Injury patterns of non-fatal accidents related to ice hockey, an analysis of 7 years of admission to a Level-1 Emergency Centre in Switzerland.

OBJECTIVE: This study was carried out to identify the frequency and types of injuries in adult ice hockey, in order to better understand injury patterns and identify potential areas for injury prevention. METHODS: We conducted a retrospective database review of acute injuries reported in ice hockey in patients presenting to a Level-1 adult Emergency Centre in Switzerland. Patients between January 1, 2013 and December 31, 2019 and over 16 years of age were identified in our computerised patient database. Each consultation was reviewed to derive information on demographics, playing level and the features of the injury, including location, type, mechanism and consequences. Different age groups were compared, as were amateur and professional players. A statistical analysis was performed. RESULTS: A total of 230 patients were identified. The most common diagnoses were fracture (28.3%), contusion/abrasion (23.9%), laceration (12.6%) and concussion (10.4%). The most commonly affected body parts were the face (31.3%), the shoulder/clavicle (13.0%) and the head (12.2%). Most lesions were caused by player-player contact (37.4%), contact with the puck (24.3%) and falls (10.9%). In comparison to the younger cohorts, patients >36 years of age more frequently suffered injuries caused by falls, (p < 0.001) and were less frequently injured by player-player contact (p = 0.01813). In amateur players, significantly more injuries were caused by stick contact (OR 0, 95% CI (0.00-0.83), p = 0.02) and surgery was more rarely performed (OR 2.35, 95% CI 0.98-5.46, p = 0.04). CONCLUSIONS: Injuries continue to play a major role in ice hockey, especially in the face and due to player-player contact. Future investigations should focus on player-player contact and possible effective preventive measures. Players must be encouraged to employ face protection and to wear a mouth guard at all times.

The Role of the Hand Surgery Consultant in the Care of the Hockey Athlete.

Ice hockey is a high-speed sport played on a slippery ice surface, using sharp skate blades, rigid sticks with a hard rubber puck, and allowing full-force physical contact that includes body checking and fighting. Although many of the same injuries to the hand and wrist occur that are seen in other sports, there is a higher frequency of certain injuries in the hockey athlete due to the forces involved, the way the hockey stick is gripped, torqued, and used, and the fact that players can slash one another with their sticks. Beyond timely and accurate management of the injury itself, the role of the consultant hand surgeon in hockey encompasses mastery of the intangible skills in the art and humanity of medical care. Injury to the hockey athlete sets in motion a dynamic process that involves many stakeholders who each require your knowledge of how this will affect the hockey athlete's immediate and long-term health, how long they may be out of competition, and the kind of treatments, splints and equipment modifications that could help foster the earliest return-to-play in a safe manner. The consultant hand surgeon needs the ability to communicate information at a high level to team physicians and trainers while remaining nimble enough to simplify that information for general managers, coaches, agents, and athletes. The role demands commitment in time and flexibility, remaining open to gray areas in treatment options, possessing a creative mindset for problem-solving, and the ability to quickly assimilate vast amounts of information to provide a risk assessment of short and long-term implications the injury presents to both the player and the team.

Which Sport Is More Dangerous: Ice Hockey or Field Hockey? A Review of the Head and Neck Injuries Associated With the Two Sports.

