Management Of Soft Tissue Injuries Research Articles

Pedicled omental flaps for complex wound reconstruction following surgery for primary spine tumors of the mobile spine and sacrum.

Surgery for primary tumors of the mobile spine and sacrum often requires complex reconstruction techniques to cover soft-tissue defects and to treat wound and CSF-related complications. The anatomical, vascular, and immunoregulatory characteristics of the omentum make it an excellent local substrate for the management of radiation soft-tissue injury, infection, and extensive wound defects. This study describes the authors' experience in complex wound reconstruction using pedicled omental flaps to cover defects in surgery for mobile spine and sacral primary tumors. A retrospective cohort analysis was conducted on 34 patients who underwent pedicled omental flap reconstruction after en bloc resection of primary sacral and mobile spine tumors between 2010 and 2020. The study focused on assessing the indications for omental flap usage, including soft-tissue coverage, protection against postoperative radiation therapy, infection management, vascular supply for bone grafts, and dural defect and CSF leak repair. Patient demographic characteristics, tumor characteristics, surgical outcomes, and follow-up data were analyzed to determine the procedure's efficacy and complication rates. From 2010 to 2020, 34 patients underwent pedicled omental flap reconstruction after en bloc resection of sacral (24 of 34 [71%]) and mobile spine (10 of 34 [29%]) primary tumors, mostly chordomas. The patient cohort included 21 men and 13 women with a median (range) age of 60 (32-89) years. The most common indication for omental flap was soft-tissue coverage (20 of 34 [59%]). Other indications included protecting abdominopelvic organs for postoperative radiation therapy (6 of 34 [18%]), treating infections (5 of 34 [15%]), providing vascular supply for free fibular bone graft (1 of 34 [3%]), and repairing large dural defects and CSF leak (2 of 34 [6%]). The median (range) follow-up was 24 (0-132) months, during which 71% (24 of 34) of patients did not require additional surgery for wound-related complications. At last follow-up, 59% (20 of 34) had stable disease and 32% (11 of 34) had recurrence, had progression of disease, or had been discharged to hospice after treatment. The pedicled omentum is an effective local tissue graft that can be used for complex wound reconstruction and management of high-risk closures in primary spine tumors. This technique may have a lower rate of complications than other approaches and may influence surgical planning and flap selection in challenging cases.

Exploring the success of fasciocutaneous flap techniques in treating distal leg injuries, a Sub-Saharan African experience from Sudan

BackgroundSoft tissue and bone injuries in the lower extremities associated with high-energy trauma remain a formidable challenge to treat. The timing of the operation, the most suitable type of tissue, and the decision between local or free flap coverage remain under discussion. MethodThis prospective, cohort, multi-center study was conducted in Khartoum, Sudan, from April 2021–September 2021. The study included 70 patients. Data was collected using a questionnaire filled with patients after getting informed consent. ResultsMales were 53(75.7 %) and females were 17(24.3 %). Male to female ratio was 3.1: 1. The mean age of the patients was 27.2 ± 3.4 years. The indications for the use of fascia-cutaneous flap in the management of traumatic soft tissue injuries of distal legs were distal substance loss areas of the leg 55(78.6 %), bone exposure 60(85.7 %), open fracture 29(41.4 %), and tendon exposure 31(44.3 %). The type of fasciocutaneous flap used for the patients in this study was perineal artery flap in 20(28.6 %), sural flap in 19(27.1 %), anterior tibial artery perforator flap in 18(25.7 %), and posterior tibial perforator flap in 13(18.6 %) of the patients in 42(60 %) of the patients, no complications were reported. The reported complications were infection 16(5.7 %), distal flap necrosis 8(11.4 %) and total loss 4(5.7 %). ConclusionDespite advances in microsurgery and free flap use, a fascia-cutaneous flap is still a valid option for distal leg soft tissue reconstruction in settings where this service is unavailable. fasciocutaneous flaps are an excellent option for distal leg defects to cover soft-tissue defects, exposed bones, and tendons.

