Sex-Specific Outcomes After Anterior Cruciate Ligament Reconstruction Using an All-Soft Tissue Quadriceps Tendon Autograft in a Young Active Population.

BACKGROUND: The ideal graft for anterior cruciate ligament (ACL) reconstruction (ACLR) in young athletes has a high return-to-sport (RTS) rate and a low reinjury rate. Quadriceps tendon autografts are being used with increasing frequency for ACLR in this population, despite a paucity of evidence to support their use. PURPOSE: To report the RTS rate, ipsilateral reinjury rate, and contralateral ACL injury rate in a young athletic population undergoing primary ACLR using an all-soft tissue quadriceps tendon (ASTQT) autograft. STUDY DESIGN: Cases series; Level of evidence, 4. METHODS: Patients aged 14 to 22 years who underwent primary ACLR using an ASTQT autograft by a single surgeon between January 1, 2005, and April 30, 2020, were identified via electronic medical records and contacted ≥24 months after ACLR to complete a survey regarding subsequent ipsilateral or contralateral ACL injuries and RTS. Patients who had undergone previous ACLR (ipsilateral or contralateral) were excluded. RESULTS: A total of 656 patients (330 male, 326 female; mean age, 17.9 years) were identified, and 395 patients completed the survey (60.2%; 174 male, 221 female; mean age, 17.8 years) with a mean follow-up of 73 ± 29 months (range, 24-139 months). The RTS rate was high (male: 87.7%; female: 82.8%; P = .19). Male and female patients had similar rates of revision ACLR (male: 12.6%; female: 10.0%; P = .40) and contralateral ACL injuries (male: 13.8%; female: 11.3%; P = .46). CONCLUSION: A high RTS rate and similar rates of ipsilateral and contralateral ACL injuries were found for male and female patients in a young athletic population undergoing primary ACLR using an ASTQT autograft. These results help one to better understand the utility of ASTQT grafts to support successful ACLR in young athletic populations, for which ASTQT grafts appear to yield favorable outcomes.

Malay Translation and Validation of the Oslo Sports Trauma Research Center Questionnaire on Health Problems.

Background: The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H) is a proven surveillance method to register acute injury, overuse injury, or illness in athletes. However, it has not yet been translated into Malay. Purpose: To translate, culturally adapt, and validate the OSTRC-H into Malay using internationally established guidelines. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The Malay translation of the OSTRC-H (OSTRC-H.M) was distributed to 54 elite (ie, professional) and recreational athletes. Face validity, content validity, and construct validity were assessed for the validity measurement properties, while test-retest and internal consistency were used for reliability measurement properties. Results: The content validity index was satisfactory at 0.93. The OSTRC-H.M showed good internal consistency, with a Cronbach α value of .84. Confirmatory factor analysis showed a good model for construct validity, with values of 0.99 and 0.04 for comparative fit index and root mean square error of approximation, respectively. Per-item intraclass correlation coefficients (ICCs) for test-retest reliability ranged from 0.55 to 0.80. The overall test-retest reliability of the questionnaire was good (ICC, 0.8; 95% CI, 0.63-0.88; P < .001). Conclusion: The OSTRC-H.M was found to be valid and reliable and therefore acceptable for application among Malay-speaking athletes.

Cardiac function and autonomic cardiac function during a multi-stage cycling event: a brief report.

Introduction: Prolonged and repeated exercise performed during an ultra-endurance event can induce general and cardiac fatigue known as exercise-induced cardiac fatigue. Our objective was to find a possible correlation between the cardiac function and the autonomic cardiac function. Methods: During a multistage ultra-endurance event, a female well-trained cyclist underwent daily rest echocardiography and heart rate variability measurements to assess the cardiac function and the cardiac autonomic function. Results: The athlete completed 3,345 km at 65% of her maximum heart rate and 39% of her maximum aerobic power. A progressive improvement of the systolic function for both the left ventricle and the right ventricle was observed during the event. Discussion: Alterations were observed on the cardiac autonomic function with an imbalance between sympathetic and parasympathetic, but there was no sign of a significant correlation between the cardiac function and the autonomic cardiac function and no signs of cardiac fatigue either. Further analysis should be performed on a larger sample to confirm the obtained results.

