Older Athletes Research Articles

Association of Ascending Aortic Dilatation and Long-term Endurance Exercise Among Older Masters-Level Athletes

Aortic dilatation is frequently encountered in clinical practice among aging endurance athletes, but the distribution of aortic sizes in this population is unknown. It is additionally uncertain whether this may represent aortic adaptation to long-term exercise, similar to the well-established process of ventricular remodeling. To assess the prevalence of aortic dilatation among long-term masters-level male and female athletes with about 2 decades of exercise exposure. This cross-sectional study evaluated aortic size in veteran endurance athletes. Masters-level rowers and runners aged 50 to 75 years were enrolled from competitive athletic events across the United States from February to October 2018. Analysis began January 2019. Long-term endurance exercise. The primary outcome was aortic size at the sinuses of Valsalva and the ascending aorta, measured using transthoracic echocardiography in accordance with contemporary guidelines. Aortic dimensions were compared with age, sex, and body size-adjusted predictions from published nomograms, and z scores were calculated where applicable. Among 442 athletes (mean [SD] age, 61 [6] years; 267 men [60%]; 228 rowers [52%]; 214 runners [48%]), clinically relevant aortic dilatation, defined by a diameter at sinuses of Valsalva or ascending aorta of 40 mm or larger, was found in 21% (n = 94) of all participants (83 men [31%] and 11 women [6%]). When compared with published nomograms, the distribution of measured aortic size displayed a rightward shift with a rightward tail (all P < .001). Overall, 105 individuals (24%) had at least 1 z score of 2 or more, indicating an aortic measurement greater than 2 SDs above the population mean. In multivariate models adjusting for age, sex, body size, hypertension, and statin use, both elite competitor status (rowing participation in world championships or Olympics or marathon time under 2 hours and 45 minutes) and sport type (rowing) were independently associated with aortic size. Clinically relevant aortic dilatation is common among aging endurance athletes, raising the possibility of vascular remodeling in response to long-term exercise. Longitudinal follow-up is warranted to establish corollary clinical outcomes in this population.

Ankle and knee extensor muscle effort during locomotion in young and older athletes: Implications for understanding age-related locomotor decline

Age-related reduction in muscle force generation capacity is similarly evident across different lower limb muscle groups, yet decline in locomotor performance with age has been shown to depend primarily on reduced ankle extensor muscle function. To better understand why ageing has the largest detrimental effect on ankle joint function during locomotion, we examined maximal ankle and knee extensor force development during a two-leg hopping test in older and young men, and used these forces as a reference to calculate relative operating efforts for the knee and ankle extensors as participants walked, ran and sprinted. We found that, across locomotion modes in both age groups, ankle extensors operated at a greater relative effort compared to knee extensors; however, slightly less pronounced differences between ankle and knee extensor muscle efforts were present among older men, mainly due to a reduction in the ankle extensor force generation during locomotion modes. We consider these findings as evidence that reduced ankle push-off function in older age is driven by a tendency to keep ankle extensor effort during locomotion lower than it would otherwise be, which, in turn, may be an important self-optimisation strategy to prevent locomotor-induced fatigue of ankle extensor muscles.

Differences in American Athletes Undergoing Preparticipation Examination by Sex, Participation Level, and Age.

