sessions of treatment was significantly lower than after 6 sessions of treatment (P&lt;0.001). Regarding daily life activities and the percentage of athlete satisfaction in performing the activity, the test results showed that the athlete’s scores after 6 and 12 sessions of treatment (P&lt;0.001) were significantly higher than before treatment. Also, their scores after 12 sessions of treatment were significantly higher than 6 sessions (P&lt;0.001). The performance scores in both groups after 6 and 12 sessions of treatment (P&lt;0.001) were significantly higher than performance scores before treatment. Also, the performance scores after 12 sessions of treatment were significantly higher than 6 sessions of treatment (P&lt;0.001). Conclusion: The results of the present study showed that tecar therapy in patients with lateral ligament sprain of the ankle joint improves the condition of symptoms after an injury, including swelling, pain, daily life activities, percentage of athlete satisfaction with daily activities, and finally his performance and it can be used as a complementary treatment along with common therapies.

General Medicine - Weightlifting

HISTORY: A 49yo M, h/o prediabetes and hyperlipidemia, presented with R medial ankle pain and unilateral RLE swelling x5 days. Had acute onset of R medial ankle pain without a specific injury following a leg workout. Seen in urgent care and diagnosed with a deltoid ligament sprain; prescribed RICE, NSAIDs, crutches, and a CAM boot. The pain did not abate and the swelling progressed from the R ankle to the entire lower leg distal to the knee. Denied chest pain, dyspnea, history of malignancy, recent travel, and history of crystalline disease. Meds: None. Allergies: None. SH: Desk job, nonsmoker. PHYSICAL EXAMINATION: Obese male with normal vital signs. Normal cardiovascular, pulmonary, and neurologic exam. RLE notable for antalgic gait, 2+ pitting edema to the knee, no erythema, 2+ DP pulse, 2+ PT pulse. R ankle with full painless AROM; 5/5 strength in dorsiflexion, plantarflexion, inversion, eversion, toe flexion; intact distal sensation; non-focal tenderness to palpation over the posteromedial ankle; negative external rotation stress test, negative anterior drawer, negative talar tilt, and negative pronation talar tilt. DIFFERENTIAL DIAGNOSIS: 1. DVT 2. Gout 3. Deltoid Ligament Sprain 4. Osteoarthritis flare 5. Posterior tibialis tendinopathy TEST AND RESULTS: Imaging - Right ankle radiographs negative. BLE Venous Duplex Vascular Ultrasound negative. RLE MRI w/o Contrast showed diffuse circumferential subcutaneous edema about the lower leg, ankle, and foot with a small focus of bone marrow edema and periostitis at the posteromedial distal tibial cortex. Minimal posterior tibialis tendinopathy. No overlying ulceration or abscess. Labs - WBC 6.3 x 103 / uL. Creatinine 1.3 mg/dL. CRP 2.0 mg/L. ESR 6 mm/h. Uric Acid: 8.1 mg/dL FINAL WORKING DIAGNOSIS: Acute gout flare plus mild posterior tibialis tendinopathy TREATMENT AND OUTCOMES: 1. NSAIDs 2. Leg Elevation 3. Weight bearing as tolerated 4. Dietary modification 5. Pain free with markedly reduced RLE swelling at one-month follow-up. Returned to exercise. Did not start urate-lowering therapy.

Collateral ligament sprains of the metacarpophalangeal joint of the long fingers: Results of a surgical series of 15 patients