Sex differences in the associations between right heart structure and peak exercise capacity parameters in amateur cyclists.

Introduction: Right heart changes and their association with exercise capacity, including sex differences, are still being investigated. We analysed right heart structure and its relationship with exercise capacity parameters in amateur cyclists. Materials and methods: A cross-sectional study involving 215 consecutive adult amateur cyclists, who underwent resting transthoracic echocardiography and a cardiopulmonary exercise test (CPET) to exhaustion was performed. Results: The median age of participants was 29 years (IQR 24-37), 71% of them were men. The mean training time was 6 h/week, and 90% participated in vigorous or moderate physical activity. Men had larger right ventricular diameters (basal - RVD1, mid-cavity - RVD2 and longitudinal - RVD3) compared to women (40.9 vs. 37.6 mm, p = 0.0005, 28.7 vs. 26.3 mm, p = 0.03, 92.2 vs. 81.9 mm, p < 0.0001). Indexing for body surface area revealed comparable right atrial volume (RAVI) between sexes (24.1 vs. 22.7 mL/m2). Men achieved higher peak exercise capacity parameters [O2 pulse, oxygen consumption (VO2) and workload] in CPET. Multivariate linear regression models revealed a positive association between peak VO2, workload and O2 pulse with RAVI in women but not with RVD1 or RVD3. Conversely, these parameters showed a positive association with RVD3 and RVD1 but not with RAVI in men. Conclusion: Sex differences exist in the relationship between right heart structural parameters and peak exercise capacity descriptors in amateur cyclists. Better exercise capacity during CPET to exhaustion is associated with greater RAVI in women but a greater RVD1 and RVD3 in men. These findings suggest different mechanisms of right heart adaptation to training in men and women.

Hair cortisol is a physiological indicator of training stress for female footballers.

PURPOSE: Chronic physical stress in female athletes can reduce mental health and athletic performance. Therefore, a chronic physical stress assessment method is required. METHODS: This study examined whether hair cortisol concentration (HCC) predicted chronic physical stress changes in female university football players. We took measurements in August and December, just before the Japan college national tournament. RESULTS: Self-reported training load was significantly positively correlated with HCC. Self-reported training load had no significant relationship with fatigue as measured by the Profile of Mood States 2nd Edition or with the stressors from the Stressor Scale for College Students. HCC was negatively correlated with reaction time in the spatial Stroop task, although the repeated correlation analysis showed no significant relationship. CONCLUSION: These results suggest that the chronic physical stress experienced by female footballers cannot be predicted by psychological indicators; however, they can be predicted by HCC, which could be used to prevent overtraining in these athletes.

Effects of coaches' autonomy support on athletes' aggressive behavior and athlete burnout: verification of the mediating effects of coach-athlete relationship and team efficacy.

Purpose: This study investigated the relationships between perceived autonomy support, coach-athlete relationship, team efficacy, aggressive behavior, and athlete burnout among team sports athletes. It verified the mediating effects of the coach-athlete relationship and team efficacy on the relationship between autonomy support and athlete burnout. Design methodology and approach: A questionnaire survey on autonomy support, coach-athlete relationships, aggressive behavior, and athlete burnout was administered to 336 team sports athletes (292 male athletes and 44 female athletes). A cross-sectional research design was used to collect the data. To analyze the collected data, frequency, reliability, descriptive statistical, and correlation analyses were performed using SPSS version 26.0. In addition, confirmatory factor analysis, convergent validity tests, and structural model analysis were conducted using AMOS version 24.0. Bootstrapping was used to examine the mediating effects. Results: The fit of the measurement model was assessed by calculating the fit indices as follows: x 2 = 329.689, df = 124, p < 0.001, TLI = 0.945, CFI = 0.956, RMSEA = 0.070 (90% CI = 0.061-0.080), and SRMR = 0.060. Autonomy support positively affected the coach-athlete relationship (ß = 0.841) and team efficacy (ß = 0.338). The coach-athlete relationship positively affected team efficacy (ß = 0.479). Furthermore, autonomy support did not significantly influence aggressive behavior (ß = -0.053), and negatively affected athlete burnout (ß = -0.305). The coach-athlete relationship also did not significantly affect aggressive behavior (ß = 0.054), and negatively affected athlete burnout (ß = -0.303). Team efficacy negatively affected aggressive behavior (ß = -0.516) and athlete burnout (ß = -0.201). Finally, autonomy support was found to affect athlete burnout through the coach-athlete relationship and team efficacy. Conclusion: Considering that autonomy support affects athlete burnout through coach-athlete relationship and team efficacy, coaches need to enhance the quality of the coach-athlete relationship and improve team efficacy to reduce athlete burnout. Above all, the study findings suggest that coaches need to provide autonomy-supportive behaviors.

