Symptomatic Athletes Research Articles

Symptoms after sport-related concussions alter gestural functions

ObjectivesSymptoms after sport-related concussions (SRC) are common. Because post-concussion symptoms are often not clearly visible, speech-accompanying gestures may help clinicians to gain additional information about the patient’s history and symptoms during medical consultation. We hypothesized that athletes with SRC and who suffered from persisting symptoms would display more gestures during concussion assessment protocols when compared to non-concussed athletes because of the athletes’ previous motor-sensory experiences made during the concussive event. DesignA retrospective cross-sectional study. MethodsThree matched groups of 40 (active) athletes were investigated in the context of concussion assessment (/and baseline) protocols: 14 symptomatic and 14 asymptomatic athletes with a SRC, and 12 non-concussed athletes. Certified raters using a standard analysis system for nonverbal behaviour analysed videotaped hand movements and gestures during a standardized concussion assessment protocol. ResultsSymptomatic athletes spent significantly more time with in space hand movements, i.e., movements that act in the body-external free space without touching anything and specifically, motion quality presentation gestures than non-concussed athletes. ConclusionsIncreased in space movements, which are functionally gestures, and specifically, motion quality presentation gestures in symptomatic athletes indicate that the more vivid sensory motor experience of the head trauma is reflected in more gestural expressions. Thus, hand movements and gestures differentiate athletes who suffer from post-concussion symptoms from non-concussed athletes indicating the athletes’ motor-sensory experiences of the event and its aftereffects. The present study highlights the fact that gestures can be employed as behavioural markers of symptoms after sport-related concussions.

Short-term effects of anti-pronation taping on foot mobility and pain in female netball athletes with medial tibial stress syndrome

Background: Medial tibial stress syndrome (MTSS) is one of the most common sources of exercise-induced leg pain, particularly in athletes involved in high impact sports, such as netball. The high incidence and substantial recovery time highlight the need for evidence-based management strategies for MTSS. Although anti-pronation taping is used clinically to manage MTSS, by controlling navicular motion and pronation (risk factors for MTSS) no published research has systematically evaluated its efficacy in MTSS symptomatic athletes. This study aimed to evaluate the short-term effects of anti-pronation taping on foot mobility and pain in netball athletes with MTSS.

Nonverbal hand movement durations indicate post-concussion symptoms of athletes

ObjectiveConcussions are common in sports and appear to be a risk factor for cognitive impairment and mental health problems. Methods of post-concussion diagnosis are still of debate, regarding sensitivity, objectivity, reliability, and costs. Spontaneous displays of nonverbal hand movement behavior during interaction are indicative of psychopathology and relatively simple to record and analyze.BackgroundIncreased durations of continuous (/irregular) body-focused hand movement activity in particular indicates psychopathology that overlaps in symptomatology with that of sport related concussions (SRC). We therefore hypothesized that the duration of irregular, on body, and act on each other hand movements is increased in athletes with SRC who suffer from post-concussion symptoms.Design/MethodsThree matched groups were investigated: 14 symptomatic athletes with a concussion, 14 asymptomatic athletes with a concussion, and 12 non-concussed athletes. Four certified raters analyzed with the NEUROGES analysis system all nonverbal hand movements that were displayed during a videotaped standardized anamnesis about concussion history, incidence, course of action, and post-concussion symptoms.ResultsIrregular Structure units of symptomatic athletes are significantly longer when compared to asymptomatic athletes. Hand movement durations of irregular, on body, and act on each other correlate positively with post-concussion symptoms. The duration of irregular units significantly predicts the PCS score.ConclusionsIncreased durations of irregular hand movement units indicate post-concussion symptoms in athletes with sport-related concussions. Because the recording of spontaneous displays of nonverbal hand movement behavior is relatively simple and cost-efficient, we suggest using the neuropsychological analysis of hand movement behavior as a future diagnostic parameter of concussion management protocols.

