Stem cells and regenerative medicine in sport science.

The estimated cost of acute injuries in college-level sport in the USA is ∼1.5 billion dollars per year, without taking into account the cost of follow up rehabilitation. In addition to this huge financial burden, without appropriate diagnosis and relevant interventions, sport injuries may be career-ending for some athletes. With a growing number of females participating in contact based and pivoting sports, middle aged individuals returning to sport and natural injuries of ageing all increasing, such costs and negative implications for quality of life will expand. For those injuries, which cannot be predicted and prevented, there is a real need, to optimise repair, recovery and function, post-injury in the sporting and clinical worlds. The 21st century has seen a rapid growth in the arena of regenerative medicine for sporting injuries, in a bid to progress recovery and to facilitate return to sport. Such interventions harness knowledge relating to stem cells as a potential for injury repair. While the field is rapidly growing, consideration beyond the stem cells, to the factors they secrete, should be considered in the development of effective, affordable treatments.

Traumatic Injuries in Pediatric Surgery in the Medical-epidemiological-economic Aspect.

BACKGROUND: The aim of this study was to present the medical, epidemiological and economic aspects of traumatic injuries in children and adolescents. The literature on the subject is scarce. MATERIAL AND METHODS: A retrospective analysis was performed on the data of 1,138 children treated at the Department of Pediatric Surgery, Stefan Zeromski Specialized Hospital in Kraków between 2012 and 2016 on account of head, abdominal and pelvic, chest, testicular and musculoskeletal injuries. Age, sex, circumstances and type of the injury as well as concomitant damage were analyzed. RESULTS: Musculoskeletal injuries accounted for 68% of all the injuries analysed. The mean age of the patients was 6.3 years. The main causes of injury were same-level fall (30%), fall from a height (22.5%), road accidents (8%), and sports injuries (19%). 36% and 29% of the patients sustained injuries at home and at or near school, respectively. CONCLUSIONS: 1. Traumatic injuries in children and adolescents are the most common cause of admissions to pediatric surgery departments, with musculoskeletal injuries being the most frequent among them. 2. Injuries occur most frequently at or near home or school. 3. The cost of treatment and hospital stay of patients with musculoskeletal injuries accounted for 50% of the total cost of treatment in the Department of Pediatric Surgery. 4. There is a need to develop and implement preventive and educational programs for parents, guardians, teachers and children to prevent injuries.

Cost-effectiveness analyses in orthopaedic sports medicine: a systematic review.

BACKGROUND: As increasing attention is paid to the cost of health care delivered in the United States (US), cost-effectiveness analyses (CEAs) are gaining in popularity. Reviews of the CEA literature have been performed in other areas of medicine, including some subspecialties within orthopaedics. Demonstrating the value of medical procedures is of utmost importance, yet very little is known about the overall quality and findings of CEAs in sports medicine. PURPOSE: To identify and summarize CEA studies in orthopaedic sports medicine and to grade the quality of the available literature. STUDY DESIGN: Systematic review. METHODS: A systematic review of the literature was performed to compile findings and grade the methodological quality of US-based CEA studies in sports medicine. The Quality of Health Economic Studies (QHES) instrument and the checklist by the US Panel on Cost-effectiveness in Health and Medicine were used to assess study quality. One-sided Fisher exact testing was performed to analyze the predictors of high-quality CEAs. RESULTS: Twelve studies met inclusion criteria. Five studies examined anterior cruciate ligament reconstruction, 3 studies examined rotator cuff repair, 2 examined autologous chondrocyte implantation, 1 study examined hip arthroscopic surgery, and 1 study examined the operative management of shoulder dislocations. Based on study findings, operative intervention in sports medicine is highly cost-effective. The quality of published evidence is good, with a mean quality score of 81.8 (range, 70-94). There is a trend toward higher quality in more recent publications. No significant predictor of high-quality evidence was found. CONCLUSION: The CEA literature in sports medicine is good; however, there is a paucity of studies, and the available evidence is focused on a few procedures. More work needs to be conducted to quantify the cost-effectiveness of different techniques and procedures within sports medicine. The QHES tool may be useful for the evaluation of future CEAs.

Prevention and screening programs for anterior cruciate ligament injuries in young athletes: a cost-effectiveness analysis.

