Comparison of cardiovascular and metabolic risk factors in professional baseball players versus professional football players.

In 2006, a newspaper report indicated an increased prevalence of cardiovascular disease and early mortality in retired professional football players compared to professional baseball players. This study included 69 professional football players from a 2008 National Football League training camp and 155 professional baseball players from an American League 2009 spring training site who volunteered to participate in a study of cardiovascular and metabolic risk factors. The prevalence of body mass index > or =30 kg/m(2), waist circumference > or =100 cm, waist/height ratio >0.5, blood pressure > or =130/85 mm Hg, triglycerides > or =150 mg/dl, triglycerides/high-density lipoprotein cholesterol ratio >3.5, high-density lipoprotein cholesterol < or =40 mg/dl, and alanine aminotransferase > or =40 IU/L was determined in baseball players and compared to measurements obtained in a matched cohort from the National Health and Nutrition Examination Survey (NHANES), professional football players, and linemen and nonlinemen subsets. In conclusion, professional baseball players had favorable cardiovascular parameters, with the exception of an increased prevalence of hypertension, compared to the reference population, and professional baseball players had decreased measures of obesity, hyperglycemia, and the cardiometabolic syndrome compared to professional football lineman.

Instrumented examination of anterior cruciate ligament injuries: minimizing flaws of the manual clinical examination.

The clinical examination is a basic language of orthopaedics; it is how orthopaedic surgeons communicate with one another. However, each surgeon speaks a different dialect that has been influenced by where and with whom that surgeon trained, as well as that person's own experiences. Because of the inherent variability in the magnitude, direction, and rate of force application during the clinical examination, manual arthrometers were developed in an attempt to more consistently quantify the clinical examination. Instrumented manual devices, such as the KT-1000 (MEDmetric, San Diego, CA), were the first to provide objective numbers to surgeons and researchers evaluating anteroposterior (AP) knee joint laxity. Although these devices provide surgeons with feedback related to the amount of force applied, the rate at which the force is applied is uncontrolled, resulting in a lack of reliability similar to that of the clinical examination itself. In addition to potential errors in measuring AP laxity, rotational laxity has proven to be very difficult to quantify. Robotic systems that make use of computer-driven motors to perform laxity testing have recently been developed to control the magnitude, direction, and rate of force application and thus improve the accuracy and reliability of both AP and rotational laxity evaluation. This review discusses the evolution of instrumented clinical knee examination over the past 3 decades and highlights the advantages and disadvantages of the various testing systems, as well as how current and future developments in this area may improve the field of orthopaedics by minimizing the flaws of the manual clinical examination.

Long-term durability of autologous chondrocyte implantation: a multicenter, observational study in US patients.

BACKGROUND: Autologous chondrocyte implantation for full-thickness lesions of the distal femur has demonstrated good short- to midterm clinical improvement. However, long-term durability (>5 years) of autologous chondrocyte implantation has not been evaluated in US patients to date. HYPOTHESIS: Patients who improve from baseline to early follow-up will sustain improvement at later follow-up. STUDY DESIGN: Case series, Level of evidence, 4. METHODS: Cartilage Repair Registry patients with full-thickness distal femur lesions who were treated with autologous chondrocyte implantation before December 31, 1996 and had modified overall Cincinnati scores at baseline and 1- to 5-year follow-up scores were re-evaluated at 6- to 10-year follow-up. Autologous chondrocyte implantation durability was determined by comparing early (1-5 years) to long-term (6-10 years) outcomes. Adverse events and treatment failures were recorded. Results Seventy-two patients met eligibility criteria (at baseline: mean age, 37 years; mean lesion size, 5.2 cm(2); and overall condition score, 3.4 points [poor]). Eighty-seven percent of patients (47 of 54) who improved at the earlier follow-up period sustained a mean improvement in overall condition score of 3.8 points from baseline to the later follow-up period (P < .001). From baseline to 10-year follow-up (mean follow-up, 9.2 years), 69% improved, 17% failed, and 12.5% reported no change from baseline. Most failures (75% [9 of 12]) occurred at a mean follow-up of 2.5 years. Thirty patients (42%) had 42 operations after autologous chondrocyte implantation; 24 operations (57%) occurred in patients who met the study definition of failure. CONCLUSION: Treatment with autologous chondrocyte implantation for large, symptomatic, full-thickness lesions of the distal femur can result in early improvement that is sustained at longer follow-up (up to 10 years) in the majority of patients.