Randomized Evaluation of the National Collegiate Athletic Association's Concussion Education Fact Sheet for Coaches.

Background. Concussion education for coaches is being increasingly recommended by leading sports organizations, yet the effectiveness of available materials has not often been assessed. This study evaluated the impact of the National Collegiate Athletic Association's (2017) publication: "Concussion safety: What coaches need to know" (the "NCAA Fact Sheet for Coaches") on participants' concussion knowledge and safety supportive intentions. Method. NCAA head coaches (n = 779) were randomized to view the NCAA Fact Sheet for Coaches either before (intervention condition) or after (control condition) responding to questions assessing concussion knowledge and intentions to engage in three behaviors (talk to team about concussion safety; allow symptomatic athlete to continue play; encourage medical staff to return athlete as quickly as possible). Results. Knowledge scores were significantly higher among coaches in the intervention condition as compared to the control condition, largely driven by differences in knowledge about the consequences of continued play postconcussion (injury, reaction time, possible death). Fewer coaches in the intervention condition expected that they would allow an athlete with a suspected concussion continue to participate in a game or practice or that they would encourage medical staff to return athletes to play as quickly as possible. Discussion. The present study provides evidence that educational content, like that contained in the NCAA Fact Sheet for Coaches, may have a positive short-term impact on concussion knowledge and behavioral intentions of coaches. In light of these findings, sports organizations should consider providing similar educational materials to coaches, evaluating whether the information is impactful in their population.

Prevalence of Spondylolysis in Symptomatic Adolescent Athletes: An Assessment of Sport Risk in Nonelite Athletes.

To assess the risk of spondylolysis by sport in nonelite adolescent athletes with low back pain (LBP). Retrospective case series. Hospital-based sports medicine clinic. The medical charts of 1025 adolescent athletes with LBP (age 15 ± 1.8 years) were examined; 308 (30%) were diagnosed with a spondylolysis. Risk of spondylolysis was assessed in 11 sports for males and 14 sports for females. Relative risk of diagnosis of spondylolysis injury. The risk of spondylolysis differed by sex with baseball (54%), soccer (48%), and hockey (44%) having the highest prevalence in males and gymnastics (34%), marching band (31%), and softball (30%) for female athletes. Baseball was the only sport to demonstrate a significant increased risk of spondylolysis. The sports with the greatest risk of spondylolysis in adolescent athletes in this study were not consistent with published literature. Clinicians should be cautious generalizing high-risk sports to their practice, as geographic region and level of the athlete may significantly influence the incidence of spondylolysis in the population they are treating.

Nonverbal Hand Movement Durations Indicate Post-Concussion Symptoms of Athletes.

Methods of post-concussion diagnosis are still under debate with regard to sensitivity, objectivity, reliability, and costs. Spontaneous displays of nonverbal hand movement behavior during interaction are indicative of psychopathology and are relatively simple to record and analyze. Increased continuous (irregular) body-focused hand movement activity in particular indicates psychopathologies that overlap in symptomatology with those of sport-related concussions (SRCs). We therefore hypothesized that the duration of "irregular," "on body," and "act on each other" hand movements is increased in athletes with SRC who suffer from post-concussion symptoms. Three matched groups of 40 athletes were investigated: 14 symptomatic athletes with a concussion, 14 asymptomatic athletes with a concussion, and 12 non-concussed athletes. Using the Neuropsychological Gesture (NEUROGES)-Elan analysis system, four certified raters analyzed all nonverbal hand movements that were displayed during a videotaped standardized anamnesis about concussion history, incidence, course of action, and post-concussion symptoms. The duration of irregular Structure units among symptomatic athletes was significantly longer compared with asymptomatic athletes. Irregular, on body, and act on each other hand movement durations correlated with post-concussion symptoms. Whereas the duration of irregular units significantly predicted the post-concussion symptom score, working memory performances showed only marginal effects. Increased duration of irregular hand movement units indicates post-concussion symptoms in athletes with SRC. Because the recording of spontaneous displays of nonverbal hand movement behavior is relatively simple and cost efficient, we suggest using the neuropsychological analysis of hand movement behavior as a future diagnostic parameter of concussion management protocols.

