Sports Medicine Practice Research Articles

Safer Return to Play After Anterior Cruciate Ligament Reconstruction: Evaluation of a Return-to-Play Checklist.

Background:Questions remain regarding the traditional protocols used in rehabilitation and clearance for return to sports after anterior cruciate ligament reconstruction (ACLR).Purpose/Hypothesis:To investigate the impact on injury rates after return to sports by developing and validating a Safer Return to Play Following ACL Reconstruction Checklist consisting of subjective and objective functional tests that can be quickly and easily implemented into a sports medicine practice. It was hypothesized that patients who successfully passed the checklist before returning to sports would experience lower rates of ipsilateral and contralateral knee injuries at a 2-year follow-up as compared with patients who returned to play before completing the checklist.Study Design:Cohort study; Level of evidence, 2.Methods:First, a systematic review was performed to generate a list of the most common outcome measures used to assess return to play after ACLR. To refine our checklist, we conducted a survey with an expert panel of 10 medical professionals utilizing the Delphi technique. After the creation of the checklist, validation was performed by prospectively evaluating patients who had undergone ACLR for injury of the ipsilateral or contralateral knee, with a minimum 2-year follow-up.Results:After our systematic review of 60 studies, 7 criteria were included in the final checklist. During the period studied, October 2014 to December 2017, a total of 222 patients met the inclusion criteria and were enrolled in the study. At a minimum 2 years of follow-up, there were 146 patients who successfully passed the checklist and 38 who did not. Overall, 24 (16.4%) patients who had passed the checklist sustained an injury to either knee, as compared with 10 (26.3%) from the group that did not pass the checklist (P = .162). Of the group that passed the checklist, 8 (5.5%) patients sustained an injury to the ipsilateral knee, as compared with 7 (18.4%) in the group that did not pass (P = .017).Conclusion:Prospective validation of our checklist demonstrated that patients who successfully passed the checklist before returning to play experienced a significantly lower incidence of ipsilateral anterior cruciate ligament injury as compared with patients who did not pass the checklist.

Clinical reviews in sports medicine – science transfer for sports medicine practice

Clinical reviews in sports medicine – science transfer for sports medicine practice

Comparison of Ultrasonography to MRI in the Diagnosis of Lower Extremity Bone Stress Injuries: A Prospective Cohort Study.

To determine the sensitivity and specificity of ultrasound imaging (USI) compared to the reference-standard of MRI in the diagnosis of bone stress injury (BSI). A prospective blinded cohort study was conducted. Thirty seven patients who presented to an academic sports medicine clinic from 2016 to 2020 with suspected lower-extremity BSI on clinical exam underwent both magnetic resonance imaging (MRI) and USI. Participant characteristics were collected including age, gender and sport. Exclusion criteria included contraindication for dedicated MRI, traumatic fracture, or severe tendon or ligamentous injury. The primary outcome measure was BSI diagnosis by USI. An 8-point assessment system was utilized on USI for diagnosis of BSI, and the Fredericson and Nattiv22 criteria were applied to classify MRI findings. Thirty seven participants who met study criteria were consented to participate. All participants completed baseline measures. Using MRI, there were 30 (81%) athletes with a positive and seven participants with a negative BSI diagnosis. The most common BSIs in the study were in the metatarsal (54%) and tibia (32%). Compared to MRI, USI demonstrated 0.80 sensitivity (95% confidence interval [CI], 0.61-0.92) and 0.71 specificity (95% CI, 0.29-0.96) in detecting BSI, with a positive predictive value of 0.92 (95% CI, 0.75-0.99) and negative predictive value of 0.45 (95% CI, 0.17-0.77). USI is a potentially useful point-of-care tool for practicing sports medicine providers to combine with their clinical evaluation in the diagnosis of BSIs. Further research is ongoing to determine the role of USI in follow-up care and return-to-play protocols.