PURPOSE: Ice hockey and field hockey are contact sports with the potential for injury, especially to the head and neck regions. The purpose of this study is to estimate and compare hospital admission (injury severity) between ice hockey and field hockey of those who presented to the emergency department with head and neck injuries. METHODS: The investigators designed and implemented a 20-year retrospective cohort study using the National Electronic Injury Surveillance System database. We included data related to ice hockey and field hockey injuries from January 2000 to December 2019 in this study. The primary predictor variable was sport played (ice hockey vs field hockey). Secondary predictor variables and covariates were derived from patient and injury characteristics. The primary outcome variable was hospital admission. Logistic regression was used to determine independent risk factors for the outcome variable. RESULTS: Our final sample was composed of 5,472 patients: 4,472 patients suffered head and neck injuries from ice hockey while the remaining 1,000 patients suffered head and neck injuries from field hockey. Players less than 18 years old were associated with 2.07-fold odds of admission (P < .01). Injury to the head (odds ratio [OR] = 14.339; 95% confidence interval [CI], 2.0 to 105.1; P < .01) and neck (OR = 89.260; 95% CI, 11.2 to 712.6; P < .01) were independently associated with an increased odds of admission. Relative to contusions/abrasions, players who suffered a concussion (OR = 141.637; 95% CI, 11.5 to 1,741.5; P < .01), fracture (OR = 155.434; 95% CI, 17.0 to 1,419.2; P < .01), internal organ injury (OR = 186.450; 95% CI, 15.5 to 2,236.8; P < .01), or hematoma (OR = 23.046; 95% CI, 1.2 to 442.5; P < .05) were all independently associated with an increased odds of admission. Ice hockey was not an independent risk factor for admission relative to field hockey. CONCLUSIONS: The findings of this study suggest that ice hockey was more associated with injuries to the head and neck as well as with concussions and internal organ injury compared to field hockey. However, ice hockey was not associated with increased risk of hospitalization relative to field hockey.

The effect of specialization and level of competition on injury in elite male ice hockey players.

OBJECTIVE: Young players experience pressure to focus on ice hockey at the exclusion of other sports in order to improve chances of success. Early specialization in other sports has been associated with increased injury without the benefit of improved success. The objective of the current study was to investigate whether earlier specialization results in increased injury without higher rates of career success. This study also aimed to compare rates of injury in athletes at various levels of competition. METHODS: An original survey was issued to men's ice hockey players at the juniorA, collegiate, and professional levels. The survey consisted of 34 questions on various demographic, specialization, and injury variables. All participants were >18 years of age. RESULTS: The survey was completed by 101 athletes. The mean age at specialization was 13 (±4) overall and 14 (±3), 13 (±4), and 11(±4) for professional, collegiate, and junior players, respectively. There was no difference in age at specialization between each group and professional players did not specialize earlier than the remainder of the cohort as a whole (p > 0.05). There was no significant correlation between age at specialization and total injuries (p > 0.05). There was no difference in concussions causing missed play time between groups (p > 0.05) but professional players had more overall concussions and underwent more surgeries due to hockey-related injuries (p = 0.01). CONCLUSIONS: Specializing exclusively in ice hockey earlier in life was not associated with playing professionally. Both collegiate and professional players do not tend to specialize prior to age 12. Age at specialization was not associated with overall number of injuries. Professional players with longer careers appear to sustain more concussions and undergo more surgery.

Mortality from mental disorders and suicide in male professional American football and soccer players: A meta-analysis.

OBJECTIVE: To determine the risk of mortality from mental disorders and suicide in professional sports associated with repeated head impacts. METHODS: A systematic search was performed in PubMed, Web of Science, Scopus, and SPORTDiscus (since inception to June 8, 2021) to find studies comparing the incidence of mortality from mental disorders or suicide in former or active professional athletes of sports characterized by repeated head impacts vs athletes with no such exposure or the general non-athletic population. RESULTS: Seven retrospective studies of moderate-to-high quality that included data from boxers and from basketball, ice hockey, soccer, and National Football League (NFL) players, respectively (total = 27 477 athletes, 100% male) met all inclusion criteria. Former male NFL players (n = 13 217) had a lower risk of mortality from mental disorders (standard mortality rate [SMR] = 0.30; 0.12-0.77; p = 0.012) and suicide (SMR = 0.54; 0.37-0.78; p < 0.001) than the general population. This finding was also corroborated in male soccer players (n = 13,065; SMR = 0.55; 0.46-0.67; p < 0.001). Male athletes participating in sports associated with repeated head impacts (n = 18,606) had also a lower risk of all-cause, cardiovascular disease (CVD), and cancer mortality (all p < 0.01) than the general population. CONCLUSIONS: Participation of male athletes in American football or soccer at the professional level might confer a certain protective effect against mortality from mental disorders or suicide, besides its association with a lower risk of all-cause, CVD, or cancer-related mortality.

