Participation In Contact Sports Research Articles

The knowledge, attitude and practices of male sports participants to sports-related dental trauma in Khobar and Dammam, Saudi Arabia - A pilot survey.

The risk of dental trauma may increase during sports participation. The purpose of this study was to evaluate the knowledge, attitude, and practices of sports participants concerning sports-related dental trauma and associated emergency/preventive practices. The study included 124 male subjects over 18 years of age participating in contact and non-contact sports in three clubs in the Eastern Province, Saudi Arabia. A questionnaire was used to assess past experience of dental trauma related to sports in addition to the use of a mouth guard and knowledge of related emergency procedures. Outcomes were compared between individuals practicing direct and non-direct contact sports. One third of the participants had experienced dental trauma while playing sports, mostly crown fracture, mobility, and avulsion. Their knowledge of first aid and emergency procedures was inadequate. A significantly higher proportion of non-direct contact sport participants sought the help of a dentist for themselves or others (P = 0.04 and 0.003, respectively). Only 33.9% used mouth guards, with higher odds of mouth guard use associated with participating in direct contact sports and believing a tooth can be lost during sports practice (odds ratio = 5.59 and 5.37, respectively). Educational programs are needed to increase the awareness in sports participants of the risk of dental trauma during sports participation, to improve their knowledge of first aid procedures, and to increase the use of mouth guards.

Neck Injury - Rugby

HISTORY: A 19-year-old rugby player sustained a neck injury while tackling. The mechanism of injury involved axial compression followed by lateral flexion of the neck. He suffered no loss of consciousness and immediately reported bilateral parasthesia of the upper limbs with no associated neck pain. His cervical spine was stabilised and the player was removed from the field in a spine board. PHYSICAL EXAMINATION: His symptoms lasted approximately 45 seconds and by the time he arrived in the medical room for secondary examination, he had no residual symptoms of parasthesia. The athlete was non tender on palpation of the cervical spinous processes, his neck movements were within normal range and no specific neurological symptoms were noted on flexion, extension or lateral rotation. He had normal sensation, reflexes and strength of his upper and lower extremities. DIFFERENTIAL DIAGNOSIS: 1. Cervical Spinal Cord Injury 2. Cervical Disc Lesion 3. Cervical Spondylosis TESTS AND RESULTS: XRAY showed no obvious structural lesions, no fractures, subluxations, or displaced vertebrae. MRI and myelogram confirmed bulging intervertabrael discs at C3/4, C4/5 and C5/6 level. Central disc herniation and an annular tear was noted at C4/5. There was no CSF anteriorly over C4-C6. Measurement of his spinal canal diameter on these levels indicated a width of 8-10mm. He had a reduced TORG ratio of 0.6. FINAL/WORKING DIAGNOSIS: Congenital Cervical Stenosis TREATMENT AND OUTCOMES: The player consulted two orthopedic spine specialists for opinion and was advised to discontinue rugby and refrain from any future participation in contact sport. Although the athlete experienced no further symptoms, athletes who have cervical spine stenosis are at increased risk for serious nerve injuries. On further enquiry, the athlete reported a 2 year history of intermittent symptoms following rugby-related neck trauma. A history of recurrent episodes of temporary paraplegia or quadriplegia is an ominous sign and justifies the decision to withdraw the athlete from future participation in contact sport.