Effectiveness of Nonoperative Management of Hip Microinstability

Background: Hip microinstability has recently gained acceptance as a cause of hip pain. In this condition, the femoral head demonstrates increased motion relative to the acetabulum, which may lead to chondrolabral damage. Even though patients are initially prescribed a trial of nonoperative treatment, the success rates of rehabilitation are unknown. Purpose: To determine the success rate of nonoperative treatment of hip microinstability. Study Design: Case series; Level of evidence, 4. Methods: After institutional review board approval was obtained, a retrospective chart review was performed on patients at a university sports medicine practice between January 2013 and July 2016. All patients older than 18 years presenting with hip microinstability who were initially recommended for treatment with physical therapy were enrolled in this study. Formal physical therapy sessions focused on strengthening the hip and core muscles. These sessions took place twice a week for a minimum of 6 weeks in conjunction with a home exercise program. The number of patients who eventually underwent surgical treatment and the clinical scores for the cohort (modified Harris Hip Score [mHHS] and 33-item International Hip Outcome Tool) were recorded. Results: A total of 64 patients (63 female, 1 male), with a mean ± SD age of 32.2 ± 10.5 years, were identified and studied. Onset of symptoms was insidious (n = 45; 70.3%), acute atraumatic (n = 12; 18.8%), and traumatic (n = 7; 10.9%). A total of 9 (14.1%) patients were high-level athletes. After a follow-up of 45.7 ± 14.6 months, 14 (29.8%) patients eventually underwent hip arthroscopy for persistent hip pain. Capsular plication was performed in all surgical cases. High-level athletes were not more likely to need surgery (50% vs 26.8%; P = .34). The mHHS was available in 24 patients who were treated nonoperatively, and it improved from 67.4 to 85.0 (P < .01). Conclusion: More than two-thirds of patients treated for hip microinstability were able to avoid surgery; they were successfully treated nonoperatively with physical therapy and a home exercise program and demonstrated improved clinical outcome scores.

Translation, cross-cultural adaptation, and validation of the Italian version of the anterior cruciate ligament\u2013return to sport after injury (ACL-RSI) scale and its integration into the K-STARTS test

BackgroundThe timing of a return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) represents a major subject of debate in sports medicine practice. Recently, the Knee Santy Athletic Return to Sport (K-STARTS) composite test was validated. This consists of a battery of physical tests and a psychological evaluation using the anterior cruciate ligament–return to sport after injury scale (ACL-RSI). This study aimed to translate the ACL-RSI and K-STARTS from English to Italian and determine the scale’s reliability and validity in an Italian context.MethodsThe translation and cultural adaptation process was performed according to the guidelines for the cross-cultural adaptation of self-report measures. The patients were asked to fill an anonymized online form created for this purpose that included the KOOS, the Lysholm, the IKDC-SKF, and the Italian translation of the ACL-RSI (ACL-RSI-It). After 1 week, the attendees were asked to repeat the ACL-RSI-It to investigate the test–retest reliability.ResultsThe final study population comprised 115 patients who underwent ACLR, with a mean follow-up of 37.37 ± 26.56 months. The ACL-RSI-It showed axcellent internal consistency (Cronbach’s α = 0.963), reliability (test–retest ICC = 0.966), and good construct validity (positive correlations with the other scales were above 75%).ConclusionsThe ACL-RSI-It is valid, reliable, and comparable to the original English version of the questionnaire for Italian-speaking patients. It can be used to assess the psychological readiness of patients for a RTS after primary and unilateral ACLR, and can be integrated into the Italian K-STARTS test.Level of evidenceLevel II.

