Anterior Cruciate Ligament Ruptures in Russian Premier League Soccer Players During the 2010 to 2021/2022 Competitive Seasons: The Epidemiology and Details of Return to Sports.

Background: There are limited data on the epidemiology of anterior cruciate ligament (ACL) ruptures in elite adult soccer players, especially in the Russian Premier League (RPL). There is an increased risk of injury due to a combination of additional risk factors such as playing in extremely high and low temperatures, frequent long flights, and regular play on natural and artificial surfaces. Purpose: To study the epidemiology of ACL ruptures and determine the patterns associated with their occurrence in RPL soccer players. Study Design: Descriptive epidemiology study. Methods: All ACL ruptures requiring surgery sustained by players competing in the RPL across 12 competitive seasons between 2010 and 2022 were analyzed. All required data were collected from media analysis and confirmed by club doctors. Results: A total of 85 players sustained 100 injuries during 12 competitive seasons. A total of 96.5% of players returned to competitive play. The injury incidence in RPL and during participation of RPL teams in European Cups were 0.4760 and 0.5622 per 1000 playing hours, respectively. When analyzing the outcomes of the primary ACL surgery (a total of 76 operations), the following data were obtained: in 11 cases (14.5%), there was a reinjury on the ipsilateral knee joint and in 4 cases (5.3%) on the contralateral knee joint. The mean return-to-play time after all operations was 284 ± 116 days. The time of return to play after primary reconstruction was 289 ± 136 days, 278 ± 91 days after reconstruction on the contralateral knee and 271 ± 51.5 days after the first ACL revision reconstruction on the ipsilateral knee joints. Conclusion: RPL ACL injury epidemiology is similar to that in the other leagues from around the world, although there are factors that can potentially influence the number of these injuries.

Physical Activity Readiness Questionnaires for Post-COVID-19 Athletes: A Valid, Reliable, Low-Athlete Burden, Self-Assessment Screening Tool for Safe Return to Physical Activity and Exercise for Categories 1 and 2 COVID-19 Survivors.

Background: No disease-specific, reliable, and valid self-assessment tools exist for athletes with mild coronavirus disease (COVID-19) to self-return to sports. This study aimed to develop a self-assessment screening method for athletes with mild COVID-19. Methods: Item generation, item reduction, and pretesting were used to develop a questionnaire that served as a screening tool to detect severe post-COVID-19 complications. The questionnaire was validated by both internal and external reviewers, and the final version consisted of 11 items. Face validity was assessed through direct interviews with 11 athletes. Severe COVID-19 complications were identified for criterion validity and correlation analysis. A total score of 11 indicates that there is no risk of severe COVID-19 complications and gradual return to play is recommended; results <11 indicate a need for further evaluation by trained medical personnel. For reliability test, 50 respondents were chosen and asked to answer the questionnaires 7 days after their first responses. Results: Physical Activity Readiness Questionnaires for post-COVID-19 athletes (PAR-COVID-Q) demonstrated excellent internal consistency (r=1, P<0.05) and test-retest reliability (r=1, P<0.05). A total of 118 athletes scored 11, had normal health screening, normal electrocardiogram and chest X-ray, and successfully returned to sports without any reported complications (r=1, P<0.05). Two athletes scored <11 and underwent further medical evaluation. Conclusion: The PAR-COVID-Q is a valid and reliable self-assessment tool with a low burden for athletes to return to sports following mild COVID-19.

Lateral extra-articular tenodesis in association to All-inside Anterior Cruciate Ligament reconstruction does not modify return to play in basketball players: a comparative cohort study. / La aumentación con tenodesis extraarticular de la reconstrucción del ligamento cruzado anterior asociado a la técnica "all-inside" no modifica la vuelta al deporte en jugadores de baloncesto federados: estudio de cohortes comparativo.

