Non-contact Injuries Research Articles

A Pilot Study on the Prediction of Non-Contact Muscle Injuries Based on ACTN3 R577X and ACE I/D Polymorphisms in Professional Soccer Athletes.

Muscle injuries are among the main reasons for medical leavings of soccer athletes, being a major concern within professional teams and their prevention associated with sport success. Several factors are associated with a greater predisposition to injury, and genetic background is increasingly being investigated. The aim of this study was to analyze whether ACTN3 R577X and ACE I/D polymorphisms are predictors of the incidence and severity of muscle injury in professional soccer athletes from Brazil, individually and in association. Eighty-three professional athletes from the first and second divisions of the Brazilian Championship were evaluated regarding the polymorphisms through blood samples. Nighty-nine muscle injuries were identified during the seasons of 2018, 2019 and 2020 and categorized according to severity. ACTN3 XX individuals had a higher frequency of severe injuries compared to the RX and RR genotypes (p = 0.001), and in the dominant model (compared to RX+RR), with p < 0.001. The trend p-value test showed an increased number of injuries/season following the order XX > RX > RR (p = 0.045). Those with the ACE II genotype had almost 2 fold the number of injuries per season compared to those with the ID+DD genotypes (p = 0.03). Logistic regression showed that the polymorphisms are predictors of the development of severe injury (ACTN3 R577X model with p = 0.004, R2: 0.259; ACE I/D model with p = 0.045, R2: 0.163), where ACTN3 XX individuals were more likely to suffer from severe injury (OR: 5.141, 95% CI: 1.472-17.961, p = 0.010). The combination of the ACTN3 577X allele and the ACE II genotype showed an increased number of injuries per season, enhanced by 100% (1.682 injuries/season versus 0.868 injuries/season, p = 0.016). Our findings suggest that both polymorphisms ACTN3 R577X and ACE I/D (and their interaction) are associated with the susceptibility and severity of non-contact muscle injury in soccer players.

Timing of contact and non-contact injuries across a season in amateur rugby: implications for injury prevention and return to play

Introduction: Injury risk may vary throughout the playing season. The rapid increase in exposure to matches or contact at the start of a season may increase injury risk; conversely, accumulation of training and match stress may increase risk towards the end of a season. The timing of injuries throughout the playing season has rarely been studied, with no identified studies on injury timing in amateur rugby players, where the majority of participation occurs. Understanding patterns in injury risk may assist in planning graded exposure, training periodisation, and injury prevention strategies.

The FIFA 11+ injury prevention program reduces the incidence of hamstring injury among soccer players: a systematic review and meta-analysis

Introduction: Hamstring injury are among the most common non-contact injuries in sports. In soccer, which is the most popular sport worldwide, hamstring injuries represent between 15 and 50 % of all muscle injuries. Sports injury prevention programs have been showing promising results in reducing the risk of hamstring injury. The purpose of this systematic review and meta-analysis was to investigate the effectiveness of the FIFA 11+ Injury Prevention Program on reducing the incidence hamstring injury among soccer players. Methods: This systematic review with meta-analysis was based upon the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search for relevant studies published from 1985-2022 using the following databases: Cochrane Library, MEDLINE, AMED, PubMed, Web of Science, and PEDro was conducted. The keywords used in the search strategy were ‘neuromuscular training’, ‘injury prevention programs’, ‘FIFA 11+’, ‘hamstring injury’, ‘soccer, and variations of these search terms. Included studies had to be randomized controlled trials using FIFA 11+ Injury Prevention Program for soccer players with the primary outcome being hamstring injury rate. There were no restrictions of age or playing level. The random-effects model was used in analysing the extracted data by the RevMan Meta-Analysis software version 5. Results: The pooled results of 2949 players and 274032 exposure hours showed 66% hamstring injury reduction per 1000 hours of exposure in the intervention group compared to control group with an injury risk ratio [IRR] of 0.34 (95% confidence interval [CI] 0.21–0.55, P < 0.0001). Discussion/Conclusion: This is the first meta-analysis of randomized controlled trials to evaluate the effectiveness of FIFA 11+ Injury Prevention Program in reducing the incidence of hamstring injury among soccer players. This meta-analysis demonstrates that the FIFA 11+ Injury Prevention Program reduces the incidence of hamstring injury by 66% among soccer players. Impact/Application to the field: The results showed a 66 % hamstring injury reduction. Therefore, it's recommended that soccer players and coaches implement the FIFA 11+ Injury Prevention Program in their current practice. Conflict of interest statement: No conflict of interest of relevance to the submission of this abstract.