Biomechanical Loading Magnitude Differences During Landing in Male Athletes with and without Patellar Tendinopathy

Mechanical loading of the patellar tendon (PT) is considered a primary factor associated with tendinopathy in jumping athletes. Prior research has not established if overloading or underloading movement profiles are present in symptomatic and asymptomatic athletes with PT structural abnormality (PTA) compared to healthy athletes. PURPOSE: To compare involved limb landing biomechanics between male athletes with and without patellar tendinopathy. METHODS: 43 males were grouped based on PT pain and ultrasound imaging of the proximal PT: symptomatic with PTA (SYM-PTA; n=13; 20±2yrs; 1.8±0.1m; 84±5kg), asymptomatic with PTA (ASYM-PTA; n=15; 21±2yrs; 1.8±0.1m; 82±13kg), and healthy control (CON; n=15; 20±2yrs; 1.8±0.1m; 79±12kg). 3D biomechanics were collected during double-limb jump-landing trials from a 30cm box placed 50% of participant height from 2 force plates. Kinematic (knee flexion angle (KF)) and kinetic (vertical ground reaction force (VGRF); internal knee extension moment (KEM); patellar tendon force (FPT)) variables were analyzed as continuous waveforms during stance phase. Mean values were calculated for each 1% of stance, normalized over 202 data points across stance phase (0-100%), and plotted with 95% confidence intervals for each group. Statistical significance was defined as a lack of 95% CI overlap for ≥ 3 consecutive %; average mean differences (MD) were calculated. RESULTS: SYM-PTA had lesser KF than CON over stance phase (8-76%, MD: 15.8±2.7°). ASYM-PTA had lesser KF than CON in the early (8-13%, MD: 8.0±0.4°; 21-24%, MD: 11.11±0.32°) and late (74-94%, MD: 9.6 ± 1.1°) stance phase. SYM-PTA group had lesser KEM than CON in early stance (6.5-9%, MD: 0.04 ± 0.004 Nm[kgm]-1), as well as ASYM-PTA in mid-stance (38-56%, MD: 0.03 ± 0.001 Nm[kgm]-1). SYM had lesser FPT in early stance (6-9%, MD: 0.9 ± 0.2BW) than CON and in mid-stance (36-60%, MD: 0.7 ± 0.1BW) than ASYM-PTA. There were no differences in VGRF between groups. CONCLUSIONS: Male athletes with SYM-PTA demonstrated a PT load-avoidance profile during a double-limb landing task compared to ASYM-PTA and CON athletes. ASYM-PTA did not show evidence of overloading compared to CON. Our findings support the use of individualized treatments for athletes along the continuum of patellar tendinopathy to maximize load-bearing capabilities of tendon.

Arthroscopic Surgery for Femoroacetabular Impingement in Skeletally Immature Athletes: Radiographic and Clinical Analysis