INTRODUCTION: Return to play rates after anterior cruciate ligament (ACL) reconstruction range between 50-98% depending on sport professionality, without being modified by the addition of an extra-articular augmentation (EA). The objective of the study is to describe the rate of return to play in our cohort. The hypothesis is that the addition of EA increases that rate. MATERIAL AND METHODS: A retrospective, descriptive and analytical study of a 130 basketball players cohort between 18 and 45 years old, whom underwent ACL reconstruction between the years 2018 and 2022, with a minimum follow-up of 18 months. Data was collected by reviewing medical records. IKDC score was registered after one year from surgery. All patients operated from 2020 received an extra-articular tenodesis. RESULTS: Of all patients, 72.31% returned to training, 70.77% returned to competition and 46.15% returned to the same level of performance prior to injury. The EA group (46.15%) did not increase the rate of return to competition (p=0.552) nor to the same level of performance (p=0.664). The mean IKDC. score was 86.83 (SD 14.85), and was not higher in the EA group (p=0.418). However, its value was higher in the players who returned to training, competition and level of performance (p<0.05). EA did not delay the return to play in any group (p=0.282). CONCLUSION: To sum up, the EA does not modify the return to sport rate. Higher IKDC values predict a greater return to sport rate. in all groups. Prospective studies with larger sample size and longer follow-up time are required.

Outcomes and Performance Following Posteromedial Elbow Debridement in Major League Baseball Players.

BACKGROUND: Overhead athletes are particularly susceptible to elbow valgus extension overload syndrome and development of pathologic changes in the posteromedial elbow. Though arthroscopic débridement/osteophyte resection is frequently performed, few studies have analyzed the outcomes of this procedure, and none have specifically addressed professional level athletes. HYPOTHESIS/PURPOSE: We hypothesized that following posteromedial elbow débridement, Major League Baseball (MLB) pitchers would exhibit a higher rate of ulnar collateral ligament (UCL) reconstruction than baseline incidence in the existing literature, along with a decline in pitching performance. METHODS: Using publicly accessible websites, MLB athletes undergoing posteromedial elbow débridement from 2007 to 2022 were identified. Demographic information, procedure details, return to play (RTP) information, return to the disabled/injured list (DL/IL), subsequent UCL reconstruction, and pitching statistics were analyzed. Pitching performance metrics included Earned Runs Average (ERA), Walks Plus Hits Per Innings Pitched (WHIP), innings pitched, and fastball velocity. RESULTS: A total of 39 MLB players, including 26 pitchers, were included. Within the first three seasons after surgery, 82.1% (n=32) of players returned to play at the MLB level at a mean time of 176.1 ± 69 days. Pitchers exhibited a return to play (RTP) rate of 76.9% (n=20) at 175.8 ± 16 days. A total of 38.5% (n=10) of pitchers returned to the DL/IL for elbow-related issues within three seasons. Subsequent UCL reconstruction was seen only in pitchers, with a frequency of 19.2% (n=5). No statistically significant differences between single season pre/postoperative pitching metrics were identified. A small but significant (p<0.05) decrease in fastball velocity (94.4 vs 92.84; p=0.02) was observed over a three-season comparison. CONCLUSION: Contrary to our hypothesis, this study demonstrates that posteromedial elbow débridement is a viable surgery in MLB athletes, with RTP rate of 82.1% and no increase in rate of UCL reconstruction. Furthermore, there was no significant difference in single season pre- and postoperative statistical pitching performance. However, over three years postoperatively, there was a 38.5% rate of return to the DL/IL for ongoing elbow ailment and a significant decrease in pitch velocity, raising some concern over the longevity of postoperative improvements.

A Change-Point Method to Detect Meaningful Change in Return-to-Sport Progression in Athletes.

PURPOSE: To explore how the change-point method can be used to analyze complex longitudinal data and detect when meaningful changes (change points) have occurred during rehabilitation. METHOD: This design is a prospective single-case observational study of a football player in a professional club who sustained an acute lower-limb muscle injury during high-speed running in training. The rehabilitation program was entirely completed in the football club under the supervision of the club's medical team. Four wellness metrics and 5 running-performance metrics were collected before the injury and until the player returned to play. RESULTS: Data were collected over 130 days. In the univariate analysis, the change points for stress, sleep, mood, and soreness were located on days 30, 47, 50, and 50, respectively. The change points for total distance, acceleration, maximum speed, deceleration, and high-speed running were located on days 32, 34, 37, 41, and 41, respectively. The multivariate analysis resulted in a single change point for the wellness metrics and running-performance metrics, on days 50 and 67, respectively. CONCLUSIONS: The univariate approach provided information regarding the sequence and time point of the change points. The multivariate approach provided a common change point for multiple metrics, information that would benefit clinicians to have a broad overview of the changes in the rehabilitation process. Clinicians may consider the change-point method to integrate and visualize data from multiple sources to evaluate athletes' progression along the return-to-sport continuum.

