The Surgical Management of NCAA Division 1 College Football Injuries Post COVID-19: A Single Institution Retrospective Review.

ABSTRACT: Cohen, JL, Cade, WH, Harrah, TC, Costello II, JP, and Kaplan, LD. The surgical management of NCAA Division 1 college football injuries post COVID-19: A single institution retrospective review. J Strength Cond Res 38(5): 906-911, 2024-The unprecedented COVID-19 pandemic had a significant impact on college football operations, including athletes' training regimens. As a result of these changes, concern for increased injury susceptibility post COVID-19 regulations has become a point of discussion. The current study sought to evaluate the incidence of surgical injury among NCAA Division 1 college football players at the authors' institution during the first full season after start of the COVID-19 pandemic compared with previous years. Retrospective chart review was performed for all players who sustained injuries requiring surgery while a member of the NCAA Division 1 football program during the 2009-2021 seasons. A p -value of ≤0.05 was used to determine significance. A total of 23 surgical injuries occurred in 22 players during the 2021 season compared with 121 in 118 players in the 12 previous seasons combined ( p = 0.0178; RR = 1.47). There was a significant increase in shoulder injuries ( n = 13 vs. n = 31; p = <0.0001; RR = 3.05) and specifically a significant increase in labral tears ( n = 10 vs. n = 30; p = 0.0003; RR = 2.74). No difference was seen in knee injuries ( n = 10 vs. n = 77; p = 0.27; RR = 1.35) and specifically no difference in anterior cruciate ligament injuries ( n = 3 vs. n = 31; p = 0.77; RR = 1.17). This phenomenon is multifactorial in nature, but alterations to players' training and preparations because of the COVID-19 pandemic likely resulted in suboptimal conditioning, leading to the increased incidence of surgical injuries emphasizing the importance of adequate strength training and conditioning.

A Comparison of Two-Year Anterior Cruciate Ligament Reconstruction Clinical Outcomes Using All-Soft Tissue Quadriceps Tendon Autograft With Femoral/Tibial Cortical Suspensory Fixation Versus Tibial Interference Screw Fixation.

PURPOSE: To contribute to future quadriceps tendon harvest and fixation guidelines in the setting of anterior cruciate ligament reconstruction by comparing 2-year patient-reported subjective knee outcome scores and incidence of graft-related complications between the shorter harvest all-inside tibial-femoral suspensory fixation (TFSF) approach versus the longer harvest standard tibial interference screw fixation technique. METHODS: Patients who underwent primary anterior cruciate ligament reconstruction with all soft tissue quadriceps tendon autograft from January 2017 to May 2019 were identified for inclusion. Patients were matched into 2 cohorts of 62 based on reconstruction technique. All patients completed baseline and minimum 2-year International Knee Documentation Committee, Tegner Activity Level, and Lysholm questionnaires and were queried regarding subsequent procedures and complications to the operative knee. RESULTS: Average graft length for the all-inside TFSF was 69.55 (95% confidence interval 68.99-70.19) mm versus 79.27 (95% confidence interval 77.21-81.34) mm in the tibial screw fixation cohort (P = .00001). Two-year Lysholm scores were greater in the TFSF cohort (P = .04) but were not clinically significant. There was no difference in 2-year International Knee Documentation Committee (P = .09) or Tegner (P = .69) scores between cohorts, but more patients in the TFSF cohort returned to or exceeded their baseline activity level compared with the tibial screw fixation cohort (73% vs 61%, P = .25). Seven patients in the TFSF cohort versus 13 in the tibial screw fixation cohort reported anterior knee pain or kneeling difficulty (P = .22). There were no differences in reported complications. CONCLUSIONS: All-inside soft-tissue quadriceps tendon autograft with TFSF resulted in clinically comparable subjective outcome scores at 2 years to tibial screw fixation. There were also no differences in complications or reports of anterior knee pain or kneeling difficulty. All-inside TFSF can be a viable alternative to tibial screw fixation for all-soft tissue quadriceps autograft. LEVEL OF EVIDENCE: III, comparative therapeutic trial.

Telehealth in an Orthopedic Sports Medicine Clinic: The First 100 Patients.