Ulnar-Sided Wrist Pain in the Athlete: Sport-Specific Demands, Clinical Presentation, and Management Options.

ABSTRACT: Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.

Hockey: a pain in the butt! Isolated superior gluteal artery rupture following blunt pelvic trauma - an unusual case.

Superior gluteal artery rupture is a rare complication of trauma but a significant one with potential for substantial morbidity and mortality. This case demonstrates the importance of early diagnosis and treatment of this injury pattern. Endovascular embolisation has become the most effective treatment for pelvic haemorrhage. Acknowledgement of this rare injury as a differential diagnosis is vital to facilitate rapid diagnosis and appropriate treatment.

A Cam Morphology Develops in the Early Phase of the Final Growth Spurt in Adolescent Ice Hockey Players: Results of a Prospective MRI-based Study.

BACKGROUND: Cam morphologies seem to develop with an increased prevalence in adolescent boys performing high-impact sports. The crucial question is at what age the cam morphology actually develops and whether there is an association with an aberration of the shape of the growth plate at the cam morphology site. QUESTIONS/PURPOSES: (1) What is the frequency of cam morphologies in adolescent ice hockey players, and when do they appear? (2) Is there an association between an extension of the physeal growth plate and the development of a cam morphology? (3) How often do these players demonstrate clinical findings like pain and lack of internal rotation? METHODS: A prospective, longitudinal MRI study was done to monitor the proximal femoral development and to define the appearance of cam morphologies in adolescent ice hockey players during the final growth spurt. Young ice hockey players from the local boys' league up to the age of 13 years (mean age 12 ± 0.5 years) were invited to participate. From 35 players performing on the highest national level, 25 boys and their parents consented to participate. None of these 25 players had to be excluded for known disease or previous surgery or hip trauma. At baseline examination as well as 1.5 and 3 years later, we performed a prospective noncontrast MRI scan and a clinical examination. The three-dimensional morphology of the proximal femur was assessed by one of the authors using radial images of the hip in a clockwise manner. The two validated parameters were: (1) the alpha angle for head asphericity (abnormal > 60°) and (2) the epiphyseal extension for detecting an abnormality in the shape of the capital physis and a potential correlation at the site of the cam morphology. The clinical examination was performed by one of the authors evaluating (1) internal rotation in 90° of hip and knee flexion and (2) hip pain during the anterior impingement test. RESULTS: Cam morphologies were most apparent at the 1.5-year follow-up interval (10 of 25; baseline versus 1.5-year follow-up: p = 0.007) and a few more occurred between 1.5 and 3 years (12 of 23; 1.5-year versus 3-year follow-up: p = 0.14). At 3-year follow-up, there was a positive correlation between increased epiphyseal extension and a high alpha angle at the anterosuperior quadrant (1 o'clock to 3 o'clock) (Spearman correlation coefficient = 0.341; p < 0.003). The prevalence of pain on the impingement test and/or restricted internal rotation less than 20° increased most between 1.5-year (1 of 25) and the 3-year follow-up (6 of 22; 1.5-year versus 3-year follow-up: p = 0.02). CONCLUSION: Our data suggest that a cam morphology develops early during the final growth spurt of the femoral head in adolescent ice hockey players predominantly between 13 to 16 years of age. A correlation between an increased extension of the growth plate and an increased alpha angle at the site of the cam morphology suggests a potential underlying growth disturbance. This should be further followed by high-resolution or biochemical MRI methods. Considering the high number of cam morphologies that correlated with abnormal clinical findings, we propose that adolescents performing high-impact sports should be screened for signs of cam impingement, such as by asking about hip pain and/or examining the patient for limited internal hip rotation. LEVEL OF EVIDENCE: Level I, prognostic study.

