Shockwave Treatment vs Surgery for Proximal Fifth Metatarsal Stress Fractures in Soccer Players: A Pilot Study.

BACKGROUND: To compare the clinical, radiologic, and functional outcomes between shockwave and operative treatments for proximal fifth metatarsal stress fractures in soccer players in a pilot study. METHODS: Between 2017 and 2019, 18 soccer players with fifth metatarsal stress fractures attended at Mutualidad de Futbolistas Españoles-Delegación Catalana were included. Patients were randomly assigned into 2 groups receiving either surgery with an intramedullary screw (group 1) or high-energy focused extracorporeal shockwave treatment (group 2 performed once a week for 3 weeks using 2000 impulses at an energy flux density of 0.21 mJ/mm2 and 4 Hz frequency). Clinical (pain), radiologic (bone healing), and functional (Tegner Activity Scale and American Orthopaedic Foot & Ankle Society [AOFAS] ankle-hindfoot scales) outcomes before and after receiving the treatment were compared between both groups. In addition, ability and time to return to play was also compared between groups. RESULTS: No patients were lost to follow-up. There were no statistically significant differences at last follow-up between surgery and extracorporeal shockwave treatment for bone healing, pain relief, AOFAS ankle-hindfoot score, Tegner score, and time return to play. No complications were reported in either of the 2 groups. CONCLUSION: In this pilot study, extracorporeal shockwave treatment and operative treatment were found to be equally effective at reducing pain, achieving bone healing, and allowing the soccer players to return to play after proximal fifth metatarsal stress fractures. This study suggests that ESWT may be a good option for the management of proximal fifth metatarsal stress fractures in soccer players. If this approach proves successful in larger trials, the shockwave approach might help avoid known complications of the surgical treatment like wound problems, nerve injury, and hardware intolerance. Further investigations with larger sample size should be conducted in order to confirm the present conclusions. LEVEL OF EVIDENCE: Level II, therapeutic, pilot randomized controlled trial.

Treatment of Partial Posterior Cruciate Ligament Injuries with Platelet-Rich Plasma in Growth Factors (PRGF) Intraligamentous Infiltration and a Specific Knee Brace.

Posterior cruciate ligament (PCL) injuries are not as common as other knee ligament injuries, but may present a challenging scenario for even skilled knee surgeons. Complete PCL tears are typically encountered in the setting of multiligament knee injuries and require surgical treatment. Isolated complete PCL injuries are uncommon and the best treatment is debated, and likely depends on the degree of symptoms and objective instability. However, many PCL injuries will be partial tears (grade I or II). The purpose of this chapter is to describe our treatment of choice for partial PCL injuries through a conservative approach. Level of evidence Level IV.

Prognostic Factors for Conversion to Arthroplasty after Hip Arthroscopy. Review of the Literature.

Arthroscopic techniques in the treatment of femoroacetabular impingement have experienced an exponential increase over recent years for both diagnosis and treatment. The main risks with treatment are poor clinical outcomes and the conversion to prosthesis. Better knowledge and understanding of the various risk factors leading to prosthesis will improve patient selection for arthroscopic treatments rendering better results. The published papers that have been selected are related to series of hip arthroscopies with risk factors that lead to total hip arthroplasty (THA), in the PubMed database, without a time limit, number of patients, or follow-up time. We selected over 302 papers, 19 papers that show risk factors for conversion to THA. The main risk factors found were femoral chondropathy grade III/IV (relative risk 58.1-12 times increased), acetabular (20-2.96 times), an articular space <2 mm (39-4.26 times), age (14.6-1.06 times), Tönnis 2 in radiographic studies (7.73-3.1 times), obesity (5.6-2.3 times), and osteoarthritis (4.6-2.4 times). There are several risk factors which in an isolated way, highly increase the risk of THA. Some of them have a clear relationship (chondropathy, reduced joint space, Tönnis 2, and osteoarthritis). Based on the review we observed that the elements that are most associated with a conversion to THA after a hip arthroscopy are a high degree of femoral and acetabular chondropathy, a reduced joint space below 2 mm, older age, Tönnis 2, obesity, and hip osteoarthritis.

Comparison of tensiomyographic neuromuscular characteristics between muscles of the dominant and non-dominant lower extremity in male soccer players.

