Short and mid-term characteristics of COVID-19 disease course in athletes: A high-volume, single-center study.

INTRODUCTION: At the pandemic's beginning, significant concern has risen about the prevalence of myocardial involvement after SARS-CoV-2 infection. We assessed the cardiovascular burden of SARS-CoV-2 in a large cohort of athletes and identified factors that might affect the disease course. We included 633 athletes in our study on whom we performed extensive cardiology examinations after recovering from SARS-CoV-2 infection. More than half of the athletes (n = 322) returned for a follow-up examination median of 107 days after the commencement of their infection. RESULTS: Troponin T positivity was as low as 1.4% of the athletes, where the subsequently performed examinations did not show definitive, ongoing myocardial injury. Altogether, 31% of the athletes' rapid training rebuild was hindered by persistent or reoccurring symptoms. Female athletes reported a higher prevalence of return to play (RTP) symptoms than their male counterparts (34% vs. 19%, p = 0.005). The development of long COVID symptoms was independently predicted by increasing age and acute symptoms' severity in a multiple regression model (AUC 0.75, CI 0.685-0.801). Athletes presenting with either or both cough and ferritin levels higher than >150 µg/L had a 4.1x (CI 1.78-9.6, p = 0.001) higher odds ratio of developing persistent symptoms. CONCLUSION: While SARS-CoV-2 rarely affects the myocardium in athletes, about one in three of them experience symptoms beyond the acute phase. Identifying those athletes with a predisposition to developing long-standing symptoms may aid clinicians and trainers in finding the optimal return-to-play timing and training load rebuild pace.

Low Femoral Tunnel Widening Incidence Rate After ACL Reconstruction Using Patellar Tendon Graft with Press-Fit Fixation.

Background: Femoral tunnel widening after ACL reconstruction is a common phenomenon. We hypothesized that using a patellar tendon graft with a press-fit fixation technique without any fixation device reduces the incidence of femoral tunnel widening. Methods: This study was conducted on 467 patients with ACL surgery between 2003 and 2015. Two hundred and nineteen of them had an ACL surgery with patellar tendon (PT) graft, and two hundred and forty-eight of them with hamstring tendon (HS). Exclusion criteria were history of previous ACL reconstruction of either knee, multiple ligament injury, or evidence of osteoarthritis on radiographs. The femoral tunnels were measured on the anteroposterior (ap) and lateral radiographs 6 months after the operation. Two independent orthopedic surgeons measured all radiographs twice and recorded the tunnel widenings. We hypothesized that using an implant-free press-fit technique with PT graft can reduce the femoral tunnel widening incidence rate. Results: The mean incidence rate of the tunnel widening in the HS group was, on the AP and the lateral femoral views, 88% (n = 217) and 83% (n = 205), while in the PT group, 17% (n = 37) and 2% (n = 4), respectively. There was a significant difference both on AP and lateral radiographs (HS vs. PT: fem. AP: 89% vs. 17% p < 0.001; HS vs. PT: fem. lat: 84% vs. 2% p < 0.001). Conclusion: The femoral tunnel widening incidence rate during an ACL reconstruction is significantly less when using PT tendon with femoral press-fit fixation than when using HT tendon with suspensory fixation method.

Outcomes After Arthroscopic Anterior Shoulder Stabilization in Professional Handball Players.

BACKGROUND: Although numerous studies have reported on the redislocation rate and functional results of arthroscopic treatment for anterior shoulder instability in athletes, they have not disclosed outcomes in the high-risk group of elite handball players. PURPOSE: To investigate the postoperative outcomes of arthroscopic treatment for anterior shoulder instability as well as the return-to-sport (RTS) rate in professional handball players. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Involved in this study were 44 competitive handball players (47 shoulders) who underwent arthroscopic anterior capsulolabral reconstruction between 2010 and 2018 and had a minimum follow-up of 24 months. After surgery, patients completed a questionnaire that collected Rowe and American Shoulder and Elbow Surgeons (ASES) scores and RTS data, and we compared these results with their preoperative scores. We also compared results according to the following subgroups: true dislocations versus recurrent subluxations, younger (<20 years) versus older (≥20 years) age, male versus female sex, and shorter versus longer duration of instability. Statistical analysis included the paired-samples t test and nonparametric Fisher exact test. RESULTS: The mean follow-up period was 52.2 ± 21.4 months. There were 4 shoulders (9%) with recurrent instability. There were significant preoperative to postoperative improvements in the mean Rowe score (from 45.2 to 91.8) and mean ASES score (from 70.6 to 95.7) (P < .001 for both). Overall, the RTS rate was 83%, and 64% (30/47 shoulders) were able to return to their preinjury level. The RTS rate was significantly lower in the younger players than in the older players (46% vs 86%, respectively; P = .005). CONCLUSION: The study results indicated that handball players with anterior shoulder instability can be treated using arthroscopic labral reconstruction successfully and 83% of the athletes were able to RTS activity. The handball players aged ≥20 years returned to their preinjury level of sport at a higher rate than did those aged <20 years.

