Increased occurrence of ACL injuries for football players in teams changing coach and for players going to a higher division.

PURPOSE: To identify football-specific factors associated with ACL injuries that can be targeted for sport-specific injury prevention. METHODS: A study-specific questionnaire was developed to study the characteristics of ACL injuries in football including intrinsic, extrinsic, and injury specific factors. The questionnaire was available at the Swedish national knee ligament registry's website for the football players to voluntarily fill out. Data are presented on group level for all football players in total and for females and males separate to examine gender-specific differences. The results are based on answers collected over a 3-year period from 2875 football players, 1762 (61%) males and 1113 (39%) females. RESULTS: ACL were more frequently sustained during games 66% than during practices 25%. The injury mechanism was non-contact in 59% and contact in 41%. For the contact injuries during games, no action was taken by the referee in 63% of the situation and a red card was shown in 0.5%. The risk of ACL injury was highest early in the football game with 47% sustained during the first 30 min and 24% in the first 15 min. Players changing to a higher level of play 15% had a higher rate of ACL injuries than players changing to a lower level 8%. This difference was especially seen in female football players with 20% of ACL injuries being sustained by players going to a higher division compared to 7% for those going to a lower division. 15% of the male and 21% of the female ACL injuries occurred in teams with a coach change during the season. Knee control exercises to warm up was used by 31% of the female players and 16% of the males. 40% of the players reported that they did not plan on returning to football. CONCLUSION: Neuromuscular training programs have proven to reduce ACL injuries, but greater adherence to these remains a challenge as only 1 in 5 of the ACL-injured football players report using them. Teams changing coach and players going to a higher division appear to have an increased risk of ACL injury warranting attention and further investigations. LEVEL OF EVIDENCE: IV.

Epidemiology of knee internal derangement injuries in United States high school girls' lacrosse, 2008/09-2016/17 academic years.

Research on knee internal derangement (KID) injuries in high school girls' lacrosse is limited, yet needed to identify sport-specific risk factors. This study describes the epidemiology of KID injuries in United States high school girls' lacrosse during the 2008/09-2016/17 academic years. Athletic trainers (ATs) reported injury and athlete-exposure (AE) data to the High School Reporting Information Online (RIO) surveillance system. KID injuries involved the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and menisci. Injury rates per 10,000AE and injury rate ratios (IRR) with 95% confidence intervals (CI) were reported. Linear regression assessed injury rate time trends. ATs reported 148 KID injuries (rate = 1.92/10,000AE). The injury rate was higher in competition than practice (IRR = 8.40; 95%CI: 5.66-12.49). ACLs comprised a large proportion of KID injuries (46.6%). The ACL injury rate increased over time (P = 0.002), highlighting the need to develop/refine lacrosse-specific KID injury prevention programs.

Outcomes and Complications of Tibial Tubercle Fractures in Pediatric Patients: A Systematic Review of the Literature.

BACKGROUND: Systematic review of the literature was done to determine (1) the frequency and type of associated injuries, (2) frequency of concomitant Osgood-Schlatter disease, (3) methods of treatment, (4) functional and radiologic outcomes according to fracture type, and (5) complications of tibial tubercle fractures in pediatric patients. METHODS: A systematic review of the English literature from 1970 to 2013 included 23 eligible articles reporting 336 fractures with a mean follow-up of 33.56 months (range, 5.7 to 115 mo). Fractures were classified by a comprehensive system that included characteristics of previous systems. Clinical outcomes were assessed by a qualitative scale (excellent/fair/poor), the rate of return to preinjury activity, and knee range of motion. Rate of fracture healing, associated injuries (patellar/quadriceps tendon avulsion and meniscal tears), compartment syndrome, and complications were also recorded. RESULTS: Mean age at surgery was 14.6 years and the most common fracture reported was type III (50.6%). The overall associated injury rate was 4.1%, most common in type III fractures (4.7%). Compartment syndrome was present in 3.57% of cases. Open reduction and internal fixation were done in 98% of surgical cases. Rates of return to preinjury activity and knee range of motion were 98%, regardless of the type of fracture. Fracture consolidation was achieved in 99.4% of cases. Overall complication rate was 28.3%; removal of an implant because of bursitis (55.8%) was most common. Tenderness/prominence (17.9%) and refracture (6.3%) were also common. CONCLUSIONS: Treatment of tibial tubercle fractures in adolescents produced good clinical and radiologic results regardless of fracture type, which was more related to potential complications. Fractures with intra-articular involvement tended to present with more associated injuries and to have fair functional outcomes, suggesting that advanced imaging may be justified with these fractures. Complications could be more common than expected without a significant effect on final outcome. Finally, there is a need for longer follow-up to determine long-term outcomes. LEVEL OF EVIDENCE: Level III-systematic review of level III/IV studies.