Background: Orthopedic specialties have begun to embrace telehealth as an alternative to in-person visits. We have not found studies assessing telehealth in sports medicine. Our goal is to evaluate patient perception of telehealth in an orthopedic sports medicine practice. Methods: Institutional review board (IRB) approval was obtained. The first 100 patients 18 years and older who had their initial videoconference telehealth appointment with our sports medicine providers from March to April 2020 were contacted at the conclusion of their visit. Surveys assessed satisfaction with telehealth, the provider, and whether attire played a role in their perception of the quality of the telehealth visit. Results: Patients on average stated excellent satisfaction with their visit (4.76 out of 5) and their provider (4.98 out of 5). Patients slightly disagreed with the notion that telehealth is equivalent to in-person provider visits (2.95 out of 5). This did not affect their perception to telehealth itself. It did not discourage patients from recommending telehealth or their provider to future patients. Patients overall felt that attire of the provider does not influence their opinion as to the standard of care they received. Returning patients versus new patient visits were more likely to recommend telehealth to others (4.83 vs. 4.56, p = 0.04). The responses from both groups were overwhelmingly positive. Conclusion: Telehealth is a viable clinic option in an orthopedic sports medicine clinic. Patients who have seen providers in-person previously are more likely to recommend telehealth versus new patients. New patients were satisfied with their telehealth experience. Level of Evidence:IV.

Training, Injury, and Lifestyle Characteristics of Recreational Triathletes.

ABSTRACT: Triathlon is a popular sport among recreational and competitive athletes. As triathletes compete in races ranging from 16 to 140.6 miles and train in three disciplines simultaneously, it is difficult to identify injury risk factors. The aim of this study was to evaluate characteristics of a group of recreational triathletes regarding their medical history, training regimen, and injuries. Thirty-four triathletes completed this survey. We found a wide range of body types, training habits, and lifestyle characteristics. As in previous studies, we found a high rate of injuries in our surveyed triathletes. Injury rates were higher in athletes who had completed a longer race and those who reported higher training times per week. Additionally, many individuals have medical problems, use a variety of supplements, and follow specific dietary restrictions, which need to be considered in addition to training when assessing injury risk and recovery from injury.

Supplement Use in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review.

PURPOSE: To assess whether a standardized dietary supplementation can help to decrease postoperative muscle atrophy and/or improve rehabilitation outcomes in patients who underwent anterior cruciate ligament reconstruction (ACLR). METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). MEDLINE, Scopus, and Cochrane Library databases were searched, and articles that examined protein or amino acid, vitamin, or any other type of supplementation in ACLR were reviewed. Two independent reviewers conducted the search using pertinent Boolean operations. RESULTS: A total of 1818 articles were found after our database search. Ten studies fulfilled our inclusion criteria and only assessed patients undergoing ACLR. Four studies assessed protein-based supplementation. One study assessed creatine as a supplement. Four studies assessed vitamin-based supplementation. One study assessed testosterone supplementation. Protein and amino acid supplementation showed potential benefits; multiple authors demonstrated a combination of improved achievement of rehabilitation benchmarks, graft maturation, muscular hypertrophic response, and peak dynamic muscle strength. When we examined creatine, vitamin, or hormone-based protocols, none demonstrated results, suggesting these factors may attenuate muscle atrophy after surgery. Vitamin C and E demonstrated potentially increased local inflammation in skeletal muscle, which runs contrary to the belief that antioxidant vitamin-based supplementation may decrease the inflammatory response that plays a role in the post injury/operative period. CONCLUSIONS: Protein-based supplementation may play a role in mitigating muscle atrophy associated with ACLR, as multiple authors demonstrated a combination of improved achievement of rehabilitation benchmarks, thigh hypertrophic response, and peak dynamic muscle strength. However, based on current literature, it is not possible to recommend a specific protein-based supplementation protocol at this time for patients undergoing ACLR. Limited evidence suggests no benefit for creatine, vitamin, or hormone-based protocols. LEVEL OF EVIDENCE: II, a systematic review of level I-II studies.

Genetic factors in nonsmokers with age-related macular degeneration revealed through genome-wide gene-environment interaction analysis.

Relatively little is known about the interaction between genes and environment in the complex etiology of age-related macular degeneration (AMD). This study aimed to identify novel factors associated with AMD by analyzing gene-smoking interactions in a genome-wide association study of 1207 AMD cases and 686 controls of Caucasian background with genotype data on 668,238 single nucleotide polymorphisms (SNPs) after quality control. Participants' history of smoking at least 100 cigarettes lifetime was determined by a self-administered questionnaire. SNP associations modeled the effect of the minor allele additively on AMD using logistic regression, with adjustment for age, sex, and ever/never smoking. Joint effects of SNPs and smoking were examined comparing a null model containing only age, sex, and smoking against an extended model including genotypic and interaction terms. Genome-wide significant main effects were detected at three known AMD loci: CFH (P = 7.51×10(-30) ), ARMS2 (P = 1.94×10(-23) ), and RDBP/CFB/C2 (P = 4.37×10(-10) ), while joint effects analysis revealed three genomic regions with P < 10(-5) . Analyses stratified by smoking found genetic associations largely restricted to nonsmokers, with one notable exception: the chromosome 18q22.1 intergenic SNP rs17073641 (between SERPINB8 and CDH7), more strongly associated in nonsmokers (OR = 0.57, P = 2.73 × 10(-5) ), with an inverse association among smokers (OR = 1.42, P = 0.00228), suggesting that smoking modifies the effect of some genetic polymorphisms on AMD risk.

