Previous Level Of Performance Research Articles

Audiovisual integration and sensory dominance effects in older adults with subjective cognitive decline: Enhanced redundant effects and stronger fusion illusion susceptibility.

Subjective cognitive decline (SCD) refers to individuals' perceived decline in memory and/or other cognitive abilities relative to their previous level of performance. Sensory decline is one of the main manifestations of decline in older adults with SCD. The efficient integration of visual and auditory information, known as audiovisual integration, is a crucial perceptual process. This study aims to evaluate audiovisual integration in older adults with SCD. We adopted the audiovisual detection task, the Colavita task, and the Sound-Induced Flash Illusion (SIFI) task to evaluate the audiovisual integration by examining both redundant and illusory effects. Older adults diagnosed with SCD (N=50, mean age=67.8 years) and a control group of non-SCD older adults (N=51, mean age=66.5 years) were recruited. All participants took part in the three aforementioned experiments. The outcomes showed that a redundant effect occurred in both SCD and non-SCD older adults, with SCD older adults gaining more benefits in audiovisual detection task. Moreover, an equivalent amount of the visual dominance effect was observed among both SCD and non-SCD older adults in Colavita task. In addition, older adults with SCD perceived an equal fission illusion but a bigger fusion illusion compared with non-SCD older adults in SIFI task. Overall, older adults with SCD exhibit increased audiovisual redundant effects and stronger fusion illusion susceptibility compared to non-SCD older adults. Besides, visual dominance was observed in both groups via the Colavita task, with no significant difference between non-SCD and SCD older adults. These findings implied that audiovisual integration might offer a potential way for the identification of SCD.

Quadriceps Tendon Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: 3-Year Clinical and Patient-Reported Outcomes.

The rate of anterior cruciate ligament (ACL) rupture in active, skeletally immature patients is increasing. Although hamstring tendon autograft (HTA) was previously deemed the gold standard, recent studies have shown HTA to have a high failure rate in this high-risk population of young competitive athletes, and quadriceps tendon autograft (QTA) has yielded excellent preliminary outcomes in some studies examining this population. To evaluate 3-year clinical and patient-reported functional outcomes of primary ACL reconstruction (ACLR) with soft tissue QTA in skeletally immature patients. Case series; Level of evidence, 4. Skeletally immature patients who underwent ACLR with a full-thickness soft tissue QTA were included. Preoperative patient and surgical data were collected. The ACLR technique was selected predicated upon skeletal age and included all-epiphyseal and complete transphyseal techniques. Patients were followed for a minimum of 2 years with successive clinical visits or were contacted via telephone. Patients who did not have minimum 2-year follow-up after 3 contact attempts via telephone were excluded. Information regarding return to sports (RTS) and concomitant or subsequent surgical procedures was collected. Pediatric International Knee Documentation Committee (Pedi-IKDC), Hospital for Special Surgery Functional Activity Brief Scale (HSS Pedi-FABS), and Single Assessment Numeric Evaluation (SANE) scores were collected. Of 85 adolescent patients aged 11.1 to 17.6 years (mean age, 14.1 ± 1.2 years), 2 patients were determined to be lost to follow-up after 3 failed contact attempts. Of the patients included in this study (N = 83), 26 patients (31%) underwent all-epiphyseal and 57 patients (69%) underwent complete transphyseal ACLR. Additionally, 48 patients (58%) underwent concomitant lateral extra-articular tenodesis using the iliotibial band with a modified Lemaire technique. The mean follow-up time was 3.7 ± 1.2 years (range, 2-7 years). Twenty (24%) patients had subsequent surgical procedures, of which 3 (4%) were due to graft failures. At a mean 3-year follow-up, the mean Pedi-IKDC, HSS Pedi-FABS, and SANE scores were 90, 23, and 94 respectively; the RTS rate was 100%; and the rate of RTS at the previous level of performance was 93%. Use of a soft tissue QTA for ALCR in a high-risk skeletally immature population of athletes resulted in excellent postoperative outcomes with low rates of graft failure and high return to sport rates.