BACKGROUND: Anterior cruciate ligament (ACL) injuries are common among young athletes. Biomechanical studies have led to the development of training programs to improve neuromuscular control and reduce ACL injury rates as well as screening tools to identify athletes at higher risk for ACL injury. The purpose of this study was to evaluate the cost-effectiveness of these training methods and screening strategies for preventing ACL injuries. METHODS: A decision-analysis model was created to evaluate three strategies for a population of young athletes participating in organized sports: (1) no training or screening, (2) universal neuromuscular training, and (3) universal screening, with neuromuscular training for identified high-risk athletes only. Risk of injury, risk reduction from training, and sensitivity and specificity of screening were based on published data from clinical trials. Costs of training and screening programs were estimated on the basis of the literature. Sensitivity analyses were performed on key model parameters to evaluate their effect on base case conclusions. RESULTS: Universal neuromuscular training of all athletes was the dominant strategy, with better outcomes and lower costs compared with screening. On average, the implementation of a universal training program would save $100 per player per season, and would reduce the incidence of ACL injury from 3% to 1.1% per season. Screening was not cost-effective within the range of reported sensitivity and specificity values. CONCLUSIONS AND CLINICAL RELEVANCE: Given its low cost and ease of implementation, neuromuscular training of all young athletes represents a cost-effective strategy for reducing costs and morbidity from ACL injuries. While continued innovations on inexpensive and accurate screening methods to identify high-risk athletes remain of interest, improving existing training protocols and implementing neuromuscular training into routine training for all young athletes is warranted.

What is the economic burden of sports injuries?

Despite the health benefits of sports activities, sports injury and fear of injury are important barriers to participation in sport. The incidence, prevalence and type of sports injuries vary among men and women as well as age groups. It is usually difficult to examine these different aspects of sports injuries due to insufficient data. This study argues that sport injuries can be considered as an important economic burden in terms of the direct and indirect costs it bears. As a result, strong and effective strategies are needed to prevent sports injuries. Sports medicine has also been attracted increasing attention in recent years, particularly. In this article, the importance of sports injuries and their economic costs as well as the role of sport medicine as a prevention method for sports injuries were discussed.

Cost-effectiveness of anterior cruciate ligament reconstruction: a preliminary comparison of single-bundle and double-bundle techniques.

BACKGROUND: There has been growing interest in anatomical reconstruction of the anterior cruciate ligament (ACL), including the use of double-bundle (DB) reconstruction techniques. HYPOTHESIS: The DB technique will not be cost-effective when compared with single-bundle (SB) reconstruction. STUDY DESIGN: Economic and decision analysis; Level of evidence, 1. METHODS: A decision-analysis model with input values derived from the literature was used to estimate the cost-effectiveness of DB ACL reconstruction compared with SB ACL reconstruction. Effectiveness was based on the revision rate and the postoperative International Knee Documentation Committee (IKDC) score. RESULTS: Sixty-four percent of DB knees result in an IKDC score of A, compared with 54% of SB knees. The incremental cost-effectiveness ratio of a DB reconstruction compared with an SB reconstruction was $6416 per quality adjusted life year in the baseline scenario and $64 371 per quality adjusted life year in the alternate scenario. The model is very sensitive to the proportions of IKDC A outcomes. The model is also sensitive to the utility values assigned to IKDC A and B outcomes and is less sensitive to the marginal cost of a DB reconstruction. CONCLUSION: This preliminary analysis based on published clinical results to date shows DB ACL reconstruction may be cost-effective, despite increased upfront cost. More research is needed to confirm whether there is any difference in the distribution of IKDC outcomes between the 2 techniques. Perhaps more importantly, the lack of any other demonstrated clinical benefit from the DB technique questions the clinical relevance of this difference in IKDC scores. CLINICAL RELEVANCE: Revision data and longer term outcomes after DB reconstruction and more reliable clinical utility data are needed to definitively compare the cost-effectiveness of DB and SB ACL reconstruction. Studies of ACL reconstruction and other sports medicine procedures should report the distribution of outcomes data to facilitate future analyses of clinical effectiveness.

Motocross morbidity: economic cost and injury distribution in children.