Aggressiveness and size: a model and two tests.

Individual variation in aggressive behavior in animals might be caused by adaptive covariation with body size. We developed a model that predicts the benefits of aggressiveness as a function of body size. The model indicated that individuals of intermediate sizes would derive the greatest benefits from being aggressive. If we assume that the cost of aggression is approximately uniform with respect to body size, selection should favor higher aggression in intermediate-sized individuals than in large or small individuals. This prediction was tested by stimulating male Madagascar hissing cockroaches, Gromphadorhina portentosa, with disembodied antennae and recording the males' aggressive responses. Antennae from larger males evoked weaker responses in subjects, suggesting that males obtained information about their opponents' size from the opponents' antennae alone. After accounting for this effect, we found support for the key prediction of our model: aggressiveness peaked at intermediate sizes. Data from actual male-male interactions validated that the antenna assay accurately measured aggressiveness. Analysis of an independent data set generated by staging male-male interactions also supported the prediction that intermediate-sized males were most aggressive. We conclude that adaptive covariation between body size and aggressiveness explains some interindividual variation in aggressiveness.

Molecular biogeography and host relations of a parasitoid fly.

Successful geographic range expansion by parasites and parasitoids may also require host range expansion. Thus, the evolutionary advantages of host specialization may trade off against the ability to exploit new host species encountered in new geographic regions. Here, we use molecular techniques and confirmed host records to examine biogeography, population divergence, and host flexibility of the parasitoid fly, Ormia ochracea (Bigot). Gravid females of this fly find their cricket hosts acoustically by eavesdropping on male cricket calling songs; these songs vary greatly among the known host species of crickets. Using both nuclear and mitochondrial genetic markers, we (a) describe the geographical distribution and subdivision of genetic variation in O. ochracea from across the continental United States, the Mexican states of Sonora and Oaxaca, and populations introduced to Hawaii; (b) demonstrate that the distribution of genetic variation among fly populations is consistent with a single widespread species with regional host specialization, rather than locally differentiated cryptic species; (c) identify the more-probable source populations for the flies introduced to the Hawaiian islands; (d) examine genetic variation and substructure within Hawaii; (e) show that among-population geographic, genetic, and host song distances are all correlated; and (f) discuss specialization and lability in host-finding behavior in light of the diversity of cricket songs serving as host cues in different geographically separate populations.

Patient-Reported Knee Outcome Scores With Soft Tissue Quadriceps Tendon Autograft Are Similar to Bone-Patellar Tendon-Bone Autograft at Minimum 2-Year Follow-up: A Retrospective Single-Center Cohort Study in Primary Anterior Cruciate Ligament Reconstruction Surgery.

BACKGROUND: Quadriceps tendon (QT)-bone autografts used during anterior cruciate ligament (ACL) reconstruction have provided comparable outcomes and decreased donor-site morbidity when compared with bone-patellar tendon-bone (BPTB) autografts. No study has directly compared the outcomes of the all-soft tissue QT autograft with that of the BPTB autograft. HYPOTHESIS: Patient-reported knee outcome scores and rates of postoperative complication after primary ACL reconstruction with QT autografts are no different from BPTB autografts at a minimum 2-year follow-up. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 75 patients who underwent primary autograft ACL reconstruction with QT or BPTB autografts between January 1, 2015, and March 31, 2016, at a single hospital center were contacted by telephone and asked to complete the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation, Tegner activity level scale, and Lysholm knee scoring scale. Information about the subsequent surgeries performed on the operative knee was also collected. Statistical analysis was performed using the Kruskal-Wallis test and the Fisher exact test for categorical data. RESULTS: Fifty patients (28 QT, 22 BPTB) completed the surveys at a mean follow-up of 33.04 months (range, 24-44 months). For the QT versus the BPTB group respectively, the median IKDC scores were 94.83 (interquartile range [IQR], 7.61) versus 94.83 (IQR, 10.92) (P = .47), the median Tegner scores were 6 (IQR, 2.5) versus 6 (IQR, 2.75) (P = .48), and the median Lysholm scores were 95 (IQR, 9) versus 95 (IQR, 13) (P = .27). Additionally, 2 QT patients and 3 BPTB patients required follow-up arthroscopy for arthrolysis (P = .64). There was 1 graft failure in the QT group requiring revision surgery. CONCLUSION: There was no statistical difference in patient-reported knee outcomes or graft complication rates between the QT and BPTB autograft groups at a minimum 2-year follow-up after primary ACL reconstruction. This study highlights that the all-soft tissue QT autograft may be a suitable graft choice for primary ACL reconstruction.