Референтные интервалы биохимических показателей крови у юных спортсменов

Comprehensive medical examination (CMO) of athletes allows timely detection of different diseases and formation of risk groups. To increase the accuracy of CMO in young athletes, it is necessary to calculate reference intervals (RIs) for blood parameters considering sex, age, and sports specialization. Objective. To calculate RIs for blood parameters of young athletes under 18 years of age using the results of CMO collected for many years. Materials and methods. We analyzed 4,568 results of blood tests of athletes aged 14 to 18 years (2,385 boys and 2,183 girls) obtained within CMO of members of Russian national sports teams in 2015–2019. This study was conducted in the Federal Research and Clinical Center for Sports Medicine and Rehabilitation. Twenty-two blood parameters were evaluated. Athletes not admitted to training, with an unsatisfactory state of health, or with a history of diseases affecting the metabolic profile of the body were excluded from the analysis. At the first stage, we calculated RIs for blood parameters in athletes with the consideration of sex and age (age groups: 14–15 years and 16–17 years). At the second stage, we compared calculated RIs for blood parameters with RIs used in CMO of athletes in healthcare institutions of Federal Biomedical Agency of Russia. Conclusion. The analysis of calculated RIs for blood parameters in athletes demonstrated their significant and multidirectional differences from the reference ranges used in the practice of sports medicine. Key words: biochemical markers, metabolism, reference intervals, professional sport, comprehensive medical examination, juniors

2664-2069.2022.19DETERMINATION OF PHYSICAL PERFORMANCE IN SPORTS: POWER-ERGOMETRY METHOD (FROM THE AUTHOR'S MANY YEARS OF EXPERIENC)

Introduction. One of the factors of highly effective competitive activity of athletes is their achievement of a high level of special ability to work. The latter (ability to work) is determined by the results of testing in sports activities ("field conditions"), which involve the use of specific loads in the selected sport. There is a large arsenal of samples (tests) conducted in these conditions. One of such tests is our proposed method of power-ergometry (submaximal power-ergometry test PWC170) in determining anaerobic-aerobic performance of a forceful nature. The results of multi-year-research by author are considered in the article. Recommendations are given on the possibilities of using power-ergometry test in the practice of sports medicine, sports, "invasport", strength fitness, etc. Aim is to analyze and summarize the research data of the author of the article, which relate to the application of the method of power-ergometry in determining the physical performance of athletes. Material and methods: 1) analysis of scientific and scientific-methodical literature on the problems of physical performance research, 2) pedagogical experiment: functional research (determination of physical performance by submaximal test PWC170), 3) pedagogical observation of pupils and students, 4) statistical methods. Results: the patented method of power-ergometry on determination of PWC170 has no analogues in the countries of near and far abroad; no such studies have been conducted in Ukraine; instrumental (hardware) and non-apparatus methods of ergometric research have been considered. Conclusions: the perspectives of using the mentioned method in the practice of sports, sports medicine, as well as in the educational process of students of the faculties of health, physical education and sports of medical and pedagogical universities of Ukraine have been shown.

The Team Physician: Return to Play Considerations and Outcomes.

Successful rehabilitation of sports-related orthopedic injuries remains a challenge for both orthopedic surgeons and their patients. Team physicians are tasked with the complex problem of minimizing time away from competition, while simultaneously mitigating the risk of reinjury. Varying levels of expectation and demand between recreational and competitive athletes coupled with the already complex nature of sports-related injuries present a multifactorial challenge for the even the most experienced physicians. In the realm of sports medicine, timing of return to sport has become a controversial yet ubiquitous criterion by which treatment outcomes are measured. While accelerated rehabilitation may be desired in many cases, surgeons must also recognize the identifiable risk factors for potential reinjury. With these principles in mind, we present a summary of the available literature on data pertaining to return to sport, with coverage of injuries commonly seen within an orthopedic sports medicine practice.

Telehealth in an Orthopedic Sports Medicine Clinic: The First 100 Patients.

Background: Orthopedic specialties have begun to embrace telehealth as an alternative to in-person visits. We have not found studies assessing telehealth in sports medicine. Our goal is to evaluate patient perception of telehealth in an orthopedic sports medicine practice. Methods: Institutional review board (IRB) approval was obtained. The first 100 patients 18 years and older who had their initial videoconference telehealth appointment with our sports medicine providers from March to April 2020 were contacted at the conclusion of their visit. Surveys assessed satisfaction with telehealth, the provider, and whether attire played a role in their perception of the quality of the telehealth visit. Results: Patients on average stated excellent satisfaction with their visit (4.76 out of 5) and their provider (4.98 out of 5). Patients slightly disagreed with the notion that telehealth is equivalent to in-person provider visits (2.95 out of 5). This did not affect their perception to telehealth itself. It did not discourage patients from recommending telehealth or their provider to future patients. Patients overall felt that attire of the provider does not influence their opinion as to the standard of care they received. Returning patients versus new patient visits were more likely to recommend telehealth to others (4.83 vs. 4.56, p = 0.04). The responses from both groups were overwhelmingly positive. Conclusion: Telehealth is a viable clinic option in an orthopedic sports medicine clinic. Patients who have seen providers in-person previously are more likely to recommend telehealth versus new patients. New patients were satisfied with their telehealth experience. Level of Evidence:IV.