Traumatic Distal Anterior Cerebral Artery Aneurysms - Pathomechanism and Revascularisation Strategies.

Traumatic intracranial aneurysms (TICA) of the distal anterior cerebral artery (dACA) are exceptionally rare and display therapeutic challenges due to their angioanatomical characteristics. The objective of this work was to discuss the mechanisms of TICA formation of the dACA and to elucidate the best treatment and revascularization strategies in these patients based on two illustrative cases. Case 1: 20-year-old patient with a traumatic, partially thrombosed 14 × 10 mm aneurysm of the right pericallosal artery (rPericA), distal to the origin of the right callosomarginal artery (rCMA). Complete trapping of the right dissection A3 aneurysm and flow replacement extra-to-intracranial (EC-IC) bypass (STA - radial artery - A4) was performed. Case 2: 16-year-old patient with a traumatic polylobulated, partially thrombosed 16 × 10 mm aneurysm of the rPericA. Microsurgical excision of the A3- segment harboring the aneurysm and flow replacement intra-to-intracranial (IC-IC) bypass via reimplantation of the right remaining PericA on the contralateral PericA (end-to-side anastomosis) was performed (in situ bypass). TICA of the dACA are exceptionally rare. Mechanical vessel wall injury and aneurysm formation of the dACA in blunt head trauma is very likely due to the proximity of the dACA with the rigid free edge of the falx. Given their nature as dissecting (complex) aneurysm, trapping and revascularization is a very important strategy. The interhemispheric cistern offers multiple revascularization options with its numerous donor vessels. The IC-IC bypass is often the simplest revascularization construct.

Incidencia de lesiones en un equipo femenino de Primera División de hockey sobre césped. San Isidro Club / Incidence of injuries in a women's First Division field hockey team. San Isidro Club

El análisis del costo fisiológico y del gasto calórico del Hockey lo han colocado en la categoría de "ejercicio intenso", exponiendo a los jugadores a constantes situaciones con un potencial de lesión muy alto. El objetivo del siguiente artículo fue describir la incidencia, frecuencia, cantidad por puesto, contexto, severidad, severidad por puesto, topografía y puesto, y, por último, segmento y tipo de lesión sufridas en jugadoras femeninas de 1° división entre los años 2018 y 2019. La incidencia fue de 28,6 cada 1000hs, o bien 0,45 cada 1000hs/jugadora. El momento del año con mayores lesiones fue el mes de septiembre, la posición con mayor incidencia fueron las mediocampistas, el mecanismo de la lesión con mayor riesgo fueron las que no tuvieron contacto, por último, las lesiones más frecuentes fueron las musculares. Futuros estudios deberán analizar de forma prospectiva la situación, estableciendo y considerando un mayor tamaño muestral del club (por ejemplo, a otras 1° divisiones del Club), a la Asociación de Hockey de Buenos Aires y de los seleccionados nacionales, para obtener mejor información y correlacionar la misma. Estableciendo parámetros epidemiológicos para conocer la realidad de nuestros clubes respecto a los otros, tanto a nivel nacional como internacional.

Surgical Repair of Bilateral Combined Rectus Abdominis and Adductor Longus Avulsion: A Case Report.

CASE: In this case report, we present an adult man who sustained bilateral rectus abdominis and adductor longus avulsions with associated symphyseal instability while playing hockey. The injury was managed surgically, and the patient returned to preinjury level of function. CONCLUSION: To our knowledge, this is the first reported case of such a bilateral injury. The surgical management and outcome add to the current literature, which lacks adequate evidence on the most effective management for injuries of this type.

MRI of the sacroiliac joints in athletes: recognition of non-specific bone marrow oedema by semi-axial added to standard semi-coronal scans.