A systematic review on the effect of light therapy in sundowning behavior of patients with dementia

Dementia is a cognitive disorder that affects daily living of the individual. According to DSM V criteria, it is defined as the evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains which interferes in everyday activity with no other structural, metabolic or psychiatric cause. However, during the course of dementia, 90% of patients suffer from behavioral and psychological symptoms of dementia (BPSD). The sundowning or nocturnal delirium is a form of BPSD which can affect patients with dementia particularly those of advanced stage. Presently, there are no established guidelines for the management of symptoms of sundowning in patients with dementia and efficacy of pharmacologic and nonpharmacologic treatments are not yet established. One of the nonpharmacologic treatment is bright light therapy. We performed a systemic review of published literature on the effects of bright light therapy on sundowning in patients with dementia. We found only two randomized controlled trials utilizing the standard 10,000 lux lamp among dementia patients. Based on the two studies, bright light therapy had no significant beneficial effect on the sundowning behavior.

Surgical Closure of Equine Abdomen, Prevention, and Management of Incisional Complications.

Although rarely fatal, complications of ventral midline laparotomy incision in equine patients increase hospitalization cost and duration and may jeopardize return to athletic function. Therefore, many techniques have been developed to reduce their occurrence and expedite their resolution when they occur. Our technique of celiotomy incision closure includes the use of tension sutures (vertical U mattress) of polyglactin 910 on the linea alba, which is then apposed by polyglactin 910 interrupted sutures or a simple continuous pattern suture with a stop midway before routine closure of the superficial layers. The celiotomy incision is protected by an elastic bandage during the immediate postoperative period. This technique has been associated with favorable results: 5.3% confirmed incisional infections after a single celiotomy and 26.7% after repeat celiotomy. The overall incisional complication (serous/sanguineous discharge, hematoma, infection, hernia formation, and complete wound breakdown) occurrence was 9.5% and 33.3% after single and repeat laparotomy, respectively. In cases considered more susceptible to infection (early relaparotomy or laparotomy incisions longer than 30 cm), negative pressure therapy was found easy to apply on closed incisions. No detrimental effects were observed. However, the potential prophylactic benefit of this therapy needs to be confirmed in a larger group. In infected laparotomy wounds requiring drainage, the use of negative pressure therapy seemed to have a positive effect on the formation of granulation tissue. However, there was no control group to allow statistical confirmation. Finally, one case of complete breakdown of the laparotomy incision was managed by stainless steel retention sutures, the application of negative pressure therapy, and a hernia belt. At re-evaluation 15 months post-surgery, several small hernias were detected, but the horse had returned to his previous level of sports performance and had not shown any episode of colic.

Equine Musculoskeletal Pathologies: Clinical Approaches and Therapeutical Perspectives-A Review.

Musculoskeletal injuries such as equine osteoarthritis, osteoarticular defects, tendonitis/desmitis, and muscular disorders are prevalent among sport horses, with a fair prognosis for returning to exercise or previous performance levels. The field of equine medicine has witnessed rapid and fruitful development, resulting in a diverse range of therapeutic options for musculoskeletal problems. Staying abreast of these advancements can be challenging, prompting the need for a comprehensive review of commonly used and recent treatments. The aim is to compile current therapeutic options for managing these injuries, spanning from simple to complex physiotherapy techniques, conservative treatments including steroidal and non-steroidal anti-inflammatory drugs, hyaluronic acid, polysulfated glycosaminoglycans, pentosan polysulfate, and polyacrylamides, to promising regenerative therapies such as hemoderivatives and stem cell-based therapies. Each therapeutic modality is scrutinized for its benefits, limitations, and potential synergistic actions to facilitate their most effective application for the intended healing/regeneration of the injured tissue/organ and subsequent patient recovery. While stem cell-based therapies have emerged as particularly promising for equine musculoskeletal injuries, a multidisciplinary approach is underscored throughout the discussion, emphasizing the importance of considering various therapeutic modalities in tandem.