Novel approach to improve patient satisfaction in the outpatient clinic setting.

BACKGROUND: With evolving reimbursement patterns and an emphasis on value-based care, patient satisfaction is increasingly becoming a more important metric. However, there remains a dearth of literature examining potential strategies to improve patient satisfaction in the outpatient setting. This study investigates if overall perception of care is influenced by providing biosketch cards to new patients in an outpatient Sports Medicine clinic. METHODS: 144 new patients were assigned to an intervention group based on the date of visit from 3/2017 to 8/2017. Eligible patients received a treating physician biosketch card (Group A), clinical practice biosketch card (Group B) or no additional literature (Control group) during the clinic check-out process. Via email, patients were asked to rate: 1- quality of care, 2- treated with courtesy and respect, 3- listened to carefully, 4- was explained things in a way you could understand, 5- overall rating, 6- recommend to family and friend? We also collected age, gender, level of education, and response time. The three groups were compared. RESULTS: 96 (66.7%) patients responded with 32 patients in each group (physician biosketch, clinic biosketch, no intervention). There were no significant demographic differences between the groups. The average age was 51.8 years with 52% being male. Mean time from visit to response was 1.6 days. The only significant difference occurred for rating "how would you rate your orthopedic doctor with treating you with courtesy and respect?", however, post hoc analysis failed to reveal a significant difference in response between each study group. There was no statistical difference between the remaining questions on patient satisfaction. CONCLUSION: Increasing a new patient's awareness, via physician or clinic information sheets, has no added benefit for patient satisfaction in the outpatient sports medicine setting.

Seven new loci associated with age-related macular degeneration.

Age-related macular degeneration (AMD) is a common cause of blindness in older individuals. To accelerate the understanding of AMD biology and help design new therapies, we executed a collaborative genome-wide association study, including >17,100 advanced AMD cases and >60,000 controls of European and Asian ancestry. We identified 19 loci associated at P < 5 × 10(-8). These loci show enrichment for genes involved in the regulation of complement activity, lipid metabolism, extracellular matrix remodeling and angiogenesis. Our results include seven loci with associations reaching P < 5 × 10(-8) for the first time, near the genes COL8A1-FILIP1L, IER3-DDR1, SLC16A8, TGFBR1, RAD51B, ADAMTS9 and B3GALTL. A genetic risk score combining SNP genotypes from all loci showed similar ability to distinguish cases and controls in all samples examined. Our findings provide new directions for biological, genetic and therapeutic studies of AMD.

Developmental environment affects risk-acceptance in the hissing cockroach, Gromphadorhina portentosa.

Consistent individual differences in the tendency to accept risk have been demonstrated in invertebrates, fish, birds, and mammals, including humans. These individual differences have been associated with size, growth rate, survival, and reproductive success. Little research, however, has investigated the effect of developmental environment on individual differences in risk-acceptance. Competing hypotheses offer different explanations of how variation in the quality of the developmental environment affects risk-acceptance in adults. The first hypothesis states that individuals developing in poor quality environments take risks because such behavior is their only means of obtaining adequate fitness returns. The second hypothesis states that individuals developing in poor environments avoid risk because their poor physical condition makes them especially vulnerable to injury or death. We measured several forms of risk-accepting behavior (exploration, foraging, and recovery after disturbance) in male hissing cockroaches (Gromphadorhina portentosa) that had developed in nutritional and social environments of varying quality. Individuals raised on poor nutrition diets exhibited lower levels of risk-acceptance than those raised on high nutrition diets. Risk-acceptance among individuals that developed on poor nutrition diets was negatively correlated with body size. We conclude that quality of developmental environment affects risk-acceptance across behavioral contexts in male hissing cockroaches. Our findings are consistent with the hypothesis that condition-dependent vulnerability mediates the relationship between developmental environment and risk-acceptance.

QUANTITATIVE GENETICS OF SEXUAL SELECTION IN THE FIELD CRICKET, GRYLLUS INTEGER.

Major theories of sexual selection predict heritable variation in female preferences and male traits and a positive genetic correlation between preference and trait. Here we show that female Texas field crickets, Gryllus integer, have heritable genetic variation for the male calling song stimulus level that produces the greatest phonotactic response. Approximately 34% of the variation in female preferences was due to additive genetic effects. Female choosiness, that is, the strength of the female response to her most preferred stimulus relative to her average response to all stimuli, did not show significant genetic effects. The male calling song character was not related to male size or age but did show significant genetic effects. Approximately 39% of the variation in the number of pulses per trill was due to additive genetic variation. The genetic correlation estimated for the field population was 0.51 ± 0.17. The number of pulses per trill produced by males is under stabilizing sexual selection.