Return to competitive football after major knee surgery: more questions than answers?

Despite significant advances in the diagnostics and treatment of knee injuries over the last decade, several challenges related to the subject "return to sport" remain largely unknown. For example, how should "return to sport" be defined precisely? What is the optimal timing and progression to enable a return to sport? Which criteria should be used during this process? What type of training is indicated? Which measurements can support the decision-making process? How do we optimally prepare athletes for competition without risking re-injury? This paper critically addresses these questions, and proposes a return to play model to prepare football players to compete after major knee surgery (anterior cruciate ligament reconstruction, cartilage repair). The goal is to re-integrate the player gradually into the game, taking into account his individual characteristics. Several evidence-based and empirical criteria are needed to plan and monitor the efficient return to competitive football. Injury-prevention education should be part of this process to maximise the chance of a durable career and decrease the risk of re-injury. However, because of the paucity of research on "return to sport", further research is more than warranted.

Update: soccer injury and prevention, concussion, and chronic groin pain.

Soccer, or football, as it is known in much of the world, is one of the most popular sports in the world. The purpose of this article was to provide a concise update on select soccer-specific medical issues published in the last year as they relate to soccer injury and prevention, concussions, and chronic groin pain. Both the Fédération Internationale de Football Association and the Union of European Football Associations published data from their longstanding injury tracking systems, providing foundation for further research. Concussion research continues to drive much interest, especially as it relates to heading and the controversy of subconcussive trauma. Lastly, our understanding of chronic groin pain continues to be refined as we try to understand the complexity of its pathophysiology and attempt to standardize a multispecialty approach of diagnosis and treatment.

[Treatment and outcome of fractures around the knee in the older patients]. / Fractures de la région du genou chez la personne agée: prise en charge et evolution.

From the age of 50 the risk of fracture during the remaining years of life is estimated to be 40% in women and 20% men. The management of a fracture in the elderly is complex for several reasons, including decreased bone strength, a frequent association with previous joint replacement surgery or another orthopaedic implant, a high risk for anesthesia, difficulty in following postoperative recommendations, and an increased postoperative mortality. This article offers a review of fractures around the knee: distal femur, proximal tibia, patella and periprosthetic fractures. The vast majority of these fractures are treated surgically. When surgery is indicated, treatment should be initiated as soon as possible according to the patient's general condition in order to minimize the risk of complications and deconditioning.

Sex and Gender Differences in Pediatric Knee Injuries.

The participation of females in sports has increased significantly since the passage of Title IX. Sports participation may place young athletes at risk for knee injuries, including patellofemoral pain syndrome (PFPS), osteochondritis dissecans (OCD), and anterior cruciate ligament (ACL) rupture. Differences in anatomy, hormone production, and neuromuscular patterns between female and male athletes can contribute to disparities in knee injury rates with female athletes more vulnerable to PFPS and ACL injury. Biological differences between sexes alone cannot fully explain worldwide differences in musculoskeletal health outcomes. Social, cultural and societal attitudes toward gender and the participation of girls and women in sports may result in a lack of accessible training for both injury prevention and performance optimization; one must recognize the effects of gender disparities on injury risk. More nuanced approaches to assess the complex interplay among biological, physiologic, and social influences are needed to inform best practices for intervention and sports injury prevention.