Long-term performance of show-jumping horses and relationship with severity of ataxia and complications associated with myeloencephalopathy caused by equine herpes virus-1.

Equine herpesvirus myeloencephalopathy (EHM) has severe impact on the sport horse population. Study the influence of EHM on the likelihood of affected horses to return to their previous performance and investigate the association of clinical variables with prognosis. Twenty-six horses positive for equine herpesvirus type 1 (EHV-1) were admitted to a veterinary teaching hospital (VTH) during a natural EHM outbreak at an international jumping event. Data collected from the VTH, the International Equestrian Federation, and surveys completed by the riders and horse owners were retrospectively analyzed. Horses affected by EHM had 68% chance of returning to exercise, and 52.9% were able to achieve their preoutbreak performance level. Horses with an ataxia grade at admission ≥4/5 had an increased fatality rate (P < .05) and 10% chance of reaching their preoutbreak performance level. None of the horses with both vascular and urinary complications returned to their previous performance level. Finally, horses vaccinated against EHV-1 and those with urinary complications had a 71.4% and 43.7% fatality rate, respectively. Horses affected by EHM were able to return to their previous performance levels, but certain clinical variables were negatively associated with postoutbreak performance. Ataxia grade upon admission and the development of systemic signs of vasculitis and urinary complications were potential poor prognostic indicators in sport horses. Variables linked to fatality included prior vaccination against EHV-1, ataxia grade upon admission, and the development of urinary complications.

Hip Fracture in the Sportive Adult: Case Report of Complete Functional Recovery After Removal of Hardware.

Pertrochanteric hip fractures in sportive young adults are mainly caused by a high-energy trauma and treated in the same way as in the older population, using an osteosynthesis immediately followed by a rehabilitation program for several months. The current standard is not to remove osteosynthesis material, similar to the case of older patients. A 45-year-old male cyclist experienced a right pertrochanteric femoral fracture, treated with cephalomedullary nails. After 9months of adequate rehabilitation, weakness of the quadriceps musculature and functional complaints persisted, objectified through an isokinetic strength test and a significantly reduced score on the Hip Disability and Osteoarthritis Outcome Score questionnaire. The patient was unable to return to his previous level of cycling performance. After exclusion of structural bone complications, nerve injury, and central sensitization, the functional complaints and strength deficiency were hypothesized to be related to the osteosynthesis material. Therefore, the hardware was removed 9months after the first surgery, and the rehabilitation was continued for another 20weeks. Very soon after the removal of the hardware, the functional complaints disappeared with a remarkable improvement of the Hip Disability and Osteoarthritis Outcome Score. The isokinetic strength test showed complete recovery of muscle strength 20weeks after osteosynthesis removal, and preinjury cycling performance values were obtained 9months posthardware removal. Despite an adequate rehabilitation following a hip fracture, sporty young adults may fail to reach their previous level of functioning. Osteosynthesis removal may be indicated in this sportive population to reach complete muscle strength and functional recovery. The management of hip fractures in the sportive young adult and the identification of patients who may benefit from removal of the hardware require more research.

Musical instruments, oral problems and prosthodontics: A review and a clinical report of a musician menopausal woman

The condition of teeth and the function of the oral organs are important when playing musical, especially brass or wind, instruments. This article describes the prosthodontic treatment provided for a musician who had lost a tooth and her subsequent musical performance. The relevant literature is also discussed. A 49-year-old professional clarinet player who fractured and avulsed the upper left central incisor during a fall sought maxillofacial rehabilitation for the missing tooth to maintain her ability to play the clarinet. Her treatment consisted of a provisional removable prosthesis with an acrylic base and clasps followed by a final fixed implant and conventional prostheses, designed accordingly. Her satisfaction with the prostheses was assessed by a self-reported questionnaire. The dental treatment helps to ensure that the musicians with oral, mainly prosthodontic, problems can continue playing the wind or brass instrument, especially the clarinet at their previous performance level professionally.