A multicomponent neuromuscular warm-up program reduces lower-extremity injuries in trained basketball players: A cluster randomized controlled trial

Objective To assess the effects of a novel multicomponent neuromuscular warm-up program on lower-extremity injury incidence in basketball players competing at the regional level. Methods : A cluster randomized controlled experimental design was adopted to compare injury incidence between players exposed to the injury prevention warm-up program and those exposed to a typical warm-up program across an entire basketball season. Four teams consisting of 57 players (male: n = 42; female: n = 15) were allocated to the intervention group (age: 21.6 ± 2.5 years; height: 186.2 ± 8.8 cm; body mass: 80.0 ± 10.4 kg) and four teams consisting of 55 players (male: n = 43; female: n = 12) were allocated to the control group (age: 21.6 ± 2.6 years; height: 186.9 ± 9.1 cm; body mass: 81.5 ± 10.9 kg). The novel warm-up combined running exercises with active stretching, plyometrics, balance, strength, and agility drills. Coaching and medical staff provided details on injury incidence each week. Data analyses included the use of poisson regression analyses and the incidence rate ratio (IRR) with 95% confidence intervals (CI). Results The intervention group experienced a significantly lower ankle sprain incidence rate (IRR = 0.26, 95% CI = 0.05, 0.98, p = 0.02) and a tendency toward a lower knee injury incidence rate (IRR = 0.32, 95% CI = 0.03, 1.78, p = 0.07) compared to the control group. Considering only non-contact lower-extremity injuries of any type, the intervention group experienced a significantly lower incidence rate compared to the control group (IRR = 0.26, 95% CI = 0.05, 0.98, p <0.001). Conclusion This multi-team study demonstrated a novel multicomponent warm-up program resulted in less non-contact lower-extremity injuries, particularly ankle sprains and knee injuries, compared to a typical warm-up program in regional-level male and female basketball players.

Psoriasis, Is It a Microdamage of Our "Sixth Sense"? A Neurocentric View.

Psoriasis is considered a multifactorial and heterogeneous systemic disease with many underlying pathologic mechanisms having been elucidated; however, the pathomechanism is far from entirely known. This opinion article will demonstrate the potential relevance of the somatosensory Piezo2 microinjury-induced quad-phasic non-contact injury model in psoriasis through a multidisciplinary approach. The primary injury is suggested to be on the Piezo2-containing somatosensory afferent terminals in the Merkel cell–neurite complex, with the concomitant impairment of glutamate vesicular release machinery in Merkel cells. Part of the theory is that the Merkel cell–neurite complex contributes to proprioception; hence, to the stretch of the skin. Piezo2 channelopathy could result in the imbalanced control of Piezo1 on keratinocytes in a clustered manner, leading to dysregulated keratinocyte proliferation and differentiation. Furthermore, the author proposes the role of mtHsp70 leakage from damaged mitochondria through somatosensory terminals in the initiation of autoimmune and autoinflammatory processes in psoriasis. The secondary phase is harsher epidermal tissue damage due to the primary impaired proprioception. The third injury phase refers to re-injury and sensitization with the derailment of healing to a state when part of the wound healing is permanently kept alive due to genetical predisposition and environmental risk factors. Finally, the quadric damage phase is associated with the aging process and associated inflammaging. In summary, this opinion piece postulates that the primary microinjury of our “sixth sense”, or the Piezo2 channelopathy of the somatosensory terminals contributing to proprioception, could be the principal gateway to pathology due to the encroachment of our preprogrammed genetic encoding.

Meniscus Repair in Pediatric Athletes.

Meniscus tears are common in the pediatric population, typically occur after noncontact injuries, and can be diagnosed clinically with MRI confirmation. Surgery should be offered to patients with loss of range of motion, persistent symptoms, or displaced/complex tears. Given poor long-term outcomes reported after meniscectomy, repair should be attempted when possible as pediatric menisci are well vascularized and have better outcomes after repair than their adult counterparts. The location of the tear is an important determining factor when deciding on the type of repair to use. Pediatric meniscus repair techniques will be discussed noting differences between pediatric and adult procedures. Further studies are needed to explore the role of biologics and define postoperative protocols.