Adjunctive hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries: a systematic review.

Traumatic crush injuries of the lower limb often accompany severe complications. The incorporation of hyperbaric oxygen therapy to standard trauma care may have the potential to diminish injury-related complications and improve outcome in such cases. This systematic review aims to evaluate the effectiveness of hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries. The electronic databases Medline, Embase and Cochrane Library were searched to identify studies involving patients with crush-associated sever lower limb soft tissue injuries who received hyperbaric oxygen therapy in conjunction with standard trauma care. Relevant data on type of injury, hyperbaric oxygen therapy protocol and outcome related to wound healing were extracted. In total seven studies met the inclusion criteria, involving 229 patients. The studies included two randomized clinical trials, one retrospective cohort study, three case series and one case report. The randomized placebo-controlled clinical trial showed a significant increase in wound healing and decrease in the need for additional surgical interventions in the patient group receiving hyperbaric oxygen therapy when compared to those undergoing sham therapy. The randomized non-placebo-controlled clinical trial revealed that early hyperbaric oxygen therapy reduces tissue necrosis and the likelihood of long-term complications. The retrospective cohort study indicated that hyperbaric oxygen therapy effectively reduces infection rates and the need for additional surgical interventions. The case series and case report presented beneficial results with regard to wound healing when hyperbaric oxygen therapy was added to the treatment regimen. Hyperbaric oxygen therapy is generally considered a safe therapeutic intervention and seems to have a beneficial effect on wound healing in severe lower limb soft tissue injuries when implemented as an addition to standard trauma care.

A Randomized Trial of Therapeutic Ultrasound on Pain, Tenderness, and Muscle Stiffness Using a High and Low Intensity Model of Delayed Onset Muscle Soreness

Purpose: This study evaluated ultrasound (US) effectiveness in an experimental model of soft tissue injury, and examined the model, delayed onset muscle soreness (DOMS), as a variable in the outcome. Methods: One hundred and twenty females completed 30 repetitions (low-DOMS) or 70 repetitions (high-DOMS) of eccentric contractions of biceps brachii muscles and received one of four protocols: no US (control), placebo US, or 3 MHz US, pulsed 20% duty cycle, at either 0.6 W/cm2, spatial-average temporal-peak intensity (SATP) (0.12 W/cm2, spatial-average temporal-average intensity (SATA)) or 1.0 W/cm2, SATP (0.2 W/cm2 SATA). A further 60 females completed a low-DOMS protocol and received one of three protocols: placebo US, or continuous wave 3 MHz US at either 0.2 or 0.4 W/cm2, SATP/SATA. US was applied to biceps muscles for 5 minutes on days 1 to 3. Muscle soreness, tenderness, and stiffness were measured pre-DOMS induction and at 24, 48, and 72 hours post-induction. Results: Pulsed US, 20% duty cycle, at 0.6 W/cm2, SATP, (0.12 W/cm2, SATA) reduced muscle soreness in a low-DOMS but not in a high-DOMS protocol. Continuous wave US at 0.4 W/cm2, SATP/SATA reduced tenderness. Continuous US at 0.2 W/cm2, SATP/SATA was marginally effective on stiffness and tenderness. Conclusion: The results have implications for US management of acute soft tissue injury and the use of DOMS as an experimental model for soft tissue inflammation.

Association of quantitative diffusion tensor imaging measures with time to return to sport and reinjury incidence following acute hamstring strain injury

