The Male Athlete Triad-A Consensus Statement From the Female and Male Athlete Triad Coalition Part 1: Definition and Scientific Basis.

ABSTRACT: The Male Athlete Triad is a syndrome of 3 interrelated conditions most common in adolescent and young adult male endurance and weight-class athletes and includes the clinically relevant outcomes of (1) energy deficiency/low energy availability (EA) with or without disordered eating/eating disorders, (2) functional hypothalamic hypogonadism, and (3) osteoporosis or low bone mineral density with or without bone stress injury (BSI). The causal role of low EA in the modulation of reproductive function and skeletal health in the male athlete reinforces the notion that skeletal health and reproductive outcomes are the primary clinical concerns. At present, the specific intermediate subclinical outcomes are less clearly defined in male athletes than those in female athletes and are represented as subtle alterations in the hypothalamic-pituitary-gonadal axis and increased risk for BSI. The degree of energy deficiency/low EA associated with such alterations remains unclear. However, available data suggest a more severe energy deficiency/low EA state is needed to affect reproductive and skeletal health in the Male Athlete Triad than in the Female Athlete Triad. Additional research is needed to further clarify and quantify this association. The Female and Male Athlete Triad Coalition Consensus Statements include evidence statements developed after a roundtable of experts held in conjunction with the American College of Sports Medicine 64th Annual Meeting in Denver, Colorado, in 2017 and are in 2 parts-Part I: Definition and Scientific Basis and Part 2: The Male Athlete Triad: Diagnosis, Treatment, and Return-to-Play. In this first article, we discuss the scientific evidence to support the Male Athlete Triad model.

Comparison of MRI and ¹8F-NaF PET/CT in patients with patellofemoral pain.

PURPOSE: To determine whether bone metabolic activity corresponds to bone and cartilage damage in patients with patellofemoral pain. MATERIALS AND METHODS: We acquired magnetic resonance imaging (MRI) and (18) F-NaF positron emission tomography (PET) / computed tomography (CT) scans of the knees of 22 subjects. We compared locations of increased tracer uptake on the (18) F-NaF PET images to bone marrow edema and cartilage damage visualized on MRI. RESULTS: We found that increased bone activity on (18) F-NaF PET does not always correspond to structural damage in the bone or cartilage as seen on MRI. CONCLUSION: Our results suggest that (18) F-NaF PET/CT may provide additional information in patellofemoral pain patients compared to MRI.

Recommendations for Enhancing Sports Medicine Fellowship Training.

Physical medicine and rehabilitation-trained physicians are increasingly interested in caring for patients with musculoskeletal and sports disorders. Sports medicine fellowships are designed to provide competency in sports medicine and musculoskeletal care. The authors, with endorsement from the Association of Academic Physiatrists, provide a framework and tools that Accreditation Council for Graduate Medical Education accredited sports medicine fellowship programs can use to enhance and meet the Accreditation Council for Graduate Medical Education program requirements. Based on the position statement from the American Medical Society for Sports Medicine, we propose recommendations for Accreditation Council for Graduate Medical Education-accredited sports medicine programs to achieve standards of excellence. We also provide recommendations for research requirements during the course of a sports fellowship. With the proposed recommendations, a sports medicine fellowship program can achieve excellence and enhance fellowship training by increasing proficiency in physical medicine and rehabilitation-based skills relevant to sports and musculoskeletal medicine. Given the multidisciplinary nature of musculoskeletal and sports medicine, it is also key that fellowship programs (regardless of the department that they are accredited through) have faculty members that represents these disciplines and accept applicants with residency training in physical medicine and rehabilitation, internal medicine, family medicine, pediatrics, and emergency medicine.

Core stability exercise principles.