ERKEN CUMHURİYET DÖNEMİ TÜRKİYE’SİNDE FUTBOL YARALANMALARI: GAZETE KUPÜRLERİNİN BETİMSEL İÇERİK ANALİZİ

Amaç&#x0D; Çalışmanın amacı 1937-1938 Milli Küme Futbol sezonunda&#x0D; oynanan futbol müsabakalarında gerçekleşen&#x0D; futbol yaralanmalarını, dönemin gazete kupürlerinden&#x0D; faydalanarak tespit edip güncel spor hekimliği yaklaşımıyla&#x0D; içerik analizine tabi tutmaktır.&#x0D; Gereç ve Yöntem&#x0D; Çalışmada 1937-1938 futbol sezonundaki spor yaralanmalarını&#x0D; incelemek üzere dönemin gazetelerinden&#x0D; içerik analizinde kullanılacaklar belirlendi. Bu gazeteler&#x0D; www.gastearsivi.com web adresindeki dijital arşivden&#x0D; incelendi. Kapsamı bakımından etik kurul onayı&#x0D; gerektirmeyen çalışmada, gazete kupürlerinde konu&#x0D; edilen futbol yaralanmaları, futbolda yaralanma sınıflamasına&#x0D; göre kategorize edildi.&#x0D; Bulgular&#x0D; Sezon boyunca oynanan 48 maçta toplam 37 adet&#x0D; spor yaralanması tespit edilmiştir. Bu 37 yaralanma&#x0D; içinde, yaralanma tipine göre %38 (n=14) kontüzyon,&#x0D; %24 (n=9) strain veya sprain, %13 (n=5) konküzyon,&#x0D; %11 (n=4) laserasyon, %8 (n=3) yorgunluk, %3 (n=1)&#x0D; künt batın travması ve %3 (n=1) hastalık hadisesi;&#x0D; yaralanma bölgesine göre incelediğimizde ise %59&#x0D; (n=22) alt ekstremite, %24 (n=9) kafa, %11 (n=4) tüm&#x0D; vücut, %3 (n=1) üst ekstremite ve %3 (n=1) karın bölgesinde&#x0D; yaralanma olduğu gözlemlenmiştir. Bu yaralanmaların&#x0D; %64’ü kontakt (n=24), %36’sı (n=13) nonkontakt&#x0D; yaralanma mekanizmasıyla gerçekleşmiştir.&#x0D; Sonuç&#x0D; 1937-38 Milli Küme sezonunda futbol yaralanmalarına&#x0D; sıkça rastlanmıştır. Dönemin tıbbi ve sportif şartlarından&#x0D; dolayı tanı ve/veya tedavi yaklaşımları günümüzden&#x0D; farklı olsa da gazete kupürlerinden elde edilen&#x0D; bilgiler doğrultusunda döneme ait yorum yapılabilmesi&#x0D; değerlidir. Çalışmamızın bu sonuca uygun olarak&#x0D; gelecekte yapılacak benzer çalışmalara metodolojik&#x0D; olarak ışık tutacağına inanmaktayız.

A novel lower extremity non-contact injury risk prediction model based on multimodal fusion and interpretable machine learning.

The application of machine learning algorithms in studying injury assessment methods based on data analysis has recently provided a new research insight for sports injury prevention. However, the data used in these studies are primarily multi-source and multimodal (i.e., longitudinal repeated-measures data and cross-sectional data), resulting in the models not fully utilising the information in the data to reveal specific injury risk patterns. Therefore, this study proposed an injury risk prediction model based on a multi-modal strategy and machine learning algorithms to handle multi-source data better and predict injury risk. This study retrospectively analysed the routine monitoring data of sixteen young female basketball players. These data included training load, perceived well-being status, physiological response, physical performance and lower extremity non-contact injury registration. This study partitions the original dataset based on the frequency of data collection. Extreme gradient boosting (XGBoost) was used to construct unimodal submodels to obtain decision scores for each category of indicators. Ultimately, the decision scores from each submodel were fused using the random forest (RF) to generate a lower extremity non-contact injury risk prediction model at the decision-level. The 10-fold cross-validation results showed that the fusion model was effective in classifying non-injured (mean Precision: 0.9932, mean Recall: 0.9976, mean F2-score: 0.9967), minimal lower extremity non-contact injuries risk (mean Precision: 0.9317, mean Recall: 0.9167, mean F2-score: 0.9171), and mild lower extremity non-contact injuries risk (mean Precision: 0.9000, mean Recall: 0.9000, mean F2-score: 0.9000). The model performed significantly more optimal than the submodel. Comparing the fusion model proposed with a traditional data integration scheme, the average Precision and Recall improved by 8.2 and 20.3%, respectively. The decision curves analysis showed that the proposed fusion model provided a higher net benefit to athletes with potential lower extremity non-contact injury risk. The validity, feasibility and practicality of the proposed model have been confirmed. In addition, the shapley additive explanation (SHAP) and network visualisation revealed differences in lower extremity non-contact injury risk patterns across severity levels. The model proposed in this study provided a fresh perspective on injury prevention in future research.