OBJECTIVE: Assessment of combined semi-axial and semi-coronal SI joint MRI in two cohorts of young athletes to explore frequency and topography of non-specific bone marrow oedema (BMO), its association with four constitutional SI joint features, and potential restriction of false-positive assignments of Assessment of SpondyloArthritis International Society-defined sacroiliitis on standard semi-coronal scans alone. METHODS: Combined semi-axial and semi-coronal SI joint MRI scans of 20 recreational runners before/after running and 22 elite ice-hockey players were evaluated by three blinded readers for BMO and its association with four constitutional SI joint features: vascular partial volume effect, deep iliac ligament insertion, fluid-filled bone cyst and lumbosacral transitional anomaly. Scans of TNF-treated spondyloarthritis patients served to mask readers. We analysed distribution and topography of BMO and SI joint features across eight anatomical SI joint regions (upper/lower ilium/sacrum, subdivided in anterior/posterior slices) descriptively, as concordantly recorded by ⩾2/3 readers on both MRI planes. BMO confirmed on both scans was compared with previous evaluation of semi-coronal MRI alone, which met the Assessment of SpondyloArthritis International Society definition for active sacroiliitis. RESULTS: Perpendicular semi-axial and semi-coronal MRI scans confirmed BMO in the SI joint of every fourth young athlete, preferentially in the anterior upper sacrum. BMO associated with four constitutional SI joint features was observed in 20-36% of athletes, clustering in the posterior lower ilium. The proportion of Assessment of SpondyloArthritis International Society-positive sacroiliitis recorded on the semi-coronal plane alone decreased by 33-56% upon amending semi-axial scans. CONCLUSION: Semi-axial combined with standard semi-coronal scans in MRI protocols for sacroiliitis facilitated recognition of non-specific BMO, which clustered in posterior lower ilium/anterior upper sacrum.

Return to Collegiate Hockey After Repair of Chronic Biceps Femoris Tendon Transection at the Knee: A Case Report.

CASE: A 22-year-old man sustained complete transection of his right distal biceps femoris tendon by a hockey skate. He experienced persistent pain and disability, symptoms of peroneal neuritis, and an inability to return to hockey. At 3-months postinjury, he underwent biceps femoris repair and peroneal neurolysis. At 9-months postoperatively, the patient returned to full activity and played a full season collegiate hockey. CONCLUSIONS: Isolated distal biceps femoris transection is rare and may be associated with peroneal neuritis. Primary repair and peroneal neurolysis is a viable treatment option (even 3 months postinjury), with satisfactory outcomes and full return to high-level activity.

A Reliable Video-based ACL Injury Screening Tool for Female Team Sport Athletes.

This study aimed to develop a 2-dimensional (2D) video screening tool capable of predicting an athlete's peak 3-dimensional (3D) knee moments during unplanned sidestepping. 2D video-based kinematic measures were simultaneously captured with 3D peak knee moments for 30 female field hockey players (15 junior, 15 senior). Intra- and intertester repeatability of 2D kinematic measures was performed. Then, linear regression models were used to model 3D knee moments from 2D kinematic variables utilizing 80% of the sample (n=24). Regression equations were then validated on the remaining 20% of the sample (n=6). Angular 2D measures had good-excellent intra- (ICC=0.936-0.998) and intertester (ICC=0.662-0.949) reliability. Displacement measures had poor-excellent intra- (ICC=0.377-0.539) and inter-tester (ICC=0.219-0.869) reliability. Significant independent predictors of peak knee moments were dynamic knee valgus, knee flexion angle at foot strike, trunk flexion range of motion (ROM), trunk lateral flexion, hip abduction and knee flexion ROM (P<0.05). Regression equations generated from these models effectively predicted peak knee extension, valgus and internal rotation moments (i. e., were not different from measured values P>0.05, ES<0.4) in the 20% subsample. 2D video-based measurements of an athlete's full body kinematics during unplanned sidestepping provide a reliable, specific, sensitive and cost-effective means for screening female team sport athletes.