IntroductionCollateral ligament sprains of the metacarpophalangeal joint (MP) of the long fingers are rare and mostly treated conservatively. Clinical examination to diagnose the severity of these injuries is mandatory. The purpose of our study is to report the results of 15 patients treated surgically. MethodsTwenty-three patients, mean age 48, underwent surgery for Stage 3 radial collateral ligament (RCL) injuries of the middle finger (12), the ring finger (4) and the little finger (7). The mean time from trauma to surgery was 53 days. The clinical evaluation consisted of measuring active joint motion, performing laxity tests at 0°, 30° and 90° of MP flexion, testing for laxity and rotation, looking for a spontaneous overlapping finger (or hyperabducted little finger) in relaxed position and measuring the strength (Jamar). ResultsAmong the 23 operated patients, RCL lesions were distal in 8 cases, proximal in 9, and mid-substance in 6. There were 2 Stener-like lesions.Preoperatively, 16 patients presented an overlapping finger over the next one and 7 had spontaneous hyperabduction of the fifth finger.Mean follow-up of the 15 patients reviewed was 24 months (8–56).Mean MP flexion-extension range of motion was 86°/11° (71–99/0–29).Mean MP ulnar laxity of the injured finger was 18°, 14° and 11° respectively at 0°, 30° and 90° and 19°, 16°and 13°on comparison to the same digit on the opposite side.Mean MP radial laxity of the injured finger was 28°, 22° and 10° respectively at 0°, 30°, 90°, same digit on opposite side was 29°, 21°, 11°.There were no postoperative overlapped or hyperabducted fingers concerning spontaneous lateral laxity in extension.The postoperative rotational laxity test showed differences of arc in supination and pronation between operated finger and healthy side of respectively −12% and +8%. ConclusionThe postoperative results of RCL repair of the MP in the long fingers are good in spite of some residual ligamentous distension, revealed by the laxity tests. The lateral laxity sign as a simple painless clinical sign for diagnosing complete RCL tears requiring surgery needs a validating study in order to spread its use. Level of evidenceIV; retrospective study.

Men’s Lacrosse Injuries in the 2018 International World Championship Play

Background:Limited data exist on injuries in men’s lacrosse at the international level. As lacrosse’s popularity grows rapidly across the globe, health care providers must understand how to treat lacrosse athletes.Purpose:To analyze injury data from the 2018 Men’s World Lacrosse Championship.Study Design:Descriptive epidemiology study.Methods:This study prospectively observed injuries that occurred during the 2018 Men’s World Lacrosse Championship. The medical staff of each team completed injury report forms, and data were categorized into body part injury, type, mechanism, time, and location of injury.Results:Over 11 days, 1019 athletes competed in 170 games, resulting in a total of 7147 athlete-exposures (AEs). A total of 140 injuries were recorded during the tournament for an injury rate of 19.6 per 1000 AEs (95% CI, 16.4-22.7). Overall, there were more contact injuries (n = 99; 70.7%) than noncontact injuries (n = 41; 29.3%) (P < .0001). Contact injuries most commonly affected the upper extremity, while noncontact injuries most commonly affected the lower extremity. Contusions were the most commonly reported injury type in the tournament (n = 41; 29.3%), followed by ligament sprains (n = 32; 22.9%) and muscle strains (n = 21; 15.0%). Although there was no difference between the first and second half of gameplay, the injury rate increased in the latter portion of each half (the first and third quarters vs the second and fourth quarters) (P < .0001). A total of 4 injuries required trips to the hospital.Conclusion:Lacrosse has a unique injury profile, as it includes both overhead and collision activity as well as multidirectional, cutting movements. Understanding common injury patterns may help with treatment and prevention. Fatigue may play a role in injury rate, and future research of within-game and within-tournament fatigue should explore this relationship.

A four-experiment examination of ankle kinetics, kinematics and lateral ligament strains during different conditions: an examination using musculoskeletal simulation