Core stability is essential for proper load balance within the spine, pelvis, and kinetic chain. The so-called core is the group of trunk muscles that surround the spine and abdominal viscera. Abdominal, gluteal, hip girdle, paraspinal, and other muscles work in concert to provide spinal stability. Core stability and its motor control have been shown to be imperative for initiation of functional limb movements, as needed in athletics. Sports medicine practitioners use core strengthening techniques to improve performance and prevent injury. Core strengthening, often called lumbar stabilization, also has been used as a therapeutic exercise treatment regimen for low back pain conditions. This article summarizes the anatomy of the core, the progression of core strengthening, the available evidence for its theoretical construct, and its efficacy in musculoskeletal conditions.

Variable criteria for patellofemoral bracing among sports medicine professionals.

OBJECTIVE: To examine whether the frequency of bracing, geographic region, clinical specialty, or percentage of practice devoted to knee pain influences the criteria used by sports medicine professionals to determine whether a brace should be prescribed for treating patients with nontraumatic patellofemoral pain syndrome. DESIGN: Cross-sectional study. SETTING: Sports medicine practices in the United States. PARTICIPANTS: A total of 1307 athletic trainers, physical therapists, and sports medicine physicians recruited from the e-mail listings of the American Medical Society for Sports Medicine, the American Osteopathic Academy of Sports Medicine, the American Physical Therapy Association Sports Physical Therapy Section, the International Patellofemoral Study Group, the International Patellofemoral Retreat list, and National Collegiate Athletic Association Division 1 athletic team registries. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Thirty-seven potential patellofemoral bracing criteria encompassing history and function, alignment, physical examination, previous treatments, and radiographic evidence. RESULTS: A total of 1307 of 7999 providers replied (response rate, 16.3%). Mean bracing frequencies were 19.8% for athletic trainers, 13.4% for physical therapists, and 25.1% for physicians. The mean number of total bracing criteria used was 10.5. The 10 most commonly cited criteria for prescribing a patellofemoral brace in descending order of frequency were: (1) hypermobile patella on physical examination; (2) positive J sign on physical examination; (3) failure of previous rehabilitation; (4) pain when performing squats or going up/down stairs on history; (5) success with previous taping; (6) pain with running activities on history; (7) pain with jumping activities on history; (8) increased dynamic Q angle; (9) vastus medialis oblique deficiency in timing or strength; and (10) positive apprehension sign on physical examination. No statistically significant trends were noted with regard to experience or percentage of practice devoted to knee pain. Increased bracing frequency was significantly associated with an increased number of bracing criteria (r = 0.89, P < .0001). CONCLUSIONS: This study identified little overall consensus and showed that significant differences exist in the criteria used to prescribe a brace for patellofemoral pain syndrome among specialties and in relation to bracing frequency.

Differences in patellofemoral kinematics between weight-bearing and non-weight-bearing conditions in patients with patellofemoral pain.

Patellar maltracking is thought to be one source of patellofemoral pain. Measurements of patellar tracking are frequently obtained during non-weight-bearing knee extension; however, pain typically arises during highly loaded activities, such as squatting, stair climbing, and running. It is unclear whether patellofemoral joint kinematics during lightly loaded tasks replicate patellofemoral joint motion during weight-bearing activities. The purpose of this study was to: evaluate differences between upright, weight-bearing and supine, non-weight-bearing joint kinematics in patients with patellofemoral pain; and evaluate whether the kinematics in subjects with maltracking respond differently to weight-bearing than those in nonmaltrackers. We used real-time magnetic resonance imaging to visualize the patellofemoral joint during dynamic knee extension from 30° to 0° of knee flexion during two conditions: upright, weight-bearing and supine, non-weight-bearing. We compared patellofemoral kinematics measured from the images. The patella translated more laterally during the supine task compared to the weight-bearing task for knee flexion angles between 0° and 5° (p = 0.001). The kinematics of the maltrackers responded differently to joint loading than those of the non-maltrackers. In subjects with excessive lateral patellar translation, the patella translated more laterally during upright, weight-bearing knee extension for knee flexion angles between 25° and 30° (p = 0.001). However, in subjects with normal patellar translation, the patella translated more laterally during supine, non-weight-bearing knee extension near full extension (p = 0.001). These results suggest that patellofemoral kinematics measured during supine, unloaded tasks do not accurately represent the joint motion during weight-bearing activities.