BACKGROUND: Motocross is a nationally organized sport that is growing in popularity. The distribution and severity of motocross injuries in the pediatric population is not known. We hypothesize a high rate of musculoskeletal injuries requiring hospitalization and/or surgical intervention. METHODS: All patients 17 years of age or younger with injuries sustained while using off-road 2-wheeled motorcycles were identified through surgical, diagnostic, and trauma registries at a level 1 regional trauma center. Type, severity, and mechanism of injury were assessed, as well as charges billed for medical care. Both recreational and competitive motocross activities were included. RESULTS: From 2000 to 2007, 299 cases were noted in 249 unique patients. In 141 instances, hospital admission was required, for a total of 412 inpatient days. Twenty patients required ICU admission. Surgery was performed in 91 cases (81 orthopaedic, 6 general, 1 urology, and 4 facial reconstructions). Orthopaedic surgical procedures included treatment of 29 femur fractures, 8 forearm, 6 ankle, 5 tibial shaft, 6 proximal tibia, 5 spine, 6 proximal humerus, 4 hand, 4 foot, 3 elbow fractures, and 5 other. Orthopaedic interventions also included 8 reductions under general anesthesia and 31 conscious sedations. Mean age at injury was 14.1 years (range: 5.4 to 17.9). Ninety-four percent of patients were male and 85% were White. The majority of patients were wearing helmets/safety equipment. One hundred and eighty-four injuries occurred on a track, with 150 during competition. The mean charge billed per injury was $14,947 (range: $105 to $217,780), with a total cost of $4.5 million. CONCLUSIONS: Nearly half of motocross patients treated at a regional level 1 trauma center required hospitalization, and nearly one-third required surgery. The vast majority of surgical procedures (89%) were orthopaedic. Despite a high usage rate of helmets and protective gear, severe injuries were still sustained, including femur fracture (29), hemiparesis/spinal cord injury (2), and head injury (43). The majority of injuries occurred during organized race or practice. Families should be counseled with regard to the use of safety equipment and the severity of injuries sustained during competitive motocross activity. LEVEL OF EVIDENCE: Level IV, case series.

Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study.

There has been an intensive research effort directed at determining the cause of non-contact anterior cruciate ligament (ACL) injury over the past decade, but few studies have reported data on the incidence of ACL and other knee ligament injury in the general population. New Zealand's no-fault injury compensation data provides a national injury resource of data on claims for knee ligament injury. The goal of this paper was to provide a descriptive epidemiology of knee ligament injury in this country. Data were obtained for knee ligament injuries between 1 July 2000 and 30 June 2005. Injuries were categorised as non-surgical (NS), ACL surgeries (ACLS) and other knee ligament surgeries (OKLS). Incidence rates per 100,000 person-years were computed using population estimates. Costs and number of treatment/rehabilitation visits were obtained as an indication of severity. The incidence rate per 100,000 person-years was 1147.1 for NS, 36.9 for ACLS and 9.1 for OKLS. Males had a higher incidence rate than females for NS, ACLS, and OKLS. The mean (and median) number of treatment visits were NS: 6.6 (4), ACLS: 27.1 (24), and OKLS: 31.3 (24). The mean (median) treatment costs of these injuries were NS $885 ($129), ACLS $11,157 ($8574), and OKLS $15,663 ($8054). Analysis of injury descriptions for ACLS injuries indicated that 58% involved a non-contact mechanism of injury. These data underscore the high level of short-term disability associated with knee ligament injuries, especially ACL injuries that require surgery.

Acute physical activity and sports injuries in children.

An increase in the physical activity of individuals has many health benefits, but a drawback of an increase in physical activity is the risk of related injuries. To reduce the short- and long-term effects in terms of social and economic consequences, prevention of physical activity injuries is an important challenge. A sequence of prevention model has been proposed that aims to prevent physical activity injuries in different steps. The model includes (i) identification of the problem in terms of incidence and severity of physical activity injuries, (ii) identification of the risk factors and injury mechanisms that play a role in the occurrence of physical activity injuries, (iii) introduction of measures that are likely to reduce the future risk and (or) severity of physical activity injuries, and (iv) evaluation of the effectiveness of the measures by conducting a randomized controlled trial (RCT). This review describes what is currently known about all of the various aspects of the sequence of prevention in children (steps i-iv).

A cost-outcome approach to pre and post-implementation of national sports injury prevention programmes.