Return to activity is a multi-faceted variable not a discrete yes-no.

OBJECTIVES: To develop a patient reported outcome that allow for tracking of return to activity after injury. By acknowledging that return to activity is not a discrete Yes/No question where participants return to their baseline activity may be unrelated to their treatment a more comprehensive understanding and measurement of the outcome of treatment after injury as it relates to activity participation was developed and evaluated. METHODS: Item development and evaluation were undertaken with the final version tested in an ongoing observational clinical trial. Descriptive statistics and test-re-test analysis using intra class correlation and percent agreement were used. RESULTS: A 5-item set of questions was identified that assess return to activity from a multi-faceted perspective. The final 5-items records preferred activity, days and hours per week of participation, impact of change in participation in activity, degree of limitation in participation and if it is related to injury or external factors. . Over 30% of the population reported that their participation in their preferred activity was no longer active and not related to their injury but other factors demonstrating the importance of documenting more than one variable. CONCLUSION: The Minnesota Activity Scale provides standardized questions to comprehensively assess return to activity as a marker of treatment effectiveness. LEVEL OF EVIDENCE: V.

Factors that influence the angular error in active knee angle reproduction tests: A systematic review and meta-analysis.

Purpose: The systematic review and meta-analysis investigated subject-independent test factors that influence the absolute angle error in active knee angle reproduction tests. Methods: Five electronic databases were searched to identify relevant studies published before 20 December 2023. Studies were included that were published in either English or German and that investigated joint proprioception in the healthy knee. Included studies were also required to have participants 18-60 years old and free of lower-limb injury, neurological disorders and diseases affecting joint position sense. Risk of bias was assessed using a Cochrane risk-of-bias tool. Results: Of the 2023 articles identified, 26 studies (1082 participants) were included in the meta-analysis. The meta-analysis showed a significant pooled standard mean difference in the absolute angular error for body orientation, direction of movement and fatigue. Active knee angle reproduction tests were found to have a lower absolute angular error when performed in the sitting position compared to the prone position (SMD = -0.56; 95% CI = -1.00 to -0.12). The absolute angular error was found to be greater in cases of knee flexion compared to knee extension (SMD = 0.71; 95% CI = 0.18-1.24). General and local muscle fatigue were found to result in a higher absolute angular error (SMD = 1.39; 95% CI = 1.04-1.75). Conclusion: Hence, fatigue, body orientation and direction of movement influence the extent of the absolute angular error in active knee angle reproduction tests. Practitioners should be aware that the test conditions and the patient's level of fatigue can affect the results of such tests and that directly comparing results obtained using different test protocols may not be appropriate. The test protocol should be well documented and applied consistently in the clinical setting. Level of Evidence: Level III, systematic review with meta-analysis.

Quantitative pupillometry as a biomarker for prediction of return to play in mild traumatic brain injury: a Military Traumatic Brain Injury Initiative study.

OBJECTIVE: This study aimed to determine the validity of quantitative pupillometry to predict the length of time for return to full activity/duty after a mild traumatic brain injury (mTBI) in a cohort of injured cadets at West Point. METHODS: Each subject received baseline (T0) quantitative pupillometry, in addition to evaluation with the Balance Error Scoring System (BESS), Standardized Assessment of Concussion (SAC), and Sport Concussion Assessment Tool 5th Edition Symptom Survey (SCAT5). Repeat assessments using the same parameters were conducted within 48 hours of injury (T1), at the beginning of progressive return to activity (T2), and at the completion of progressive return to activity protocols (T3). Pupillary metrics were compared on the basis of length of time to return to full play/duty and the clinical scores. RESULTS: The authors' statistical analyses found correlations between pupillometry measures at T1, including end-initial diameter and maximum constriction velocity, with larger change and faster constriction predicting earlier return to play. There was also an association with maximum constriction velocity at baseline (T0), predicting faster return to play. CONCLUSIONS: The authors conclude that that pupillometry may be a valuable tool for assessing time to return to duty from mTBI by providing a measure of baseline resiliency to mTBI and/or autonomic dysfunction in the acute phase after mTBI.