A Longitudinal and Multilevel Investigation of Grateful Climate in Cultivating Psychological Resilience: The Mediating Role of Athlete’s Gratitude

For athletes facing high levels of pressure and experiencing significant psychological and physical demands, mere adaptation to the pressure is insufficient. They must also possess psychological resilience, which entails the ability to rebound from stressful conditions or even surpass their previous performance levels. Previous research has indicated that receiving unilateral positive support is one of the factors contributing to psychological resilience. Therefore, the objective of this study is to examine the relationship between athlete gratitude and psychological resilience. Gratitude is considered a relational, reciprocal, and prosocial construct that aligns well with the interdependence inherent in the sports context. This research focuses on both the environmental and individual levels of gratitude, drawing on the multilevel model of gratitude framework. The study investigates how the grateful climate, representing environmental gratitude, influences athletes’ psychological resilience through individual gratitude. A longitudinal survey method was employed, involving a total of 289 high school student-athletes from 49 teams who participated in a five-wave survey conducted over a three-year period. The results indicate a significant influence of the grateful climate on changes in athletes’ psychological resilience. This influence operates through individual gratitude, which acts as a mediating factor in predicting changes in psychological resilience. The findings of this study can provide practical guidance for human resource managers and educators by highlighting the importance of fostering gratitude at both the individual and environmental levels to enhance athletes’ psychological resilience.

PLAR: a combined percutaneous and arthroscopic treatment for iliotibial band syndrome description of surgical technique and short-term results: description of surgical technique and short-term results

IntroductionDescription of a new surgical procedure (percutaneous lengthening and arthroscopic release, PLAR) that combines all the possible interventions on the iliotibial band (ITB), and evaluates its outcomes in a group of distance runners diagnosed with ITBS.MethodsA prospective observational study was made of distance runners diagnosed with ITBS and operated upon using the PLAR technique between 1 and 2018 and 31 June 2020. The surgical technique is described in detail, and the demographic data and functional outcomes measured by the sports performance scales Activity Rating Scale (ARS) and International Knee Documentation Committee (IKDC) are presented.ResultsA total of 14 patients were included, with a mean follow-up of 16 months (range 12–42 months). All the patients resumed their previous sporting activity after an average of 4 (range 2.5-6) months, and no complications were recorded. In all cases, statistically significant improvement was evidenced by the ARS and IKDC scales following PLAR (p < 0.001), with excellent outcomes in 71% of the cases according to the ARS scale and in 86% according to the IKDC scale (mean difference between preoperative and final follow-up scores of 12.1/16 and 34.2/100 points, respectively).ConclusionThe PLAR technique is effective in allowing a return to previous sports performance levels in a short period of time among patients with ITBS refractory to conservative management, with a high satisfaction rate and the absence of complications.

The Effect of asymptomatic versus mild symptomatic COVID-19 infection on male athletic performance: A cross-sectional clinical research