Upper Extremity Paresthesias in a High School Football Player

HISTORY: A 16 year old male football player presents with recurrent episodes of bilateral arm paresthesias. This first occurred six weeks prior to presentation after he was tackled with his neck axially loaded in a flexed position, and was associated with mild subjective weakness. This lasted a few minutes and resolved spontaneously. This happened four more times with each episode lasting longer in duration. He denied any lower extremity symptoms. One week prior to presentation, he was blocking an opposing player and had a hyperflexion injury which precipitated paresthesias which lasted for hours. He denied any bowel/bladder incontinence or saddle anesthesia. PHYSICAL EXAMINATION: No malalignment or rotational deformity of the neck. No bony tenderness or cervical paraspinal tenderness. Full cervical range of motion in all planes without pain. Spurling test is negative bilaterally. Full motor power in the bilateral upper and lower extremities except for slight weakness in right shoulder abduction and right hand finger abduction. No Hoffman sign present. Sensation intact to light touch bilaterally DIFFERENTIAL DIAGNOSIS: Cervical cord neurapraxia Spinal stenosis Cervical radiculopathy Stinger/Burner Brachial plexopathy Parsonage Turner Syndrome TEST AND RESULTS: Cervical cord neurapraxia without cord contusion in the setting of congenital stenosis of the cervical spine FINAL WORKING DIAGNOSIS: X-rays of the cervical spine showed normal lordosis, proper alignment, preserved intervertebral disc height, and no acute osseous abnormalities. An MRI showed significant central canal stenosis at C3-4, C5-6, and C6-7 with loss of surrounding CSF fluid signal at these levels. Smallest canal diameter is 8mm at C5-6. There was no cord edema noted. TREATMENT AND OUTCOMES: Though a validated risk stratification mechanism or return to play criteria does not presently exist in the literature, the results of the MRI and the progressively increasing duration of symptoms suggest an increased risk of future spinal cord injury with continued participation in contact sports. He does score in the “Moderate risk” category based on the Cervical Spine Injury Rating Scale proposed by Watkins, et al in 1990. He was held from participation and referred to spine surgery to discuss additional treatment options and return to play prognosis.

Extra-articular procedures for the ACL-deficient knee: a state of the art review

Some patients have continued rotatory instability following intra-articular anterior cruciate ligament (ACL) reconstruction, which limits their functional abilities. Advanced surgical techniques, such as double-bundle reconstruction and anteromedial portal drilling, have not solved this problem. This has led many surgeons to revisit the use of extra-articular procedures to control rotatory laxity. Multiple anatomic studies have confirmed the presence of an anterolateral ligament (ALL) that attaches to the tibia at the site of the Segond fracture. The biomechanical importance of this ligament is still being debated. Extra-articular reconstructions decrease the forces produced by intra-articular ACL grafts. Patients likely to benefit from additional extra-articular reconstruction are: (1) those with high-grade pivot shifts; (2) patients with previous failed ACL reconstructions without an obvious cause; (3) participants in contact sports and (4) patients in subgroups that have a high risk of failure (eg, generalised laxity). A variety of extra-articular reconstructions have been developed. Those techniques that have long-term follow-up data were described before most current orthopaedic surgeons were in practice. The available evidence suggests that performing an additional extra-articular reconstruction can improve rotational stability in patients undergoing intra-articular ACL reconstructions. Newer ‘anatomic’ reconstructions of the ALL have recently been proposed but there are limited data on their effectiveness. Currently, there are no studies comparing different extra-articular procedures.

Head Impact Measurement Devices.

Context:Concussive injuries are at the forefront of sports medicine research. Recently, researchers have used a variety of head- and helmet-based impact-monitoring devices to quantify impacts sustained during contact sport participation. This review provides an up-to-date collection of head accelerometer use at the youth, high school, and collegiate levels.Evidence Acquisition:PubMed was searched for articles published between 1980 and 2015 using the terms accelerometer and concussion, impact sensor and concussion, head impact telemetry system, head impact telemetry, and linear acceleration and concussion. An additional Google search was performed to capture devices without publications.Study Design:Clinical review.Level of Evidence:Level 4.Results:Twenty-four products track and/or record head impact for clinical or research use. Ten of these head impact devices have publications supporting their utility.Conclusion:Head impact measuring devices can describe athlete exposure in terms of magnitude and/or frequency, highlighting their utility within a multimodal approach for concussion assessment and diagnosis.

Return-to-activity after anatomical reconstruction of acute high-grade acromioclavicular separation.