Impacts of the Certificates of Added Competence credentialling program: a qualitative case study of enhanced-skill family medicine practice across Canada.

Background:In 2015, the College of Family Physicians of Canada (CFPC) expanded its Certificates of Added Competence (CAC) program to include enhanced-skill certification in Care of Elderly, Family Practice Anesthesia, Palliative Care, and Sports and Exercise Medicine. We aimed to describe the impact of these 4 CACs on the provision of comprehensive care in Canada, while also identifying the factors of influence that foster these impacts.Methods:Between September 2018 and June 2019, we conducted qualitative case studies of 6 family medicine practices across Canada, sampled to represent geographic, population and practice arrangement diversity. We developed a framework of relevant factors and their relations to CAC-mediated comprehensive care delivery. We took an exploratory approach to the first 4 case studies, guided by theoretical propositions based on a literature review, and the CFPC’s 4 principles of family medicine and goals for practice. The emerging theory was confirmed and adapted through the final 2 explanatory case studies. Data were obtained through semistructured qualitative interviews with enhanced-skill and generalist physicians, specialists, trainees and administrators associated with these cases. We performed a descriptive content analysis, within and across cases.Results:Interviews with 48 participants showed considerable variation in the way CACs are operationalized related to the specific domain of care, the community, relationships among practitioners, motivations of the practitioner and needs of the patient population. The presence of CAC holders in communities expands the scope of available services, reduces the need for patients to travel and encourages continuity of care; however, comprehensive care may be negatively affected when CAC holders develop enhanced-skill practices according to clinical interests rather than community needs. Factors associated with collaborative care models, practice requirements, remuneration structure, community culture and individual aspirations interact to reinforce or undermine the effectiveness of enhanced-skill practices.Interpretation:Holders of CACs have a positive impact when they work in collaborative models that align with the needs of communities and that support local generalist family physicians. Health care policies should incentivize CAC activities that contribute to planned care delivery at the practice and community levels.

Lack of Methodological Rigor for Task-Based Functional Magnetic Resonance Imaging: Injury-Related Fear or Failure to Correct?

Lack of Methodological Rigor for Task-Based Functional Magnetic Resonance Imaging: Injury-Related Fear or Failure to Correct?

Influence of beta-rhythm neurofeedback on the functional state of the cardiovascular system of athletes

