Sports Activities Of Patients Research Articles

Thromboembolic prevention in athletes: management of anticoagulation in sports players affected by atrial fibrillation.

Atrial fibrillation (AF) is a common cardiac arrhythmia that poses a significant risk of stroke and thromboembolic events. Anticoagulation therapy is essential for preventing stroke in patients with AF. An increasing number of people of all ages, including cardiac patients, approach physical activity as both a leisure-time exercise and a competitive sport. Therefore, patients at risk of AF are increasingly allowed to practice sports activities. Management of oral anticoagulant therapy (OAT) in these patients is extremely challenging because of the need to balance the risks and benefits of medications, considering both hemorrhagic (in case of trauma) and ischemic complications when the drugs are avoided. Official recommendations are limited for these patients and forbid sports that increase the risk of trauma and consequent bleeding in most cases. These recommendations are strongly influenced by the "traditional" management of OAT, which mainly involves coumarin derivatives. Non-vitamin K antagonist direct oral anticoagulants (DOACs), with their more favorable pharmacokinetic-pharmacodynamic profile than that of coumarin derivatives, may represent an opportunity to modify the approach to sports activity in patients with AF and indications for OAT. This study aimed to review the use of anticoagulants in athletes with AF, highlight their efficacy and safety, and provide practical considerations regarding their management.

Efficacy of the pridie drilling technique in knee osteochondritis dissecans among children and young adults: follow-up of 41 cases.

This study aims to examine whether Pridie drilling, a form of bone marrow stimulation, can expedite the healing process and enable a faster return to sports activity in patients with knee Osteochondritis dissecans (OCD). The primary objective is to assess the effectiveness of Pridie drilling in stable OCD lesions that do not respond to non-operative treatment, by evaluating the absence of painful symptoms 6months after the procedure. Secondary objectives include evaluating radiographic reconstruction 6months post-surgery and determining the time it takes to resume sports participation. This single-center retrospective study included all cases of stable OCD in the knee that underwent anterograde chondral drilling between 2008 and 2020. Diagnosis of OCD was established using knee radiographs, and the surgical technique involved multiple multidirectional subchondral drilling. Treatment efficacy was defined by the absence of painful symptoms for 6months postoperatively. A total of 41 knees were included in the study, and no complications were observed before or after surgery. At 6months postoperatively, 32 knees (78%) showed complete resolution of symptoms. Complete radiographic reconstruction was observed in 66% of cases. Asymptomatic patients at 6months returned to sports activity of similar intensity to that practiced previously in an average time of 7.9months; while, patients who were symptomatic at 6months returned in an average time of 16.5months. This study provides evidence supporting the short-term efficacy of anterograde chondral drilling in stable lesion of OCD in children and adolescents after failed functional treatment. Level III (retrospective cohort study).

Sport activity in patients with cardiomyopathies: a review.

Exercise has undisputable benefits and is an important therapy component for most cardiovascular diseases, with a proven role in reducing mortality. On the contrary, exercise may paradoxically trigger sudden cardiac arrest in patients with cardiomyopathies requiring refrain from competitive sports participation. The 2020 European guidelines for patients with cardiovascular disease provided indication for sports participation for patients with cardiac conditions, including cardiomyopathies. Although in some cases, the knowledge of the natural history of the disease and the risk of death during intensive exercise is more robust, in others, the evidence is scarce. Therefore, recommendations are not available for all possible scenarios with several uncertainties. In addition, many patients aspire to continue competitive sports or practise recreational activities after a diagnosis of cardiomyopathy. These aspects generate concern for the physician, who should make complex decisions, and confronts the request to design specific exercise programmes without specific indications. This article will review the available evidence on the sports-related risk of sudden cardiac death or cardiovascular events and the progression of the disease in cardiomyopathies.