Assessing readability of online patient educational material on concussion and return to play.

OBJECTIVE: Concussions are self-limited forms of mild traumatic brain injury (TBI). Gradual return to play (RTP) is crucial to minimizing the risk of second impact syndrome. Online patient educational materials (OPEM) are often used to guide decision-making. Previous literature has reported that grade-level readability of OPEM is higher than recommended by the American Medical Association and the National Institutes of Health. The authors evaluated the readability of OPEM on concussion and RTP. METHODS: An online search engine was used to identify websites providing OPEM on concussion and RTP. Text specific to concussion and RTP was extracted from each website and readability was assessed using the following six standardized indices: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. One-way ANOVA and Tukey's post hoc test were used to compare readability across sources of information. RESULTS: There were 59 concussion and RTP articles, and readability levels exceeded the recommended 6th grade level, irrespective of the source of information. Academic institutions published OPEM at simpler readability levels (higher FRE scores). Private organizations published OPEM at more complex (higher) grade-level readability levels in comparison with academic and nonprofit institutions (p < 0.05). CONCLUSIONS: The readability of OPEM on RTP after concussions exceeds the literacy of the average American. There is a critical need to modify the concussion and RTP OPEM to improve comprehension by a broad audience.

Sport-related concussions in baseball and softball: do mechanisms of injury affect recovery?

OBJECTIVE: Baseball and softball pose unique risks for sport-related concussion (SRC). Although these are not collision sports, concussions in baseball and softball can nonetheless involve high-speed impacts. In a regional, single-institution cohort of baseball and softball athletes who sustained an SRC, the current study sought to 1) describe the mechanisms of injury that led to SRC, and 2) compare initial symptom burden and recovery metrics across mechanisms, including time to return to learn (RTL), time to symptom resolution, and time to return to play (RTP) by mechanism of injury. METHODS: A retrospective cohort study was performed of baseball and softball athletes 12 to 23 years old who sustained an SRC between November 2017 and April 2022. Mechanisms of injury were divided into two categories: 1) contact mechanism (i.e., what initiated contact with the injured player, such as head-to-ball), and 2) player mechanism (i.e., the action the injured player was performing at the time of injury, such as fielding). The recovery outcomes of time to RTL, symptom resolution, and RTP were compared between mechanisms using bivariate analysis and multivariable regression analysis, controlling for sex, age, time to present to concussion clinic, and initial total symptom score. RESULTS: The sample included 58 baseball and softball players (60.3% female, mean age 16.0 ± 1.9 years). Most SRCs (62.1%) occurred during competition. Head-to-ball (50.0%) was the most common contact mechanism, followed by head-to-head/body (31.0%) and head-to-wall/ground/equipment (17.2%). Fielding (63.8%) was the most common player mechanism, followed by drills (20.7%) and running (13.8%). SRCs sustained in practice had significantly longer RTL (median 10.0 [interquartile range (IQR) 3.3-16.3] vs 4.0 [IQR 2.0-8.0] days; U = 421.5, p = 0.031) and symptom resolution (37.0 [IQR 18.0-90.0] vs 14.0 [IQR 7.0-41.0] days; U = 406.5, p = 0.025) compared with SRCs sustained in competition. Multivariable regression analysis revealed that head-to-wall/ground/equipment contact mechanism was associated with longer RTL (ß = 0.30, 95% CI 0.07-0.54, p = 0.013). CONCLUSIONS: The current study found that SRCs in baseball and softball occurred more often in competition than in practice. Head-to-ball and fielding were the most common contact and player mechanisms, respectively. SRCs sustained in practice were associated with longer time to RTL and symptom resolution, and head-to-wall/ground/equipment was associated with longer RTL in multivariable regression analysis. These results provide empirical data to improve concussion safety in baseball/softball.

Concussions in ice hockey: mixed methods study including assessment of concussions on games missed and cap hit among National Hockey League players, systematic review, and concussion protocol analysis.