PurposeFirst, to provide insight into the differences in ankle kinetics, kinematics and lateral ligament strain between males and females during functional sports movements. In addition this study explores the prophylactic efficacy of different footwear and bracing modalities.MethodsExperiment 1 examined male and female athletes performing run, 45° cut and one-legged hop movements, experiment 2 observed court, energy return and trainer footwear conditions during a change of direction task, experiment 3 examined high-cut, low-cut and trainer footwear conditions in a change of direction, run, 45° cut and vertical jump movements and experiment 4 explored an ankle sleeve and an ankle brace during a change of direction movement. In each experiment ankle kinetics and ligament strain were measured using a musculoskeletal simulation approach.ResultsExperiment 1 indicates that males exhibited increased inversion velocity (male = 260.39 and female = 219.18°/s) in the cut movement as well as enhanced peak posterior force (male = 2.24 and female = 1.35BW), anterior talofibular ligament (ATFL) strain rate (male = 266.77 and female = 133.16%/s). Experiment 2 showed that both calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL) strain velocities were greater in the court footwear (CFL = 90.86 and PTFL = 151.45%/s) compared to the trainer (CFL = 69.07 and PTFL = 119.57%/s). Experiment 3 showed in the run movement anterior talofibular ligament (ATFL) strain was enhanced in the trainer (7.86%) compared to the high (3.61%) and low (5.87%) conditions and the trainer (8.14%) compared to the low footwear (5.39%) for the cut movement. PTFL strain velocity was greater in the high footwear (188.01%/s) compared to the trainer (175.60%/s) during the run movement and in both high (221.55%/s) and low (220.29%/s) footwear compared to the trainer (202.05%/s) during the cut. Experiment 4 revealed that PTFL strain was greater in the sleeve condition (17.05%) compared to the ankle brace (15.42%).ConclusionThis study provides insight into the potentially increased incidence of lateral ankle ligament sprain injuries in males, whilst also highlighting the prophylactic efficacy of ankle braces in attenuating the ankle strain mechanisms linked to the aetiology of lateral ankle ligament injuries.

Epidemiology of Foot and Ankle Injuries in NCAA Jumping Athletes in the United States During 2009-2014

Background:Foot and ankle injuries comprise a significant proportion of all injuries sustained by National Collegiate Athletic Association (NCAA) athletes. In particular, sports that combine jumping and rapid changes in direction are associated with increased lower extremity injuries.Purpose:To describe the epidemiology of foot and ankle injuries in men’s and women’s jumping sports, including NCAA men’s and women’s basketball, women’s volleyball, and women’s gymnastics, during the 2009-2010 through 2013-2014 seasons.Study Design:Descriptive epidemiology study.Methods:Injury-surveillance data were obtained from the NCAA Injury Surveillance Program for the 2009-2010 through 2013-2014 seasons. Injuries were examined by mechanism, activity during injury, and participation restriction time. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios, and risk ratios with 95% CIs were calculated. Reported sex differences were calculated for men’s and women’s basketball. All 95% CIs not containing 1.0 were considered statistically significant.Results:A total of 1136 players sustained foot and ankle injuries (483 male and 653 female) over 612,680 AEs. These injuries resulted in a combined rate of 1.85 per 1000 AEs (95% CI, 1.75-1.97). Ankle sprains were the most common injury (63.7%), with lateral ligamentous complex injuries making up 77.1% of all ankle sprains. The most common foot injury varied based on sport and sex. Ankle injury rates were higher in male versus female basketball players (injury rate ratio, 1.33 [95% CI, 1.13-1.57]), but foot injury rates did not differ. Among basketball and volleyball players, player contact during jumping was the most common injury mechanism. Female gymnasts had higher overuse injury rates than other athletes (0.49/1000 AEs [95% CI, 0.30-0.74]; P < .002). Overall, female basketball players were 1.81 times more likely to sustain an overuse injury than male basketball players (95% CI, 1.02-3.20; P = .02).Conclusion:The most common foot and ankle injury sustained in collegiate jumping sports was a lateral ligamentous complex ankle sprain. Injury-prevention programs focusing on ankle flexibility, strength, and proprioception may help to alleviate the injury burden and lessen severity. Improving the anticipation of contact during jumping and landing may reduce injury rates and increase player safety. The increased prevalence of overuse injuries in female collegiate athletes competing in jumping sports necessitates further investigation to reduce injury rates through prevention and training programs.

Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021.

This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.