In New Zealand (NZ), the Accident Compensation Corporation (ACC) has developed a pre and post-implementation cost-outcome formulae for sport injury prevention to provide information regarding the success of a prevention programme. The ACC provides for the cost of all personal injuries in NZ and invests in prevention programmes to offset 1.6 million annual claims that cost $NZD 1.9 billion. The ACC invests in nine national community sport injury prevention programmes that represent 40% of sport claims and costs. Pre-implementation is used to determine the decision whether to invest in implementation and to determine the level of such investment for the injury prevention programme. Post-implementation is calculated two ways: unadjusted, assuming ceteris paribus; and adjusted assuming no prevention programme was in place. Post-implementation formulae provide a return on investment (ROI) for each dollar invested in the programme and cost-savings. The cost-outcome formulae approach allows ACC to manage expectations of the prevention programme as well as when it will provide a ROI, allowing it to take a long-term view for investment in sport injury prevention. Originally developed for its sport injury prevention programmes, the cost-outcome formulae have now been applied to the other prevention programmes ACC invests in such as home, road and workplace injury prevention.

Knee surgery costs in football, floor ball, European team handball and ice hockey.

UNLABELLED: The purpose of this study was first, to identify the health costs of knee surgery related to different sports (football, floor ball, European team handball and ice hockey) among players at competitive level in Stockholm 1997. Information was retrieved from three different databases, one containing information on all players in different sports, another one containing information on all surgery performed at S:t Gorans Hospital, Stockholm, and a third one containing information on all surgery performed in Stockholm. The National Registration Number (NRN) was used to identify the patients. The NRN is a unique personal identifier assigned to all Swedish residents, which allows linkage between different registers and databases. In Stockholm in 1997, 6781 surgical procedures related to the knee were performed at a cost of SEK (Swedish Crowns) 39,026,657. On players in all studied sports, 762 knee surgical procedures were performed on 657 patients in Stockholm at a cost of SEK 4,884,076. At S:t Gorans Hospital, 319 knee surgical procedures were performed on 288 patients, and 293 (92%) of these were directly related to sport participation. It was also found that only 74% of anterior cruciate ligament injuries that resulted in a surgical intervention were reported to the insurance company. CONCLUSION: The average cost for knee surgery in the studied sports was low. Knee surgery costs for European team handball players were the highest compared with other sports studied.

The effect of payer type on orthopaedic practice expenses.

BACKGROUND: Orthopaedic practice expenses are the costs associated with providing treatment that are incurred by a physician's practice. Certain payer types are thought to increase orthopaedic practice expenses by increasing paperwork and other administrative activities. Our study investigated the hypothesis that orthopaedic practice expenses would vary significantly by payer type. METHODS: With use of the method of activity-based costing, data on the orthopaedic practice expenses for 518 consecutive patients (286 men and 232 women) who had a sports-related knee condition were collected. For each patient enrolled in the study, all employees recorded the actual amount of time that they spent on each of seventeen specific activities previously shown to be associated with orthopaedic practice. The seventeen activities were categorized as either a value-added activity, which adds value to the services provided to the patient, or a nonvalue-added activity, which does not add value. The total orthopaedic practice expense was the sum of the value-added and nonvalue-added activity expenses. To capture all practice expenses associated with a particular episode of care, data collection continued until the patient was discharged and the financial account had been settled. We evaluated the differences in orthopaedic practice expenses among six payer types: self-pay, indemnity plan, Medicare, health maintenance organization/point-of-service plan (HMO/POS), preferred provider organization (PPO), and Workers' Compensation. RESULTS: The differences among payer types with respect to orthopaedic practice expenses were significant (p = 0.0000000004). The total orthopaedic practice expense per episode of care was $123 for self-pay, $195 for an indemnity plan, $148 for Medicare, $178 for PPO, $208 for HMO/POS, and $299 for Workers' Compensation. These differences among payer types persisted even after accounting for patient age, gender, treatment type (nonoperative versus operative), and number of office visits. Nonvalue-added activity expenses differed to a greater degree among the payer types than did value-added activity expenses. CONCLUSIONS: The payer type was found to be an important factor affecting orthopaedic practice expenses, particularly with respect to nonvalue-added activity expenses.

Achilles tendon ruptures in South-East Finland between 1986-1996, with special reference to epidemiology, complications of surgery and hospital costs.