To describe the preparticipation examination findings among American athletes by sex, participation level, and age. Hypothesis-generating retrospective cohort study. Saint-Luke's Athletic Heart Center, Kansas City, Missouri. A total of 2954 student athletes. Athletes underwent preparticipation examination, which included history and physical, electrocardiogram, and 2-D transthoracic echocardiogram. Differences noted on screening preparticipation examination by sex, participation level, and age. Female athletes reported more symptoms than male athletes (odds ratio [OR] = 1.61; 95% confidence interval [CI], 1.32-1.97; P < 0.0001) but had lower prevalence of abnormal electrocardiogram (OR 0.52; CI, 0.39-0.68; P < 0.0001). College athletes reported fewer symptoms than novice athletes (OR 0.35; CI, 0.29-0.43; P < 0.0001) with no difference in the prevalence of abnormal electrocardiography (ECG) (OR 0.96; CI, 0.73-1.26; P = 0.78). Older athletes reported fewer symptoms than younger athletes (OR 0.61; CI, 0.52-0.71; P < 0.0001) with no difference in the prevalence of abnormal ECG (OR 1.00; CI, 0.81-1.23; P = 0.89). There were 43 athletes with clinically important findings with no difference in prevalence of these findings across sex, participation level, and age. Among this American cohort of athletes, male athletes reported fewer symptoms and had higher prevalence of abnormal ECG findings compared with female athletes. College and older athletes reported fewer symptoms and had no difference in prevalence of abnormal ECG findings compared with novice and younger athletes, respectively. Despite these differences between groups, the prevalence of clinically important findings was comparable among groups.

Activity and functional readiness, not age, are the critical factors for second anterior cruciate ligament injury — the Delaware-Oslo ACL cohort study

ObjectiveTo elucidate the relationships between age, return to level I sport (RTS) within the first postoperative year, passing RTS criteria and second anterior cruciate ligament (ACL) injury.MethodsIn a prospective cohort...

Changes in performances/characteristics of French female runners over the last 12 years

ABSTRACT This study investigated the changes in performance of five official track running distances (800m, 1500m, 3000m, 5000m and 10,000m) and the characteristics of French female runners between 2005 and 2016. 22,839 official track performances were scrutinized. For each performance, the race time, the indication of personal record, age, and performance level were recorded. The main results showed that: (1) the number of French track performances has increased in recent years (except for the 10,000m) and the level of these performances has improved significantly only for the longer distances (5000 and 10,000m), (2) the longest distances were generally performed by older athletes, and (3) the highest percentage of international athletes was for the 10,000m event. These findings may be explained by: (1) the development plan put into place by the Fédération France d’Athlétisme, (2) age-dependent physiological and psychological factors and environmental conditions, and (3) the minima to access the international level.

Regulation of Skeletal Muscle Function by Amino Acids

Amino acids are components of proteins that also exist free-form in the body; their functions can be divided into (1) nutritional, (2) sensory, and (3) biological regulatory roles. The skeletal muscle, which is the largest organ in the human body, representing ~40% of the total body weight, plays important roles in exercise, energy expenditure, and glucose/amino acid usage—processes that are modulated by various amino acids and their metabolites. In this review, we address the metabolism and function of amino acids in the skeletal muscle. The expression of PGC1α, a transcriptional coactivator, is increased in the skeletal muscle during exercise. PGC1α activates branched-chain amino acid (BCAA) metabolism and is used for energy in the tricarboxylic acid (TCA) cycle. Leucine, a BCAA, and its metabolite, β-hydroxy-β-methylbutyrate (HMB), both activate mammalian target of rapamycin complex 1 (mTORC1) and increase protein synthesis, but the mechanisms of activation appear to be different. The metabolite of valine (another BCAA), β-aminoisobutyric acid (BAIBA), is increased by exercise, is secreted by the skeletal muscle, and acts on other tissues, such as white adipose tissue, to increase energy expenditure. In addition, several amino acid-related molecules reportedly activate skeletal muscle function. Oral 5-aminolevulinic acid (ALA) supplementation can protect against mild hyperglycemia and help prevent type 2 diabetes. β-alanine levels are decreased in the skeletal muscles of aged mice. β-alanine supplementation increased the physical performance and improved the executive function induced by endurance exercise in middle-aged individuals. Further studies focusing on the effects of amino acids and their metabolites on skeletal muscle function will provide data essential for the production of food supplements for older adults, athletes, and individuals with metabolic diseases.