To evaluate radiographic and clinical outcomes after arthroscopic femoroacetabular impingement (FAI) correction in symptomatic adolescent athletes with open physes. We retrospectively reviewed radiographic and clinical outcomes in patients treated with a non-physeal-sparing arthroscopic approach for symptomatic FAI with open physes and a minimum 1-year follow-up. Specific plain radiographic and computed tomography parameters were determined, and preoperative and postoperative outcomes were prospectively evaluated with modified Harris Hip Score (mHHS), 12-Item Veterans-Rand, and pain on a visual analog scale. Thirty-seven hips (28 patients; 75% male) with a mean age of 15.9years (range, 12.8-18.3years) had imaging studies consistent with open femoral neck and iliac crest physes. The ischial tuberosity and greater trochanteric physes were open in 95% and 54% of the hips, respectively. All patients participated in organized athletics, and 50% were in multiple sports year-round. Mean follow-up was 39.8months post-arthroscopic FAI correction. There was a mean 27.7-point improvement in the mHHS (P < .001), a 4.8-point decrease in the visual analog scale for pain (P < .001), and a 15.2-point improvement in the 12-Item Veterans-Rand physical component (P < .001). Ninety-three percent of patients returned to their preinjury level of sports participation without limitations. Thirty (81.1%) patients demonstrated improvements in mHHS greater than the minimally clinically important difference (of mHHS 8 points). Two patients could not reach minimally clinically important difference because of a preoperative mHHS of > 92. There were no postoperative physeal growth arrests, growth disturbances, physeal instability, or avascular necrosis. A non-physeal-sparing arthroscopic approach for FAI in adolescents with open physes is safe and effective with no evidence of clinically relevant complication of growth arrest-related deformity or physeal instability in patients with a minimum of 1year (mean, 39.8months) of follow-up after surgery. Young, highly athletic adolescent patients with larger FAI deformities demonstrated greater outcomes improvement after arthroscopy. Level IV, therapeutic case series.

What is the Prevalence of Hip Intra-Articular Pathologies and Osteoarthritis in Active Athletes with Hip and Groin Pain Compared with Those Without? A Systematic Review and Meta-Analysis.

In athletes, hip and groin pain is considered to be associated with hip intra-articular pathologies and hip osteoarthritis (OA). A greater understanding of the relationship between hip and groin pain and imaging findings is required. Our objective was to undertake a systematic review and meta-analysis to determine the prevalence of hip intra-articular pathologies and hip OA in athletes with and without hip and groin pain. Seven electronic databases were searched on 29 January 2018 for studies investigating the prevalence of hip intra-articular pathologies and hip OA using X-ray, magnetic resonance imaging, magnetic resonance arthrography or computed tomography. The search, study selection, quality appraisal and data extractionwere performed by two independent reviewers. When studies were considered homogenous,meta-analysis was undertaken. A strength of evidence was given to pooled results. Twenty studies reporting on the prevalence of hip intra-articular pathologies and hip OA in athletes were identified. Included studies were considered moderate to high risk of bias, with only three studies adjudged as low risk of bias. In asymptomatic athletes, limited evidence identified a labral tear prevalence of 54% per person and moderate evidence of 33% per hip. In symptomatic athletes, moderate evidence of a labral tear prevalence of 20% per hip was found. Moderate evidence of a cartilage defect prevalence of 10% per person was reported in asymptomatic athletes. In symptomatic athletes, cartilage defect prevalence was 7-40%. In asymptomatic athletes, the prevalence of hip OA was 0-17%, compared with 2% in symptomatic athletes. The prevalence of hip intra-articular pathologies and hip OA in symptomatic and asymptomatic athletes is variable. Labral tears and cartilage defects appear to be seen often in athletes with and without pain. Hip OA is rarely seen in athletes either with or without hip and groin pain. PROSPERO registration CRD42017082457.

Bennett lesions in overhead athletes and associated shoulder abnormalities on MRI.