Dropping the Hammer: An Uncommon Case of Right-Hand Pain in a Professional Hockey Player.

A 26-year-old, right-handed male professional hockey player presented for a second opinion with dysesthesia of the tips of his right third, fourth, and fifth fingers after 2 previous incidents of hyperextension injuries to his right wrist while holding his hockey stick. Radiographs and computed tomography scans were negative for fracture. After magnetic resonance angiography and Doppler ultrasound imaging, the athlete was diagnosed with hypothenar hammer syndrome (HHS) with ulnar artery aneurysm and thrombosis. He underwent successful surgery with ligation and excision of the aneurysmal, thrombosed ulnar artery and was able to return to hockey 4 weeks after surgery. HHS is thought to be a rare posttraumatic digital ischemia from thrombosis and/or aneurysm of the ulnar artery and was traditionally considered an occupational injury but has been reported more frequently among athletes. There have only been 2 previous case reports of hockey players diagnosed with HHS, and in the previous 2 case reports, both involved repetitive trauma from the hockey stick, which resulted in thrombotic HHS. We present a case of a professional hockey player diagnosed with HHS also due to repetitive trauma from the hockey stick, but this time resulting in aneurysmal HHS with thromboembolism. This case report highlights the importance of keeping HHS in the differential diagnosis in athletes with pain, cold sensitivity, and paresthesia in their fingers with or without a clear history of repetitive trauma to the hypothenar eminence, as HHS is a condition with good outcomes after proper treatment.

"Hockey wrist:" dorsal ulnotriquetral ligament injury.

BACKGROUND: Ulnar-sided wrist pain at the dorsal proximal triquetrum, especially during wrist pronation, flexion and radial deviation, is common in athletes, particularly ice hockey players. The purpose of this study was to evaluate in which position the dorsal ulnotriquetral ligament (DUTL) is placed under the greatest strain, the torque to failure and the injury pattern. We hypothesized that the DUTL is maximally strained with wrist flexion, pronation and radial deviation, and that, at failure, the ligament tears off the triquetrum. METHODS: We performed a biomechanical study on 7 fresh frozen cadaveric upper extremities, with testing done on a wrist-movement stimulator to identify the position (45° of wrist flexion, 45° of wrist extension or neutral) that generated the highest and earliest strain increases in the DUTL. We performed load-to-failure testing, characterized the ligament's pattern of failure, and repaired and retested the DUTL using the same load-to-failure protocol. RESULTS: The DUTL reached 3 N∙m the earliest in 45° of wrist flexion (p = 0.02). The native DUTL failed at 0.35 N∙m (standard deviation [SD] 0.13 N∙m) per degree of angular stiffness, 12.93 N∙m of yield strength and with angular deformation of 57.73° (SD 20.62°). There was no significant difference in these variables between the native and repaired DUTL. Tearing occurred at a mean of 10 mm (SD 2 mm) proximal from the triquetrum's insertion in a transverse midsubstance pattern. CONCLUSION: This study showed a reproducible pattern of injury to the DUTL in a cadaveric model. Additional work is needed to further characterize the pathoanatomy of "hockey wrist."