Prevention of Non-Contact Anterior Cruciate Ligament Injuries among Youth Female Athletes: An Umbrella Review.

Anterior cruciate ligament (ACL) injuries account for a large percentage of knee injuries, disproportionately affecting female athletes. To help health professionals stay current, we performed an umbrella review to evaluate the effectiveness of ACL injury prevention programs in reducing non-contact ACL injury rates, determine the effective components within interventions, and provide clinical recommendations. Twelve databases (Medline, Embase, Cochrane Database of Systematic Reviews, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, PEDro, Web of Science Core Collection, Epistemonikos, TRIP, BC Guidelines and Protocols, CPG Infobase, ProQuest Dissertations and Theses Global) were searched in May 2021 to identify relevant systematic reviews and meta-analyses. Four databases were searched again in September 2021 to identify recent primary literature. Non-contact ACL injury data were extracted to calculate incidence rate ratios (IRRs) and these were combined using an inverse variance random-effects model. A qualitative assessment of included reviews was performed. The methodological quality of the studies was assessed using a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) or Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). Sixteen reviews and two primary studies met the inclusion criteria. Across 11 primary studies, prevention programs were effective in reducing non-contact ACL injuries by 64% (IRR = 0.36 (95% CI: 0.18-0.70)). A multi-faceted exercise program, beginning in the pre-season and containing at least three exercise types, may be beneficial in reducing ACL injury risk.

What is the true evidence for gender-related differences during plant and cut maneuvers? A systematic review.

PURPOSE: Female athletes have a significantly higher risk of sustaining an anterior cruciate ligament (ACL) injury than male athletes. Biomechanical and neuromuscular factors have been reported as the main cause. The purpose of this review was to critically review results of the published literature on gender differences regarding biomechanical and neuromuscular movement patterns during plant and cutting maneuvers. METHODS: MEDLINE (1966 to December 2008), EMBASE (1947 to December 2008) and CINAHL (1981 to December 2008) searches were performed. The seven studies meeting the inclusion criteria were analyzed. RESULTS: Biomechanical gender differences were of questionable clinical relevance. Quadriceps dominance was not found in women. CONCLUSION: The question raises whether ACL injuries during plant and cutting maneuvers are purely gender related and whether women do have to move like men in order to reduce injury risk? Caution is warranted in making inferences as studies were heterogeneous in terms of subject and study characteristics and had low statistical power as a result of insufficient number of subjects. It is advised that future research moves beyond the isolated gender comparison and that larger sample sizes will be included. This review may aid in improving experiments to draw valid conclusions, in order to direct future ACL injury prevention programs, which might need to be more individualized.

Diagnoses and mechanisms of musculoskeletal injuries in an infantry brigade combat team deployed to Afghanistan evaluated by the brigade physical therapist.

UNLABELLED: Musculoskeletal injuries are the most common cause for disability in deployed environments. Current research is limited to body region affected by the injury. OBJECTIVE: To determine the prevalence of musculoskeletal diagnoses and mechanisms of injury (MOI) as well as associations to specific Military Occupational Specialties (MOS) in a deployed Brigade Combat Team (BCT). METHODS: Data collected on 3,066 patient encounters by the Brigade Combat Team physical therapist over 15 months were analyzed using descriptive statistics and X2 tests. RESULTS: Mechanical low back pain was the most common diagnosis (19%), whereas overuse was the most prevalent MOI (22%). The Infantry MOS was significantly associated with meniscal tears and pre-existing injuries, the Maintenance MOS with contusions, Signal and Transportation MOSs with weight lifting injuries, and the Administrative MOS with running injuries. CONCLUSION: Different MOSs are preferentially susceptible to different diagnoses and MOIs. Therefore, different injury prevention strategies may be needed across occupations.