Association of the ACTN3 rs1815739 Polymorphism with Physical Performance and Injury Incidence in Professional Women Football Players.

The p.R577X polymorphism (rs1815739) in the ACTN3 gene causes individuals with the XX genotype to be deficient in functional α-actinin-3. Previous investigations have found that XX athletes are more prone to suffer non-contact muscle injuries, in comparison with RR and RX athletes who produce a functional α-actinin-3 in their fast-twitch fibers. This investigation aimed to determine the influence of the ACTN3 R577X polymorphism on physical performance and injury incidence of players competing in the women’s Spanish first division of football (soccer). Using a cross-sectional experiment, football-specific performance and epidemiology of non-contact football-related injuries were recorded in a group of 191 professional football players. ACTN3 R577X genotype was obtained for each player using genomic DNA samples obtained through buccal swabs. A battery of physical tests, including a countermovement jump, a 20 m sprint test, the sit-and-reach test and ankle dorsiflexion, were performed during the preseason. Injury incidence and characteristics of non-contact injuries were obtained according to the International Olympic Committee (IOC) statement for one season. From the study sample, 28.3% of players had the RR genotype, 52.9% had the RX genotype, and 18.8% had the XX genotype. Differences among genotypes were identified with one-way analysis of variance (numerical variables) or chi-square tests (categorical variables). Jump height (p = 0.087), sprint time (p = 0.210), sit-and-reach distance (p = 0.361), and dorsiflexion in the right (p = 0.550) and left ankle (p = 0.992) were similar in RR, RX, and XX football players. A total of 356 non-contact injuries were recorded in 144 football players while the remaining 47 did not sustain any non-contact injuries during the season. Injury incidence was 10.4 ± 8.6, 8.2 ± 5.7, and 8.9 ± 5.3 injuries per/1000 h of football exposure, without differences among genotypes (p = 0.222). Injury rates during training (from 3.6 ± 3.7 to 4.8 ± 2.1 injuries per/1000 h of training exposure, p = 0.100) and match (from 47.8 ± 9.5 to 54.1 ± 6.3 injuries per/1000 h of match exposure, p = 0.209) were also similar in RR, RX, and XX football players. The ACTN3 genotype did not affect the mode of onset, the time needed to return to play, the type of injury, or the distribution of body locations of the injuries. In summary, women football players with different genotypes of the p.R577X ACTN3 polymorphism had similar values of football-specific performance and injury incidence. From a practical perspective, the ACTN3 genotyping may not be useful to predict performance or injury incidence in professional women football players.

The Relationship between Acute: Chronic Workload Ratio of High-Speed Running and Hamstring Injuries in Professional Footballers

Hamstring strain injuries are common within professional footballers with high-speed running (HSR) being known to increase the likelihood of sustaining a hamstring injury. This study aimed to assess the acute: chronic workload ratio (ACWR) of HSR that preceded hamstring injuries in professional footballers. Global positioning system (GPS)-derived HSR distances and weekly ACWR were obtained from 18 footballers from one English Football League (EFL) club during the 2018-2019 season. Hamstring injuries were documented by the club’s medical team and the ACWR data of the four weeks preceding each hamstring injury were analysed. The mean ACWR of injured players was calculated for each season along with the ACWR of the squad. Ten hamstring injuries were recorded in total, across eight of the 18 players (44%). The most common site of injury was the medial part of the hamstring (70%). At the time of injury the mean ACWR for injured players was 0.90, while the squad mean ACWR for the season was 1.04. In conclusion, this study evidenced a high prevalence of non-contact hamstring injuries over a competitive season within an EFL club. The majority of hamstring injuries occurred when the mean ACWR was below the squad mean ACWR for the season. The loading pattern of ‘moderate to high’ followed by ‘low to moderate’ ACWR was commonly observed in the four weeks prior to injury.