Return to Sport After Arthroscopic Treatment of Posterior Shoulder Instability.

BACKGROUND: Arthroscopic treatment of posterior shoulder instability has become more popular and effective in recent years, but few data are available concerning the rate of return to sport. PURPOSE: To present our experiences with arthroscopic posterior labral reconstruction in athletes and review our results, with a particular focus on the rate of return to sport. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Included in the study were 40 arthroscopic stabilizations performed because of posterior shoulder instability in 37 athletes at a single institution. During follow-up, the athletes' rate of return to sport was calculated. Shoulder function was evaluated based on a pre- versus postoperative comparison of the Rowe instability score and the American Shoulder and Elbow Surgeons score. Additionally, the return-to-sport rate was compared among different subgroups: traumatic versus atraumatic origin of injury, competitive versus recreational athletes, high-risk versus low-risk sport, and posterior-only versus anterior and posterior stabilization. Data were statistically analyzed using paired-samples t test and nonparametric Fisher exact test. RESULTS: The average follow-up period was 54.4 months (range, 24-112 months). Three shoulders (7.5%) continued to have posterior subluxations postoperatively. There were 34 excellent, 3 good, and 3 fair results based on the Rowe score (average postoperative score, 92.9), and patients achieved an average postoperative American Shoulder and Elbow Surgeons score of 92.7. The pre- to postoperative improvement was statistically significant in both scoring systems (P < .001). Of the 37 patients, 36 (98.2%) were able to return to sport activity: 27 of them (72.9%) to their original sport and 19 (51.4%) at their preinjury level. A significantly higher rate of return to the same sport occurred in athletes who had traumatic injury compared with a subgroup of athletes without a traumatic event (P < .02). CONCLUSION: More than half of the athletes were able to return to their preinjury level of sport after arthroscopic posterior labral reconstruction. In addition, low recurrence rates and good functional outcomes were seen in >90% of the patients, and 98% returned to sport activity. The athletes had a significantly higher rate of return to sport if their posterior shoulder instability had a clear traumatic origin.

SLAP Lesion and Injury of the Proximal Portion of Long Head of Biceps Tendon in Elite Amateur Wrestlers.

BACKGROUND: Injuries to the proximal portion of the tendon of the long head of the biceps are challenging, and often only diagnosed at arthroscopy. However, it is important to be able to formulate a preoperative plan based on physical examination and imaging studies, so as to inform patients correctly, plan the likely procedure, and give indication to length and modalities of rehabilitation. MATERIALS AND METHODS: Eleven elite wrestlers who suffered their injury between 2008 and 2018 were investigated retrospectively. We aimed to identify an association between the mechanism and the symptoms of the biceps-labral complex injury. RESULTS: The injury was sustained at a mean age of 20.63 years, and most wrestlers were middle or light weight. All injuries occurred during shoulder movements in closed kinetic chain with the elbow extended, the forearm pronated and the shoulder slightly elevated. The surgical procedures performed were tenodesis in three wrestlers, reinsertion in seven wrestlers, and one tenotomy of the tendon of the long head of the biceps. The postoperative rehabilitation was shorter (1-3 month) in case of tenodesis or tenotomy, and markedly longer after reinsertion (6-9 months). CONCLUSIONS: Injuries to the proximal part of long head of biceps tendon are relatively frequent in elite wrestlers, reflecting the high functional demands imposed on the upper limb. Though necessitating surgery, in these athletes, such injuries are not career ending, and most of our elite athletes returned to high performance levels after surgery.

Femoral press-fit fixation technique in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft: a prospective clinical evaluation of 285 patients.

BACKGROUND: The security of the graft fixation is an important factor of anterior cruciate ligament reconstruction, especially in the early postoperative period. HYPOTHESIS: The femoral press-fit fixation technique is a safe, alternative technique for the fixation of the bone-patellar tendon-bone graft. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between January 1, 1998, and June 30, 2002, 285 patients, with a mean age of 29.1 years, underwent operation and observation in our department. All patients had arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft with femoral press-fit and tibial interference screw fixation. The mean follow-up period was 35.8 months (range, 24-77 months). During each patient's evaluation, a physical examination, a subjective evaluation, the International Knee Documentation Committee and Lysholm scores, KT-1000 arthrometer testing, and radiological evaluation were performed. The paired Student t test or chi(2) test was used for statistical analysis. RESULTS: According to the International Knee Documentation Committee score, 241 patients (85%) had good (46 normal and 195 nearly normal) results, whereas 39 patients had abnormal and 5 patients had severely abnormal overall results. The preoperative mean Lysholm score was 63.5 +/- 12.7 points. At the final examination, the mean value was 93.5 +/- 7.8 points (P < .01). One hundred ninety-seven athletes could return to their previous sports activity level, whereas 13 patients gave up their sports career. The KT-1000 arthrometer results showed a side-to-side difference of 1.91 +/- 2.1 mm at the maximum manual strength tests. CONCLUSION: The femoral press-fit fixation is an alternative fixation method for the bone-patellar tendon-bone graft and provides good stability for the anterior cruciate ligament reconstruction. The use of press-fit fixation technique avoids most interference screw or other hardware-induced complications at the femoral side.