Hamstring strain injuries (HSI) are a common occurrence in athletics and complicated by limited prognostic indicators and high rates of reinjury. Assessment of injury characteristics at the time of injury (TOI) may be used to manage athlete expectations for time to return to sport (RTS) and mitigate reinjury risk. Magnetic resonance imaging (MRI) is routinely used in soft tissue injury management, but its prognostic value for HSI is widely debated. Recent advancements in musculoskeletal MRI, such as diffusion tensor imaging (DTI), have allowed for quantitative measures of muscle microstructure assessment. The purpose of this study was to determine the association of TOI MRI-based measures, including the British Athletic Muscle Injury Classification (BAMIC) system, edema volume, and DTI metrics, with time to RTS and reinjury incidence. Negative binomial regressions and generalized estimating equations were used to determine relationships between imaging measures and time to RTS and reinjury, respectively. Twenty-six index injuries were observed, with five recorded reinjuries. A significant association was not detected between BAMIC score and edema volume at TOI with days to RTS (p-values ≥ 0.15) or reinjury (p-values ≥ 0.13). Similarly, a significant association between DTI metrics and days to RTS was not detected (p-values ≥ 0.11). Although diffusivity metrics are expected to increase following injury, decreased values were observed in those who reinjured (mean diffusivity, p = 0.016; radial diffusivity, p = 0.02; principal effective diffusivity eigenvalues, p-values = 0.007–0.057). Additional work to further understand the directional relationship observed between DTI metrics and reinjury status and the influence of external factors is warranted.

Evaluating the efficacy of recombinant human growth factors in scar remodelling for patients with facial soft tissue injuries.

Facial soft tissue injuries, often resulting in scarring, pose a challenge in reconstructive and aesthetic surgery due to the need for functional and aesthetic restoration. This study evaluates the efficacy of recombinant human growth factors (rhGFs) in scar remodelling for such injuries. A retrospective evaluation was conducted from January 2020 to January 2023, involving 100 patients with facial soft tissue injuries. Participants were divided equally into a control group, receiving standard cosmetic surgical repair, and an observation group, treated with rhGFs supplemented cosmetic surgery. The study assessed scar characteristics (pigmentation, pliability, vascularity, height), hospital stay duration, tissue healing time, complication rates and patient satisfaction. The observation group demonstrated significant improvements in all scar characteristics, with notably better pigmentation, pliability, vascularity and height compared with the control group. The rhGF treatment also resulted in reduced hospital stay duration and faster tissue healing. Notably, the total complication rate was significantly lower in the observation group (10%) compared with the control group (34%). Additionally, patient satisfaction levels were higher in the observation group, with 98% combined satisfaction compared with 76% in the control group. The application of rhGFs in treating facial soft tissue injuries significantly enhances scar remodelling, expedites healing, reduces complications and improves patient satisfaction. These findings establish rhGFs as a valuable tool in the management of facial soft tissue injuries, highlighting their potential in improving both functional and aesthetic outcomes.