Presence of subchondral bone marrow edema at the time of treatment represents a negative prognostic factor for early outcome after autologous chondrocyte implantation.

INTRODUCTION: Since introduction of autologous chondrocyte implantation (ACI), various factors have been described that influence the clinical outcome. The present paper investigates the influence of bone marrow edema at time of treatment on clinical function before and in the early clinical course after ACI. METHODS: 67 patients treated with ACI for cartilage defects of the knee joint were included. Presence of subchondral bone marrow edema was graded as absent (1), mild (2), moderate (3) or severe (4) using magnetic resonance (MR) imaging before surgery. All patients were assessed in terms of clinical function before surgery and 6 as well as 12 months after ACI using IKDC and Lysholm scores. Presence of subchondral edema was correlated with functional outcome. RESULTS: In 18 patients edema on initial MRI was graded as "absent", while 17 patients had grade 2 edema, 19 patients had grade 3 edema and 13 patients had grade 4 edema. IKDC score increased significantly from 49.8 points (SD +/- 14.9) to 72.3 points (SD +/- 17.5) at 12 months (p < 0.01). At all time points investigated, patients of group "4" showed inferior results to all other groups (p < 0.05). In addition, in patients without any edema, better clinical function was detected compared to all other groups before surgery (p < 0.05) and compared to group 3 at 6 months following ACI (p < 0.05). CONCLUSIONS: Presence of severe subchondral bone marrow edema seems to correlate with knee function in patients with cartilage defects and may be a reliable prognostic factor for the early clinical course after ACI.

Playing field issues in sports medicine.

The use of artificial turf on playing fields has increased in popularity. Advances in technology have allowed for the development of turf that closely mimics the properties of natural grass. Overall injury incidence does not differ between the two surfaces, but unique injury patterns are apparent between the two surfaces. Differences in shoe-surface interface, in-shoe foot loading patterns, and impact attenuation may provide insight into the different injury patterns. Player perceptions of artificial turf vary and may be related to different physiological demands between the two surfaces. Artificial turf has been implicated in skin infections, but concerns about other health consequences related to the synthetic materials have not been proven yet. Understanding the differences between artificial turf and natural grass will help physicians, athletic trainers, and coaches better care for and train their athletes.

Pediatric Anterior Cruciate Ligament Reconstruction.

The increasing incidence of anterior cruciate ligament injuries in skeletally immature children demands careful attention by orthopedic surgeons. Assessing skeletal age is essential to selecting the appropriate reconstruction technique. Males with a bone age of 15 years or older and females of 13 years and older are ideal candidates for a transphyseal anterior cruciate ligament reconstruction because there is minimal risk of growth disturbance. Children with substantial growth remaining (skeletal age males ≤12 years and females ≤10 years) seem to be at risk for more significant growth disturbance, so we generally recommend physeal-sparing techniques for these younger patients.

Sock systems to prevent foot blisters and the impact on overuse injuries of the knee joint.

The incidence of foot blisters and other overuse injuries of the lower limb is very high during basic military training (BMT). One hundred and eighty-nine subjects were divided into two intervention groups wearing alternative sock systems and one control group. Overall, 57% of the 173 recruits who completed the training, developed foot blisters. Binary logistic regression revealed the type of sock, race, previous hiking or military experience, and known orthopedic foot conditions to be predictive variables for foot blisters. Fifty-three percent of the 173 recruits also developed another overuse injury of the lower limb (25.4% related to the knee joint). Previous military or hiking experience and the association of foot blisters revealed to be predictive for the overuse injuries of the knee joint. The results of the present study suggest associated foot blisters are also an important factor in the development of overuse injuries of the knee joint during BMT.

Knee Injuries in Elite Level Soccer Players.