BACKGROUND: The study of the effects of urgent and long-term adaptation of the cardiovascular system of athletes under the influence of beta-rhythm neurofeedback expands its corrective and restorative potential for use in the practice of sports medicine and rehabilitation. AIMS: Study of the restorative and rehabilitation potential of the influence of beta-rhythm neurofeedback on the functional state of the cardiovascular system of athletes. MATERIAL AND METHODS: The course of neurofeedback on the beta rhythm of the brain consisted of 10 sessions, including a graphical and game version of the representation of the controlled parameter (beta rhythm) on the computer monitor screen, the success of controlling the beta rhythm with the specified conditions of voluntary muscle relaxation during the session was supported by visual and auditory biological feedback. Registration of indicators of the cardiovascular system was carried out before and after the 1st, 5th and 10th sessions of the course, the dynamics during the course and individual sessions is represented by the growth rate (%) of the indicators. RESULTS: A course of neurofeedback on the beta-rhythm of the brain of 10 sessions were young athletes (n=1020) aged 1821, representatives of cyclic, acyclic and game sports in the preparatory period of the training cycle. The effects of urgent adaptation in athletes at the 1st session of the neurofeedback course according to the beta-rhythm of the brain are reflected by positive changes in the strengthening of the vagal influence of the parasympathetic nervous system on the functional state of the cardiovascular system, expressed in a decrease in heart rate, systemic pressure, performance and pumping functions of the heart, in the transition of the type of regulation of blood circulation from the unfavorable hyperkinetic type to the physiological ― eukinetic ― type. At the same time, the load on the peripheral vascular bed increased, especially on its precapillary section. The effects of long-term adaptation at the 10th session of the neurofeedback course according to the beta-rhythm of the brain are represented by systemic rearrangements with an increased influence of the parasympathetic nervous system in the functioning of the cardiovascular system of athletes, reflected in the maximum decrease in heart rate throughout the course, in an equivalent decrease in systemic pressure, stabilization of performance and pumping function of the heart, achievement and preservation of the eukinetic type of regulation of blood circulation, achievement of a stable stable state of the central and peripheral vascular bed with a slight response to environmental factors. CONCLUSION: A course of neurofeedback on the beta-rhythm of the brain of 10 sessions helps to reduce stress in the functioning of the cardiovascular system of athletes by enhancing the vagal influences of the parasympathetic nervous system, has a positive effect on heart rate, systemic pressure, performance and pumping function of the heart; promotes the transition from an unfavorable hyperkinetic to a physiological eukinetic type of circulatory regulation; has a positive effect on adaptive changes in indicators of general and peripheral vascular resistance. The revealed effects of the course of neurofeedback on the beta-rhythm of the brain are of a pronounced corrective and restorative nature during the intense functioning of the cardiovascular system of athletes and can be used in sports rehabilitation and rehabilitation practice.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Basketball: 2014-2015 Through 2018-2019.

Frequent inspection of sports-related injury epidemiology among National Collegiate Athletic Association (NCAA) women's basketball student-athletes is valuable for identifying injury-related patterns. Emerging patterns in epidemiology of NCAA women's basketball injuries are unknown though general sports medicine practices, and playing rules and regulations have evolved in recent years. Athlete exposures (AEs) and injury incidence data were reported to the NCAA Injury Surveillance Program between 2014-2015 and 2018-2019. Injury counts, rates, and proportions were used to examine injury characteristics, and injury rate ratios (IRRs) were used to assess injury rate differences. Practice and competition injury rates were 5.93 and 10.35 per 1000 AEs, respectively. Preseason injury rates were higher than regular (IRR = 1.41; 95% CI = 1.31, 1.53) and postseason (IRR = 3.12; 95% CI = 2.39, 4.07). Ankle sprains (14.3%), concussions (7.5%), and anterior cruciate ligament tears (2.5%) were the most commonly reported injuries. Higher rates of practice and competition injuries, as well as ankle sprains, were observed relative to previous reports; continuous monitoring is necessary to identify potential contributing factors to these trends.