Short-term functional outcomes of anatomic single-bundle ACL reconstruction using modified I.D.E.A.L technique

To achieve a satisfactory knee function and successful return to sports activities in patients with an ACL injury, it is essential to accurately reproduce the native ligament anatomy and biomechanics by placing the graft in the anatomical position within the ACL footprint. Our objectives are to investigate the short-term functional outcomes of an anatomic single-bundle reconstruction using the modified I.D.E.A.L technique of femoral tunnel placement, with 1-year follow-up.A retrospective observational study of 120 patients who developed ACL rupture and underwent anatomic single-bundle reconstruction in TUY MALIK private hospital/ Sulaymaniyah city/Iraq from March 2020 till March 2022. The functional outcomes of the procedure were assessed using the subjective knee evaluation scores (IKDC, Lysholm, and Tegner scores) preoperative and 1-year postoperatively. The mean preoperative IKDC score was 50.96 (40.22- 60.91), and 1-year postoperative score was 83.81 (72.41-95.40), with a (p-value 0.000), whereas the mean Lysholm score was 51.17 (40-67) and 86.19 (75-95) preoperative and postoperative, respectively, with a (p-value 0.000). The mean Tegner score was 7.59 preinjury, while 3.63 before the operation and 7.18 after the operation with (p-value 0.000), representing a statistically significant enhancement in functional outcomes between preoperative and final clinical follow-up assessment.Reconstructing ACL anatomically by placing the graft in the modified I.D.E.A.L position within the native femoral footprint can reestablish near-normal knee biomechanics, obtain unrestricted knee range of motion, and successful return to preinjury activity level.

Exercise and Sports Activities in Patients with Heart Failure

Exercise training is an essential additional non-pharmacological method to treat heart failure patients that has been shown to have significant impacts on mortality, morbidity, exercise capacity and quality of life. Various type of training are developed to resolve the needs of heart failure patients, including those who want to participate in sport activities. It is critical and challenging to prescribe personalized exercise training program perfectly, therefore, this review provides brief overview of the advantages and recommendations to prescribe individualized type of exercise training including aerobic, resistance, respiratory, aquatic and competitive sport activities for patients with heart failure. A comprehensive electronic search was conducted using PubMed, Google Scholar, and ScienceDirect. The search was limited to English-language publications from 2004 to 2021. Hand searching of relevant journals and reference lists was also performed. Exercise training should be component of a comprehensive heart failure care approach. Each patient with heart failure may have a different endurance to tolerate the same relative training. Individualized exercise training combined with a preliminary examination improves disability while also decreasing morbidity and mortality
 Keywords: heart failure, nonpharmacological management, sport exercise

Sport activity in patients with cardiac implantable electronic devices: evidence and perspectives.

Demographic characteristics of patients with cardiac implantable electronic devices have significantly changed during the last few years, according to the ageing of the population and the consequent increase in the number of elderly individuals with indication for pacemaker implant and, on the other hand, to the increased number of young individuals implanted with an implantable cardioverter defibrillator for the primary prevention of sudden death. More and more often, both elderly and young patients ask the physician to deal with the device in their daily activities, which often include sport practice. This latter is advisable because of its recognized benefits on cardiovascular prevention, although there are many limitations for patients with a cardiac implantable electronic device. Hence, the need to balance the patient's request with the appropriate precautions emerging from existing evidence. The current article aims to provide an overview of the most recent data on this topic, derived from registries and observational studies. Over the years an attempt to standardize recommendations has been made, but robust evidence is still lacking. Substantial differences exist between countries based on their sports regulations. Official recommendations of European and American Scientific Societies are resumed. The future perspective is to obtain data to allow these patients a safer practice of sport activity also through technological advances in terms of device materials and programming improvement and the possibility of remote monitoring.