Objective: Novel Coronavirus Disease 2019 (COVID-19) pandemic has affected the whole world and still host many obscurities. Researches involving athletes investigated the lifestyle, athletic performance and psychological alterations compared to pre-pandemics and returning-to-sports process. But, knowledge about the past symptomatic COVID-19 effects on athletic performance is immature. Athletes are prone to asymptomatic or mild symptomatic COVID-19 rather than severe form; so this study aimed to compare the muscular athletic performance, cardiorespiratory function and psychological condition after COVID-19 between asymptomatic and mild symptomatic athletes. Materials and Methods: This case-control designed study recruited a total of 40 young adult male long-distance runners who survived COVID-19 asymptomatically (n=20), and with mild symptoms (n=20). All of the subjects had completed the isolation period and been approved to return-to-sports. The age, anthropometric properties, athletic license term and dominant hand and foot sides of the subjects were recorded. The muscular strength of upper limb, isokinetic and isometric muscular strengths of lower limb flexor and extensors, and VO2max were measured. The self-reported depression, anxiety and COVID-19-related fear were evaluated. Results: The values of all muscular strength parameters, VO2max and anxiety level were similar between the groups (p&gt;0.05). However, the levels of depression (p=0.048) and COVID-19-related fear (p=0.012) were significantly higher in mild symptomatic group in comparison with asymptomatic (p&lt;0.05). Conclusions: Mild symptomatic COVID-19 did not affect muscular athletic performance and cardiorespiratory fitness, but caused psychological disorder in comparison with asymptomatic infection. In case of COVID-19, the psychological state of the athlete should be paid close attention. We suggest the supply of adequate and quick psychological support while targeting the previous level of physical fitness and athletic performance in the returning-to-sports process.

Effectiveness of a Nonoperative Tailored Treatment and Return to Sport of a Rugby Union Player After a Cervical Spine Disc Herniation: A Case Report

BACKGROUND: This case report aims to illustrate the nonoperative rehabilitation of a rugby union player following a cervical spine disc herniation with neck pain and radicular pain. CASE PRESENTATION: A 23-year-old male rugby player presented with neck pain and radicular pain and was evaluated using clinical and neck-motor control assessments, self-report questionnaires, neck-strength, and magnetic resonance imaging. OUTCOME AND FOLLOW-UP: A well-structured rehabilitation program was followed to ensure early recovery and optimal functional outcome. The player was able to participate in full rugby training sessions without limitation. He returned to his previous level of performance, playing in the first team. DISCUSSION: This is the first case report of a rugby union player with an isolated disc herniation managed with nonoperative treatment. The treatment objectives, interventions, and assessments are provided in detail. JOSPT Cases 2023;3(4):260-266. Epub 25 September 2023. doi:10.2519/josptcases.2023.11886

Total removal of the fourth metacarpal bone in an Icelandic horse.

Fractures of the splint bones are the most common fractures in horses. Various treatment options for splint bone fractures (MC/MT II and IV), including conservative and surgical management, have been described. This report describes an acute splint bone fracture due to external trauma in a 17-year-old Icelandic mare. The fracture was diagnosed as an open multifragment fracture of the proximal third of the fourth metacarpal bone (MCIV) in the right front limb. Surgery was performed with the horse under general anaesthesia. The distal fragments were removed, and the distal part of the proximal remnant splint bone was cut with an osteotome. During the postoperative period, a routine x-ray-control two days after surgery showed a dislocated fracture of the remaining proximal part of the fourth metacarpal bone. In a second surgery, the proximal part of MCIV was entirely removed. After a reconvalescence period of 5 month, the horse reached her previous level of performance as a leisure horse. The mare is still free of lameness 6 years after the incident.

Effects of individualised rehabilitation for horses with equine herpesvirus myeloencephalopathy

SummaryIn 2019, a Swedish outbreak of equine herpes virus type 1 (EHV‐1) led to varying neurological symptoms also known as EHM (equine herpes myeloencephalopathy). Nineteen of the 39 exposed horses developed EHM. EHM outbreaks have become more common in recent decades and can result in large economic losses for the horse industry in addition to clear welfare implications. However, there is limited information about the estimated time to recovery from EHM and return to previous level of performance and there is limited published information regarding neurological rehabilitation in horses. Our objective was to describe and evaluate the potential benefit of implementing individual rehabilitation plans for horses recovering from EHM. Four horses with EHV‐1 and with clinical signs of neurological dysfunction were selected. All horses were initially hospitalised at an intensive care unit between 4 and 9 days and approximately 3 months after the outbreak they were considered sufficiently recovered to start a rehabilitation programme. The programs mainly focused on regaining proprioception, core stability and strength with consideration given to fatigue in the horse and risk to the handlers. A repeated neurological examination was performed six times over the first year and the rehabilitation programs were modified accordingly. The owners considered the horses ‘normal’, both mentally and physically, between 6 and 8 months after the outbreak. All horses were back to their previous level of performance after 8–11 months. A limitation of the study was a small study population with no control group. Our conclusions are that horses suffering from severe EHM may return to an acceptable athletic function given time and an individually adapted rehabilitation program. To potentially show that an individually adapted rehabilitation plan brings the horse back to acceptable function faster than nonspecific rehabilitation, a case‐control study would be required.