To determine if a Bennett lesion and its size are associated with additional MRI shoulder abnormalities in an overhead athlete. An IRB-approved retrospective review of our database from 1 January 2012 to 1 April 2018 identified 35 overhead athletes with a Bennett lesion on MRI. A control group consisting of 35 overhead athletes without a Bennett lesion were matched for age, level of play (professional vs non-professional), and type of study (arthrogram vs non-arthrogram). Each study was assessed independently by two MSK fellowship trained radiologists. The sizes of the Bennett lesions were measured. Each MRI was assessed for the presence of a labral tear, posterior glenoid cartilage abnormality, humeral head notching or cysts, and fraying or tear of the supraspinatus or infraspinatus tendons. Statistical analyses were performed using Student's t test, Fisher's exact test, and Chi-squared test. There was an increased incidence of posterior glenoid cartilage abnormalities in athletes with Bennett lesions vs those without (23% vs 3%, p value = 0.01). There was no difference in any other MRI abnormalities, including labral tears and findings of internal impingement between these two groups (p value range = 0.09-0.46). There was no association between the size of a Bennett lesion and the presence of glenoid cartilage lesions, labral tears, internal impingement, age, professional status, or need for surgery (p value range = 0.08-0.96). Symptomatic overhead athletes with Bennett lesions have an increased frequency of posterior glenoid cartilage abnormalities, but not labral tears or findings of internal impingement compared to those without Bennett lesions.

Invasive Coronary Physiological Assessment in Symptomatic Middle-Aged Endurance Athletes

Abstract Despite the health benefits of routine exercise, coronary artery disease (CAD) is common among older competitive athletes and is an important cause of sudden cardiac death. Athletes with suspected or confirmed CAD routinely undergo conventional coronary angiography involving the performance of invasive coronary physiological assessment using the fractional flow reserve (FFR) or the instantaneous-wave free ratio (iFR). Data defining the role of invasive coronary physiological assessment, while robust in general clinical populations, are untested among older competitive athletes with [...]

Psycho-affective health, cognition and neurophysiological function following sports-related concussion in symptomatic and asymptomatic athletes

The proposed normal recovery window for a concussive-injury is 10–14 days. However, a significant portion of athletes who sustain a sports-related concussion (SRC) exhibit symptoms beyond this recovery window. Little is known about the neuropsychiatric and neurophysiologic differences within these slow-to-recover athletes, that may explain these prolonged recovery periods. The present study aimed to investigate the psycho-affective and neuropsychological profiles of symptomatic and asymptomatic athletes who recently experienced an SRC. Additionally, we compared these concussed athletes with healthy controls, without a history of concussion. Accordingly, 78 participants with a history of concussion (26 Symptomatic, 26 Asymptomatic) and 26 healthy controls completed a neuropsychiatric and neuropsychological test battery; including the Beck's Depression Index (BDI II), Profile of Mood States (POMS), and 2-Back task. Additionally, event-related brain potentials (ERPs) were recorded during an experimental oddball paradigm. The results suggest that symptomatic athletes report significantly worse levels of depressive symptoms and negatively altered mood, compared to both asymptomatic and control athletes. Additionally, symptomatic athletes demonstrated poorer performance on the 2-back test, characterized by increased commission errors and slower reaction times. Finally, ERP analyses revealed that both symptomatic and asymptomatic athletes demonstrated reduced allocation of attentional resources during the oddball task, indexed by reduced P3b amplitude. However, only asymptomatic athletes exhibited prolonged P3 latency indicative of delayed information processing. Taken together these results suggest that compared to asymptomatic and healthy athletes, athletes with persistent concussive-like symptoms not only report greater disruptions in affect and mood, but also demonstrate impaired cognitive and neurophysiologic function.

Exercise recommendations in patients with valvular heart disease.

Valvular heart disease affects 1%-2% of young individuals, many of whom aspire to partake in competitive sport or high intensity recreational exercise. There are limited reports on the impact of intensive physical activity on the progression of valvular heart disease; therefore, current recommendations are based on consensus opinion. The management of exercising individuals with valvular heart disease requires a structured approach that incorporates several key factors including symptomatic status, functional capacity, type and nature of the valvular lesion, impact on ventricular structure and function and effect on pulmonary artery pressure. Asymptomatic individuals with minor valvular abnormalities may engage in all forms of competitive sport, whereas those with lesions of moderate severity may exercise intensively if an exercise stress test tailored to the relevant physical activity reveals good functional capacity without myocardial ischaemia, haemodynamic disturbances or arrhythmia. Symptomatic athletes and those with severe valvular heart disease, impaired ventricular function, pulmonary hypertension and arrhythmias should refrain from most competitive sports. Athletes with a bicuspid aortic valve and aortic root diameter >40 mm should avoid sport with a strong isometric component even with minimal valvular dysfunction. There is an association between mitral valve prolapse and sudden cardiac death in the general population; however, there is limited evidence of increased risk with competitive sport. Athletes undergoing corrective surgery may return to exercise after 3 months if ventricular function and exercise capacity are preserved. Individuals anticoagulated for mechanical bioprosthetic valves should avoid contact or collision sport to minimise the risk of bleeding.