Postural balance asymmetry and subsequent noncontact lower extremity musculoskeletal injuries among Tunisian soccer players with groin pain: A prospective case control study

BackgroundRecent studies reported postural balance disorders in patients and soccer players with groin pain (GP) compared to controls. Since postural balance asymmetry identified after an initial injury contributes for subsequent injuries, identification of this asymmetry in soccer players with GP may highlight the risk of sustaining subsequent noncontact lower extremity musculoskeletal injuries in these players. Therefore, the aims of this study were to (i) examine static and dynamic unipedal postural balance asymmetry in soccer players with GP compared to healthy ones, and (ii) quantify the risk of subsequent noncontact lower extremity injuries in these players. Research questionDo soccer players with GP exhibit higher static and dynamic unipedal postural balance asymmetry, and higher risk of sustaining subsequent injuries compared to controls? MethodsIn this prospective case control study, 27 soccer players with non-time loss GP (GP group: GPG), and 27 healthy ones (control group: CG) were enrolled. Static and dynamic unipedal postural balance asymmetry were evaluated with a force platform using symmetry index (SI), and Y-balance test (Y-BT), respectively. Additionally, subsequent noncontact lower extremity musculoskeletal injuries were tracked for 10 months. ResultsThe GPG revealed higher (p < 0.01) SI in eyes closed condition, higher (p < 0.001) side-to-side asymmetry in anterior, posteromedial and posterolateral reach distances and in composite Y-BT score compared to CG. They showed lower (p < 0.001) composite score for injured limb and higher (p < 0.001) side-to-side asymmetry in posteromedial reach distance compared to the cut-off values of 89.6 % and 4 cm, respectively. Moreover, GPG exhibited higher odds (OR= 7.48; 95 % CI = 2.15, 26.00; p < 0.01) of sustaining subsequent injuries compared to CG. SignificanceThe Y-BT should be instituted into existing pre-participation physical examinations to screen for soccer players with non-time loss GP at an elevated risk of sustaining subsequent injuries. This could help coaches and clinicians make valid return to play decisions.

Recovery During a Congested Schedule and Injury in Professional Football.

To analyze the relationships between the recovery kinetics experienced by professional football players and noncontact injury. A cohort of 46 professional football players (age 24.2 [4.7]y) from the same team (French Ligue 1) was monitored each day between matches when the team played twice a week. The recovery monitoring procedure was implemented after 38 matches and included some questionnaires: duration of sleep, Hooper scale (quality of sleep, level of stress, fatigue, and muscle soreness), perceived recovery status scale, creatine kinase concentrations, a countermovement jump, and an isometric force test. Noncontact injuries were collected during these periods. Noncontact injuries were associated with perceived fatigue and muscle soreness 2 days (relative risk [RR] = 1.89 and 1.48, respectively) and 3 days following the matches (RR = 2.08 and 2.08, respectively). An increase of sleep quantity during the 2 nights following a match was significantly associated with a lower RR (RR = 0.65), as well as a lower decrement score on the isometric force test on each of the 3 days after the matches (RR = 0.97, RR = 0.99, and RR = 0.97, respectively). No other association was reported for the variables sleep quality, stress, perceived recovery, creatine kinase concentrations, countermovement jump, and noncontact injuries. During a congested schedule, implementing a recovery monitoring protocol including questionnaires about fatigue, muscle soreness, quantity of sleep, and a physical test of isometric force could help practitioners prevent injuries.