OBJECTIVE: Concussions can occur at any level of ice hockey. Incidence estimates of concussions in ice hockey vary, and optimal prevention strategies and return-to-play (RTP) considerations have remained in evolution. The authors performed a mixed-methods study with the aim of elucidating the landscape of concussion in ice hockey and catalyzing initiatives to standardize preventative mechanisms and RTP considerations. METHODS: The authors performed a five-part mixed-methods study that includes: 1) an analysis of the impact of concussions on games missed and income for National Hockey League (NHL) players using a publicly available database, 2) a systematic review of the incidence of concussion in ice hockey, 3) a systematic review of preventative strategies, 4) a systematic review of RTP, and 5) a policy review of documents from major governing bodies related to concussions in sports with a focus on ice hockey. The PubMed, Embase, and Scopus databases were used for the systematic reviews and focused on any level of hockey. RESULTS: In the NHL, 689 players had 1054 concussions from the 2000-2001 to 2022-2023 seasons. A concussion led to a mean of 13.77 ± 19.23 (range 1-82) games missed during the same season. After cap hit per game data became available in 2008-2009, players missed 10,024 games due to 668 concussions (mean 15.13 ± 3.81 per concussion, range 8.81-22.60 per concussion), with a cap hit per game missed of $35,880.85 ± $25,010.48 (range $5792.68-$134,146.30). The total cap hit of all missed games was $385,960,790.00, equating to $577,635.91 per concussion and $25,724,052.70 per NHL season. On systematic review, the incidence of concussions was 0.54-1.18 per 1000 athlete-exposures. Prevention mechanisms involved education, behavioral and cognitive interventions, protective equipment, biomechanical studies, and policy/rule changes. Rules prohibiting body checking in youth players were most effective. Determination of RTP was variable. Concussion protocols from both North American governing bodies and two leagues mandated that a player suspected of having a concussion be removed from play and undergo a six-step RTP strategy. The 6th International Conference on Concussion in Sport recommended the use of mouthguards for children and adolescents and disallowing body checking for all children and most levels of adolescents. CONCLUSIONS: Concussions in ice hockey lead to substantial missed time from play. The authors strongly encourage all hockey leagues to adopt and adhere to age-appropriate rules to limit hits to the head, increase compliance in wearing protective equipment, and utilize high-quality concussion protocols.

Acute psychological symptom profiles in high school athletes following sport-related concussion.

OBJECTIVE: Psychological symptoms following a sport-related concussion may affect recovery in adolescent athletes. Therefore, the aims of this study were to 1) describe the proportion of athletes with acute psychological symptoms, 2) identify potential predictors of higher initial psychological symptoms, and 3) determine whether psychological symptoms affect recovery in a cohort of concussed high school athletes. METHODS: A retrospective cohort study of high school athletes (14-18 years of age) who sustained a sport-related concussion from November 2017 to April 2022 and presented to a multidisciplinary concussion center was performed. The main independent variable was psychological symptom cluster score, calculated by summing the four affective symptoms on the initial Post-Concussion Symptom Scale (PCSS) (i.e., irritability, sadness, nervousness, feeling more emotional). The psychological symptom ratio was defined as the ratio of the psychological symptom cluster score divided by the total initial PCSS score. The outcomes included time to return to learn (RTL), symptom resolution, and time to return to play (RTP). Univariable and multivariable regressions were performed to adjust for demographic factors and health history. RESULTS: A total of 431 athletes (58.0% female, mean age 16.2 ± 1.3 years) were included. Nearly half of the sample (45%) reported at least one psychological symptom, with a mean psychological symptom cluster score of 4.2 ± 5.2 and psychological symptom cluster ratio of 0.10 ± 0.11. Irritability was the most commonly endorsed psychological symptom (38.1%), followed by feeling more emotional (30.2%), nervousness (25.3%), and sadness (22.0%). Multivariable regression showed that female sex (B = 2.15, 95% CI 0.91-3.39; p < 0.001), loss of consciousness (B = 1.91, 95% CI 0.11-3.72; p = 0.037), retrograde/anterograde amnesia (B = 1.66, 95% CI 0.20-3.11; p = 0.026), and psychological history (B = 2.96, 95% CI 1.25-4.70; p < 0.001) predicted an increased psychological symptom cluster score. Female sex (B = 0.03, 95% CI 0.00-0.06; p = 0.031) and psychological history (B = 0.06, 95% CI 0.02-0.10; p = 0.002) predicted an increased psychological symptom ratio. Multivariable linear regression showed that both higher psychological symptom cluster score and ratio were associated with longer times to RTL, symptom resolution, and RTP. CONCLUSIONS: In a cohort of high school athletes, 45% reported at least one psychological symptom, with irritability being most common. Female sex, loss of consciousness, amnesia, and a psychological history were significantly associated with an increased psychological symptom cluster score. Higher psychological symptom cluster score and psychological symptom ratio independently predicted longer recovery. These results reinforce the notion that psychological symptoms after concussion are common and may negatively impact recovery.