Core stability, shoulder peak torque and function in throwing athletes with and without shoulder pain

ObjectiveThis study compared core stability, shoulder isokinetic peak torque and shoulder function in throwers with and without shoulder pain. DesignCross-sectional study. SettingsThrowing athletes. ParticipantsThirty healthy athletes and 21 with shoulder pain were included. Main outcome measuresEndurance time of the trunk, the modified star excursion balance test, isokinetic peak torque of internal and external rotation of the shoulder, questionnaires, level of satisfaction with the throwing arm and active range of motion. ResultsThe symptomatic athletes presented with shorter endurance time for the trunk lateral flexors (P < .05), and decreased reach distance for both limbs in the posteromedial direction (P < .05) and for takeoff limb in the posterolateral direction (P = .04), and smaller composite score for both limbs (P < .05) during star excursion balance test as compared to the healthy ones. No significant differences between groups were found for peak torque of internal and external rotation of the shoulder. Athletes with shoulder pain demonstrated more shoulder disability and a lower level of satisfaction with the throwing arm (P = .000). Range of motion was not different between groups for shoulder internal and external rotation. ConclusionThrowing athletes with shoulder pain have lower core stability and shoulder function compared to healthy athletes.

Ulnar collateral ligament reconstruction in athletes using a cortical button suspension technique

A variety of techniques currently exist for ulnar collateral ligament (UCL) reconstruction in symptomatic overhead athletes, all with the potential complication of fracture about the humeral or ulnar tunnels. Far cortical button fixation is a reproducible, biomechanically attractive option; however, no clinical series has been published on this technique to date. This study reports the clinical outcomes, with minimum 2-year follow-up, of a dual far cortical button suspension technique for UCL reconstruction in athletes. A retrospective evaluation was performed of 23 consecutive athletes who underwent UCL reconstruction with the use of ulnar and humeral-sided far cortical button fixation with minimum 2 years of follow-up. Data were collected from electronic medical records and patient telephone calls. The primary outcome was return to sport. Secondary outcomes included Disabilities of the Arm, Shoulder and Hand score, range of motion, and complications. We included 23 athletes with a mean follow-up of 47.2 months (range, 24-81 months). Autograft was used in 22 patients (16 palmaris, 6 gracilis, 1 semitendinosus, and 1 gracilis allograft). Overall, 82.6% (19 of 23) of patients returned to sport. At final follow-up, the average Disabilities of the Arm, Shoulder and Hand score was 3.8, and range of motion averaged 0° to 140°, with 87% (20 of 23) of patients achieving full motion. The visual analog scale score improved from 3.8 preoperatively to 0.2 at the final follow-up (P < .0001). There was 1 reconstruction failure. The humeral and ulnar far cortical button suspension technique provides a new UCL fixation option with theoretically lower concern for tunnel fracture and with predictable return to sport and good functional outcomes.