BackgroundTo evaluate return-to-activity (RtA) after anatomical reconstruction of acute high-grade acromioclavicular joint (ACJ) separation.MethodsA total of 42 patients with anatomical reconstruction of acute high-grade ACJ-separation (Rockwood Type V) were surveyed to determine RtA at a mean 31 months follow-up (f-u). Sports disciplines, intensity, level of competition, participation in overhead and/or contact sports, as well as activity scales (DASH-Sport-Module, Tegner Activity Scale) were evaluated. Functional outcome evaluation included Constant score and QuickDASH.ResultsAll patients (42/42) participated in sporting activities at f-u. Neither participation in overhead/contact sports, nor level of activity declined significantly (n.s.). 62 % (n = 26) of patients reported subjective sports specific ACJ integrity to be at least the same as prior to the trauma. Sporting intensity (hours/week: 7.3 h to 5.4 h, p = .004) and level of competition (p = .02) were reduced. If activity changed, in 50 % other reasons but clinical symptoms/impairment were named for modified behavior. QuickDASH (mean 6, range 0–54, SD 11) and DASH-Sport-Module (mean 6, range 0–56, SD 13) revealed only minor disabilities at f-u. Over time Constant score improved significant to an excellent score (mean 94, range 86–100, SD 4; p < .001). Functional outcome was not correlated with RtA (n.s.).ConclusionAll patients participated in sporting activities after anatomical reconstruction of high-grade (Rockwood Type V) ACJ-separation. With a high functional outcome there was no significant change in activity level (Tegner) and participation in overhead and/or contact sports observed. There was no correlation between functional outcome and RtA. Limiting, there were alterations in time spent for sporting activities and level of competition observed. But in 50 % those were not related to ACJ symptoms/impairment. Unrelated to successful re-established integrity and function of the ACJ it should be considered that patients decided not return-to-activity but are very content with the procedure.

Evaluation of a Standardized Approach to the Diagnosis of Mild Platelet Function Defects: Recommendation for a Targeted Approach to the Diagnosis of Mild Platelet Function Defects and Identification of a Subset of Children with a "Developmental" Form

Mild platelet function defects (MPFD) are a variable group of common inherited disorders characterized by mucocutaneous bleeding and excessive bleeding with trauma, surgery and procedures. The diagnosis is often based on subjective interpretations of expensive platelet function tests that require a substantial volume of blood. Furthermore, the diagnosis of MPFD can significantly limit participation in contact sports and physically demanding careers. To explore these issues, a retrospective chart review of patients from the Comprehensive Center for Bleeding Disorders of the BloodCenter of Wisconsin with a diagnosis of MPFD, and who had at least one follow-up evaluation was undertaken. The majority of patients had been evaluated by a two-step process; initially screened with CBC, PT, PTT, TT and a von Willebrand factor (VWF) panel. If these tests were normal, platelet function was assessed with light transmission aggregometry and chemiluminesence detection of ATP release in platelet rich plasma by the agonists TRAP, arachidonic acid (0.5 nM), ADP (10 uM), collagen (2.5 ug/mL) and high and low dose ristocetin.One hundred forty-eight patients diagnosed with a primary MPFD between 1982-2014 and with at least one recorded follow-up were identified. Bleeding scores were assigned by a system incorporating principles developed for the ISTH bleeding assessment tool. Patients ranged in age from 2 months to 57 years. For assessment of age on platelet function, patients were grouped as follows: Group A <2 years (N=23), Group B 2-4 years (N=33), Group C 5-8 years (N=36), Group D 9-16 years (N=30), and group E >16 years (N=26).At diagnosis, median bleeding score was 3 (range 0-12). Bleeding scores increased with age (p<.0001); the median (range) score was 2 (0-8) for A, 2 (0-5) for B, 3 (0-9) for C, 3 (0-7) for D and 4 (0-12) for E. There was no difference in gender by age group except group E with 23 females and 1 male; twenty of the 23 females reported menorrhagia. One hundred twenty eight (86%) of the patients had abnormal ATP release (122) or platelet aggregation (6) in the presence of ADP, the most common defect identified. Of those with abnormal release of ATP, 50% had another platelet function abnormality; there was no difference in bleeding scores between those with either single or multiple abnormalities. Of those who did not have abnormal aggregation or release with ADP, 8 had an abnormal response(s) with collagen alone and 1 had abnormal ATP release with arachidonic acid alone. At the most recent follow-up visit, (median 97 months, range 1-368 ) after the initial evaluation, the interim median bleeding scores were lower; for each age group the bleeding score (range) was 2 (0-8) for A, 1 (0-6) for B, 3 (0-7) for C, 2 (0-8) for D and 3.5 (0-10) for E. When compared to the oldest group (E), groups B and D showed a statistically significant difference (p <0.05).Twenty-nine of the patients had follow-up platelet function studies; of these, 13 (all were children) had a significant decrease in bleeding score and normalization of platelet function studies. There were no differences in age, gender, or family history of bleeding between those with persistent MPFD and those with normal follow-up platelet function tests. The persistent group had higher initial (p<0.03) and follow-up (p<0.02) bleeding scores. Those with normalization had a significant decrease in bleeding scores from diagnosis to follow-up (p<0.01) while the persistent MPFD group had no difference.These results suggest that a more targeted approach utilizing the analysis of ATP release by ADP, with TRAP release to confirm the presence of granules, will identify the majority of patients with mild platelet function defects. For those with suspected MPFD and normal ATP release with ADP, a full panel of agonists followed by additional step-wise evaluation as recommended by the ISTH should be undertaken. Limiting initial platelet function testing will reduce the volume of blood required and the cost. The reassessment of platelet function studies in patients with MPFD whose bleeding symptoms subside will identify a subset of these patients with normalization of platelet function. This group will no longer require treatment for procedures and restrictions of career choices or athletic pursuits. Thus, by utilizing a standard approach, patients with MPFD can be diagnosed and managed more efficiently and effectively with less cost to both the patient and healthcare system. DisclosuresFriedman:Alexion: Speakers Bureau; Novo Nordisk: Consultancy; CSL-Behring: Consultancy; Instrumentation Laboratories: Consultancy. Flood:Baxter: Consultancy; CSL Behring: Consultancy. Jobe:Bayer: Membership on an entity's Board of Directors or advisory committees; Biogen: Membership on an entity's Board of Directors or advisory committees; CSL-Behring: Membership on an entity's Board of Directors or advisory committees. Gill:Bayer: Membership on an entity's Board of Directors or advisory committees; Baxalta: Membership on an entity's Board of Directors or advisory committees; CSL-Behring: Membership on an entity's Board of Directors or advisory committees.

Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank.

Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder linked to repetitive traumatic brain injury (TBI) and characterized by deposition of hyperphosphorylated tau at the depths of sulci. We sought to determine the presence of CTE pathology in a brain bank for neurodegenerative disorders for individuals with and without a history of contact sports participation. Available medical records of 1721 men were reviewed for evidence of past history of injury or participation in contact sports. Subsequently, cerebral cortical samples were processed for tau immunohistochemistry in cases with a documented history of sports exposure as well as age- and disease-matched men and women without such exposure. For cases with available frozen tissue, genetic analysis was performed for variants in APOE, MAPT, and TMEM106B. Immunohistochemistry revealed 21 of 66 former athletes had cortical tau pathology consistent with CTE. CTE pathology was not detected in 198 individuals without exposure to contact sports, including 33 individuals with documented single-incident TBI sustained from falls, motor vehicle accidents, domestic violence, or assaults. Among those exposed to contact sports, those with CTE pathology did not differ from those without CTE pathology with respect to noted clinicopathologic features. There were no significant differences in genetic variants for those with CTE pathology, but we observed a slight increase in MAPT H1 haplotype, and there tended to be fewer homozygous carriers of the protective TMEM106B rs3173615 minor allele in those with sports exposure and CTE pathology compared to those without CTE pathology. In conclusion, this study has identified a small, yet significant, subset of individuals with neurodegenerative disorders and concomitant CTE pathology. CTE pathology was only detected in individuals with documented participation in contact sports. Exposure to contact sports was the greatest risk factor for CTE pathology. Future studies addressing clinical correlates of CTE pathology are needed.

Neuroimaging Biomarkers of a History of Concussion Observed in Asymptomatic Young Athletes.

Participation in contact sports places athletes at elevated risk for repeated head injuries and is associated with negative mental health outcomes later in life. The current study identified changes observable on neuroimaging that persisted beyond the apparent resolution of acute symptoms of concussion. Sixteen young adult ice hockey players with a remote history of concussion but no subjective complaints were compared against 13 of their teammates with no history of concussion. Participants completed a detailed phenotypic assessment and a neuroimaging battery including diffusion kurtosis imaging and resting-state functional magnetic resonance imaging. Athletes with a history of concussion performed no differently from those without on phenotypic assessment, but showed significantly elevated fractional anisotropy (FA) in the left genu and anterior corona radiata relative to those without. Post hoc analyses revealed that elevated FA was associated with increased microstructural complexity perpendicular to the primary axon (radial kurtosis). Athletes with concussion history also showed significant differences in the organization of the default mode network (DMN) characterized by stronger temporal coherence in posterior DMN, decreased temporal coherence in anterior DMN, and increased functional connectivity outside the DMN. In the absence of deficits on detailed phenotypic assessment, athletes with a history of concussion displayed changes to the microstructural architecture of the cerebral white matter and to the functional connectivity of the brain at rest. Some of these changes are consistent with those previously associated with persisting deficits and complaints, but we also report novel, complementary changes that possibly represent compensatory mechanisms.