[Femoral press-fit fixation in anterior cruciate ligament reconstruction: postoperative histological examination of bone block incorporation in pigs]. / Femoralis press-fit rögzítés elülso keresztszalag pótlás során. A csontblokk beépülésének posztoperatív szövettani vizsgálata sertéseken.

INTRODUCTION: The histological properties of the femoral press-fit fixation in anterior cruciate ligament reconstruction have not been extensively examined. The purpose of the study was to analyse the histological properties of the bone-patellar tendon graft in the bone tunnel area during the early stages of healing in an animal model. Furthermore the authors wanted to draw conclusions for the postoperative rehabilitation program on the basis of their data. MATERIAL AND METHODS: ACL reconstruction was performed in pigs using femoral press-fit fixation. After 3 and 6 weeks the incorporation of the bone block in the femur in 2 pigs was histological and radiological evaluated. RESULTS: After 3 and 6 weeks the examination showed almost similar histology on the bony side the grafts except (1) a higher amount of fibrotic tissue in-between the lamellae of the inserted patellar bone after 6 weeks, (2) the presence of direct osseous unions between the two lamellar systems and (3) thicker lamellae at the base than toward the condylar tissue. CONCLUSIONS: Concerning the progression of graft healing by histological findings our study showed, that after 6 weeks the femoral press-fit fixation appear to have good incorporation after ACL reconstruction.

Arthroscopic treatment of painful snapping of the scapula by using a new superior portal.

PURPOSE: To evaluate the results of arthroscopic resection of the superomedial corner of the scapula, using a new superior portal, in patients with a snapping scapula problem. TYPE OF STUDY: Case series. METHODS: Ten patients with painful snapping of the scapula were treated arthroscopically using standard portals as well as a recently developed superior arthroscopic portal. There were 4 women and 6 men with a mean age of 26.9 years (range, 16 to 40 years). All patients were right-handed with a right side operation in 8 cases. There was a history of significant shoulder trauma in 6 patients. All patients had normal preoperative computed tomography scans and radiographs. The average duration of symptoms before surgery was 53.2 months (range, 12 to 154 months). At follow-up, the results were scored using the UCLA system. RESULTS: All patients were followed-up at an average of 11.5 months (range, 3 to 23 months). There were no intraoperative or postoperative complications and, in particular, no neurologic lesions resulting from the introduction of arthroscopic instruments. The scapulothoracic crepitus resolved in 2 patients and decreased in 8 patients. There was reduction of pain in all cases, with a mean postoperative visual analog pain score of 2.6. Nine patients were able to return to their preoperative work and 6 could return to their previous sports activity. According to the UCLA scores, the results were 4 excellent, 5 good, and 1 fair. All patients reported that the procedure was worthwhile. CONCLUSIONS: Arthroscopic surgery is beneficial for patients with painful snapping of the scapula. The new superior portal is safe and has made the operation easier to perform.

Contralateral brachial plexus neuropathy after arthroscopic shoulder surgery.

This case report presents a neurologic complication that occurred after shoulder arthroscopic surgery on the contralateral arm. This brachial plexus palsy has been documented as a reversible C7-T1 lesion, which was the consequence of the patient's unknown cervical rib and the applied lateral position during the operation. In this case, the recovery was almost complete within 3 months postoperatively; however, one should take care to prevent these complications with an appropriate positioning of patients with an anatomic variant.

[Femoral press-fit fixation technique in anterior cruciate ligament reconstruction. Preliminary report]. / Elülsó keresztszalag pótlás során alkalmazott femoralis press-fit rögzítés. Korai eredmények.