Asymmetry In Single Leg Vertical Countermovement Hop Kinematics In Collegiate Female Soccer Players

Multidirectional sports such as soccer have a high incidence rate of anterior cruciate ligament injury. Asymmetries between limb have been linked to such non-contact injuries, thereby outlining the importance of screening measures that may identify at-risk groups. Specifically, tasks such as a vertical single leg countermovement (SLC) jump can provide an objective measure of frontal and sagittal plane asymmetries. PURPOSE: To identify lower limb asymmetries during a SLC jump. METHODS: 25 collegiate female soccer players (height: 167.4 ± 6.0 cm, mass: 67.16 ± 6.6 kg) completed 3 maximum SLC jumps on each limb. The side with the highest average jump height was defined as the high performance (HP) side and compared to the low performance side (LP). An 8 camera markerless motion capture system was utilized to analyze kinematic data at peak knee flexion during both the takeoff (TO) and landing (LN) phase using advanced machine learning. Force platforms measured the peak takeoff and landing vertical ground reaction force (GRF). A two-factor repeated measures ANOVA (p < 0.05) was used to determine differences between side (HP, LP) and phase (TO, LN) during the SLC task. RESULTS: 52% of the players had greater jump performance on their preferred kicking side. A main effect of side (p = 0.035) and phase (p < 0.001) was found for knee flexion (HP: TO 67.2 ± 7.2°, LN 60.5 ± 10.8°; LP: TO 65.0 ± 6.5°, LN 58.8 ± 7.2°). Likewise, a main effect of side (p < 0.001) and phase (p < 0.001) was found for GRF (HP: TO 1373 ± 236 N, LN 2238 ± 435 N; LP: TO 1341 ± 224 N, LN 2088 ± 280 N). A phase main effect was found for both hip flexion (p = 0.002) (HP: TO 49.8 ± 10.9°, LN 42.5 ± 11.9°; LP: TO 50.8 ± 10.1°, LN 41.0 ± 12.8°) and adduction (p = <0.001) (HP: TO 8.1 ± 4.4°, LN 5.5 ± 4.9°; LP: TO 8.7 ± 3.8°, LN 5.1 ± 5.7°). Significant main effects were not present for knee abduction (p > 0.05). CONCLUSIONS: Collegiate female soccer players demonstrate greater knee and hip flexion and hip adduction occur during the take-off phase of the single leg vertical jump compared to the landing phase. Additionally, the leg with greater performance has increased knee flexion during both take-off and landing which corresponds to greater peak force. These identified asymmetries between phase and limb could be considered important factors in monitoring potentially at-risk populations.

Video analysis of Achilles tendon rupture in male professional football (soccer) players: injury mechanisms, patterns and biomechanics

BackgroundAchilles tendon rupture (ATR), while rare in football, is a severe career-threatening injury associated with long-layoff times. To date, no study has documented ATR’s mechanism in professional football players.AimTo describe...

The pattern of non-contact injuries in a South African professional football team.

The incidence, pattern and severity of non-contact injuries in European football has been researched extensively. In South African football only two studies have been conducted to date and with disparate outcomes. Further research into injury rates in South African football is therefore warranted. To determine the incidence and pattern of non-contact injuries in a South African professional football team during the course of a single season (2016-2017) in relation to competition exposure, training load and playing position. Thirty-four male professional football players belonging to a single team competing in the Premier Soccer League (PSL) in South Africa were studied. Non-contact time-loss injuries (total training and match injuries) were recorded. Injury incidence, location, severity, type, and playing position (defender, midfielder, attackers, goalkeepers) during either match play or training were recorded. The non-contact incidence was 52 injuries with an injury rate of 3.74 per 1 000 exposures (training and competition). Competitions resulted in an incidence of 26.4 injuries per 1 000 exposure and training incidence 2.08 injuries per 1 000 exposures. Hamstring, groin and quadriceps injuries were the most frequently injured locations and muscle-tendon injuries accounted for the majority of injuries. The majority of injuries (52%) occurred during match play while 48% occurred during training. The greatest absolute number of injuries were sustained by midfielders (50%), followed by defenders (33%) and attackers (17%). However, relative to player numbers, the greatest number of injuries during match play were for defenders (44%), attackers (32%) and midfielders (24%). During training attackers sustained the most injuries (39%), followed by defenders (31%) and midfielders (30%). Goalkeepers did not sustain any non-contact injuries during the duration of the study. The non-contact injury incidence in South African professional football players is similar to European football players. Hamstrings and groin injuries are predominant and were sustained throughout the competitive season. Defenders sustained the most non-contact injuries within the team relative to exposure time compared to attackers and midfielders. To our knowledge, injuries relative to player position have not been reported previously.