ДИНАМІЧНА М'ЯЗОВА ВИТРИВАЛІСТЬ У ЗВ'ЯЗКУ ЗІ СТАНОМ ПСИХОФІЗІОЛОГІЧНИХ ФУНКЦІЙ КВАЛІФІКОВАНИХ СПОРТСМЕНОК

The aim of the study was to determine the relationship between dynamic muscular endurance of the hand (according to the tapping test) with the state of psychophysiological functions of qualified female handball players at different stages of sports training. Diagnostic complex "Diagnostics-1" (MV Makarenko, VS Lyzogub) was used to determine the state of psychophysiological functions of athletes, the maximum rate ofmovement of the brush. Dynamic muscular endurance of the right and left brushs, properties of the nervous system (functional mobility and strength of nervous processes), the effectiveness of sensorimotor activity and the dynamics of nervous processes, the latency period of a complex reaction of choice, the accuracy of the reaction to a moving object were studied in accordance with the purpose of the study. Dynamic muscular endurance of subdominant hand was significantly higher in older female athletes. There is a tendency to increase the dynamic muscular endurance of the dominant hand in older female athletes. The asymmetry according to the indicators of the tapping test between the right and left hand was lower in the older age group than in the younger age group. In general, the results indicate a higher level of dynamic muscular endurance of both arms in older female athletes, who are more adapted to long-term specific physical activity. That is, the improvement of special training in handball leads to the development of dynamic muscular endurance. This is confirmed by the results of the correlation analysis of the obtained data: dynamic muscular endurance of the subdominant arm was associated with the experience of sports training. The maximum rate of movement of the brush of both hands in the surveyed female athletes was associated with the strength of nervous processes and the accuracy of the reaction to a moving object. The dynamic muscular endurance of the dominant hand' brush was associated with the functional mobility of nervous processes.

Relative age effect in U-16 Asian Championship Soccer Tournament

Athletes born at the beginning of the year may present the advantage of physical characteristics, motor ability or cognitive knowledge that could increase their chances for selection against their peers. This circumstance could lead to the over-representation of older athletes in an age-defined competition which is commonly referred to as relative age effect (RAE). Although, a number of studies have demonstrated that RAE is apparent in youth soccer, such studies barely investigates the performance advantage that may likely exists across the birth month of the athletes. The current study aims to determine the presence of RAE in the under 16 Asian Football Confederation Championship (AFC), investigate the effect of RAE on the team qualification success as well as ascertain the existence of RAE in the playing position amongst the soccer players. Data of the 2018 AFC under 16 qualifications matches were obtained from the AFC. A total of 719 players from 32 countries participated in the qualification competitions. Chi-square for goodness fit is used to determine the existence of the RAE across the players’ month of birth while logistic regression is applied to analyze the differences of the quartiles’ distribution with respect to the quartile, qualification status (qualifier or non-qualifier) as well as the playing position of the players. The results demonstrate the presence of RAE in the AFC under 16 soccer tournaments [χ2(4) = 21.53; p &lt; 0.001] with the largest number of older players dominating the qualified team. Likewise, a substantial difference is observed with regards to the quartile and various playing position of the players p &lt; 0.05.

La participación de los atletas veteranos en deportes competitivos: ¿El ideal de envejecimiento activo?

In the last few years, participation in competitive sports in later life has considerably increased. The purpose of this article is to reflect if older Master athletes can be considered an ideal model of active aging. In order to this, the determinants and impacts of the competitive sports participation for older athletes are explored. Finally, this article offers a critical view that highlights the problem of considering this group as an ideal example of "well aging".