UNLABELLED: The authors have reported the experiences at femoral press-fit fixation technique used in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft. Their surgical technique have been described and early results have been compared with those from anterior cruciate ligament plasties with the interference screw fixation technique during a prospective study. PATIENTS AND METHODS: 665 anterior cruciate ligament reconstructions were performed between September 1997 and August 1999 at the Department of Sports Surgery of the National Institute for Sports Medicine. 418 of them were operated on by transtibial technique using free bone--patellar tendon--bone autografts with 265 femoral press-fit and 153 interference screw fixations. 110 patients from the press-fit and 72 from the interference screw group could be followed-up (average follow-up period: 19 months). Physical examination, evaluation by International Knee Documentation Committee and Lysholm scores, radiology, and stability test by KT-1000 arthrometer were used as follow-up tests with statistical comparison. RESULTS: According to the International Knee Documentation Committee score, 77% of the patients with the interference screw and 87% of the patients from the press-fit group turned out to get to the normal or nearly normal categories. Neither the Lachman, anterior drawer and pivot shift tests, nor the results of the KT-1000 measurements have shown statistically significant difference between the two groups of patients. Mild (3-5 degrees) extension deficit has been detected at 14% of the patients with interference screw and 8% of the patients in the press-fit group. Mild (6-15 degrees) flexion deficit has been observed at 22% of the patients with interference screw and 24% of the patients from press-fit group with moderate (16-25 degrees) of flexion deficit at 4% of the patients. The subjective opinions of more than 90% of the patients were that the operation proved to be excellent or good. Based on the functional and stability data of the follow-up study, 87% of the patients operated on with femoral press-fit autograft fixation technique for their anterior cruciate ligament have shown excellent or good results. CONCLUSIONS: When compared with the interference screw technique well-accepted in the literature, no statistically significant difference could be found, therefore this method can be recommended as alternative one for the femoral fixation of the anterior cruciate ligament graft.

[Prevalence of patellofemoral pain syndrome. Evaluation of the role of biomechanical malalignments and the role of sport activity]. / A patellofemoralis fájdalom szindróma prevalenciája. A biomechanikai tengelyeltérések es a sportaktivitás szerepének elemzése.

INTRODUCTION: Disorders around the patella are the most frequent knee complaints seen in adolescents. In the literature many intrinsic and extrinsic risk factors have been linked to Patellofemoral Pain Syndrome (PFPS), but the role of these risk factors is controversial. AIM: The goal of this study was to evaluate the prevalence of PFPS in a group of adolescents aged 12-20 years in Hungary, and to gain more information on the relationship between the biomechanical anomalies of the lower extremity and the PFPS. MATERIAL AND METHODS: In this epidemiological study the authors investigated the effect of sporting activity in the maturation of symptoms among 586 randomly selected students. Different physical examinations, anthropometric measurements, stability tests, footscan analysis were performed. RESULTS: Concerning the prevalence of this syndrome they could not find any differences between males (n = 60, 20.41%) and females (n = 61, 20.89%). The authors could not identify any statistically significant intrinsic risk factors, although changes in the Q angle may be linked to increased prevalence of PFPS. The study supports the theory of the importance of "overload", for there was a significant correlation between the prevalence of PFPS and the different levels of sporting activities (competitive, recreational and non-athletes). CONCLUSION: The authors concluded that the prevalence of PFPS among Hungarian students is 20.65%.

Biomechanical evaluation of press-fit femoral fixation technique in ACL reconstruction.

In this experimental study, the authors evaluated the biomechanical properties of the femoral press-fit graft fixation technique in ACL reconstruction. 20 fresh frozen distal femurs, patellae and patellar ligaments were used from 10 cadaver specimens. Three bone-patellar tendon grafts of 10 mm width were prepared from each sample; altogether 60 bone-patellar tendon grafts were prepared for the experiment. Three 9 mm wide tunnels were drilled in each distal femur at different angles (0, 15, 30, 45, and 60 degrees). This means that 60 tunnels were drilled into the 20 femurs, 12 at each angle. The trapezoid bone blocks were impacted into the holes. The primary stability and stiffness of this press-fit fixation method were measured with a Zwick 020 computer-controlled testing device using maximum-failure tensile-strength tests. The ultimate tensile strength was the greatest at 45 degrees (534+/-20 N, range 507-554), with 118+/-10 N/mm (range 99-126) stiffness, followed by 485+/-35 N (range 416-510) with 122+/-13 N/mm (range 104-136) stiffness at 30 degrees, 353+/-18 N (range 320-371) with 113+/-13 N/mm (range 83-124) stiffness at 15 degrees, and 312+/-30 N (range 261-343) with 89+/-14 N/mm (ranged:68-103) stiffness at 0 degrees. In the cases of 0, 15, 30 and 45 degrees the bone blocks were pulled out of the drilled holes, but at 60 degrees rupture of the patellar tendon or breakage of the bone block occurred more frequently. It can be seen that the ultimate tensile strength increased with the angle between the loading direction and the bone block. When compared to data in the literature, these data showed similar and satisfying biomechanical properties of femoral press-fit fixation. Because of the known advantages of an implantation-free fixation technique, the femoral press-fit fixation technique can be a good alternative in ACL surgery. These results provide the basis for future studies involving the postoperative healing process of this femoral press-fit fixation technique in porcine knees.