Influence of total hip arthroplasty and physicians advices in the sports activity performed after the surgery

Background and objectivesThere are no randomized prospective studies that evaluate sports activity after total hip arthroplasty (THA). The objective of this study is to assess the level and type of sports activity in patients undergoing THA and to assess the recommendations given by physicians. Materials and methodsWe performed a descriptive study that analyzes 46 patients (the average age was 41 years, range 37–48) under 50 years of age who underwent THA (58 hips) in our center. The average follow-up was 7.5 (1–11) years. Age, sex, sports activity according to the UCLA scale, sports activities practiced before and after the intervention, complications and recommendations given by doctors were evaluated. ResultsThe average time to resume sport activity after the surgery was 5 (3–10) months. There were no differences in the UCLA scale before and after the operation (P > 0.05). The most practiced sport before the surgery was swimming (17%). The 31% of patients did not receive advice from their physician and the 65.2% were dissuaded from playing sports after ATC. The recommended sports were swimming (44%) and the static bicycle (17.5%), correlating with the most practiced sports after the operation. ConclusionThe patients modified their sport activity after having undergone a total hip arthroplasty. The surgery and the physician’s advice were the ones that influenced the choice of the sports activity performed after being operated on.

Influencia de la artroplastia total de cadera y el consejo médico en la actividad deportiva realizada después de la intervención

Background and objectivesThere are no randomized prospective studies that evaluate sports activity after total hip arthroplasty (THA). The objective of this study is to assess the level and type of sports activity in patients undergoing THA and to assess the recommendations given by physicians. Materials and methodsWe performed a descriptive study that analyzes 46 patients (the average age was 41 years, range 37 – 48) under 50 years of age who underwent THA (58 hips) in our center. The average follow-up was 7.5 (1 - 11) years. Age, sex, sports activity according to the UCLA scale, sports activities practiced before and after the intervention, complications and recommendations given by doctors were evaluated. ResultsThe average time to resume sport activity after the surgery was 5 (3-10) months. There were no differences in the UCLA scale before and after the operation (P> 0.05). The most practiced sport before the surgery was swimming (17%). The 31% of patients did not receive advice from their physician and the 65.2% were dissuaded from playing sports after ATC. The recommended sports were swimming (44%) and the static bicycle (17.5%), correlating with the most practiced sports after the operation. ConclusionThe patients modified their sport activity after having undergone a total hip arthroplasty. The surgery and the physician's advice were the ones that influenced the choice of the sports activity performed after being operated on.

Non-vitamin K antagonist oral anticoagulants and sport.

Physical activity is worldwide recommended for its benefits on cardiovascular system. There is an increasing number of people of all ages that approach sport activity both as leisure time physical activity and as competitive sport. It is always more frequent the request even from older subjects and cardiac patients to be allowed to practice physical activity. Some problems could arise when these subjects present or develop pathologic conditions that require specific pharmacological treatment, in particular an anticoagulation therapy. This review focalizes on the management of oral anticoagulant therapy (OAT) in patients practicing sport activity, especially due to atrial fibrillation and deep vein thrombosis, which represent two highly prevalent conditions, particularly with increasing age. Official recommendations in this field may appear limiting for patients, forbidding in the majority of cases sports at risk of trauma and consequent bleeding. These recommendations still resent the heritage of the "traditional" management of OAT, mainly represented by vitamin-K antagonists (VKAs). The non-vitamin K antagonist oral anticoagulants, with their more favorable pharmacokinetic-pharmacodynamic profile compare to VKAs, may now represent an opportunity to modify the approach to sport activity in patients with an indication to OAT. This review of the literature deals with possible strategies to overcome the present limitations for OAT subjects willing to pursue a healthy lifestyle, that include sport activity, minimizing at the same time their risk of bleeding.