Assessing clinicopathological correlation in chronic traumatic encephalopathy: rationale and methods for the UNITE study.

IntroductionChronic traumatic encephalopathy (CTE) is a progressive neurodegeneration associated with repetitive head impacts. Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) is a U01 project recently funded by the National Institute of Neurological Disorders and Stroke and the National Institute of Biomedical Imaging and Bioengineering. The goal of the UNITE project is to examine the neuropathology and clinical presentation of brain donors designated as “at risk” for the development of CTE based on prior athletic or military exposure. Here, we present the rationale and methodology for UNITE.MethodsOver the course of 4 years, we will analyze the brains and spinal cords of 300 deceased subjects who had a history of repetitive head impacts sustained during participation in contact sports at the professional or collegiate level or during military service. Clinical data are collected through medical record review and retrospective structured and unstructured family interviews conducted by a behavioral neurologist or neuropsychologist. Blinded to the clinical data, a neuropathologist conducts a comprehensive assessment for neurodegenerative disease, including CTE, using published criteria. At a clinicopathological conference, a panel of physicians and neuropsychologists, blinded to the neuropathological data, reaches a clinical consensus diagnosis using published criteria, including proposed clinical research criteria for CTE.ResultsWe will investigate the validity of these clinical criteria and sources of error by using recently validated neuropathological criteria as a gold standard for CTE diagnosis. We also will use statistical modeling to identify diagnostic features that best predict CTE pathology.ConclusionsThe UNITE study is a novel and methodologically rigorous means of assessing clinicopathological correlation in CTE. Our findings will be critical for developing future iterations of CTE clinical diagnostic criteria.

A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters

Growing evidence suggests that temporally proximal acute concussions and repetitive subconcussive head injuries may lead to long-term neurological deficits. However, the underlying mechanisms of injury and their relative time-scales are not well documented in human injury models. The current study therefore investigated whether biomarkers of brain chemistry (magnetic resonance [MR] spectroscopy: N-acetylaspartate [NAA], combined glutamate and glutamine [Glx], total creatine [Cre], choline compounds [Cho], and myo-inositol [mI]) and structure (cortical thickness, white matter [WM]/subcortical volume) differed between mixed martial artists (MMA; n = 13) and matched healthy controls (HC) without a history of contact sport participation (HC; n = 14). A subset of participants (MMA = 9; HC = 10) returned for follow-up visits, with MMA (n = 3) with clinician-documented acute concussions also scanned serially. As expected, MMA self-reported a higher incidence of previous concussions and significantly more cognitive symptoms during prior concussion recovery. Fighters also exhibited reduced memory and processing speed relative to controls on neuropsychological testing coupled with cortical thinning in the left posterior cingulate gyrus and right occipital cortex at baseline assessment. Over a 1-year follow-up period, MMA experienced a significant decrease in both WM volume and NAA concentration, as well as relative thinning in the left middle and superior frontal gyri. These longitudinal changes did not correlate with self-reported metrics of injury (i.e., fight diary). In contrast, HC did not exhibit significant longitudinal changes over a 4-month follow-up period (p > 0.05). Collectively, current results provide preliminary evidence of progressive changes in brain chemistry and structure over a relatively short time period in individuals with high exposure to repetitive head hits. These findings require replication in independent samples.

Posterior Shoulder Instability in Athletes.