Dietary Intake of Branched-Chain Fatty Acids, Metabolic Parameters, High-Sensitivity C-Reactive Protein Levels, and Anthropometric Features Among Elite and Subelite Soccer Players.

BACKGROUND: Several studies have revealed the positive healthy impacts of branched-chain fatty acids (BCFAs). However, most of these studies evaluated the serum BCFAs in humans, or treatment with exogenous BCFAs in animal or in-vitro models and the health impacts of dietary BCFAs have not yet been studied. Due to positive effects of BCFAs in sport, in the current study, we aimed to investigate the association between dietary BCFAs and metabolic and inflammatory parameters among elite and subelite soccer players. METHODS: A cross-sectional study was carried out among 335 elite and subelite soccer players (196 male), aged between 20 and 45 years old. Soccer players were enrolled from 32 teams under the directive of The Chinese Football Association. Demographic, anthropometric, and dietary assessments were performed and laboratory measurement including serum lipids, glycemic markers, and high-sensitivity C-reactive protein was measured. RESULTS: Those with the highest dietary BCFAs consumption had higher appetite (p = .009). Also, high consumption of dietary BCFAs was associated with lower diastolic blood pressure (odds ratio: 0.958; confidence interval: 0.918-0.999; p = .046) and low high-sensitivity C-reactive protein concentrations in the third tertile of dietary BCFAs (odds ratio: 0.431; confidence interval: 0.300-0.618; p < .001). No other association between biochemical variables and dietary BCFAs was found. CONCLUSION: As shown in the current study, higher dietary BCFAs consumption was associated with lower diastolic blood pressure and inflammation. Due to very limited number of studies, further studies are needed to have a better perspective of these associations and their underlying mechanisms.

Myocardial Fibrosis in Young and Veteran Athletes: Evidence from a Systematic Review of the Current Literature.

Background: Exercise is associated with several cardiac adaptations that can enhance one's cardiac output and allow one to sustain a higher level of oxygen demand for prolonged periods. However, adverse cardiac remodelling, such as myocardial fibrosis, has been identified in athletes engaging in long-term endurance exercise. Cardiac magnetic resonance (CMR) imaging is considered the noninvasive gold standard for its detection and quantification. This review seeks to highlight factors that contribute to the development of myocardial fibrosis in athletes and provide insights into the assessment and interpretation of myocardial fibrosis in athletes. Methods: A literature search was performed using the PubMed/Medline database and Google Scholar for publications that assessed myocardial fibrosis in athletes using CMR. Results: A total of 21 studies involving 1642 endurance athletes were included in the analysis, and myocardial fibrosis was found in 378 of 1595 athletes. A higher prevalence was seen in athletes with cardiac remodelling compared to control subjects (23.7 vs. 3.3%, p < 0.001). Similarly, we found that young endurance athletes had a significantly higher prevalence than veteran athletes (27.7 vs. 19.9%, p < 0.001), while male and female athletes were similar (19.7 vs. 16.4%, p = 0.207). Major myocardial fibrosis (nonischaemic and ischaemic patterns) was predominately observed in veteran athletes, particularly in males and infrequently in young athletes. The right ventricular insertion point was the most common fibrosis location, occurring in the majority of female (96%) and young athletes (84%). Myocardial native T1 values were significantly lower in athletes at 1.5 T (p < 0.001) and 3 T (p = 0.004), although they had similar extracellular volume values to those of control groups. Conclusions: The development of myocardial fibrosis in athletes appears to be a multifactorial process, with genetics, hormones, the exercise dose, and an adverse cardiovascular risk profile playing key roles. Major myocardial fibrosis is not a benign finding and warrants a comprehensive evaluation and follow-up regarding potential cardiac disease.