CONTEXTE: La douleur cubitale au poignet, au niveau du triquetrum proximal dorsal, surtout à la pronation, à la flexion et à la déviation radiale du poignet, est fréquente chez les athlètes, particulièrement chez les joueurs de hockey. Le but de cette étude était d'évaluer la position dans laquelle le ligament ulnotriquétral dorsal (LUTD) est soumis à la pression la plus grande, le couple de torsion menant à la défaillance et le mode de blessure. Selon notre hypothèse, le LUTD est soumis au maximum de pression lorsque le poignet est en flexion, pronation et déviation radiale, et au moment de la défaillance, le ligament ulnotriquétral se déchire. MÉTHODES: Nous avons procédé à une étude biomécanique sur 7 membres supérieurs de cadavres frais congelés, et effectué des tests sur un stimulateur de mouvements du poignet pour établir la position (flexion du poignet à 45°, extension du poignet de 45° ou position neutre) générant les augmentations de pression les plus fortes et les plus rapides sur le LUTD. Nous avons procédé à des tests de mise en charge jusqu'à défaillance, caractérisé le mode de défaillance du ligament et réparé et retesté le LUTD à l'aide du même protocole de mise en charge jusqu'à défaillance. RÉSULTATS: Le LUTD a atteint 3 N∙m le plus rapidement avec une flexion du poignet à 45° (p = 0,02). Le LUTD natif a connu une défaillance à 0,35 N∙m (écart-type [É.-T.] 0,13 N∙m) par degré de raideur angulaire, 12,93 N∙m d'élasticité et avec une déformation angulaire de 57,73° (É.-T. 20,62°). On n'a noté aucune différence significative de ces variables entre les LUTD natifs et réparés. La déchirure s'est produite en moyenne à 10 mm (É.-T. 2 mm) en proximal par rapport à l'insertion du triquetrum selon un trajet transverse affectant la moitié de la substance ligamentaire. CONCLUSION: L'étude a démontré un mode reproductible de lésion du LUTD à l'aide d'un modèle cadavérique. Il faudra approfondir la recherche pour caractériser avec plus de précision l'anatomopathologie de la lésion au poignet typiquement causée par la pratique du hockey.

Return-to-Play and Performance Outcomes of Professional Athletes in North America After Hip Arthroscopy From 1999 to 2016.

BACKGROUND: The effect of hip arthroscopy on athletic performance compared with preinjury levels for professional athletes in different sports remains unknown. In addition, while return rates have been reported for professional baseball, football, and hockey players, return rates have not been reported for professional basketball players. HYPOTHESIS: Professional athletes in 4 major North American sports would be able to return to their sport and preoperative level of performance at a high rate after arthroscopic hip surgery. STUDY DESIGN: Descriptive epidemiology study. METHODS: Major League Baseball (MLB), National Basketball Association (NBA), National Football League (NFL), and National Hockey League (NHL) athletes who underwent hip arthroscopy were identified through a previously reported protocol based on public sources. Successful return to play (RTP) was defined as returning for at least 1 professional regular season game after surgery. Performance scores were calculated by use of previously established scoring systems. Each player served as his own control, with the season prior to surgery defined as baseline. To make comparisons across sports, the authors adjusted for expected season and career length differences between sports and calculated percentage changes in performance. RESULTS: The authors identified 227 procedures performed on 180 professional athletes between 1999 and 2016. Successful RTP was achieved in 84.6% (192/227) of the procedures. Compared with all other athletes, NBA athletes returned at a similar rate (85.7%, P ≥ .999). NFL offensive linemen returned at a significantly lower rate than all other athletes (61.1%, P = .010). NHL athletes returned at a significantly higher rate than all other athletes (91.8%, P = .048) and demonstrated significantly decreased performance during postoperative season 1 compared with baseline (-35.1%, P = .002). Lead leg surgery for MLB athletes (batting stance for hitters, pitching stance for pitchers) resulted in a 12.7% reduction in hitter performance score ( P = .041), a 1.3% reduction in pitcher fastball velocity ( P = .004), and a 60.7% reduction in pitch count ( P = .007) one season after surgery compared with baseline. Players in nearly every sport demonstrated significant reductions in game participation after surgery. CONCLUSION: This study supports the hypothesis that hip arthroscopy in professional athletes is associated with excellent rates of return at the professional level. However, postoperative performance outcomes varied based on sport and position.

Dupuytren disease is highly prevalent in male field hockey players aged over 60†years.