OSTEOCHONDRAL ALLOGRAFTING IN THE SKELETALLY IMMATURE KNEE: HIGH RATES OF INCORPORATION AND EXCELLENT EARLY OUTCOMES

Background:While an excellent option for osteochondral defects in the adult knee, outcomes following fresh osteochondral allograft (OCA) the skeletally immature are limited. Purpose: To compare radiographic and patient reported outcomes (PROs) in mature and skeletally immature adolescents following OCA of the knee.Methods:An IRB-approved review of fresh size-matched OCA treatment of knee lesions in patients aged < 19 years within a pediatric sports medicine practice from 1/2006-3/2019 was completed. Following exclusion of patients with less than 12 months follow-up, demographics, lesion characteristics, reoperations, and PROs were evaluated. A novel grading scale (k= 0.832) was utilized to evaluate radiographic OCA incorporation: A=complete, B= >50%, or C= <50% healed.Results:Forty-four patients [15.5 years (9.6-19.8) treated with OCA of the distal femur or patella (LFC= 18, MFC=17, Trochlea=6, Patella=3), 24 with open and 20 with closed physes, with 2.2 year follow up (range 1-5.3 years) were evaluated. Overall average graft size was 4.76cm2 and did not differ significantly between groups. Thirty-nine patients underwent at least one prior procedure to the ipsilateral knee, most frequently for attempted osteochondral lesion healing (77%), followed by realignment (22.7%), and meniscal pathology (15.9%). Graft failure occurred in only one skeletally immature patient with a trochlear lesion.Those with open physes were more likely to demonstrate complete graft incorporation (66.6%, p=0.001). 21(88%) patients with open physes and 17(85%) patients with closed physes had radiographic healing grades of A or B one year post-operatively. There was no difference in healing grade based on graft size, depth, or location within the knee.There was no difference in pre-operative PROs or activity scores. At final follow-up, open physes OCA patients demonstrated better KOOS scores (KOOS daily living 97.0 vs 89.5, p=0.02; KOOS pain 95.7 vs 84.6, p= 0.04; KOOS quality of life 157.2 vs 59.6, p= 0.005). Final activity scores did not vary by skeletal maturity (Pedi-IKDC 75.8 vs 77.99; Pedi-FABS 17.2 vs 13.5,) or radiographic healing grade. Daily living and pain scores were better in those with more radiographic healing (KOOS daily living 98.6 vs 86,2, p= 0.02; KOOS pain 96.7 vs 82.3, p= 0.048).Conclusion:Fresh osteochondral allograft treatment in the young knee may be expected to yield good early results. Despite relatively large graft size, when indicated for patients with open physes, equivalent or improved healing and patient reported outcomes may be expected.

COMMUNITY IMPACT FOR CLINICALLY INTEGRATED ATC PROGRAM IN A SPORTSMEDICINE PRACTICE

Background:Health Systems routinely make investments in clinically driven outreach programs to build for future community needs, improve health outcomes, and serve their community mission. Many community sports programs have limited access to sports medicine care, including access to athletic trainers. Hypothesis/Purpose:The primary purpose of this study was to evaluate the impact of a clinically integrated Certified Athletic Trainer (ATC) Community Sports Outreach Program, by evaluating the outreach into the community, sports clubs, schools, covered events.Methods:The ATC Community Outreach Program monitored key metrics over a 3 and 1/2-year period. Metrics included the partnerships developed with local clubs and schools, number of athletes covered in each organization, games covered and hours spent supporting organizations. Categories were divided into fiscal years (FY) running from September to August. Fiscal Year 2016 was calculated from January – August, as it was the first year of the program. The percentage of growth of the amount of games covered was calculated from the adjacent FY.Results:Over the first 3 and 1/2 years (FY2016-FY2019), the number clubs, schools, programs covered grew from 10, 19, 25, to 31 from FY2016 - FY2019. Number of athletes from 7,363, 12,552, 15,104, to 19,794 from FY2016 - FY2019. The number of community outreach events grew from 6, 11, 57, to 190 from FY2016 - FY2019 (Table/Figure 1.1). The percentage of growth of games covered grew from 183%, 518% to 333% between FY2016 and FY2019.Discussion/Conclusion:Building, maintaining a sports medicine practice is a complex undertaking, and represents a significant investment for the health system and community. In many communities, access to sports medicine care for athletes is very limited. A clinically integrated ATC program can generate a significant impact on the community by building relationships with local sports clubs/schools and improving sports medicine care access to young athletes.Tables/Figures:Figure 1.1.

A descriptive prospective study of sports medicine practices for athletes in Uganda.

Many international sporting organizations have recommended practices to reduce the risk of injury. These practices include screening for injury, having appropriate emergency medical care, and protocols for managing injury before return-to-play. The extent of the uptake of these practices in a developing country such as Uganda, is unknown. Using a descriptive case study approach, this investigation focused on a sample of injured athletes (n = 75) in Uganda from four main sports associations (football, athletics, basketball and rugby). The data were collected through observations and interviews after the injury. Using a best medical practice framework the phases of emergency, intermediate, rehabilitative, and return-to-sports participation were described. Nine conditions/types of injury were included. The results revealed a lack of specific pre-season screening or return-to-play readiness for all the injured athletes. Further, there was a lack of application of best practice principles for most of the injury types. For athletes who received medical care, the results show inconsistencies and inadequacies from the acute stage of the injury to return-to-sports participation. This study identified barriers such as up-to-date knowledge among the sports resource providers; the gaps for appropriate and adequate specific facilities for managing injured athletes, and policies to mandate care of injured athletes. These barriers detract from applying best medical practices.