Outcome of Hamstring Autograft With Preserved Insertions Compared With Free Hamstring Autograft in Anterior Cruciate Ligament Surgery at 2-Year Follow-up

To compare mechanical stability, functional outcome, and level of return to sports activity in patients undergoing anterior cruciate ligament (ACL) reconstruction with a free hamstring graft versus a graft with preserved insertions at 2-year follow-up. This study was a prospective, single-blind (the evaluator was blinded), randomized trial of 110 adult professional athletes who were randomly allocated into 2 groups. Group 1 consisted of 55 patients who underwent ACL reconstruction with hamstring tendon autograft with preserved insertions (technique 1), and group 2 consisted of 55 patients who underwent ACL reconstruction with free hamstring tendon autograft (technique 2). An anteromedial portal was used for drilling of the femoral tunnel in all cases. Patients were assessed for a minimum follow-up of 2years with clinical tests, the Activities of Daily Living Function Scale and Sports Function Scale (Cincinnati knee score), knee arthrometer (KT-1000) testing, and the Tegner activity scale. The average age of the patients was 27.0 ± 7.5years in group 1 and 27.2 ± 5.7years in group 2. At 24months, the mean side-to-side difference by KT-1000 testing was 1.4 in group 1 and 2.2 in group 2 (P < .0001); the mean Cincinnati knee score (Activities of Daily Living Function Scale and Sports Function Scale) was 418.5 (median, 420; range, 400-420) and 406.8 (median, 420; range, 350-420), respectively (P < .0001); and the mean difference between the preinjury and postsurgery Tegner level of sports activity was 0.3 and 1.08, respectively (P= .027). Although ACL reconstruction using hamstring autograft with preserved insertions resulted in statistically superior anterior stability, a better functional outcome, and a closer return to the preinjury level of sports activity as compared with free autograft, no clinically significant difference was proved. Level I, randomized controlled trial.

Recreational Sports Activities After Calcaneal Fractures and Subsequent Subtalar Joint Arthrodesis

Subtalar joint arthrodesis is a common treatment for the management of hindfoot pathologic entities. Despite pain reduction, hindfoot stiffness is a common concern of active patients, who wish to continue or start exercising for fitness. The purpose of the present retrospective observational clinical study was to assess the rate and type of recreational sports activities in patients before and after subtalar joint arthrodesis and to correlate the clinical outcome and the level of sports activities. In 33 patients (22 males, 11 females) treated with subtalar joint arthrodesis, the pre- and postoperative participation in sports and recreational activities was evaluated. The American Orthopaedic Foot and Ankle Society hindfoot scale score, 36-item Short Form Health Survey, and a visual analog scale for pain were used as clinical outcome measures. The weekly session number, session time, and interval to activity recovery after surgery were registered. Patients with a subtalar joint arthrodesis returned to a satisfactory level of activity postoperatively. The sports participation almost reached levels similar to those preoperatively but with a shift from high- to low-impact activities.

Effects of Correction Surgery on Sports Activities in Patients with Adolescent Idiopathic Scoliosis

Effects of Correction Surgery on Sports Activities in Patients with Adolescent Idiopathic Scoliosis

Effect of posterior surgery on pre- and post-operative sports activity in patients with adolescent idiopathic scoliosis

Materials and method Among the patients with AIS who underwent surgery in our institution, 15 patients were analyzed. Minimum follow up period post-surgery was 2 years. Patients were all females with an average follow-up of 38 months. The mean patient age at surgery was 14.2±1.5 mean Cobb angle of the major curve preoperatively was 54.3±7.4 and 21.8±6.9 degrees postoperatively. We evaluated the strength, speed and agility of these patients pre- and postoperatively using the government-prescribed Physical Fitness Test. Results Postoperatively, general performance in the Physical Fitness Test improved for 4 patients, remained stable for 10 patients and decreased for 1 patient. There were no significant differences seen for the individual physical fitness tests done for these patients pre-and postoperatively (p<0.05). Conclusion