Posterior instability represents up to 10% of all cases of shoulder instability1. In athletes, posterior instability can result from a single traumatic injury, repetitive microtrauma, or, rarely, atraumatic instability. The demands on the athlete’s shoulder, especially in contact or overhead throwing sports, can be dramatic, and, as a result, the managing orthopaedic surgeon must understand the complexities of such an injury complex. Participation in contact sports may result in an increased risk for the development of traumatic posterior instability. In overhead athletes, posterior instability can result from repetitive microtrauma sustained from an early age, which can be further exacerbated with the increase in year-round play. ### Static Stabilizers The static stabilizers of the glenohumeral joint include the glenoid and the humeral head, the capsulolabral complex, the articular surface, and the glenohumeral ligaments. Anatomic alterations of the retroversion of the osseous and chondrolabral portions of the glenoid have been shown to be associated with posterior shoulder instability2. Cadaveric studies of …

Utility of the Instability Severity Index Score in Predicting Failure After Arthroscopic Anterior Stabilization of the Shoulder

Background: The redislocation rate after arthroscopic stabilization for anterior glenohumeral instability is up to 30%. The Instability Severity Index Score (ISIS) was developed to preoperatively rationalize the risk of failure, but it has not yet been validated by an independent group. Purpose: To assess the utility of the ISIS in predicting failure of arthroscopic anterior shoulder stabilization and to identify other preoperative factors for failure. Study Design: Case-control study; Level of evidence, 3. Methods: A case-control study was performed on 141 consecutive patients, comparing those who suffered failure of arthroscopic stabilization with those who had successful arthroscopic stabilization. The mean follow-up time was 47 months (range, 24-132 months). The ISIS was applied retrospectively, and an analysis was performed to establish independent risk factors for failure. A receiver operator coefficient curve was constructed to set a threshold ISIS for considering alternative surgery. Results: Of 141 patients, 19 (13.5%) suffered recurrent instability. The mean ISIS of the failed stabilization group was higher than that of the successful stabilization group (5.1 vs 1.7; P < .001). Independent risk factors for failure were Hill-Sachs lesion (P < .001), glenoid bone loss (P < .001), age <21 years at the time of surgery (P < .001), age at first dislocation (P = .01), competitive-level participation in sports (P < .001), and participation in contact or overhead sports (P = .03). The presence of glenoid bone loss carried the highest risk of failure (70%). There was a 70% risk of failure if the ISIS was ≥4, as opposed to a 4% risk of failure if the ISIS was <4. Conclusion: This is the first completely independent study to confirm that the ISIS is a useful preoperative tool. It is recommended that surgeons consider alternative forms of stabilization if the ISIS is ≥4.

Sports participation and radiographic findings of adolescents treated nonoperatively for displaced clavicle fractures

BackgroundThere is a relative paucity of high-level evidence that guides the treatment of displaced midshaft clavicle fractures in adolescents. Some use overhead sports or significant shortening as relative indications for surgical treatment, while others rarely consider operative intervention for these patients. The purpose of this study is to determine the effect of overhead sports participation and fracture shortening on subjective and objective outcomes after nonoperative treatment of displaced midshaft clavicle fractures in those aged 10–17 years. MethodsUsing a radiographic database, adolescents with displaced clavicle fractures were identified and contacted over the phone. These subjects were invited to take part in the study in return for compensation. Radiographic measurements of dedicated clavicle films around the time of injury were performed, and a custom survey aimed at elucidating participation in overhead or contact sports was given. The Nottingham Clavicle Score (NCS) and the Constant Shoulder Score were obtained for each patient to provide both subjective and objective outcome data. Statistical Package for Social Science (SPSS) software (version 22, IBM) was used to compare radiographic and sports data to the outcome measures. ResultsGender, age at the time of fracture, time since fracture, relative and absolute radiographic shortening, and hand dominance were all not significantly correlated with subjective or objective outcomes. Five patients (23%) reported not feeling happy with the appearance of their shoulder at the beach or at the pool. This group had statistically lower NCS results. Eleven of 22 participated in ≥6 months per year of overhead or contact sports; they did not have worse subjective or objective outcomes. ConclusionsFracture shortening and sports participation do not have a significant impact in adolescents on outcomes after displaced midshaft clavicle fracture.