As one of the most popular sports in the world, soccer injury rates involving the knee continue to rise. An alarming trend of knee injuries, including increased anterior cruciate ligament ruptures, underscores the need to review our current understanding of these injuries in soccer players. This article includes a critical review of the epidemiology of knee injuries in soccer, anterior cruciate ligament and other ligamentous injuries, cartilage and meniscal injury, post-traumatic osteoarthritis, as well as current prevention initiatives.

Prevention of knee joint injuries in winter sports training / Prevenção de lesões articulares do joelho no treino dos esportes de inverno / Prevención de las lesiones articulares de la rodilla en el entrenamiento de los deportes de invierno

ABSTRACT Introduction: With the 2022 Winter Olympic Games launch, ice and snow sports have come into the spotlight, receiving government incentives to encourage their practice. Objective: Examine the causes of knee injury in skiers, proposing preventive measures for joint injury. Methods: The current situation of joint injury in skiers' knees, joint movement in skiing, the cause of joint injury, and the prevention of joint injury were analyzed, and scientific prevention and corresponding treatment plan were developed according to the results of the analysis. Results: The injury rate among skiers is high. Ligament injury, tendon injury, and muscle strain are the three main types of injury. There are 57 mild injuries of various types to the knee joint - 53.27% of all injuries; 41 moderate injuries, representing 38.32% of all injuries; 9 serious injuries, representing 8.41% of all injuries, with minor injuries. Conclusion: This article examines knee motion and the causes of knee injury in skiers and proposes preventive measures for joint injury. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Com o lançamento dos Jogos Olímpicos de Inverno de 2022, os esportes de gelo e neve entraram em evidência, recebendo incentivos governamentais para encorajamento de sua prática. Objetivo: Examinar as causas da lesão no joelho em esquiadores, propondo medidas preventivas para a lesão articular. Métodos: Foram analisadas a situação atual de lesão articular nos joelhos dos esquiadores, o movimento articular no esqui, a causa das lesões articulares e a prevenção de lesões articulares, além de um plano de prevenção científica e tratamento correspondente, de acordo com os resultados da análise. Resultados: A taxa de lesões em esquiadores é alta. Lesão ligamentar, lesão tendinosa e tensão muscular são os três principais tipos de lesão. Há 57 lesões leves de vários tipos na articulação do joelho - 53,27% de todas as lesões; 41 lesões moderadas, representando 38,32% de todas as lesões; 9 lesões graves, representando 8,41% de todos os ferimentos, com ferimentos menores. Conclusão: Este artigo examina o movimento do joelho e as causas da lesão no joelho em esquiadores, e propõe medidas preventivas para lesão articular. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Con la puesta en marcha de los Juegos Olímpicos de Invierno de 2022, los deportes de hielo y nieve han pasado a ser el centro de atención, recibiendo incentivos gubernamentales para fomentar su práctica. Objetivo: Examinar las causas de las lesiones de rodilla en los esquiadores, proponiendo medidas preventivas de las lesiones articulares. Métodos: Se analizó la situación actual de las lesiones articulares en las rodillas de los esquiadores, el movimiento articular en el esquí, la causa de las lesiones articulares y la prevención de las mismas, y se elaboró un plan científico de prevención y tratamiento correspondiente según los resultados del análisis. Resultados: El índice de lesiones en los esquiadores es alto. Las lesiones de ligamentos, las lesiones de tendones y las distensiones musculares son los tres tipos principales de lesiones. Hay 57 lesiones leves de diversos tipos en la articulación de la rodilla, el 53,27% de todas las lesiones; 41 lesiones moderadas, que representan el 38,32% de todas las lesiones; 9 lesiones graves, que representan el 8,41% de todas las lesiones, con lesiones leves. Conclusión: Este artículo examina el movimiento de la rodilla y las causas de las lesiones de rodilla en los esquiadores, y propone medidas preventivas para las lesiones articulares. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Medical attention seeking dance injuries: systematic review of case reports.