IMPROVING SURGICAL STRATEGIES FOR TREATING EXTENSIVE SOFT TISSUE WOUNDS RESULTING FROM MINE AND EXPLOSIVE TRAUMA

Introduction.Since February 24, 2022, a primary focus of surgical care in Ukraine has been to provide assistance to citizens affected by Russian aggression. A significant proportion of wounds and injuries sustained in this context involves mine-explosive wounds, manifesting as soft tissue damage in the form of lacerations, shrapnel injuries, and wounds of varying degrees of contamination and size.
 The widespread adoption of Vacuum-Assisted Closure (VAC) therapy for wounds characterized by extensive muscle and skin defects involves the localized application of negative pressure to damaged tissues. Typically, this precedes planned autodermoplasty, which, despite being a scheduled intervention, follows urgent surgical corrections. These interventions offer a distinct opportunity for individuals with substantial soft tissue injuries— and, as evidenced by experience, not limited to them— to restore their pre-injury quality of life.
 The aim of this study is to enhance the quality of life for individuals affected by mine-explosive injuries and extensive soft tissue wounds.
 Materials and methods. The outcomes of surgical treatment of 57 civilian victims afflicted by landmine-explosive wounds and extensive soft tissue injuries were examined. These individuals underwent treatment at the Surgical Department of the Regional Clinical Hospital" during the period 2022 – 2023. Among the cohort, 34 were women, constituting 59%, while 23 were men, representing 41%, the ages of the patients ranged from 34 to 74 years.
 Results and discussion. All 57 patients initially underwent surgical treatment of wounds, involving the removal of foreign bodies if present, necrectomy, and subsequent application of the second-stage Vacuum-Assisted Closure (VAC) therapy. The VAC therapy was used to cleanse the wounds and reduce their surface area. Continuous VAC therapy was administered at a negative pressure ranging from 50 mmHg (on the anterior abdominal wall and the back surface of the chest) to 110 mmHg (on tissues of the lower extremities). The replacement of the VAC dressing occurred every 3-5 days, contingent upon the quantity and quality of the exudate, with typically 2-3 changes required. The third stage involved the application of free autodermoplasty utilizing a perforated skin flap. Mechanical wound treatment was performed iteratively until the level of "bloody dew" was reached.
 We suggest that all these stages are essential for achieving favorable treatment outcomes, irrespective of any severe accompanying pathology that may arise. Indeed, comorbidity stands out as a defining factor that distinguishes the civilian population qualitatively from the military category.
 Conclusions. The application of Vacuum-Assisted Closure (VAC) therapy followed by autodermoplasty in the management of extensive soft tissue injuries caused by mine-explosive incidents significantly enhances the efficacy of surgical treatment and reduces the period of patient incapacitation, presenting clear economic benefits. Autodermoplasty, in particular, holds a commendable position within the realm of reconstructive surgery for mine and explosive wounds. Within this context, autodermoplasty emerges as a surgical intervention that not only yields positive aesthetic outcomes but also facilitates an accelerated adaptation of the affected body part. This, in turn, contributes to an improved quality of life for victims of mine-explosive trauma grappling with substantial soft tissue damage.

Management of Soft Tissue Injuries in Children-A Comprehensive Review.

Airway injury, Ocular injury and neurovascular tissue damage, burns is all a spectrum of pediatric soft tissue injury complex. Soft tissue injuries to the head and neck area in children are challenging to manage, because these injuries significantly affect the child's overall health and development. Management of such injuries requires a multidisciplinary approach involving surgical and nonsurgical interventions and close collaboration among health care professionals, parents, and caregivers. This article reviews the various causes of injuries, specific considerations for each region of the head and neck, and approaches to the surgical management of soft tissue injuries in pediatric patients, including surgical and adjuvant therapies. Specific anatomic regions reviewed include the scalp/forehead, periorbital region, nose, cheeks, lips, ears, and neck/airway.Laceration repair in the growing pediatric populations may require revisions in the future. Facial soft tissue injuries are prone to poor cosmesis as in many occasions as may be constrained by available surgical specialists, thus proper multispecialty team approach along with surgical alignment and symmetry should be considered comprehensively.

Advances in Soft Tissue Injuries Associated with Open Fractures.

Management of soft tissue injury is a key component in the overall treatment of upper extremity fractures. Hand surgeons must rely on their armamentarium for treating soft tissue deficits for functional outcomes. Understanding the role of fracture fixation and wound adjuncts, including negative pressure wound therapy and dermal regenerative templates, is the keys to success. In addition, detailed knowledge of local and free tissue options is essential for hand reconstruction.

Management of Maxillofacial Soft Tissue Trauma with Parotid Gland Exposure: Case Report

Introduction: Soft tissue trauma in Oral and Maxillofacial cases occurs quite often in the Emergency Room at Hasan Sadikin Hospital, Bandung. Trauma that occurs to the facial area is very susceptible to causing problems, both aesthetic sensory and motor function problems in that area. The existence of important structures in the facial area, such as the parotid gland and the location of the Facial Nerve (N.VII) in the facial area, requires special attention in treating soft tissue trauma to the face. Emergency management aims to ensure appropriate action in treating wounds, preventing infection, and ensuring the presence or absence of gland damage, as well as involvement of N.VII damage. Management of soft tissue wounds in the facial area is carried out by suturing, pain management and administering antibiotics. Emergency management of soft tissue trauma must be carried out quickly and precisely to obtain maximum results and consider function and aesthetics. Case report: A 16 year old female came with complaints of bleeding from the face and ears due to a motorbike accident approximately 2 hours before entering the hospital. Physical examination revealed an asymmetrical face, a torn wound on the left cheek with the parotid gland exposed and otorrhea. The patient's intraoral examination was normal. Conclusion: In this paper we will report a case of trauma to the maxillofacial soft tissue with exposure of the parotid gland. It is hoped that this article will expand insight into how to examine damage to the parotid gland and examine the function of N.VII in soft tissue trauma to the facial area. Keywords: Facial Soft Tissue Trauma; Parotid Gland; Management, N.VII