PURPOSE: Tensiomyography (TMG) has been used to assess neuromuscular characteristics of muscles of the lower extremity in soccer players. However, the effects of lower extremity dominance on TMG characteristics in this population have not been reported to date. The purpose of this study was to compare the TMG neuromuscular characteristics between the dominant and non-dominant lower extremity in male soccer players. METHODS: Thirty-eight consecutive healthy male soccer players underwent resting TMG assessment of vastus medialis (VM), vastus lateralis (VL), rectus femoris (RF), semitendinosus (ST), biceps femoris (BF), gastrocnemius medialis (GM), and gastrocnemius lateralis (GL) in both lower extremities. The maximal displacement, delay time, contraction time, sustained time, and half-relaxation time were obtained and compared between both sides. RESULTS: There were no significant differences in the vast majority of the TMG parameters between both lower extremities. The dominant side demonstrated higher VM contraction time (p = 0.008), RF sustained time (p = 0.009), RF half-relaxation time (p = 0.01), and BF sustained time (p = 0.04), but lower VL contraction time (p = 0.03) and VL delay time (p = 0.02) compared to the non-dominant side. CONCLUSION: In general, TMG-assessed neuromuscular characteristics of the VM, VL, RF, ST, BF, GM, and GL were not affected by lower extremity dominance in male soccer players. Therefore, there is no need to assess both sides when using TMG to monitor the response to training or muscles at risk of injury in soccer players unless there is a specific reason. LEVEL OF EVIDENCE: Prognostic study, Level II.

Healing of donor site in bone-tendon-bone ACL reconstruction accelerated with plasma rich in growth factors: a randomized clinical trial.

PURPOSE: To determine whether the use of plasma rich in growth factors accelerates healing of the donor site in bone-tendon-bone anterior cruciate ligament (ACL) reconstruction (patellar graft). The use of the patellar graft presents post-operative problems such as anterior knee pain, which limits its use and leads to preference being taken for alternative grafts. METHODS: A double-blind, randomized, clinical trial was performed comparing two groups of patients who underwent ACL reconstruction using patellar tendon graft and comparing the use of plasma rich in growth factors at the donor site after graft harvest in terms of local regeneration by ultrasound assessment. RESULTS: The plasma rich in growth factors group shows earlier donor site regeneration in comparison with the control group (2 months earlier), with significant differences in the first 4 months of the follow-up. CONCLUSION: The application of plasma rich in growth factors shows accelerated tissue regeneration processes with respect to the control group. This fact, together with the previously published with similar conclusions, can create a knowledge basis in order to set out new recovery guidelines following ACL reconstruction. LEVEL OF EVIDENCE: Therapeutic study, Level I.

Effects of anterior cruciate ligament reconstruction on neuromuscular tensiomyographic characteristics of the lower extremity in competitive male soccer players.

PURPOSE: To investigate the effects of anterior cruciate ligament (ACL) reconstruction on mechanical and contractile properties of the skeletal muscles of the lower extremities in soccer players through tensiomyography (TMG). METHODS: All soccer players with acute ACL tear included underwent resting TMG assessment of muscles of both lower extremities before and 1 year after ACL reconstruction. The muscles assessed were vastus medialis (VM), vastus laterals (VL), rectus femoris (RF), semitendinosus (ST), biceps femoris (BF), gastrocnemius medialis (GM), and gastrocnemius lateralis (GL). The TMG parameters obtained for each muscle were maximal displacement (D m), delay time (T d), contraction time (T c), sustained time (T s), and half-relaxation time (T r). RESULTS: The injured leg had a significant decrease in VL-T c, ST-T c, GM-T c, GL-T r, and GL-T d, and a significant increase in VM-T r and GM-T s in the postoperative compared to preoperative period. The non-injured leg demonstrated significant preoperative-postoperative changes in the VL, RF, and BF, but not in VM, ST, GM, and GL The magnitude of preoperative-postoperative differences in the injured leg was significantly higher in RF-T c, ST-T c, BF-D m, and GL-T r, but lower in RF-T r and GM-T s, compared to the non-injured leg. Both groups improved their symmetry between the quadriceps and hamstring muscle groups in both sides. CONCLUSIONS: The quadriceps muscles improved their resistance to fatigue and contraction velocity in both sides, and the hamstring muscles improved their contraction velocity and muscle tone in both sides as well. Improvements in contraction velocity and muscle tone were more evident in the quadriceps and hamstrings of the injured compared to the uninjured side. In addition, the intervention increased the percentage of symmetry between both sides in the TMG of the quadriceps muscles and the balance between ACL-agonist (hamstrings) and ACL-antagonist (quadriceps) muscle groups in both sides. This study shows how ACL reconstruction (and subsequent rehabilitation) can positively impact neuromuscular characteristics of the quadriceps and hamstrings. LEVEL OF EVIDENCE: Therapeutic, Level II.