Risk accepters and problem solvers: managing risk in the masters Highland Games

Narratives of ageing are often negative, focussing on later life as a period defined by biological decline. A growing population of older adults (Masters athletes) participating in sport challenge these assumptions. Existing research demonstrates how Masters athletes transcend and challenge dominant discourses of ageing and resist enfeeblement. To do so requires a negotiation with risk, pain and injury. Examining these processes in younger athletes developed within the sociology of sport during the 1990s. This literature explored risk-taking sub-cultures across different sports and between genders. Yet an analysis of how older athletes manage risk has hitherto not taken place. In order to expand this corpus of work to Masters athletes, this article provides a case study of the Masters Highland Games. Drawing upon in-depth interviews with 19 athletes aged between 40 and 75, two ideal types that describe approaches to risk taking are proposed. Informed by the ideas of Giddens, these ideal types will demonstrate the variety of ways that resistance relates to risk, pain and injury. This case study demonstrates that some Masters athletes share traits identified in research with younger athletes, such as the acceptance of their practice being inherently risky and the act of normalising pain. However, most Masters athletes exhibit a more problem solving approach that adopts various strategies that manage the risks of ageing.

Aging and Physiological Lessons from Master Athletes.

Sedentary aging is often characterized by physical dysfunction and chronic degenerative diseases. In contrast, masters athletes demonstrate markedly greater physiological function and more favorable levels of risk factors for cardiovascular disease, osteoporosis, frailty, and cognitive dysfunction than their sedentary counterparts. In many cases, age-related deteriorations of physiological functions as well as elevations in risk factors that are typically observed in sedentary adults are substantially attenuated or even absent in masters athletes. Older masters athletes possess greater functional capacity at any given age than their sedentary peers. Impressive profiles of older athletes provide insight into what is possible in human aging and place aging back into the domain of "physiology" rather than under the jurisdiction of "clinical medicine." In addition, these exceptional aging athletes can serve as a role model for the promotion of physical activity at all ages. The study of masters athletes has provided useful insight into the positive example of successful aging. To further establish and propagate masters athletics as a role model for our aging society, future research and action are needed. © 2020 American Physiological Society. Compr Physiol 10:261-296, 2020.

"You Can Sit in the Middle or Be One of the Outliers": Older Male Athletes and the Complexities of Social Comparison.

Sporting events for older adults are proliferating in both popularity and participation numbers, mirroring the growth that is occurring globally with an aging population. Preliminary evidence indicates that older athletes have a tendency to compare themselves (in terms of their performance, participation, and aging) to inactive older adults deemed “worse-off.” Our aim was to examine the stories and experiences of older, male Masters athletes, not only in terms of their own lives and in relation to others but also in the broader context of current (neoliberal) policies that promote sport across the lifespan. We use social comparison theory to interpret our findings and highlight the strengths and limitations of social comparison as a psychological strategy. For this study, 17 male competitive athletes (age range from 70 to 90 years) who participated in either the 2013 or 2017 World Masters Games were interviewed as part of a larger project on the meaning of sport in their lives. Seven different sports were represented, and participants hailed from multiple countries. Within the interpretive paradigm, we used qualitative methods to interview each participant, analyze individual transcripts, and develop common themes across the data set to address the aforementioned aims. Our two major themes were, Sport as social comparison:“It’s the competitive nature” and Downward comparisons. A number of participants commented on the nature of sport, and competitive sport in particular, as being important to their motivation to train and prepare. Within the theme of Downward comparisons, we established two categories: Resisting loss and Assigning blame. While downward comparisons were used by our participants to separate themselves from other seniors of the same age, thereby bolstering their sense of self, participants also tied those comparisons to neoliberal notions of individual and moral responsibility for health. Participants believed that compromised health was due to individual negligence and bad decisions, with little reference to uncontrollable factors, such as non-modifiable risk factors for disease, disability, and/or socioeconomic status, which could be affecting people’s lives or decisions. Ultimately, our findings show that the useful psychological strategy of social comparison for maintaining a positive sense of self and performance may also have some negative individual and societal consequences.

Exercise Recommendations for the Athlete With Coronary Artery Disease.