Acute Concussion.

Concussions are the most common type of traumatic brain injury. They result from external force to the head that causes a neuro-metabolic cascade to unfold. This can then lead to a variety of symptoms in the domains of physical, cognition, mood, and sleep. Concussions are a clinical diagnosis but it is important to rule out acute intracranial pathology through a detailed history and physical examination in addition to possible head imaging. Treatment should include an individualized approach that focuses on what domains are affected after concussion.

Long-term Outcomes of Multiligament Knee Injuries in American Football Players.

BACKGROUND: Long-term outcomes for isolated anterior cruciate ligament (ACL) reconstructions in competitive American football athletes are well reported in the literature, but little data currently exist regarding multiligament knee injury (MLKI) reconstruction outcomes. PURPOSE: To examine patient-reported and return-to-sport outcomes of competitive American football athletes who underwent primary, single-staged, multiligament knee reconstruction. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We identified patients from our institution's prospectively collected data repository between 2001 and 2020 who underwent single-staged surgical reconstruction of an MLKI sustained during competitive participation in American football. We assessed patient-reported outcomes at a minimum of 2 years after surgery using the International Knee Documentation Committee (IKDC) Subjective Knee Form and questions regarding surgical satisfaction and return to sport. Successful return to sport was defined as a return to preinjury level of competition. We summarized all outcome data and compared outcomes between 2-ligament and >2-ligament groups and between ACL-only MLKI injury and bicruciate MLKI injury groups using independent t test for IKDC scores and chi-square test for return to sport. Additionally, we evaluated predictors of postoperative IKDC scores using linear regression and predictors of return to sport using logistic regression. RESULTS: Outcome data were successfully collected for 53 of 73 total eligible patients (73%; mean follow-up time, 7.7 ± 4.0 years; all male; mean age at surgery, 18.1 ± 2.7 years). The mean postoperative IKDC score was 84 ± 16. The most common level of preinjury competition was high school (n = 36; 68%), followed by college (n = 10; 19%). Seven patients did not return to sport competition at any level due to limitations from their knee surgery, and 82% of patients that attempted to return to preinjury level of sport were able to do so. A total of 50 patients (94%) were satisfied or very satisfied with their surgical outcome. The 2-ligament (n = 39) and >2-ligament (n = 14) groups did not significantly differ in IKDC scores (P = .96) or proportions with successful return to sport (P = .77). Similarly, the ACL-MLKI injury (n = 39) and bicruciate MLKI injury (n = 14) groups did not significantly differ in IKDC scores (P = .89) or proportions with successful return to sport (P = .77). Age and body mass index were not significantly associated with IKDC scores or successful return to sport at follow-up (all P > .05). CONCLUSION: This study may represent the largest cohort of competitive American football athletes evaluated for longitudinal outcomes after multiligament knee reconstruction. Despite the severity of these injuries, we found good knee-related function and that the large majority of athletes who attempted to return to sport were successful. The majority of athletes (94%) were satisfied with their operative treatment.

The Role of Platelet-Rich Plasma Injection for Muscle Strains in Athletes.