MRI to investigate iliac artery wall thickness in triathletes

ABSTRACTObjectives: Endofibrosis was first described in endurance athletes. This rare disease is characterized by intimal hyperplasia of iliac arteries. Due to non-specific symptoms diagnosing could be very challenging and delayed. This represents a serious problem not only for affected athletes but also for consulting physicians. The aim of this study was to analyze intimal thickness of iliac arteries using non-contrast magnetic resonance imaging (MRI) in competitive triathletes suffering from exercise induced leg pain consistent with symptoms caused by endofibrosis.Methods: 18 highly trained triathletes (16 triathletes, 12 male) with a mean age of 45.4 ± 10.2 years were investigated by non-contrast MRI. We divided subjects into two groups: 10 complaint about exercise- induced leg pain and 7 were free of any symptoms. In all 10 symptomatic athletes consulting physicians excluded musculoskeletal or neurological disorders before and we suspected endofibrosis. One patient was excluded from statistical analysis due to a known recurrent external iliac artery (EIA) occlusion after surgical repair 6 month ago.Results: Mean wall thickness (T) of all 17 subjects was 1.34 ± 0.11mm for the common iliac artery (CIA) and 1.74 ± 0.18mm for the EIA. We found no significant differences by comparing T of symptomatic (s) and asymptomatic (a) legs. There were no significant differences in mean ratio of patent artery to whole artery between the symptomatic and asymptomatic legs for the CIA (0.81 vs 0.82, p = 0.87) and for the EIA (0.71 vs 0.72, p = 0.78). MRI shows a thickening of the left EIA (4.41mm) in the patient who suffered from recurrent occlusion of the left EIA and after surgical repair and histological examination confirmed an endofibrotic lesion.Conclusion: Non-contrast MRI seems to be an appropriate diagnostic tool to exclude endofibrosis in triathletes, but it cannot be recommended as initial screening modality for athletes suffering from exercise-induced leg pain.

Cross-cultural adaptation of Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score: Reliability and validity in Turkish-speaking overhead athletes

ObjectiveKerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES) is a subjective assessment tool to measure functional status of the upper extremities in overhead athletes. The aim was to translate and culturally adapt the KJOC-SES and to evaluate the psychometric properties of the Turkish version (KJOC-SES-Tr) in overhead athletes. MethodsThe forward and back-translation method was followed. One hundred and twenty-three overhead athletes completed the KJOC-SES-Tr, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the American Shoulder and Elbow Surgeons Evaluation Form (ASES). Participants were assigned to one of the following subgroups: asymptomatic (playing without pain) or symptomatic (playing with pain, or not playing due to pain). Internal consistency, reliability, construct validity, discriminant validity, and content validity of the KJOC-SES-Tr were tested. ResultsThe test–retest reliability of the KJOC-SES-Tr was excellent with an interclass coefficient of 0.93. There was a strong correlation between the KJOC-SES-Tr and the DASH and the ASES, indicating that the construct validity was good for all participants. Results of the KJOC-SES-Tr significantly differed between different subgroups and categories of athletes. The floor and ceiling effects were acceptable for symptomatic athletes. ConclusionThe KJOC-SES-Tr was shown to be valid, reliable tool to monitor the return to sports following injuries in athletes.

Effects of Altering Trunk Position during Landings on Patellar Tendon Force and Pain.

This study aimed to verify the immediate effects of altering sagittal plane trunk position during jump landings on lower limb biomechanics, patellar tendon force, and pain of athletes with and without patellar tendinopathy. Twenty-one elite male athletes were categorized into three groups: athletes with patellar tendinopathy (TG; n = 7), asymptomatic athletes with patellar tendon abnormalities (n = 7), and asymptomatic athletes without tendon abnormalities (CG; n = 7). A biomechanical evaluation was conducted while the athletes performed drop landings from a bench in a self-selected trunk position (SS). Afterward, the athletes were randomly assigned to land with either a flexed trunk position (FLX) or an extended trunk position (EXT). Variables of interest for this study included sagittal plane peak kinematics, kinetics, patellar tendon force, and pain during the landing tasks. Peak patellar tendon force, knee extensor moment, and knee pain decreased in the FLX landing compared with the SS landing, regardless of group. In addition, peak patellar tendon force, knee extensor moment, and vertical ground reaction force were smaller in the FLX landing compared with the EXT landing. The TG had smaller peak ankle dorsiflexion compared with the CG during jump landings, regardless of trunk position. Landing with greater trunk flexion decreased patellar tendon force in elite jumping athletes. An immediate decrease in knee pain was also observed in symptomatic athletes with a more flexed trunk position during landing. Increasing trunk flexion during landing might be an important strategy to reduce tendon overload in jumping athletes.