We provide a framework for formulating exercise prescriptions for those with CAD in order to achieve the "optimal" dose of exercise for each individual. Multiple epidemiological studies demonstrate that exercise is inversely associated with atherosclerotic coronary artery disease (CAD), yet the risk of an acute coronary event is transiently elevated during vigorous exercise. In turn, CAD is the most common cause of exercise-related sudden cardiac death (SCD) in older athletes. When prescribing exercise recommendations for athletes with CAD, we should maintain equipoise between the benefits derived from sports participation and the risk of an adverse cardiac event. Athletes are not immune from atherosclerotic CAD, and we should perform risk assessments regardless of physical and athletic prowess. Cardiopulmonary exercise testing may be a useful tool to develop individualized exercise regimens for athletes with CAD.

Coronary Atherosclerosis in Masters Athletes: Mechanisms and Implications for Cardiovascular Disease Risk.

This manuscript reviews the data on the mechanisms and significance of atherosclerotic cardiovascular disease (ASCVD) in masters athletes. It describes recent advances in understanding the biological pathway for the development and progression of ASCVD in athletes. It also reviews salient clinical trials, guidelines on managing ASCVD in masters athletes, and future research directions. Recent data have produced controversy as to whether high levels of physical activity and endurance training can promote ASCVD. Longstanding, vigorous endurance exercise may increase the development of calcified and non-calcified coronary plaques. There are no clinical trials to inform clinicians on how to manage masters athletes with occult ASCVD. We provide a review of the data on ASCVD in older athletes, the risks and benefits of exercise in active individuals with ASCVD, and our approach to evaluating and managing these patients. Vigorous physical exertion transiently increases the risk of acute coronary syndrome (ACS) and sudden cardiac death in patients with ASCVD. New research has demonstrated increases in both calcified and non-calcified plaque in athletes, although the dominant plaque type is usually calcific. The mechanisms mediating this possible increase in atherosclerosis in active individuals is uncertain, as is the prognostic implications of the increased atherosclerosis. The predominance of calcified plaque may indicate that coronary plaques in athletes are less prone to rupture and to produce acute coronary events. Some guidelines offer recommendations on the management of non-athletic patients with elevated CAC but data on athletes is scarce. Until additional studies are available, we suggest that athletes with CAC values > 100 Agatston units be managed as if they have preclinical ASCVD. They should be informed of the symptoms of angina and ACS and the importance of prompt medical attention should such symptoms occur. Serum calcium and parathyroid hormones levels should be measured to exclude hyperparathyroidism. Patients should undergo symptom-limited maximal exercise stress testing and aggressive lipid treatment to achieve low-density lipoprotein cholesterol (LDL-C) values < 70mg/dl.

Feasibility Study of Hydration Monitoring Using Microwaves–Part 1: A Model of Microwave Property Changes With Dehydration

Dehydration is a prevalent condition that can have profound health consequences. If detected early, it can often be treated by oral fluid replacement (drinking or eating). However, existing assessment techniques lack the accuracy and/or convenience for ongoing monitoring, motivating the development of novel methods. We propose using low-power microwave measurements (2–12 GHz) at the extremities to monitor human hydration, relying on the strong relationship between dielectric properties of tissues and water content. Electromagnetic simulations of realistic models are used to explore changes in microwave signals transmitted through the forearm to changes in hydration. Tissue properties are adjusted according to expected changes in water content, and average dielectric properties are estimated from signals transmitted through the arm by ultrawideband antennas placed in contact with the tissues. A causal relationship between weight loss due to water loss and dielectric permittivity is found in human simulation models. Little relationship is found with conductivity. The theoretical groundwork for hydration assessment with microwaves is developed through a model which relates changes in total body water content with changes in microwave properties at the extremities. This model could be useful for monitoring hydration in at-risk populations such as older adults and athletes.

Social Withdrawal and Loneliness Among Older Adult Athletes: A Case for Playing Alone.