Muscle tears/strains are among the most common musculoskeletal injuries, posing a serious challenge for sports medicine. Aiming to reduce the time to return to play and the rate of reinjuries, apart from the traditional conservative treatments and rehabilitation protocols, new and innovative therapeutic options have emerged, particularly platelet-rich plasma (PRP). This study aims to present the available evidence regarding PRP injection for the treatment of muscle strains in athletes. Two databases were searched for articles published between January 2012 and December 2022 in Portuguese or English. The query used for the PubMed database was ("Muscles/injuries"[Mesh]) AND ("Athletes"[Mesh] OR "Athletic Injuries"[Mesh]) AND "Platelet-Rich Plasma"[Mesh], while for the Web of Science database the search was performed for "Platelet-rich plasma" AND "Muscle injuries" AND ("Athletes" OR "Athletic injuries"). Eleven studies involving athletes diagnosed with muscle injuries who received treatment with PRP injection alone, or in combination with traditional conservative treatment, compared to a control group, were included. Four randomized controlled trials, four systematic reviews/meta-analyses, two retrospective studies, and one comparative study were included. Current evidence from the highest-quality studies does not support the hypothesis of reduction of time to return to play and the rate of reinjuries after PRP injection, even though some studies reported positive results. However, the available evidence suggests that PRP might have a beneficial effect on the pain perceived by athletes following an acute muscle strain. It is challenging to arrive at definitive conclusions and translate these findings into a clinical context for treating muscle strains in athletes. The existing trials present several inconsistencies and limitations, with a heterogeneous set of patients and injuries, as well as the use of different and inconsistent methods for preparing, administering, and measuring the effects of PRP. To achieve consistent outcomes, standardizing PRP administration procedures is essential.

Overview of Treatment Options for Mild Traumatic Brain Injury: A Literature Review.

The incidence and prevalence of concussion, a type of mild traumatic brain injury (mTBI), have steadily increased among athletes, both students and professionals, across a wide variety of sports, including, but not limited to, swimming, tennis, football, and boxing. Recent data have demonstrated that sports are one of the leading causes of concussions among student athletes. While the exact mechanism of concussion onset has yet to be fully elucidated, data suggest that the pathophysiology involves rotational acceleration and deceleration of the brain, leading to axon tearing and disturbance in the metabolic cascade of glucose. Concussive events can have debilitating effects on an athlete, including chronic traumatic encephalopathy (gradual degeneration of brain tissue) that is related to personality changes, emotional disorders, and even dementia. Common symptoms associated with concussion include dizziness, nausea, vomiting, and headaches. The physical assessment consists of a combination of tools involving the mental status examination, vital signs, cervical spine exam, eye exam, and neurological testing. The use of osteopathic manipulative medicine (OMM), pharmacotherapy, hyperbaric oxygen therapy (HBOT), aerobic exercise, balance, and/or vestibular therapy are many common treatment approaches for concussion and post-concussion sequelae. This literature review aims to provide insight into concussions, the current treatment options available, and the new developments in concussions per the Amsterdam 2022 International Consensus Statement on Concussion in Sport published in 2023.

High variability among surgeons in evaluation, treatment, and rehabilitation of medial ulnar collateral ligament injuries.

Hypothesis and/or Background: The incidence of elbow medial ulnar collateral ligament (MUCL) injuries has been increasing, leading to advances in surgical treatments. However, it is not clear that there is consensus among surgeons regarding diagnostic imaging, the indications for acute surgery and postoperative rehabilitation. The purpose of this study is evaluate surgeon variability in the presurgical, surgical, and postsurgical treatment of MUCL injuries regarding the imaging modalities used for diagnosis, indications for acute surgical treatment, and postoperative treatment recommendations for rehabilitation and return to play (RTP). Our hypothesis is that indications for acute surgical treatment will be highly variable based on MUCL tear patterns and that agreement on the time to RTP will be consistent for throwing athletes and inconsistent for nonthrowing athletes. Methods: A survey developed by 6 orthopedic surgeons with expertise in throwing athlete elbow injuries was distributed to 31 orthopedic surgeons who routinely treat MUCL injuries. The survey evaluated diagnostic and treatment topics related to MUCL injuries, and responses reaching 75% agreement were considered as high-level agreement. Results: Twenty-four surgeons responded to the survey, resulting in a 77% response rate. There is 75% or better agreement among surveyed surgeons regarding acute surgical treatment for distal full thickness tears, ulnar nerve transposition in symptomatic patients or with ulnar nerve subluxation, postoperative splinting for 1-2 weeks with initiation of rehabilitation within 2 weeks, the use of bracing after surgery and the initiation of a throwing program at 3 months after MUCL repair with internal brace by surgeons performing 20 or more MUCL surgeries per year. There were a considerable number of survey topics without high-level agreement, particularly regarding the indications for acute surgical treatment, the time to return to throwing and time RTP in both throwing and nonthrowing athletes. Discussion and/or Conclusion: The study reveals that there is agreement for the indication of acute surgical treatment of distal MUCL tears, duration of bracing after surgery, and the time to initiate physical therapy after surgery. There is not clear agreement on indications for surgical treatment for every MUCL tear pattern, RTP time for throwing, hitting and participation in nonthrowing sports.

