Anterior cruciate ligament injuries in elite ski jumping reliably allow return to competition but severely affect future top performance.

PURPOSE: In recent years, anterior cruciate ligament (ACL) injuries have been frequently observed in ski jumping. However, available data in this discipline are very scarce. Therefore, the purpose of this study was to investigate whether an ACL injury in elite-level ski jumping limits the performance level after ACL reconstruction (ACLR). METHODS: Both male and female elite-level ski jumpers from five national A-teams who suffered an ACL injury were identified retrospectively by searching available media reports and Fédération Internationale de Ski (FIS) database. World Cup (WC) results and time-out-of-competition before ACL injury and after ACLR were compared. Only athletes who suffered the injury during or after the 2009-2010 season and who participated in at least one WC competition before the injury were included in this study. The level of athletes' performance from two full seasons before until three seasons after the injury was compared. RESULTS: Eighteen elite-level ski jumpers (11 males/seven females) were eligible for the study. All male and four female athletes returned to professional competition after ACLR. One female athlete ended her career due to prolonged recovery and two have not yet recovered due to a recent injury. The mean return-to-competition (RTC) time was 14.6 months in males and 13.5 months in females. The mean WC placement decreased after the ACL injury: two seasons before injury the mean position was 17.9 ± 11.0 (n = 12), one season before it was 22.4 ± 12.8 (n = 15). After recovery, the mean placement in seasons 1-3 was: 26.4 ± 8.9 (n = 7), 25.7 ± 10.3 (n = 13), 33.6 ± 12.2 (n = 10) (p = 0.008). Among the athletes returning to competition, only six males and three females reached their preinjury level and only one male and one female (compared to seven males and three females preinjury) reached an individual top-3 placement after ACLR, accounting for less than 10% of podiums compared to preinjury. CONCLUSION: Only 60% of the professional ski jumpers reached the preinjury level and less than 15% reached a top-3 placement after the ACL injury. These results support the fact that ACL tear during a ski jumping career may be a significant factor limiting high-level performance. In terms of clinical relevance, the findings implicate the need to analyse the reasons of these very low rates of return to elite-level performance, to analyse ACL injury and RTC rates at lower levels of performance and to develop specific prevention strategies in order to reduce the number of ACL injuries in this sport. LEVEL OF EVIDENCE: Level IV.

The awareness of injury prevention programmes is insufficient among French- and German-speaking sports medicine communities in Europe.

PURPOSE: Evaluate the current state of sports injury prevention perception, knowledge and practice among sports medicine professionals located in Western Europe and involved in injury prevention. METHODS: Members of two different sports medicine organizations (GOTS and ReFORM) were invited to complete a web-based questionnaire (in German and in French, respectively) addressing perception, knowledge and implementation of sports injury prevention through 22 questions. RESULTS: 766 participants from a dozen of countries completed the survey. Among them, 43% were surgeons, 23% sport physicians and 18% physiotherapists working mainly in France (38%), Germany (23%) and Belgium (10%). The sample rated the importance of injury prevention as "high" or "very high" in a majority of cases (91%), but only 54% reported to be aware of specific injury prevention programmes. The French-speaking world was characterized by lower levels of reported knowledge, unfamiliarity with existing prevention programmes and less weekly time spent on prevention as compared to their German-speaking counterparts. Injury prevention barriers reported by the respondents included mainly insufficient expertise, absence of staff support from sports organizations and lack of time. CONCLUSION: There is a lack of awareness regarding injury prevention concepts among sports medicine professionals of the European French- and German-speaking world. This gap varied according to the professional occupation and working country. Relevant future paths for improvement include specific efforts to build awareness around sports injury prevention. LEVEL OF EVIDENCE: Level IV.

[Segmental stabilization in low back pain: a systematic review]. / Segmentale Stabilisation zur Behandlung von lumbalen Rückenschmerzen: Ein systematisches Review.

BACKGROUND: Segmental Stabilizing Exercises (SSE) has a strong theoretical basis in treatment and prevention of Low Back Pain (LBP). The clinical effectiveness has not been clearly established. STUDY DESIGN: A systematic review of clinical- and randomized. controlled trials. OBJECTIVES: To evaluate the effectiveness of SSE for acute, subacute, chronic and recurrent LBP. METHODS: Electronic database PubMed was searched for reviews of SSE from November 2008 to March 2009. Keywords were low back pain, lumbar stabilization, segmental stabilizing exercises, spinal stabilization exercises. For chronic LBP, four comparisons were made: Effectiveness of SSE versus minimal intervention, effectiveness of SSE as a supplement, effectiveness of SSE versus other physiotherapy treatment and effectiveness of SSE versus surgery. RESULTS: 17 trials were included. For acute LBP, SSE is equally effective as treatment by general practitioner in reducing short- term pain or disability. For long-term effects after an acute episode of LBP, SSE is more effective in reducing recurrence. For chronic LBP, SSE is more effective than a minimal intervention and may be as effective as other physiotherapeutic treatments in reducing pain and disability. Equal improvement in both groups was measured for surgery. There are no results concerning subacute LBP. CONCLUSION: For LBP, SSE is more effective than a minimal intervention, but it is not more effective than other physiotherapy interventions.

The effects of task complexity on brake response time before and after primary right total knee arthroplasty.

OBJECTIVE: To study the effects of an increase in task complexity on brake response time (BRT) in patients undergoing total knee arthroplasty (TKA). DESIGN: A prospective repeated-measures design was used. The measurements took place 1 day before and 10 and 30 days after surgery. SETTING: Clinic. PARTICIPANTS: The data of patients (N=21) who were admitted for primary total arthroplasty of the right knee were pooled for analysis. INTERVENTIONS: On each measurement day patients performed 5 practice and 10 test trials for 2 tasks (1 simple, 1 complex) in a car simulator. Task complexity was increased by adding a second movement to the first task performed. MAIN OUTCOME MEASURES: BRT, reaction time (RT), and movement time were assessed. RESULTS: An increase in task complexity increased BRT, RT, and movement time at all measurement times. Right TKA increased BRT by increasing movement time. Thirty days after surgery BRT was no longer increased compared with preoperative values in both tasks. CONCLUSIONS: Task complexity consistently increased BRT and its components. The effects of task complexity remained constant throughout the 3 measurements. After right TKA, we suggest patients should be advised to wait 30 days after surgery before resuming driving.

Does the brake response time of the right leg change after left total knee arthroplasty? A prospective study.

Patients undergoing total knee arthroplasty often ask when they can safely resume car driving. There is little evidence available on which physicians can rely when advising patients on this issue. In a prospective study we assessed the brake response time of 24 patients admitted to the clinic for left total knee arthroplasty preoperatively and then 10 days after surgery. On each measurement day the patients performed two tasks, a simple and a complex brake response time task in a car simulator. Ten days after left TKA the brake response time for the simple task had decreased by 3.6% (p=0.24), the reaction time by 3.1% (p=0.34) and the movement time by 6.6% (p=0.07). However, the performance improvement was not statistically significant. Task complexity increased brake response time at both time points. A 5.8% increase was significant (p=0.01) at 10 days after surgery. Based on our results, we suggest that patients who have undergone left total knee arthroplasty may resume car driving 10 days after surgery as long as they drive a car with automatic transmission.