Some older adults may not receive social connection due to social withdrawal, potentially resulting in loneliness. The purpose of this study was to examine relationships between social withdrawal and loneliness, in the context of sports participation. The authors hypothesized that individuals who are more shy and avoidant would be more lonely than those who are less shy and avoidant, and that those who are unsocial would not necessarily be more lonely. The authors also hypothesized individual sport participation would further exacerbate loneliness over group sport participation. Results from participants in the Huntsman Senior Games (n = 374) indicated that as shyness, avoidance, and unsociability increased, loneliness increased as well. Furthermore, shy athletes in group sports reported higher levels of loneliness than those in individual sports. Although the authors seek to prevent individuals from being lonely in later life, there may be instances where removing oneself from a group is beneficial for mental health.

Risk Factors Associated With a Noncontact Anterior Cruciate Ligament Injury to the Contralateral Knee After Unilateral Anterior Cruciate Ligament Injury in High School and College Female Athletes: A Prospective Study

Background: The incidence of contralateral anterior cruciate ligament (CACL) injuries after recovery from a first-time anterior cruciate ligament (ACL) disruption is high in women; however, little is known about the risk factors associated with this trauma. Hypothesis: Patient characteristics, strength, anatomic alignment, and neuromuscular characteristics of the contralateral uninjured leg at the time of the first ACL trauma are associated with risk of subsequent CACL injury, and these risk factors are distinct from those for a first-time ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Sixty-one women who suffered a first-time noncontact ACL injury while participating in high school or college sports and underwent measurement of potential risk factors on their contralateral limb soon after the initial ACL injury and before reconstruction were followed until either a CACL injury or an ACL graft injury occurred, or until the last date of contact. Results: Follow-up information was available for 55 (90.0%) of the 61 athletes and 11 (20.0%) suffered a CACL injury. Younger age, decreased participation in sport before the first ACL disruption, decreased anterior stiffness of the contralateral knee, and increased hip anteversion were associated with increases in the risk of suffering a CACL injury. Conclusion: A portion of CACL injury risk factors were modifiable (time spent participating in sport and increasing anterior knee stiffness with bracing), while others were nonmodifiable (younger age and increased hip anteversion). The relationship between younger age at the time of an initial ACL injury and increased risk of subsequent CACL trauma may be explained by younger athletes having more years available to be exposed to at-risk activities compared with older athletes. A decrease of anterior stiffness of the knee is linked to decreased material properties and width of the ACL, and this may explain why some women are predisposed to bilateral ACL trauma while others only suffer the index injury. The risk factors for CACL injury are unique to women who suffer bilateral ACL trauma compared with those who suffer unilateral ACL trauma. This information is important for the identification of athletes who may benefit from risk reduction interventions.

Evaluation of Rock Climbing Related Injuries in Older Athletes

With the growing enthusiasm from people of all ages about rock climbing and bouldering, adaptions and medical conditions of the older athlete have become increasingly important. We aimed to analyze injury demographics, distribution, and severity for the older rock-climbing athlete. During a 3-y period, we performed a single-center injury surveillance in athletes ≥35 y of age presenting with rock climbing-related injuries or complaints. A standard questionnaire and examination protocol were conducted. A total of 198 patients (age 44.2±7.1 [35-77] y) (mean±SD, with range) with 275 independent injuries were recorded. Ninety percent of all injuries affected the upper extremity, 6% the lower extremity, and 4% other body regions. The Union Internationale des Associations d'Alpinisme injury scores were 2.0±0.3 (1-4), and no fatalities occurred. Acute injuries were observed in 32% and overuse injuries in 68% of all injuries. Among the overuse injuries, 47% were classified as degenerative overuse conditions. Athlete age did not significantly correlate with the development of overuse injuries and UIAA injury score, but subgroup analysis showed a weak correlation of the climber age with the development of degenerative conditions (P<0.05). The leading diagnosis of degenerative conditions was subacromial impingement syndrome of the shoulder. Compared to younger athletes, older rock climbers demonstrate a higher proportion of overuse injuries, especially degenerative conditions. Profound knowledge of climbing injuries patterns and conditions in older rock climbers is crucial to prevent injuries among all age groups and to decrease the number of degenerative injuries.