Successful transabdominal treatment of a chronic splenic abscess caused byClostridium perfringensafter penetrating external trauma in a horse

SummaryThis report describes the successful treatment of a traumatic splenic abscess by transabdominal drainage under ultrasonographic guidance. The gelding presented for investigation of recurrent pyrexia, mild abdominal pain and weight loss after a penetrating trauma to the caudolateral abdomen 5 weeks previously. At this stage, the abdominal wall had healed and a splenic abscess was diagnosed. Before treatment, mature adhesions between the abdominal wall and the spleen were confirmed by diagnostic laparoscopy in the standing horse. Transabdominal ultrasound‐guided drainage was performed, followed by intralesional placement of a balloon catheter for 2 weeks and a silicone drain for an additional week. Postoperatively, the horse was treated with intralesional and systemic antibiotics. The healing process was unremarkable and the horse was discharged 4 weeks postoperatively. At 10 months post‐surgery, after the body condition score had normalised, the horse returned to its previous level of performance.

Conservative management of equine tarsal collateral ligament injuries may allow return to normal performance.

To describe type and distribution of tarsal collateral ligament (CL) injuries and to assess the long-term outcome in horses treated conservatively. 78 horses (median age, 7 years [IQR, 4 to 9.75 years]) of different breeds and disciplines. Retrospective analysis (2000 through 2020) of horses with tarsal CL lesions diagnosed on ultrasound. The resting time, ability to return to work, and performance level after the injury were compared between horses having a single ligament (group S) or multiple ligaments (group M) affected and according to the case severity. Most of the horses (57/78) presented a single CL injury, while 21 had multiple CLs affected simultaneously, for a total of 108 CLs injured and 111 lesions. In both groups, the short lateral CL (SLCL) was the most commonly affected (44/108), followed by the long medial CL (LMCL; 27/108). Enthesopathies (72.1%) were more frequent than desmopathies alone (27.9%) and involved mostly the proximal insertion of the SLCL and the distal attachment of the LMCL. Conservative treatment (n = 62) consisted mainly of stall rest. The median resting time (120 days [IQR, 60 to 180 days]) did not significantly differ between the 2 groups (group S vs M) or according to the severity. Most horses (50/62) were able to return to work within 6 months. Horses that did not return (12/62) were more likely to have severe lesions (P = .01). Thirty-eight horses were able to perform at a level equal to or higher than before the injury. This study highlights the importance of thorough ultrasound assessment of tarsal CL injuries and demonstrates that conservative management is a viable option to allow these horses to return to previous performance level.

Poster 107: Biomechanical Effect of “AIGHL Reconstruction” for Bankart Lesion in Thrower’s Shoulder: A Novel Surgical Treatment to Maintain Maximum Shoulder External Rotation Angle after Surgery