BACKGROUND AND AIMS: The incidence of achilles tendon (AT) ruptures is increasing. The aim of the present study was to evaluate annual incidence, aetiology, operative complications and direct hospital costs of AT ruptures. MATERIAL AND METHODS: A retrospective study of 93 consecutive patients operated on for AT rupture from January 1986 to December 1996 at Kuusankoski District Hospital (area with 92,500 inhabitants) was performed. During the observation period no patient with an AT rupture was treated conservatively. RESULTS: 95 AT ruptures were treated including one rerupture (1%) and one patient with two ruptures. There were 7 (7%) patients with an open AT rupture. The total annual incidence in the hospital area was 8.6 (+/- 4.3) and for closed AT ruptures 8.0 (+/- 3.8). The total incidence was 9.3 (+/- 4.6)/10(5) and for closed AT ruptures 8.6 (+/- 4.1)/10(5) inhabitants per year. Most of the injuries were sport related, the most frequent sport being volleyball. Patients operated for closed AT rupture had major surgical complications in 4.5% of the cases and the total complication rate was 11%. The average direct hospital costs per patient was USD 1375. CONCLUSIONS: The incidence of AT ruptures is increasing in South-East Finland. The rate of major surgical complication was low (4.5%) and comparable with earlier studies.

[Typical sports injuries, sports specific risks and comparison with other sources of accidents]. / Typische Sportverletzungen, sportartspezifische Risiken und Vergleich mit anderen Unfallbereichen.

In the discussion of limiting the growth of medical spending there are intentions to exclude the costs of sport injuries from coverage by the public health insurance system. The aim of this study is to analyse typical sport injuries and to compare them with injuries from other fields of accidents and thus to deliver arguments in the discussion of costs in public health system.

Skiing injuries: the increasing workload.

All skiing injuries presenting to a fracture clinic during the period December 1992 to April 1993 were studied. Fifty five patients with 59 injuries were treated during this period. Thirty (54.5%) were male and 25 (45.5%) female. The mean age was 34 years (range 9-61). The anatomical distribution of injuries seen corresponded very closely with those seen in much larger studies abroad. There were 35 upper limb injuries (59.3%), 22 lower limb injuries (37.3%), with only two spine and trunk injuries (3.4%). While only two patients underwent surgery abroad, a further 12 needed surgical intervention on return, requiring a total stay of 61 'inpatient days'. The bulk of the workload was, however, on an outpatient basis, with a total of 172 appointments. Many advances have been made towards improving the safety of skiing. However with skiing becoming increasingly popular we can expect an increasing workload and cost associated with such injuries.

Trampoline-related injuries.

Two hundred and seventeen patients who had sustained an injury during the recreational use of a trampoline were managed in the emergency room of Logan Regional Hospital in Logan, Utah, from January 1991 through December 1992. We retrospectively reviewed the charts and radiographs of these patients to categorize the injuries. Additional details regarding the injuries of seventy-two patients (33 per cent) were obtained by means of a telephone interview with use of a questionnaire. The injuries occurred from February through November, with the peak incidence in July. The patients were eighteen months to forty-five years old (average, ten years old); ninety-four patients (43 per cent) were five to nine years old. Eighty-four patients (39 per cent) sustained a fracture; fifty-four (25 per cent), a sprain or strain; forty-five (21 per cent), a laceration; and thirty-four (16 per cent), a contusion. Fifty-seven injuries (26 per cent) involved the elbow or forearm; forty-six (21 per cent), the head or neck; forty (18 per cent), the ankle or foot; thirty-three (15 per cent), the knee or leg; nineteen (9 per cent), the trunk or back; thirteen (6 per cent), the shoulder or arm; and nine (4 per cent), the wrist or hand. Thirteen patients (6 per cent) had a back injury, but none of them had a permanent neurological deficit. One patient who had an ocular injury was transferred to a tertiary care center. One hundred and fifty-six patients (72 per cent) were evaluated radiographically, fifteen (7 per cent) were admitted to the hospital, and thirteen (6 per cent) had an operation.(ABSTRACT TRUNCATED AT 250 WORDS)

A claims-made study of knee injuries due to football in high school athletes.

This article is an analysis of the insurance claims for injuries sustained in high school football for the 1965, 1975-1977, and 1983-1985 football seasons. Thirteen percent of all injuries each season involved the knee. In 1965, 12% of patients were treated operatively, and, in 1985, 33% underwent surgery. Follow-up questionnaires completed by 446 (68%) of the players injured during 1975, 1976, and 1977, after a mean of 10 years, showed that 25% of players with ligament injuries, 30% with internal derangement of the knee, and 17% with patellar injuries claim disability for some athletic pursuits.