P3683Diagnosis of arrhythmogenic cardiomyopathy and overlap with cardiac adaptation to exercise: insights from a cardiac magnetic resonance study

Abstract Background The diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) is often challenging and some structural abnormalities typical of the disease may overlap with changes reflective of cardiac adaptation to exercise. Purpose The aim of the study was to assess the performance of the cardiac magnetic resonance (CMR) 2010 Task Force Criteria (TFC) in a cohort of patients with definite diagnosis of ARVC and define the overlap with a cohort of highly trained athletes of similar age and sex. Methods We compared the CMR features of 43 patients (mean age 49±17 years, 49% males, 32 (74%) genotyped) with a definite diagnosis of ARVC according to the revised TFC to 97 (mean age 45±16 years, 61% males) highly-trained athletes of similar age and sex, in whom cardiac disease was excluded after comprehensive work-up. Results The CMR was abnormal in 37 (86%) patients. The right ventricle (RV) was affected in isolation in 17 (39%) patients, with 18 (42%) patients exhibiting biventricular involvement and 2 (5%) patients showing isolated left ventricular (LV) involvement. The most common RV abnormalities were regional wall motion abnormalities (RWMA) (n=34; 79%), RV dilatation fulfilling a major or minor volume TFC (n=18; 42%), impaired systolic function (RV ejection fraction (EF) ≤45%: n=17; 40%) and myocardial fibrosis (n=13; 30%). The predominant LV abnormality was myocardial fibrosis (n=20; 47%), with a small proportion of patients exhibiting RWMA (n=6; 14%) and impaired systolic function (LVEF &lt;50%: n=6; 14%). Twenty-three (53%) patients fulfilled a major (n=14; 32%) or a minor (n=9; 21%) CMR TFC. Sixteen (16%) athletes exceeded the cut-off values for RV volumes used as a major (n=10; 10%) or a minor (n=6; 6%) TFC with an inverse relationship between age and RV volumes (r=−41, p=0.001). None of the athletes fulfilled the TFC for RV ejection fraction. Applying the CMR TFC to the ARVC patient population showed a sensitivity of 33% for the major and 28% for the minor criteria. Applying the RV volume and systolic function TFC values in the entire study population showed a sensitivity of 53%, a specificity between 83% and an accuracy of 0.68. Conclusions The great majority (86%) of patients with ARVC demonstrates structural abnormalities suggestive of cardiomyopathy on CMR but only 53% fulfills any of the CMR TFC. Only a small proportion (16%) of older athletes demonstrate significant RV dilatation that overlaps with the volume criteria for ARVC, in juxtaposition to younger athletes who exhibit a greater degree of overlap. The emergence of ARVC as a biventricular disease provides an opportunity to re-evaluate the diagnostic criteria and include LV involvement in conjunction with RV involvement to improve diagnostic accuracy. Acknowledgement/Funding CRY (Cardiac Risk in the Young) charity

Os Acromiale: Reviews and Current Perspectives

Os acromiale is a developmental defect which results from the lack of an osseous union between the ossification centers of the acromion, leading to the fibrocartilaginous tissue connection. The prevalence of os acromiale is 1% to 15%, and is quite common in the African American population. Os acromiale in adults is easily diagnosed by symptoms and X‐ray, particularly on the axillary view; however, the differential diagnosis of adolescents may require MRI or SPECT–CT. Generally, nonoperative therapy for symptomatic os acromiale should be started, including physiotherapy, nonsteroidal anti‐inflammatory drugs, and injections. Surgical treatment is indicated after failed conservative treatment. In symptomatic patients with fixable acromiale, the tension band technique should be used to make the anterior aspect of the acromion elevated from the humerus head. In patients with small fragments which are unsuitable for reattachment, excision might be the best therapeutic option and lead to good outcomes. Whether using internal fixation or resection, the arthroscopic technique results in a better outcome and fewer complications, especially in older patients or athletes with overhead movement, because of the high incidence of shoulder impingement or rotator cuff tears which can be treated concurrently.