Objectives: For anterior shoulder instability, antero-inferior labral repair (Bankart repair) is a reliable surgery to prevent shoulder dislocation. However, in biomechanical and clinical studies, maximum shoulder external rotation angle is reported to be decreased by about 10 degrees due to shortening of the anterior band of the inferior glenohumeral ligament (AIGHL) length after Bankart repair. For overhead throwing athletes, the 10 degrees reduction in shoulder external rotation makes it difficult to return to the previous performance level, although it does not affect daily activity. To prevent shortening of the AIGHL length, an AIGHL reconstruction was developed using fascia lata graft. Preliminary clinical results in overhead throwing athletes showed that a throwing program could start with complete restoration of maximum shoulder external rotation angle 3 months after AIGHL reconstruction. In this study the effect of AIGHL reconstruction on shoulder external rotation and anterior stability for simulated Bankart lesion in a cadaveric model of a thrower’s shoulder was evaluated (Fig. 1). Methods: Eight cadaveric shoulders were tested at 60° of glenohumeral abduction (90° of shoulder abduction) to simulate throwing motion. Glenohumeral translations at 60° and 90° of external rotation, maximum humeral rotational range of motion, and humeral head shift were measured using goniometer and MicroScribe 3D-digitizer. Each specimen was subjected to five experimental stages: (1) intact condition; (2) simulation of thrower’s shoulder by anterior capsular stretching based on previously reported method; (3) creation of Bankart lesion (AIGHL and the labrum were detached at glenoid side); (4) Bankart repair using three suture anchors; and (5) AIGHL reconstruction using allograft of fascia lata. In the AIGHL reconstruction, allograft was patched between the detached AIGHL and glenoid at maximum shoulder external rotation position to restore the original AIGHL length (Fig. 2). For statistical analysis, linear mixed-effects model and Tukey’s post-hoc analysis were used. Results: After 20% stretching, shoulder external rotation and anterior translation were significantly increased (intact 128.3° and 2.8mm, thrower’s shoulder 141.9° and 7.3mm, p&lt;0.001). Creation of Bankart lesion significantly increased anterior translation (8.3mm) compared with intact condition (p=0.021). Bankart repair completely restored anterior translation (3.0mm) to intact level; however, maximum shoulder external rotation angle after Bankart repair (134.8°) was significantly less than that in thrower’s shoulder (p=0.009). AIGHL reconstruction completely restored anterior translation (6.5mm) to thrower’s shoulder without decreasing maximum shoulder external rotation angle (144.4°) compared with thrower’s shoulder (Fig. 3 &amp; 4). At maximum humeral external rotation, the humeral head was significantly shifted superiorly after creation of Bankart lesion compared with intact condition(p=0.005). After Bankart repair, the humeral head was significantly shifted inferiorly from the Bankart lesion (p=0.003) and was significantly inferior relative to the position after AIGHL reconstruction (p=0.007). Conclusions: While Bankart repair completely restored anterior translation to the intact level (tighter than thrower’s shoulder), AIGHL reconstruction completely restored to the thrower’s level. Furthermore, maximum shoulder external rotation angle was maintained after AIGHL reconstruction although Bankart repair decreased external rotation significantly. Therefore, AIGHL reconstruction can be a useful surgical option for Bankart lesion in overhead throwing athletes to restore anterior stability while maintaining maximum shoulder external rotation angle after surgery.

Return to sport after conservative treatment of elbow dislocation in judoka.

Injuries to the elbow are frequent in judo combat, but studies on down-time and effect on performance after conservative treatments are rare. This issue is particularly relevant for elbow dislocations in high-performance patients such as elite athletes. The purpose of this study was to evaluate (1) time-loss and (2) the regained level of performance in judoka after conservative treatment of simple elbow dislocation. In cooperation with the European Judo Union, judoka were asked to complete a 139-item survey regarding elbow injuries they suffered during their career. Besides demographics, injury data, diagnosis and treatment options, the athletes were asked about down-time and reductions in performance level. This study enrolled 108 judoka with conservative treatment of elbow dislocation out of a population of 5426 volunteers. 69% (n=74) reported a time-loss of less than three months; 6% reported a time-loss of more than six months. The majority (68%, n=73) reported that they had returned to their previous performance level, while 22% (n=24) suffered from a slightly reduced level of performance. In the subgroup of international and national athletes (n=54), 63% returned to judo after less than three months, with 72% achieving the same level and 15% reporting a slightly reduced performance level. Level of performance and time lost after conservative treatment for elbow dislocations were comparable for male and female judoka. Approximately two out of three judoka returned to the same level of performance after three months of down-time after undergoing conservative therapy for simple elbow dislocations. Despite the high performance level of the study population, conservative treatment of simple elbow dislocation resulted in satisfactory outcomes. The presented data can guide medical professionals and competitive-level contact-sport athletes with respect to expectations in the process of returning to sport.