Assessment of gastrocnemius tensiomyographic neuromuscular characteristics as risk factors for anterior cruciate ligament injury in male soccer players.

PURPOSE: There is a large number of publications evaluating neuromuscular risk factors for anterior cruciate ligament (ACL) injury in athletes. However, most of them have involved the female athlete and, in addition, the gastrocnemius muscles have been less investigated by far compared with the quadriceps and hamstring. The purpose of this study was to investigate the role of the gastrocnemius muscles as neuromuscular risk factors for ACL injury in male soccer players, through tensiomyography (TMG). METHODS: All competitive male soccer players with confirmed ACL tear included in this study underwent resting TMG assessment of gastrocnemius medialis (GM) and gastrocnemius lateralis muscles of the uninjured side. The same values were obtained from a sex-, and sports level-matched control group in both sides. The maximal displacement (D m), delay time (T d), contraction time (T c), sustained time (T s), and half-relaxation time (T r) were obtained for both muscles. TMG values of the uninjured side in ACL-injured group were compared with the mean values between both sides in the control subjects. RESULTS: There were no significant between-group differences in demographic characteristics. Most TMG parameters of the gastrocnemius muscles were not significantly different between the two groups. Only the GM-T r (p = 0.02) and GM-D m (p = 0.006) were significantly higher in the ACL-injured group compared with control group. CONCLUSIONS: Neuromuscular characteristics in terms of mechanical and contractile properties of the gastrocnemius muscles may not be significant risk factors for ACL injury in male soccer players.

Conservative treatment of lumbar spondylolysis in young soccer players.

PURPOSE: The purpose of this study was to report the functional outcomes of young active soccer players with lumbar spondylolysis undergoing conservative treatment. METHODS: Between 2002 and 2004, all soccer players diagnosed with spondylolysis with a minimum 2-year follow-up were retrospectively reviewed. All patients were treated nonoperatively with cessation of sports activity and rehabilitation for 3 months. The rehabilitation protocol was identical for all patients and emphasized strengthening of abdominal muscles, stretching of the hamstrings, "core" stability exercises, and trunk rotational movements in a pain-free basis. Those patients with pain at rest and with daily life activities were also treated with a thoracolumbar orthosis. Symptomatic patients or those with positive SPECT were not allowed to return to sports and continued the rehabilitation protocol for 3 more months. RESULTS: The mean time of cessation of sports activity was 3.9 months (SD 0.8) and 5.2 months (SD 2.1) for a complete return to sports. At the 2-year follow-up, 28 patients (82%) obtained excellent results, 4 (12%) good results, 1 patient (3%) a fair result, and 1 patient (3%) a poor result. CONCLUSIONS: Conservative treatment of spondylolysis in young soccer players with cessation of sports and rehabilitation, with or without thoracolumbar orthosis, was associated with excellent functional results in terms of return to sports and level of achievable physical activity.

[Prevalence of main cardiovascular risk factors in women from Biscay]. / Prevalencia de los principales factores de riesgo cardiovascular en mujeres de Vizcaya.

INTRODUCTION AND OBJECTIVES: The aim of this study was to analyze the prevalence of principal cardiovascular risk factors in the female population from Biscay (northern Spain). PATIENTS AND METHOD: We selected a random representative sample of 1,317 women aged between 16 and 65 years from this province. For each participant we recorded the following parameters: weight and height, physical activity, smoking, blood pressure, glycemia, total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. RESULTS: A total of 1,100 women (mean age 39.83 14 years) participated. Regarding physical activity, 31.9% of the women had a sedentary lifestyle and 48.4% did not exercise during leisure time. The prevalence of smoking was 31.9%. We found a mean body mass index of 24.9 4.6 kg/m2, and 42.4% of the women were overweight. The prevalence of hypertension was 13.1%, hypertension being defined as a mean systolic blood pressure > or = 160 mmHg, diastolic blood pressure > or = 95 mmHg, current antihypertensive treatment, or any combination of these criteria. When a cutoff value of > or = 140/90 mmHg was used, the prevalence increased to 26.7%. Total cholesterol values were > or = 240 mg/dl in 26.2%, triglyceride levels were > or = 200 mg/dl in 2.6%, LDL-cholesterol was > or = 160 mg/dl in 26.8%, and HDL-cholesterol values were < 45 mg/dl in 12.2%. The prevalence of hyperglycemia was 3.3%. CONCLUSIONS: The prevalences of main cardiovascular risk factors were similar to those in other Spanish studies. Except for smoking, the rest of these risk factors increased with age. Long-term measures should be adopted to modify dietary habits and lifestyles to obtain improvements in the cardiovascular risk profile.