Sports Activity in Patients with Total Ankle Replacement

Summary Background We performed a systematic literature review of relevant clinical studies targeting the following criteria: preoperative and postoperative sports activities in patients who underwent total ankle replacement (TAR) and TAR failure in sports-active and sports-inactive patients. Materials and Methods Literature review was performed using different databases including PubMed, MEDLINE, and GoogleScholar. Study eligibility was assessed independently and in duplicate by two independent reviewers. Coleman Methodology Score (CMS) was used to assess the quality of included studies. Results In total, 5 clinical studies have been included for the review based on the inclusion criteria. There were 2 Level III and 3 Level IV studies. The mean CMS of included studies was 33.4±10.9 points. Conclusions In the current literature, there is no evidence demonstrating that participation in sports activities may be associated with increased failure rate of TAR. It remains controversial, whether TAR results in higher participation in sport activities. Level of evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Analysis of the talocrural and subtalar joint motions in patients with medial tibial stress syndrome

BackgroundThe rearfoot motion during sports activities in patients with the medial tibial stress syndrome (MTSS) is unknown. This study aimed to investigate the difference in kinematics of the rearfoot in MTSS patients (eight male soccer players) and control participants (eight male soccer players) during a forward step.MethodsSixteen male soccer players, including eight players with MTSS, participated. Forward step trials were recorded with cineradiographic images obtained at a sampling rate of 60 Hz. Geometric bone models of the tibia and talus/calcaneus were created from computed tomography scans of the distal part of one lower limb. Following a combination of approaches, anatomical coordinate systems were embedded in each bone model. The talocrural joint motion (relative motion of the talus with respect to the tibia) and subtalar joint motion (relative motion of the calcaneus with respect to the talus) were examined.ResultsA significantly larger range of internal/external rotation and inversion/eversion motion was observed in the subtalar joint of MTSS patients compared to healthy controls (P < 0.05) from heel contact to heel off. There were no significant differences between the MTSS patients and healthy participants in the ranges of all talocrural joint angles during the forward step.ConclusionOur results indicate that the range of subtalar joint motion is greater in patients with MTSS during the stance phase of the forward step. The kinematic results obtained of this study may have important clinical implications and add quantitative data to an in vivo database of MTSS patients.

Luxación patelar traumática en una niña menor de 10 años: reporte de caso

Traumatic dislocation of the patella is a frequent event in some age groups, but is very uncommon in children and adolescents. It has an incidence of 4.3 per 100,000 inhabitants, but it has been reported to be as high as 5.8 per 100,000 inhabitants. Patellar femoral dislocation is the second cause of traumatic hemarthrosis of the knee, and has a strong association with sport activity in patients under 20 years-old. There are risk factors reported in the literature such as, genus valgus, higher femoral anteversion, ligaments hyper-laxity, etc., that may be associated or are present in 80% of the patients. The case is presented of patient under 10 years-old with a traumatic dislocation of the patella, as well as the surgical technique used to repair it, and a further review of the literature.

The Clinical Outcomes and Assessment of Quality of Life in Arthroscopic Repair of Isolated Type II Superior Labral Anterior and Posterior Lesion Caused by Sports Injuries from Public

The purpose of this study was to morphologically classify the superior labral anterior and posterior (SLAP) lesion in people with athletic injuries and further research into the clinical result of arthroscopic repair of type II SLAP lesions. January 2005 to June 2012 occurred after sports activity in patients with shoulder pain diagnosed with isolated SLAP lesion by magnetic resonance imaging and arthroscopy were classified according to the tear type. Of these patients, 40 cases of type II SLAP patients were evaluated using American Shoulder and Elbow Surgeons (ASES) questionnaire and range of motion. Also satisfaction of surgery was evaluated by following up through phone calls using translated short form-36 (SF-36). At average of 35 months postoperatively, external rotation decreased slightly from 60.4 degrees to 56.2 degrees, forward elevation and internal rotation were both recovered to a range of pre-surgery but no significant changes were noticed statistically (p>0.05). Visual analogue scale, ASES scores, physical component summary, and mental component summary of SF-36 improved from 5, 1 to 1.2 (p=0.01), from 65.4 to 91.5 (p=0.017), 42.6 to 52.5 (p=0.047), and from 48.5 52.6 to (p=0.036), respectively. In comparison of a group of patients over forty years and less than forty, both groups showed good results, but group of patients less than forty years showed more improvement in pain relief, functional test, and postoperational satisfaction (p=0.004). Arthroscopic repair showed good results in patients with type II SLAP lesion due to athletic injuries especially when they were less than 40 years and it can be regarded as a good treatment with high satisfaction.