Effects of a Dietary Microalgae (Arthrospira platensis) Supplement on Stress, Well-Being, and Performance in Water Polo Players: A Clinical Case Series.

BACKGROUND: A common tactic used by athletes to improve performance, lessen tiredness, and hasten recovery is dietary supplementation. We aimed to assess the role of a microalgae dietary liquid supplement additivated with Copper 22.5% NRV in water polo players' performance. METHODS: Twenty male water polo players were split into two groups: ten (spirulina group) took a twice-daily nutritional supplement containing 15 mL of spirulina liquid extract (titrated in Phycocyanin 1 mg/mL) and additivated with Copper 22.5% NRV for eight weeks, and ten (the placebo group) did not take the supplement. Subjective evaluations were finished using the Athlete's Subjective Performance Scale (ASPS). Levels of the biomarker creatine phosphokinase (CPK) were also assessed. RESULTS: The spirulina group's mean total ASPS score increased significantly from baseline to follow-up and was significantly better than that of the placebo group (p < 0.001). Conversely, ASPS ratings in the placebo group slightly decreased. A positive correlation between spirulina supplementation and less severe ASPS was found using correlation matrix analysis. However, there was a slight difference in CPK levels from the baseline to the follow-up in the spirulina group. CONCLUSIONS: A dietary supplement comprising spirulina and copper may help water polo players' subjective performance measurements by lowering muscular tension. Larger, randomized controlled trials are yet required.

Prevalence, severity, and predictors of self-reported depression in ultra-distance runners: An online survey based on 265 athletes.

BACKGROUND: Literature suggests a high prevalence of mental health disorders among athletes practicing elite and extreme sports. One of the most commonly encountered disorders in this group of individuals is depression. OBJECTIVE: The aim of this study was to examine the prevalence, severity, and risk factors of symptoms of self-reported depression among ultra-distance runners. METHODS: Data was collected using an online survey (February to April 2023) and included 265 (age 48.35 ± 10.52 years) adult ultra-runners. The Beck Depression Inventory-II (BDI-II) was used to measure self-reported depression. Additional variables comprised basic sociodemographic information and information regarding training, ultramarathon experience, and previous injury. Descriptive and interferential statistics were performed using JASP Version 0.16.4. RESULTS: We found that 21.9 % (n = 58) of ultra-runners suffered from self-reported depression (i.e., BDI-II score ≥ 14) with an average BDI-II score of 22.7 ± 7.1 (moderately severe symptoms). Female ultra-runners had a higher prevalence (30.8 %) of self-reported depression than males (16.2 %, p = .001). Logistic regression revealed that ultra-runners without previous sports injury (p = .01) and those of increasing age (p = .003) had a significantly lower risk of self-reported depression. Similarly, linear regression showed the absence of injury (p < .001) and increasing age (p = .02) resulted in significantly lower BDI-II scores. Training volume in distance and hours per week as well as ultra-running experience did not show any significant association. CONCLUSIONS: Affecting more than one-fifth of our collective, depressive symptoms appear to be highly prevalent among ultra-runners. Our findings underline the importance of screening for clinical depression, especially among injured athletes. However, the previously assumed peculiarities of the sport in the area of high training volume do not appear to be a significant factor.

Advanced myocardial deformation echocardiography for evaluation of the athlete's heart: Functional and mechanistic analysis.