BACKGROUND/AIM: Dupuytren disease is a fibroproliferative hand condition. The role of exposure to vibration as a risk factor has been studied with contradictory results. Since field hockey is expected to be a strong source of hand-arm vibration, we hypothesised that long-term exposure to field hockey is associated with Dupuytren disease. METHODS: In this cross-sectional cohort study, the hands of 169 male field hockey players (IQR: 65-71 years) and 156 male controls (IQR: 59-71 years) were examined for signs of Dupuytren disease. Details about their age, lifestyle factors, medical history, employment history and leisure activities were gathered. Prior to the analyses, the groups were balanced in risk factors using propensity score matching. The association between field hockey and Dupuytren disease was determined using a subject-specific generalised linear mixed model with a binomial distribution and logit link function (matched pairs analysis). RESULTS: Dupuytren disease was observed in 51.7% of the field hockey players, and in 13.8% of the controls. After propensity score matching, field hockey playing as dichotomous variable, was associated with Dupuytren disease (OR=9.42, 95% CI 3.01 to 29.53). A linear dose-response effect of field hockey (hours/week x years) within the field hockey players could not be demonstrated (OR=1.03, 95% CI 0.68 to 1.56). DISCUSSION: We found that field hockey playing has a strong association with the presence of Dupuytren disease. Clinicians in sports medicine should be alert to this less common diagnosis in this sport.

[Tendonitis calcarea of the piriformis muscle in a young amateur athlete]. / Tendinitis calcarea des M. piriformis bei einer jungen Amateursportlerin.

Distinct calcific tendonitis associated with chronic pain refractory to conservative treatment can require operative treatment. Symptomatic calcific tendonitis of the piriform muscle, despite calcific tendonitis of other regions, is an extremely rare diagnosis. We report about a young athlete with persistent gluteal pain despite long-term conservative treatment. MRI scans revealed tendonitis calcarea with surrounding soft tissue inflammation. On open surgical removal of the calcification, pain symptoms were relieved and the patient was able to return to sports.

Risk Factors for Reoperation and Performance-Based Outcomes After Operative Fixation of Foot Fractures in the Professional Athlete: A Cross-Sport Analysis.

BACKGROUND: Professional athletes are predisposed to fractures of the foot due to large stresses placed on the lower extremity. These players are concerned with efficiently returning to play at a high level. Return-to-play rates after operative treatment have been previously reported, yet performance outcomes after such treatment are generally unknown in this population. HYPOTHESIS: Overall, professional athletes sustaining a foot fracture would return to play at high rates with little impact on postoperative performance or league participation. However, National Football League (NFL) athletes would have a significantly greater decline in performance due to the high-impact nature of the sport. STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 4. METHODS: Athletes in the National Basketball League (NBA), NFL, Major League Baseball (MLB), and National Hockey League (NHL) undergoing operative fixation of a foot fracture were identified through a well-established protocol confirmed by multiple sources of the public record. Return-to-play rate and time to return were collected for each sport. League participation and game performance data were collected before and after surgery. Statistical analysis was performed, with significance accepted as P ≤ 0.05. RESULTS: A total of 77 players undergoing 84 procedures met the inclusion criteria. Overall, 98.7% (76/77) of players were able to return to play, with a median time to return across all sports of 137 days. Players returned to preoperative performance levels within 1 season of surgery. Six players (7.8%) sustained refracture requiring reoperation, all of whom were in the NBA. Percentage of games started during the season after primary operative treatment was a predictive factor for reinjury (99% vs 40%, P = 0.001). CONCLUSION: Athletes returned to play at a high rate after foot fracture fixation, with excellent postoperative performance levels, regardless of sport and fracture location. NBA athletes sustaining fifth metatarsal and navicular fractures are at greater risk of reinjury compared with other athletes. Returning to high levels of athletic participation soon after surgery may predispose athletes to refracture and subsequent reoperation. CLINICAL RELEVANCE: Players, coaches, and team physicians should be aware of the impact of foot fractures on career performance and longevity to best guide therapy.