Risk of anterior cruciate ligament injury in population with elevated body mass index.

Aim Anterior cruciate ligament (ACL) injury is among the most common orthopaedic injuries. The elevated body mass index (BMI) can contribute to non-contact ACL injury. This study aims to assess the risk of ACL injury among elevated BMI population people (BMI ≥25 Kg\m2 ). Methods This is a cross sectional study that was conducted in a tertiary care centre in the Kingdom of Saudi Arabia. A total of 302 patients, who had an ACL reconstruction surgery in a ten-year-period (January 2008 to December 2018) were included. Results Sport related injury is significantly higher among the overweight and obese groups (p=0.002). Moreover, the combined ACL tear was higher among the overweight and obese groups (p=0.001). In univariate regression analysis for the selected baseline characteristics, it was found that individuals with higher BMI have chance to develop combined (ACL) injury 2 times higher when compared to those with isolated ACL injury (p=0.003). Also, the ACL type, mode of injury, types of injury and type of sports were statistically significant in univariate regression analysis. However, only the mode of injury was statistically significant after controlling the confounding factors. Other selected variables like type of sport, type of injury and ACL type were not significant. Conclusion Elevated BMI was associated with a higher risk of developing combined ACL tear as well as reinjured individuals.

Osteoporosis in Light of a New Mechanism Theory of Delayed Onset Muscle Soreness and Non-Contact Anterior Cruciate Ligament Injury.

Osteoporosis is a disorder, with a largely unknown pathomechanism, that is often marked as a “silent thief”, because it usually only becomes undisguised when fractures occur. This implies that the pathological damage occurs earlier than the sensation of pain. The current authors put forward a non-contact injury model in which the chronic overloading of an earlier autologously microinjured Piezo2 ion channel of the spinal proprioceptor terminals could lead the way to re-injury and earlier aging in a dose-limiting and threshold-driven way. As a result, the aging process could eventually lead the way to the metabolic imbalance of primary osteoporosis in a quad-phasic non-contact injury pathway. Furthermore, it is emphasised that delayed onset muscle soreness, non-contact anterior cruciate injury and osteoporosis could have the same initiating proprioceptive non-contact Piezo2 channelopathy, at different locations, however, with different environmental risk factors and a different genetic predisposition, therefore producing different outcomes longitudinally. The current injury model does not intend to challenge any running pathogenic theories or findings, but rather to highlight a principal injury mechanism.

Liposomal Bupivacaine Decreases Post-Operative Opioid Use after Anterior Cruciate Ligament Reconstruction: A Review of Level I Evidence.

Anterior Cruciate Ligament tears are common after a non-contact injury and several thousand reconstructions (ACLR) occur yearly in the United States. Multimodal pain management has evolved greatly to include nerve blocks to minimize physical therapy losses post-operatively, pericapsular and wound injections, and other adjunctive measures. However, there is a surprisingly high use of opioid use after ACLR. The purpose of present investigation is to summarize the current state of knowledge regarding opioid use after ACLR and to synthesize the literature regarding the use of liposomal bupivacaine and its potential to reduce post-operative opioid use in ACLR patients. The literature search was performed in Mendeley. Search fields were varied until redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. A full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by three authors until an agreement was reached. Eighteen articles summarized the literature around the opioid epidemic in ACL surgery and the current context of multimodal pain strategies in ACLR. Five primary articles directly studied the use of liposomal bupivacaine as compared to reasonable control options. There remains to be over prescription of opioids within orthopedic surgery. Patient and prescriber education are effective methods at decreasing opioid prescriptions. Many opioid pills prescribed for ACLR are not used for the correct purpose. Several risk factors have been identified for opioid overuse in ACLR: American Society of Anesthesiologists score, concurrent meniscal/cartilage injury, preoperative opioid use, age < 50, COPD, and substance abuse disorder. Liposomal bupivacaine is effective in decreasing post-operative opioid use and reducing post-operative pain scores as compared to traditional bupivacaine. LB may also be effective as a nerve block, though the data on this is more limited and the effects on post-operative therapy need to be weighed against the potential therapeutic benefit. LB is associated with significantly greater costs than traditional bupivacaine. The role for opioid medications in ACLR should continue to decrease over time. Liposomal bupivacaine is a powerful tool that can reduce post-operative opioid consumption in ACLR.