BACKGROUND: Assessment of the athlete's heart is challenging because of a phenotypic overlap between reactive physiological adaptation and pathological remodelling. The potential value of myocardial deformation remains controversial in identifying early cardiomyopathy. AIM: To identify the echocardiographic phenotype of athletes using advanced two-dimensional speckle tracking imaging, and to define predictive factors of subtle left ventricular systolic dysfunction. METHODS: In total, 191 healthy male athletes who underwent a preparticipation medical evaluation at Nancy University Hospital between 2013 and 2020 were included. Clinical and echocardiographic data were compared with 161 healthy male subjects from the STANISLAS cohort. Borderline global longitudinal strain value was defined as<17.5%. RESULTS: Athletes demonstrated lower left ventricular ejection fraction (57.9±5.3% vs. 62.6±6.4%; P<0.01) and lower global longitudinal strain (17.5±2.2% vs. 21.1±2.1%; P<0.01). No significant differences were found between athletes with and without a borderline global longitudinal strain value regarding clinical characteristics, structural echocardiographic features and exercise capacity. A borderline global longitudinal strain value was associated with a lower endocardial global longitudinal strain (18.8±1.2% vs. 22.7±1.9%; P=0.02), a lower epicardial global longitudinal strain (14.0±1.1% vs. 16.6±1.2%; P<0.01) and a higher endocardial/epicardial global longitudinal strain ratio (1.36±0.07 vs. 1.32±0.06; P<0.01). No significant difference was found regarding mechanical dispersion (P=0.46). CONCLUSIONS: Borderline global longitudinal strain value in athletes does not appear to be related to structural remodelling, mechanical dispersion or exercise capacity. The athlete's heart is characterized by a specific myocardial deformation pattern with a more pronounced epicardial layer strain impairment.

Development and initial validation of the Engagement in Athletic Training Scale.

The current study presents the development process and initial validation of the Engagement in Athletic Training Scale (EATS), which was designed to evaluate athletes' engagement in athletic training. In study 1, item generation and initial content validity of the EATS were achieved. In study 2, the factor structure of the EATS was examined using exploratory factor analysis (EFA) and exploratory structural equation modeling (ESEM). Internal consistency reliabilities of the subscales were examined (N = 460). In study 3, factor structure, discriminant validity, internal consistency reliability, and nomological validity of the EATS were further examined in an independent sample (N = 513). Meanwhile, measurement invariance of the EATS across samples (study 2 and study 3) and genders was evaluated. Overall, results from the 3 rigorous studies provided initial psychometric evidence for the 19-item EATS and suggested that the EATS could be used as a valid and reliable measure to evaluate athletes' engagement in athletic training.

Strength and Conditioning in the Young Athlete for Long-Term Athletic Development.

The safety and efficacy of youth strength and conditioning programs depend on proper instruction, coaching, and supervision. Types of training include bodyweight strengthening, resistance bands, medicine balls and weights, agility, plyometrics, and cardiovascular exercise. These should be preceded by a proper warm up using a combination of static stretching, self-myofascial release, dynamic warm-ups, and sport-specific warm-ups. Coaches and trainers should consider the athlete's age, maturity level, cognitive ability, puberty status, sport volume, and readiness levels in designing and supervising strength and conditioning programs. This review article covers the latest evidence supporting training to improve movement skills and promote long-term athletic development, while also preventing injury, for young athletes.

Management of Concussion in the Young Athlete.

Sports-related concussion continues to be a rapidly growing public health concern in nearly all sports, and at all levels, in children and adolescents. Evidence-based clinical guidelines are constantly evolving but those specific to the pediatric population are less robust. There are nuances to treatment of the developing pediatric brain in the context of mild traumatic brain injury (mTBI). The purposes of this review are to (1) analyze the differences in concussion symptom presentation and recovery in children versus adults, (2) describe the role of the physical therapist in management of pediatric concussion, (3) examine current recommendations for return to participation in school and return to sport, and (4) highlight the psychological implications of concussion in the young athlete. We find that additional research is needed in nearly all aspects of concussion in the young athletic population. The current evidence stresses the importance of an active approach to recovery using a stepwise progression.

Tarsal Coalition: Surgical Management in the Young Athlete.

Tarsal coalition is an abnormal bony, cartilaginous, or fibrous bridge between 2 or more tarsal bones. Adolescent athletes with tarsal coalitions typically present with symptoms that include foot and/or ankle pain and limited range of motion. Loss of mobility can lead to abnormal loading, articular instability, deformity, and joint degeneration. Nonoperative management includes immobilization, physical therapy, and custom foot orthosis. Surgical options include coalition excision and fat graft interposition, foot realignment, or a combination of these. Surgical treatment requires evaluation of the coalition type, foot alignment, and degenerative changes in the adjacent joints.