Emergency Management of Symphysis and Right Angle of Mandible Fracture with Laceration Wound at Buccal and Submental Region: A Case Report

Introduction: Fracture of the mandible is a case that is quite commonly found in the ER of The Oral and Maxillofacial Surgery Department at Dr. Hasan Sadikin General Hospital Bandung, fractures of the mandible rank second to fractures of the facial area because it is a prominent bone that is located at the edge and position in the lower third of the face. Emergency management aims to take any appropriate action, prevent complications, and consult other departments involved. Objective: To explain the emergency management of symphysis and right angle of mandible fracture with laceration wound at buccal and submental region. Case report: A manage 21 year came with bleeding from the mouth due to a motorcycle accident approximately 24 hours before admission to the hospital. Physical examination showed asymmetrical face, edema at right cheek region, laceration wound at right cheek and chin region, and multiple abrasive wound at facial region. There were steps, crepitus on symphysis, and right angle of mandible region. Intraoral examination showed laceration wounds on the gingiva. Case management: The laceration area is then sutured both intraoral and extraoral followed by the application of closed reduction in the mandible with interdental wiring at the lower jaw aiming to prevent infection and malunion. The management of soft tissue and hard tissue injury is by reduction, fixation, and immobilization of fractures, management of pain, and administration of antibiotics. Conclusion: The emergency management of symphysis and right angle of mandible fracture with laceration wound at the buccal and submental region is promptly and rapidly carried out with minimal intervention by using closed reduction method gave good results in stability and function before definitive treatment.

Management of open wounds in dogs using a bioresorbable polymeric wound matrix: 14 Cases (2019-2021)

The objective of this retrospective case series is to evaluate clinical outcomes associated with the use of a bioresorbable polymeric wound matrix (MicroLyte Vet; Imbed Biosciences) for the management of soft tissue wounds of various etiologies in dogs. Medical records were reviewed between August 2019 and November 2021 for signalment, wound etiology, location, size, initial wound management, antibiotic therapy, time to initial application, number of applications, time between applications, secondary dressing used, time to wound closure, complications, and clinical outcomes. Time to initial application ranged from 1 to 61 days (median, 7.5). The number of applications ranged from 1 to 15 (median, 4.5). Time between applications ranged from 1 to 8 days (median, 3.7). Additional surgical interventions were implemented in 3 dogs. Wound closure by second intention healing (n=14) ranged from 2 to 12 weeks (median, 5). There were no adverse events attributed to the use of bioresorbable polymeric wound matrix. Complete wound healing occurred with use of the bioresorbable polymeric wound matrix in all dogs.

Wound Coverage Considerations for Leg Defects: Our Experience

Abstract Background: Lower limb injuries are common and account for 40-50% of emergency department visits. These injuries occur frequently in poly-trauma, which remains a leading cause of long hospitalization, disability and death for all ages. Clinical treatment of these injuries poses a great challenge because the surgeons need to face serious complications such as shock, wound coverage and infection, and has to choose a right time to deal with the combined fractures and injuries of the blood vessels, nerves and tendons. The aim of this study is to study clinical profile and management of various below knee soft tissue injuries. Methods: This study was conducted in two tertiary care centres of Northern India. Subjects were recruited from patients presenting in Emergency/Surgery OPD, a primary diagnosis of lower limb soft tissue injuries. Results: A total of 125 patients with lower limb injuries were included in the study. Different treatment options were individualized and exercised which included skin grafting (49.6%), flap coverage (44%) primary closure (4.8%) and skin substitutes like Integra (1.6%). While in 46 wounds (36.8%) negative pressure wound therapy (NPWT) VAC was used. It was observed that 92 patients (73.6%) underwent surgery only once whereas 33(26.4%) patients had to undergo surgery 2 or more times. Conclusion: The aim of surgical treatment in lower limb reconstructions is maximum limb functional recovery and return to work activities. Problems in reconstruction are mainly encountered in the ankle and lower third leg defects because, local tissue availability is very minimal in these areas.