The objective of this study was to conduct a systematic review of case reports documenting the epidemiology of unique and rare musculoskeletal injuries in dancers. A systematic review was conducted online using PubMed and Google Scholar, as per PRISMA guidelines up to July 30, 2016. Predefined eligibility criteria were applied, and the data thus compiled was analysed. Study quality was assessed based on CARE guidelines. 72 studies reporting 92 dance injuries were included in the review. The average age of dancers was 23 years (SD = 10 years) with majority being females (65%). Chronic injuries were the most common presentation with lower extremity injuries being the commonest. Foot and knee injuries were the top two articulations involved across injuries and groups. Overall bony injuries were most frequently reported, with stress injury being the most common type. Conservative approach was the most commonly reported treatment approach across case reports. The methodological quality of case reports included in the study varied considerably and lacked uniformity. The evidence provided, though not sufficient for any recommendation, it should alert the physicians and those concerned with the primary care of the dancers to be vigilant of the eccentricity and severity of the injuries, their atypical presentation, mode, mechanism and trend, thereby being prepared for the unexpected.

Long-term outcome of total knee replacement: does obesity matter?

BACKGROUND: Although arthritic complications are common in the obese, many surgeons are reluctant to perform joint replacements in this population. We compared outcomes of total knee arthroplasties (TKAs) in normal weight and obese patients. METHODS: 30 TKAs in 21 obese patients with BMI 30-49 (Group A--mainly mildly and moderately obese) were compared to a matched group of 53 TKAs in 41 non-obese patients with BMI 16-29.9 (Group B). Outcome measures included the Knee Society Score (a composite of clinical and functional parameters), radiographic results, and the need for revision or reoperation. RESULTS: Median follow-up was 11.3 years; no patients were lost to follow-up during this time. The Knee Society Score rose 92 points in Group A to a final score of 184, and 95 points in Group B to a score of 193. There was no statistical difference in Groups A and B between the improvement in scores or the final score achieved. Osteolysis rates were not significantly different between the 2 groups (5% vs 13%), nor were radiolucency rates (0% vs 9.7%). Median alignment was also similar in both groups (8.1 degrees vs 8.0 degrees valgus). 13.3% of Group A required reoperation while none required revision, and 13.2% of Group B required reoperation with 3.8% requiring revision. Survival rates were similar in both groups (71.4% vs 61.5%). CONCLUSIONS: Moderate obesity does not affect the clinical and radiologic outcome of TKA. However, TKA results in improved mobility, enhancing the success of subsequent weight loss therapy.

Anterior cruciate ligament injuries in female athletes: Part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention.

Female athletes have a 4 to 6 times higher incidence of anterior cruciate ligament injury than do male athletes participating in the same landing and pivoting sports. This greater risk of anterior cruciate ligament injury, coupled with a geometric increase in participation (doubling each decade), has led to a significant rise in anterior cruciate ligament injuries in female athletes. The gender gap in anterior cruciate ligament injury, combined with evidence that the underpinnings of this serious health problem are neuromuscular in nature, leads to the development of neuromuscular interventions designed to prevent injury. A systematic review of the published literature yielded 6 published interventions targeted toward anterior cruciate ligament injury prevention in female athletes. Four of 6 significantly reduced knee injury incidence, and 3 of 6 significantly reduced anterior cruciate ligament injury incidence in female athletes. A meta-analysis of these 6 studies demonstrates a significant effect of neuromuscular training programs on anterior cruciate ligament injury incidence in female athletes (test for overall effect, Z = 4.31, P < .0001). Examination of the similarities and differences between the training regimens gives insight into the development of more effective and efficient interventions. The purpose of this "Current Concepts" review is to highlight the relative effectiveness of these interventions in reducing anterior cruciate ligament injury rates and to evaluate the common training components between the training studies. In addition, the level of rigor of these interventions, the costs and the difficulty of implementation, the compliance with these interventions, and the performance benefits are discussed. This review summarizes conclusions based on evidence from the common components of the various interventions to discuss their potential to reduce anterior cruciate ligament injury risk and assess their potential for combined use in more effective and efficient intervention protocols.