Workload is associated with the occurrence of non-contact injuries in professional male soccer players: A pilot study.

Injuries in professional soccer are a significant concern for teams, and they are caused amongst others by high training load. This cohort study describes the relationship between workload parameters and the occurrence of non-contact injuries, during weeks with high and low workload in professional soccer players throughout the season. Twenty-one professional soccer players aged 28.3 ± 3.9 yrs. who competed in the Iranian Persian Gulf Pro League participated in this 48-week study. The external load was monitored using global positioning system (GPS, GPSPORTS Systems Pty Ltd) and the type of injury was documented daily by the team's medical staff. Odds ratio (OR) and relative risk (RR) were calculated for non-contact injuries for high- and low-load weeks according to acute (AW), chronic (CW), acute to chronic workload ratio (ACWR), and AW variation (Δ-Acute) values. By using Poisson distribution, the interval between previous and new injuries were estimated. Overall, 12 non-contact injuries occurred during high load and 9 during low load weeks. Based on the variables ACWR and Δ-AW, there was a significantly increased risk of sustaining non-contact injuries (p < 0.05) during high-load weeks for ACWR (OR: 4.67), and Δ-AW (OR: 4.07). Finally, the expected time between injuries was significantly shorter in high load weeks for ACWR [1.25 vs. 3.33, rate ratio time (RRT)] and Δ-AW (1.33 vs. 3.45, RRT) respectively, compared to low load weeks. The risk of sustaining injuries was significantly larger during high workload weeks for ACWR, and Δ-AW compared with low workload weeks. The observed high OR in high load weeks indicate that there is a significant relationship between workload and occurrence of non-contact injuries. The predicted time to new injuries is shorter in high load weeks compared to low load weeks. Therefore, the frequency of injuries is higher during high load weeks for ACWR and Δ-AW. ACWR and Δ-AW appear to be good indicators for estimating the injury risk, and the time interval between injuries.

Lower Kinetic Chain, Meet the Thinking Brain: A Scoping Review of Cognitive Function and Lower Extremity Injury Risk

The classic model of non-contact ACL injury includes environmental, anatomical, hormonal and biomechanical risk factors which directly impact either the amount of stress placed on the ligament or the relative capacity of ligament to withstand the forces placed on it. However, cognition also clearly plays a role in successful athletic performance, yet diminished cognitive function is rarely considered a risk factor for injury. Objective To examine the existing literature to determine the extent to which cognitive function (both cognitive ability and task cognitive load) influences non-contact lower extremity injury risk in male and female athletes with a broad variety of athletic expertise. Study Design Scoping Review Methods An electronic search was conducted of CINAHL, SPORTDiscus, Google Scholar, and MEDLINE using the PRISMA method. Search terms included Boolean combinations of “cognition”, “concussion”, “ImPACT”, “cognitive deficit”, “mild traumatic brain injury (mTBI)”, and “neuropsychological function” as cognitive descriptors and the terms “injury risk” and “lower extremity injury” as injury descriptors. Inclusion criteria included papers written in English published between 2000-2021. Exclusion criteria included neurological and cognitively atypical populations, except for concussion (included). Included articles were appraised using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results Fifty-six studies utilizing across the spectrum of levels of evidence met inclusion criteria. Forty-one articles had good, fourteen had fair, and one had poor methodological quality. Studies examined baseline cognitive function in healthy athletes (n=7); performance during dual-task paradigms (n=13); and the impact of concussion on dual-task performance (n=4), LE injury risk (n=22), or post-concussion testing (n=10). Six articles examining cognitive function and all dual-task studies (including concussion studies) found altered biomechanics associated with injury or increased processing demands. Studies related to concussion and injury incidence consistently found an increased risk of LE injury following concussion. Half of the studies that examined concussion and post-concussion cognitive testing demonstrated significant effects. Discussion Consistent across participant demographics, tasks, and dependent measures, fifty-one of fifty-six assessed articles concluded that decreased cognitive ability or increased cognitive load led to risky LE mechanics or a direct increase in non-contact LE injury risk. Conclusion The robustness of results across gender, performance level, sport, cognitive ability, task cognitive load suggest that the inclusion of cognitive training in the design of optimal LE injury prevention programs warrants further study. Level of Evidence: Ia