What the COVID pandemic taught us about the management of pediatric minor trauma

The COVID-19 pandemic necessitated a change in our practice in the management of pediatric soft-tissue injuries. Patients were managed conservatively whenever possible. Our aim in this study was to see whether this more conservative approach adversely affected clinical, and patient-reported outcomes, including scarring. A prospective record of children presenting to the plastic surgery "Early Bird" clinic for pediatric trauma between 01.04.2020 and 30.06.2020 was kept. Electronic patient records were reviewed. An outpatient telephone clinic was scheduled for all patients. Parents were asked about complications and what they thought about the scar and to rate it as either: "poor," "satisfactory," "good," or "excellent." There were 240 patients, including 136 (57%) males and 104 (43%) females. The most frequent type of injury was a facial laceration in 123 patients (51.3%), followed by hand lacerations in 43 (17.9%), fingertip injuries in 31 (12.9%), and others. Ninety out of 240 (37.5%) were offered surgery. Follow-up times ranged from 17 to 20 months. Most parents (86.2%) were happy with the scarring and reported it as "good" or "excellent." The proportion rating the scar "excellent" or "good" was similar in the non-operated cohort (i.e., 85.5%) versus the operated cohort (88.5%) (p-value 0.16). The overall complication rate of patients seen during this time was 5.9%; 7.4% in the conservatively managed and 4.9% of those who went to the theater. Despite managing more wounds, including some dog bites, conservatively, patients and parents reported low complication rates and high levels of satisfaction with the final scarring.

Emergency Treatment of Soft Tissue and Dentoalveolar Fractures using Risdon Wiring in Children due to Motorcycle Accident : Case Report

Introduction: Dentoalveolar fractures are often found in children due to physical trauma, falls, and motorized accidents. In pediatric patients, there are variations in age, jaw development, and dentition which are the primary considerations in choosing a dentoalveolar fracture treatment method. This case report aims to describe and discuss the emergency management of soft tissue injuries and mandibular dentoalveolar fractures with Risdon wiring in pediatric patients due to motorized accidents. Case report: A 9-year-old female patient complained of bleeding from the mouth due to a traffic accident. Clinical and radiographic examination showed dentoalveolar segment fractures in tooth region 32-42, stab wounds, and lacerations on the inferior lip, vestibule, and gingiva in tooth region 32-42. The patient underwent wound cleaning, wound suturing, and treatment of dentoalveolar fractures with fixation using Risdon wiring in the mandibular region 36-46. Conclusion: Conservative treatment of dentoalveolar fractures in pediatric patients with minimal intervention can give good results. Risdon wiring as a fixation method can be used in the emergency treatment of dentoalveolar fractures in pediatric patients with mixed dentition. Keywords: Soft tissue trauma, dentoalveolar fracture, Risdon wiring, emergency

Emergency Management of Maxillofacial Soft Tissue Wounds due to Physical Trauma

Introduction: Soft tissue trauma is common in the head and neck, limited to superficial structures or involving deeper anatomical structures. Various types of trauma occur depending on the aetiology and mechanism. Managing oral and maxillofacial soft tissue trauma poses a challenge for surgeons due to the importance of facial esthetics. The purpose of this case report is to report and discuss the emergency management of soft tissue injuries in the maxillofacial region due to physical trauma. Case report: Three cases with diagnoses of abrasive wounds, lacerations, and punctum wounds on the lips, cheeks, eyebrows, chin, and oral cavity were encountered at the emergency department of Hasan Sadikin Hospital, Bandung City, due to a motor accident. Treatment includes debridement, reconstruction, and wound closure. Conclusion: Emergency treatment of soft tissue wounds in the maxillofacial area that is fast and according to the procedure will reduce infection and dehiscence. Keywords: emergency, soft tissue injury, Maxillofacial, Physical trauma