Practice Patterns in the Perioperative Treatment of Patients Undergoing Septorhinoplasty

IMPORTANCE The common practices used in the perioperative care of patients undergoing septorhinoplasty are diverse and controversial. A consensus statement on the preferred clinical pathway in the perioperative treatment of patients undergoing septorhinoplasty has yet to be approached formally. OBJECTIVES To investigate the perioperative treatment of patients undergoing septorhinoplasty and to identify common practice patterns based on the preferences of leading facial plastic surgeons. DESIGN, SETTING, AND PARTICIPANTS We distributed an online survey to members of the American Academy of Facial Plastic and Reconstructive Surgery. Specifically, fellowship directors and academic contact members were anonymously polled and stratified by the number of septorhinoplasties performed annually. MAIN OUTCOME AND MEASURE A cohesive clinical guide to perioperative treatment after rhinoplasty. RESULTS Of the 92 members surveyed, 67 (73%) successfully completed the survey. The distribution of respondents included 43 academicians (64%) and 24 physicians in private practice (36%). Twenty-eight surgeons (42%) performed fewer than 50 rhinoplasties a year and 39 (58%), more than 50, representing 3510 to 4549 septorhinoplasties in total among respondents. Forty-four surgeons (66%) refrained from using any packing, and 41 (61%) used intranasal splints, with polymeric silicone splints the most popular of these (n = 24 [59%]). Sixty-six surgeons (99%) used external nasal splints, including 49 (74%) who used a thermoplastic splint and 49 (74%) who left the external nasal splint in place for 7 days or longer. The most common postoperative interventions to reduce edema and ecchymosis were elevation of the head of bed by 62 (93%), ice packs by 50 (75%), and Arnica montana by 33 (49%). Only 12 surgeons (18%) used postoperative corticosteroids to reduce edema. Fifty-six respondents (84%) prohibited participation in contact sports until at least 6 weeks after surgery. CONCLUSIONS AND RELEVANCE Perioperative care and practices after nasal surgery vary among the most highly trained and leading rhinoplasty surgeons. No published communication or consensus on perioperative practices has been disseminated in this setting. Given the results from those surgeons performing the most rhinoplasties in our field, some surgeons may choose to vary their practices to coincide with those of experienced surgeons. These guidelines could facilitate future studies of patient outcomes.

The influence of injury cause, contact-sport participation, and personal knowledge on expectation of outcome from mild traumatic brain injury

Objective: This study investigated the influence of injury cause, contact-sport participation, and prior knowledge of mild traumatic brain injury (mTBI) on injury beliefs and chronic symptom expectations of mTBI. Method: A total of 185 non-contact-sport players (non-CSPs) and 59 contact-sport players (CSPs) with no history of mTBI were randomly allocated to one of two conditions in which they read either a vignette depicting a sport-related mTBI (mTBIsport) or a motor-vehicle-accident-related mTBI (mTBIMVA). The vignettes were otherwise standardized to convey the same injury parameters (e.g., duration of loss of consciousness). After reading a vignette, participants reported their injury beliefs (i.e., perceptions of injury undesirability, chronicity, and consequences) and their expectations of chronic postconcussion syndrome (PCS) and posttraumatic stress disorder (PTSD) symptoms. Results: Non-CSPs held significantly more negative beliefs and expected greater PTSD symptomatology and greater PCS affective symptomatology from an mTBIMVA vignette thann mTBIsport vignette, but this difference was not found for CSPs. Unlike CSPs, non-CSPs who personally knew someone who had sustained an mTBI expected significantly less PCS symptomatology than those who did not. Despite these different results for non-CSPs and CSPs, overall, contact-sport participation did not significantly affect injury beliefs and symptom expectations from an mTBIsport. Conclusions: Expectations of persistent problems after an mTBI are influenced by factors such as injury cause even when injury parameters are held constant. Personal knowledge of mTBI, but not contact sport participation, may account for some variability in mTBI beliefs and expectations. These factors require consideration when assessing mTBI outcome.

Consideration for Lumbar Disc Degeneration and Herniation in Sports

Lower-back related injuries in an athletic population are common and may have severe implications for the athletes sporting career. The focus of this work was to review epidemiology, intervention strategies, and recommendations for return to practice and competition for athletes with lumbar disc degeneration and herniated disc. Conservative treatments for discogenic degeneration and lumbar spine herniation are generally sufficient for athletic populations to restore functional movement. Athletes that fail to respond to conservative measures may consider lumbar discectomy, with high levels of return to pre-competition levels observed following effective surgery. Surgical procedures such as spinal fusion and disc replacement require careful consideration, and should only be recommended if the athlete fails to respond to vigorous conservative treatments. Spinal disc implants have durability and mechanical loading concerns, whereas spinal fusion may ultimately prevent participation in contact sports. Specific guidelines for return to practice and competition remain poorly defined, thus future investigations should address this gap in knowledge. Return to sports should be carefully recommended after the athlete demonstrates sufficient improvements in neuro-physiological, biomechanical, and psychological domains. The correct rehabilitative exercise programme is vital to the rehabilitation of athletes following injury, and should consider frequent monitoring of pain, range of motion and muscle function.