Twisting technique for ulnar collateral ligament reconstruction of the elbow: new possibilities toward enhancing the strength of autografts.

Background: Although the ulnar collateral ligament reconstruction procedure has been increasing in popularity annually owing to its stable postoperative outcomes, the number of revision surgeries following ulnar collateral ligament reconstruction has increased. The success of the initial reconstruction surgery and further improvement in the return-to-play rates of the initial surgery are crucial. In this study, we report on ulnar collateral ligament reconstruction using the twisting technique, which aims to enhance the strength of the graft (palmaris longus tendon) to improve return-to-play rates. Methods: We investigated the return-to-play rate and period in 60 cases (2016-2021) that underwent ulnar collateral ligament reconstruction using the twisting technique and 211 cases (2007-2019) that did not use the twisting technique. The twisting technique involved inserting the graft through the bone tunnel and then twisting the doubled tendon. Results: According to the Conway-Jobe scale, the twisting technique group had 98.3% excellent, 1.7% good, 0% fair, and 0% poor results, with a mean return-to-play period of 9.8 months. The non-twisting technique group had 86.7% excellent, 9.0% good, 1.9% fair, and 2.4% poor results, with a mean return-to-play period of 11.4 months. The two groups showed significant differences in return-to-play rate (P = .020) and period (P = .022). Conclusion: The clinical results of the twisting technique showed that the return-to-play rate of the twisting technique group was higher after than before the procedure, and the return-to-play period was shortened by more than 1 month. The twisting technique may improve the results of ulnar collateral ligament reconstruction surgery.

Are Functional Performance Test Scores Better When Compared to Baseline or Contralateral Limb Scores Following LE Injury in Adolescent Athletes?

Background: Functional performance tests (FPT) have been used with athletes following an injury to determine readiness to return-to-play (RTP), usually using limb symmetry indices to the contralateral limb or a baseline score. There is not a consensus as to which criterion scores are best compared. Hypothesis/Purpose: This study aimed to compare common functional performance test scores from injured athletes at the time of release to RTP to both preseason baseline scores and to the contralateral limb. It was hypothesized that using baseline scores for comparison would be more responsive to residual deficits following injury than using the contralateral limb. Study Design: Prospective longitudinal cohort study. Methods: High school athletes (n=395) from all varsity sports completed a battery of FPTs including the Y-Balance Test (YBT), single limb hop tests and T-Test for agility (TT) during their preseason to establish baseline data. Injured athletes (n=19) were re-tested using all FTP's again at the time of RTP. Paired t-tests were used to detect if significant (p\<0.05) residual deficits were present at time of RTP when compared to baseline and to contralateral scores on FPTs. Results: Differences in YBT scores were found in the anterior direction only (p=0.021) when comparing RTP to preseason, but there were no differences when compared to RTP data for the contralateral limb. Differences were detected with the single leg hop test (p = 0.001) when comparing the RTP to preseason and were also detected in both the single leg hop (p= 0.001) and triple hop (p=0.018) when compared to the contralateral limb. Differences in TT scores were detected when comparing RTP to preseason for cutting first with both the unaffected (p = 0.019) and affected (p = 0.014) limbs. Conclusions: The YBT in the anterior direction and the TT are better able to detect residual deficits when comparing RTP to preseason scores. Hop tests are better able to detect deficits when compared to the contralateral limb. These results could make preseason testing more efficient when creating a reference for determining RTP readiness following lower extremity injury.