Return to play and performance guidelines in rugby union

Models and guidelines on factors associated with the safe return to play (RTP) of an injured athlete have been established, but very limited research has been conducted on components necessary for returning an athlete to their previous level of performance, known as return to performance (RTPerf). The study aimed to establish guidelines applicable to RTP and RTPerf in rugby union. A mixed-methods study design using an e-Delphi survey was conducted to obtain the opinions of medical team members of the Currie Cup rugby unions across South Africa on RTP (Part 1 of the study). In Part 2, medical team members and coaches of the Free State Rugby Union were consulted for RTPerf guidelines. Part 1 of the study comprised a three-step decision-based RTP model used to identify RTP components in rugby. The e-Delphi questionnaire was compiled based on literature analyses and vast experience of the authors. Part 1 involved three steps of integrated guidelines for RTP decision-making in rugby union established by agreement (&gt;80%) (first or second round): Step 1: medical history; Step 2: evaluation of participation risk; and Step 3: decision modifiers. Part 2 focused on components to consider during the RTPerf decision-making process, including psychological readiness, limb symmetry index, acute:chronic training load, external load and internal load. Twelve key performance indicators (KPIs) to measure RTPerf in rugby reached consensus (&gt;80%). The comparison of performance profiles and current KPIs of a rugby player could be used to evaluate the player's performance level and whether they truly achieved RTPerf.

Outcome following local injection of a liquid amnion allograft for treatment of equine tendonitis or desmitis – 100 cases

BackgroundTendon and ligament injuries are significant causes of loss of use and early retirement in performance horses. Amniotic fluid and tissue are excellent sources of growth factors and cytokines important in tendon and ligament healing. Thus, an equine-origin liquid amnion allograft (ELAA) may be beneficial in the treatment of equine tendonitis and desmitis. Objectives of this study were to report the outcome achieved (i.e. ability to return to work) for horses diagnosed with tendonitis or desmitis lesions treated with local injection of ELAA and to compare these outcomes to those reported for other regenerative medicine modalities.MethodsA prospective, multi-center, non-blinded clinical trial was conducted. Equine veterinarians at 14 sites were selected to participate in the data collection for the trial. Criterion for inclusion was a horse presenting with lameness which was attributed to tendonitis or desmitis by diagnostic anesthesia and/or imaging. These horses were subsequently treated by local injection of the lesion with ELAA by the attending veterinarian. Standardized questionnaires describing each horse’s signalment, discipline, ability to return to work, and any adverse events were completed and submitted by the attending veterinarian following a minimum of six months of follow-up. The current literature was reviewed to identify clinical studies reporting outcomes of equine tendonitis/desmitis lesions treated with other regenerative therapies. Contingency table analyses were performed comparing outcomes.ResultsQuestionnaires for 100 horses with 128 tendonitis and desmitis lesions met the inclusion criteria. Of these, 72 horses with 94 lesions returned to or exceeded their original level of work, 10 horses with 13 lesions returned to work but could not perform to previous standards, and 18 horses with 20 lesions did not return to work as a result of the injury. No differences were observed when outcome of horses treated with ELAA were compared to those of similar studies using other regenerative therapies.ConclusionsTreatment of tendonitis and desmitis lesions by local injection of ELAA resulted in similar outcomes for horses returning to previous level of performance as other regenerative modalities such as mesenchymal stem cells, platelet-rich plasma, and autologous conditioned serum; however, blinded placebo-controlled studies are indicated.