Open Bankart Repair in Contact Athletes: Why and How

Anterior shoulder instability is a common problem in athletes. The risk factors for recurrent instability include young age, male gender, number of previous instability events, and contact or collision sport participation. Owing to the high rate of recurrent instability in the young athlete, surgical management is often indicated. Although arthroscopic Bankart repair has grown in popularity over the last several years, we still consider the open Bankart repair with capsular shift a superior form of treatment in the highest-risk patient (ie, the young male collision athlete). Arthroscopy followed by open repair allows the surgeon the opportunity to address all critical aspects at once—Bankart repair, capsular tensioning, rotator interval closure, bony defects, and any humeral avulsion glenohumeral ligament lesions. In this report, we review the indications for open Bankart repair in athletes and describe in detail our particular surgical approach and rehabilitation protocol.

Normative Data of Shoulder Activity Level by Age and Sex

Background: The shoulder activity score is a valid and reliable shoulder-specific questionnaire that measures a patient’s shoulder activity level over the previous year. No age- and sex-based normative data exist for the shoulder activity score. Hypothesis: The hypothesis was that age is inversely related to the shoulder activity score in patients with no history of shoulder symptoms or treatment for a shoulder condition. The authors also tested the hypothesis that in the same population of patients, men are more active with their shoulders than women. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Participants in 8 age/sex groups, composed of adults aged 18 years and older in the United States, were surveyed via the Internet by a marketing research firm. Participants completed the shoulder activity score and reported their age, sex, and any history of shoulder symptoms or treatment. The survey was sent to 2773 people, with 2403 people completing the entire survey. Participants with a history of shoulder symptoms or treatment were excluded from this analysis, leaving 1625 patients as healthy controls. Results: The mean shoulder activity score of healthy controls was 8 ± 5 (range, 0-20). Men scored higher on the shoulder activity score than women of the same age group (9 vs 7, respectively; P < .0001). Shoulder activity scores decreased with age in both men and women (P < .0001). Men were more likely to participate in contact (15% vs 7.4%, respectively; P < .001) and overhead-throwing sports (19% vs 10%, respectively; P < .001) than women. Participation in contact and overhead-throwing sports also decreased with age. Conclusion: In healthy controls, the shoulder activity score decreased with age and was lower in women than in men. Participation in contact and overhead-throwing sports decreased in women and older patients. These normative data are an important baseline for comparing untreated and treated shoulder cohorts to better understand the variance in shoulder activity level and how it may relate to clinical outcomes.

Knowledge And Use Of Mouthguards Among University Athletes In Malaysia

Participation in contact sports has been shown to carry a considerable risk of sustaining dental injuries. It is important for athletes to use available preventive gear to protect themselves from these injuries. Aim of the study: To assess the knowledge, habit and preferences of using mouthguards among university athletes. Materials and Method: Self-administered questionnaires, consisting of Part A - Age, gender, type of sporting activities, total hours dedicated to sports training, level of sports representation; Part B - Awareness of risk of dental injuries, knowledge on mouthguards such as definition of a mouthguard, role of mouthguard, use of mouthguards and reasons for not wearing mouthguards; and Part C – Experience of sustaining dental injuries during sports activities, were distributed. Athletes who were university students over 18 years and under 30 years of age and athletes who claimed to know about mouthguards were included in the study. Results: Data of a total of 225 respondents were analysed, consisting of 68% (n=154) male and 32% female (n=71) with the mean age of 21 years old. Only 46% (n=104) knew exactly about mouthguards and its role in the prevention of dental injuries during sports. Thirty seven percent of them (n=84) have used mouthguards and they were mostly in the martial arts group. The mouthguards were usually provided by the management team (62%). Forty percent of the respondents (n=91) claimed to have sustained dental injuries while playing sports and the injuries occurred more frequently in hockey (65.3%), basketball (60%) and soccer (45.2%). Conclusions: The incidence of dental trauma in contact sports shows that the awareness and use of mouthguards must be intensified. Awareness campaigns focusing on dental trauma should be organized to improve the knowledge of athletes.