EVALUATION OF THE OUTCOME OF THE ILIZAROV TECHNIQUE FOR THE TREATMENT OF TIBIAL BONE AND SOFT TISSUE INJURY

This study was designed to assess the outcome of the illizarov method for treating patients with dead bone segments or open fractures along with severe soft tissue injury. This retrospective study was conducted at Bakhtawar Ameen Trust Hospital, Multan, from September 2019 to September 2022. A total of 35 patients having non-union tibial fractures and dead bone segments were included in the study. These patients had tibia grade 3 open fractures and had undergone bone grafting and soft tissue closure. The defective bone segment was debrided, and radical resection was done. Illizarov technique was performed on all subjects. All patients reported good smooth tissue coverage and bone transport. The mean docking period of bone transport in all subjects was 3.87 ± 0.45 months. A leg length discrepancy of 1 cm occurred in 4 subjects. No subject complained of pain at follow-up. The Illizarov method is effective for the management of bone and soft tissue injuries.

Etiology, Prevalence, and Management of Oral and Maxillofacial Soft Tissue Injuries in Children at the Komfo Anokye Teaching Hospital, Kumasi-Ghana

Etiology, Prevalence, and Management of Oral and Maxillofacial Soft Tissue Injuries in Children at the Komfo Anokye Teaching Hospital, Kumasi-Ghana

A study of pattern, management, and outcome of complex soft-tissue injuries

A study of pattern, management, and outcome of complex soft-tissue injuries

Gene variants previously associated with reduced soft-tissue injury risk: Part 2 – Polygenic associations with elite status in Rugby

ABSTRACT Part 1 of this genetic association series highlighted several genetic variants independently associated with elite status in rugby. However, it is highly likely that the genetic influence on elite status is polygenic due to the interaction of multiple genes. Therefore, the aim of the present study was to investigate whether polygenic profiles of elite rugby athletes differed from non-athletes utilising 13 genetic polymorphisms previously associated with tendon/ligament injury. Total genotype score (TGS) was calculated and multifactor dimensionality reduction (MDR) was used to calculate SNP-SNP epistasis interactions. Based on our elite rugby data from Part 1, mean TGS was significantly higher in elite rugby athletes (52.1 ± 10.7) than non-athletes (48.7 ± 10.8). There were more elite rugby athletes (54%) within the upper TGS quartile, and fewer (46%) within the lower quartile, compared to non-athletes (31% and 69%, respectively; P = 5·10−5), and the TGS was able to distinguish between elite rugby athletes and non-athletes (area under the curve = 0.59; 95% confidence interval 0.55-0.63; P = 9·10−7). Furthermore, MDR identified a three-SNP model of COL5A1 rs12722, COL5A1 rs3196378 and MIR608 rs4919510 that was best able to predict elite athlete status, with a greater frequency of the CC-CC-CC genotype combination in elite rugby athletes (9.8%) than non-athletes (5.3%). We propose that elite rugby athletes possess “preferable” musculoskeletal soft-tissue injury-associated polygenic profiles that have helped them achieve success in the high injury risk environment of rugby. These data may, in future, have implications for the individual management of musculoskeletal soft-tissue injury. Highlights Elite rugby athletes have preferable polygenic profiles to non-athletes in terms of genetic variants previously associated with musculoskeletal soft-tissue injury. The total genotype score was able to distinguish between elite rugby athletes and non-athletes. COL5A1 rs12722, COL5A1 rs3196378 and MIR608 rs4919510 produced the best model for predicting elite athlete status. We propose that elite rugby athletes may have an inherited advantage to achieving elite status due to an increased resistance to soft-tissue injury.