Uso del plasma rico en plaquetas en cirugía ligamentosa de rodilla

Platelet Rich Plasma (PRP) is used in musculoskeletal lesion surgery, including muscle, bone, tendons and ligaments. PRP might accelerate the healing process and the integration of the graft, allowing an earlier return to sports activities of patients. PRP is obtained from autologous blood, which is centrifuged, obtaining platelet and supposedly growth factor concentrations three to five times higher than those of regular blood. The clinical results of studies performed in Chile and elsewhere on PRP use in knee anterior cruciate ligament (ACL) reconstruction have been variable. Therefore, there is not enough evidence to support or deny the usefulness of PRP in ACL reconstructions.

Assessment of sports activity in patients diagnosed with familial cardiopathies

Background: Sports activity was associated with an increased risk of sudden cardiac death (SCD) in adolescents and young adults with undiagnosed cardiomyopathies or channelopathies. It is estimated that one in 1000 athletes may be affected. The present study sought to determine the percentage of patients diagnosed with familial cardiopathies that do physical exercise regularly, their clinical characteristics, and follow-up through a specialized consultation. Methods: A prospective observational study was designed. 1128 consecutive patients (age 49±19, 418 (37%) women) from 765 families that satisfied diagnostic criteria for cardiomyopathy or channelopathy were included. Age of diagnosis, clinical characteristics, and electrocardiographic and echocardiographic parameters were collected. Rate of events was determined in both groups: SCD; resuscitated sudden cardiac death (RSCD); and implantable cardioverter defibrillator (ICD) discharge. Results: 85 athletes (7,5%) were identified. The mean age at diagnosis was significantly lower in the group of patients that practiced sports (31,5±15 years vs 45,6±20 years; p<0,001). Among patients diagnosed with hypertrophic cardiomyopathy, athletes group presented a lower thickness of ventricular septum (median 15mm, range 14 to 20mm vs 19mm, range 16 to 22mm; p=0,001). Left ventricular ejection fraction (LVEF) in patients diagnosed with idiopathic dilated cardiomyopathy was higher in the group of athletes (mean 51,1±5,6% vs 35,4±13,6%; p<0,001). Four patients that practiced sports routinely had events: 3 SCD and one RSCD; while in the group of non-athlete patients, 64 of them presented events: 23 SCD, 26 RSCD, and 15 ICD discharges. There were no significant differences in the development of events between the two groups. Conclusions: A significant proportion of patients with familial cardiopathies practice sport regularly. Diagnosis of heart disease was earlier in the group of athletes. In this group, the thickness of ventricular septum among patients with hypertrophic cardiomyopathy was lower and patients with idiopathic dilated cardiomyopathy had higher LVEF than in the group of non-athletes. There were no differences between both groups in the development of events. Further studies are required to understand the relationship between sport and the development of adverse events in patients diagnosed with familial cardiopathies.

Implantable Cardioverter-Defibrillator Therapy in Athletes

Although sports participation improves quality of life and lowers cardiovascular risk, sport may represent a hazard for certain high-risk groups, such as young athletes with cardiovascular conditions necessitating an implantable cardioverter-defibrillator (ICD). There are few data weighing the risks and benefits of sports participation for patients with ICDs. Sports participants with ICDs incur the potential risk of failure of therapy, inappropriate interventions, and device injury. Severe exercise may worsen the course of the cardiovascular disease of the athlete, predisposing to more adverse clinical events. This article reviews the potential risks and recommendations for sports activity in patients with ICDs.