Variable Guidelines for Pediatric Medial Patellofemoral Ligament Reconstruction Rehabilitation Exists Across PRiSM Member Organizations.

Medial patellofemoral ligament (MPFL) reconstruction, typically used to restore stability to the patellofemoral joint after dislocation, often requires extensive rehabilitation to address acute impairment related to surgical intervention and also underlying non-anatomical deficits that may have contributed to the index injury. Rehabilitation guidelines, including objective functional performance assessment criteria, are lacking in the literature. We sought to summarize the clinical guidelines for rehabilitation and return to activity assessment after MPFL reconstruction as advocated by the member organizations of the Pediatric Research in Sports Medicine (PRiSM) Patellofemoral Research Interest Group (PF-RIG). We obtained and reviewed MPFL rehabilitation guidelines from 11 member organizations of the PRiSM PF-RIG, extracting information on weight-bearing advancement, bracing, use of supplemental strengthening modalities, and any objective criteria for advancing rehabilitation phases. We found highly variable agreement among guideline parameters at each treatment stage, with time-based criteria most widely used for early progression. Although functional metrics like strength or movement tests were more widely used in later phases of rehabilitation, there was substantial variation in testing mode and level of acceptable performance. Our review found that significant variability exists in current practice among PRiSM and PF-RIG member institutions regarding rehabilitation standards after MPFL reconstruction. Although we found broad consensus that objective strength or performance criteria should be employed to establish a better framework for clinical decision-making, most current guidelines lack standardization and sufficient detail to guide ideal clinical practice.

Psychological Well-Being From Sports Injuries in Adolescence: A Narrative Review.

The objective of this paper is to review how the mental and psychological well-being of the adolescent athlete population may be impacted by sports injuries, specifically the development of their personal identities. To answer this question, we conducted a narrative review using keywords such as "adolescence," "psychological," "injury," and "sport" in the PubMed database. When conducting the research, we included sources from the past 15 years in order to gain a more present and accurate analysis of our question, and no countries were excluded from our population. Through our research, we identified risk factors that contribute to the rising psychological stress on adolescents. The return to sport was also found to be primarily affected by implied psychological illnesses such as self-confidence and identity, along with parental and coach guidance through the rehabilitation process. Despite the lack of research, scientists work to pursue additional psychological interventions to ensure the emotional well-being of adolescent athletes. Through this review, we aim to inform athletes, coaches, parents, and pediatricians about psychological issues that they may face as they continue to pursue their respective roles in sports. This study also paves a path for future research concerning potential interventions to prevent such psychological issues and ensure both physical and mental health for young athletes.

A study on the relationship and path between mental health and burnout of Chinese athletes.

Background: This study aims to explore the relationship and influencing pathways between mental health indicators and athlete burnout among Chinese competitive athletes. Methods: A cross-sectional study was conducted on 501 elite Chinese athletes from several national and provincial sports teams. Generalized Anxiety Disorder Scale (GAD-7) was used to measure anxiety, Patient Health Questionnaire (PHQ- 9) was used to measure depression, Athlete Psychological Strain Questionnaire (APSQ) was used to measure perceived stress, and Athlete Burnout Questionnaire (ABQ) was used to measure burnout. The results were derived using reliability testing, descriptive statistics, correlation analyses, and structural equation modeling. Results: The following results were obtained: (a) the clinical detection rates of anxiety and depression in this sample were within normal levels, but the detection rate of perceived stress (78.64%) was relatively high; (b) all three mental health indicators were significantly correlated with athlete burnout; (c) in our model, there was a direct path with APSQ directly contributing to 69.95% of the variance in athlete burnout, and two indirect paths with APSQ exerting an indirect effect through depression or/and anxiety accounting for 30.05% of the variance. Conclusion: The findings revealed the psychological characteristics of Chinese competitive athletes and the direct and indirect effects of the APSQ on burnout. Future research should actively promote the international development and application of burnout assessment tools, conduct more comprehensive studies on athlete mental health monitoring, and intensify efforts in athlete education, treatment, and support services, as well as strategies for athlete's coping stress.