(Invited) Adding a New Sensing Dimension to Soft Electronics: From the Skin to below the Skin

Soft electronic devices that can noninvasively and continuously acquire vital signs from the human body represent an important trend for healthcare. Combined strategies of materials design and advanced microfabrication allow the integration of a variety of components and devices on a soft platform, resulting in functional systems with minimal constraints on the human body. In this presentation, I will demonstrate a wearable multichannel patch that can sense a collection of signals from the human skin in a wireless mode. Additionally, integrating high-performance ultrasonic transducers on the stretchable substrate adds a new third dimension to the detection range of conventional soft electronics. Ultrasound waves can penetrate the skin and noninvasively capture dynamic events in deep tissues, such as blood pressure and blood flow waveforms in central arteries and veins. This soft platform holds profound implications for a wide range of applications in consumer electronics, sports medicine, defense, and clinical practices. Figure 1

ACL injury prevention: Where have we come from and where are we going?

Anterior cruciate ligament (ACL) injuries are one of the most common and severe knee injuries across sports. As such, ACL injury prevention has been a focus of research and sports medicine practice for the past three-plus decades. Examining the current research and identifying both clinical strategies and research gaps, the aim of this review is to empower clinicians and researchers with knowledge of where the ACL injury prevention literature is currentlyand where it is going in the future. This paper examines the mechanism of ACL injury prevention, screening, implementation, compliance, adherence, coronavirus, and areas of future research. Clinical significance:The time lag between research and practical implementation in general healthcare settings can be as long as 17 years; however, athletes playing sports today are unable to wait that long. With effective programs already established, implementationand adherence to these programs is essential. Strategies such as coaching education, increasing awareness of free programs, identifying barriers, and overcoming implementation obstacles through creative collaborationare just a few ways that could help improve both ACL injury prevention implementation and adherence.

Sports Medicine Physician Decision-Making, Practice Changes, and Mental Health During the Early Phase of the SARS-CoV-2 Global Pandemic.

The SARS-CoV-2 pandemic has had a profound effect on the healthcare system. This study aimed to identify its effects on sports medicine physicians during the early phase of this pandemic. Survey study. Sports medicine providers. Physician members of the American Medical Society for Sports Medicine were surveyed between March 25 and April 4, 2020. A total of 810 responses were obtained from 2437 physicians who viewed the survey. The survey consisted of questions examining demographics, prepandemic practice patterns, anxiety and depression screening, and new beliefs and behaviors following government-based medical policy changes resulting from the pandemic. Changes in clinical volume and treatment practices, Patient Health Questionnaire (PHQ-4). The mean in-person clinic visits reduced to 17.9%, telephone visits to 24.4%, telemedicine (video) visits to 21.8%, and procedural visits to 13.8% of prepandemic practice volume. The mean PHQ-4 scores for physicians were 2.38 ± 2.40. Clinic and procedural volumes were reduced less by male physicians, as well as more experienced physicians, nonphysical medicine and rehabilitation training background, in government or private practice, and in the Southern region of the United States (P < 0.05). Physicians were more likely to reduce their anti-inflammatory (37.8% decreasing vs 6.8% increasing, P < 0.001) and opioid (10.5% vs 6.8%, P = 0.003) prescriptions rather than increase. During the early phase of the SARS-COV-2 pandemic sports medicine physicians reported reducing in-person evaluation, management, and procedure volume by over 80%. Multiple demographic and geographic factors were associated with practice volume changes.

Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management.

Background:Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms.Purpose:To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT.Study Design:Case series; Level of evidence, 4.Methods:A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded.Results:The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points (P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure.Conclusion:Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.