Anomalous origin of coronary arteries from the "wrong" sinus in athletes: Diagnosis and management strategies.

Although anomalous origin of left (AOLCA) and right coronary artery (AORCA) from the wrong sinus may cause sudden death (SD) in athletes, early diagnosis and management of these anomalies are still challenging. We analysed clinical/instrumental profiles of athletes identified with AOLCA/AORCA focusing our attention on diagnosis, management and follow-up. We report 23 athletes (17 males, mean age 27±17yrs.), 6 with AOLCA and 17 with AORCA. Diagnosis was made by trans-thoracic echocardiography (TTE) in 21/23(91%). Symptoms were present only in 10(41%). Only 3 had an abnormal rest-ECG and 9(39%) an abnormal stress test ECG (3 ST-depression, 4 ventricular arrhythmias, 1 supraventricular arrhythmias, 1 rate-dependent left-bundle-branch-block). Anatomy of the anomalous coronary artery showed no significant correlation with clinical presentation, except for a tendency to higher occurrence of proximal hypoplasia in symptomatic athletes (83% vs 40%, p=0.09). All athletes were disqualified from competitive-sports and advised to avoid strenuous effort. Surgery was recommended to all athletes with AOLCA and 6 with AORCA, but only 6 underwent surgery. No major cardiac events or ischemic symptoms/signs occurred during a mean follow-up of 65±70months. Early diagnosis of AOLCA/AORCA in athletes is feasible by TTE. Typical symptoms/signs of myocardial ischemia are present only in one third of cases thus underlying the need of a high index of clinical suspicion to achieve the diagnosis. After exercise restriction, none had major cardiac events or ischemia symptoms/signs recurrence. There was no correlation between anatomical characteristics and clinical presentation with the possible exception of coronary hypoplasia.

Outcomes of capsulolabral reconstruction for posterior shoulder instability

BackgroundSurgical treatment of isolated posterior shoulder instability—a rare and often misdiagnosed condition—is controversial because of poor outcomes. Failure of physical therapy in symptomatic young athletes requires capsulolabral reconstruction or bone block procedures. The goal of this study was to report the outcomes of patients who have undergone surgical capsulolabral reconstruction and to look for risk factors that contribute to failure of this procedure. Material and methodWe analyzed the outcomes of 101 patients who underwent capsulolabral reconstruction: 83 included retrospectively, 18 included prospectively. The procedures were performed alone or in combination with capsular shift, labral repair, closure of the rotator interval and notch remplissage. The primary endpoint was failure of the procedure, defined as recurrence of the instability and/or pain. We also determined the outcomes based on specific (Walch–Duplay, modified Rowe) and non-specific (Constant, resumption of activities) scores of shoulder instability. ResultsThe results were satisfactory despite a high failure rate: 35% in the retrospective cohort with 4.8±2.6 years’ follow-up and 22% in the prospective cohort with 1.1±0.3 years’ follow-up. The various outcome scores improved significantly. Ninety-two percent of patients returned to work and 80% of athletes returned to their pre-injury level of sports. Eighty-five percent of patients were satisfied or very satisfied after the surgery. No risk factors for failure were identified; however, failures were more common in older patients, those who underwent an isolated procedure and those who had unclassified clinical forms. ConclusionTreatment of posterior shoulder instability by capsulolabral reconstruction leads to good clinical outcomes; however, the recurrence rate is high. Level of evidence4 – retrospective study.