Elevated alanine aminotransferase in current national football league players: correlation with cardiometabolic syndrome markers, obesity, and insulin resistance.

OBJECTIVES: Media reports suggest increased cardiovascular mortality in former National Football League (NFL) players. We previously demonstrated that current heavier players already have cardiometabolic syndrome markers: blood pressure (BP) >or=130/85 mm Hg, fasting glucose >or=100 mg/dL, triglycerides >or=150 mg/dL, waist circumference >or=100 cm, and high-density lipoprotein (HDL) or=30 IU/L was significantly correlated with mean body mass index (BMI), BMI >or=30 kg/m, BP >or=130/85 mm Hg, waist circumference >or=100 cm, and triglycerides-to-HDL ratio >3.5. An elevated ALT was significantly more common in linemen. CONCLUSIONS: An elevated ALT was significantly associated with visceral obesity, hypertension, cardiometabolic syndrome markers, and insulin resistance in current NFL players.

Cardiometabolic abnormalities in current National Football League players.

Media reports suggested an increased prevalence of cardiovascular disease and premature death in former National Football League (NFL) players. The prevalence of cardiometabolic syndrome was determined in current active NFL players. The presence of cardiometabolic syndrome was defined as > or =3 of (1) blood pressure > or =130/85 mm Hg, (2) fasting glucose > or =100 mg/dl, (3) triglycerides > or =150 mg/dl, (4) waist circumference > or =100 cm, and (5) high-density lipoprotein cholesterol < or =40 mg/dl. Sixty-nine of 91 players (76%) from 1 NFL team were studied before the 2008 preseason training camp. Cardiometabolic syndrome markers, body mass index (BMI), waist-height ratio, and triglycerides/high-density lipoprotein cholesterol ratio were compared between 69 players and an age- and gender-matched reference population from NHANES (1999 to 2002) and by player position of linemen versus nonlinemen. Blood pressure > or =130/85 mm Hg, glucose > or =100 mg/dl, and BMI > or =30 kg/m(2) were significantly more prevalent in the 69 players than the NHANES cohort (28% vs 17%, p = 0.032; 19% vs 7%, p = 0.002; and 51% vs 21%, p <0.001, respectively), although cardiometabolic syndrome prevalence was similar in both groups. However, cardiometabolic syndrome prevalence, BMI > or =30 kg/m(2), and waist-height ratio >0.5 were significantly more common in the linemen versus the nonlinemen subgroup (22% vs 0%, p = 0.004; 100% vs 32%, p <0.001, and 95% vs 36%, p <0.001 respectively). In conclusion, cardiometabolic syndrome and its individual components were noted in current NFL players, particularly linemen.

Relation of race to electrocardiographic patterns in elite American football players.

OBJECTIVES: The purpose of this study was to establish an electrocardiographic (ECG) profile in a biracial population of highly-trained American football players. BACKGROUND: Intense physical training can induce cardiac structural and functional changes ("athlete's heart"), including 12-lead ECG alterations. That race might play a role in determining ECG patterns has been suggested, although not studied in a large athletic population comparing black and white athletes. METHODS: Electrocardiographic analysis of 1,959 elite male athletes attending the National Football League Invitational Camp from 2000 to 2005 was performed. Subjects were classified by race and player position and judged free of structural heart disease. RESULTS: Abnormal ECG patterns were present in 480 (25%) athletes and were significantly more common among black players (n = 396; 30%) compared with white players (n = 78; 13%) or other races (n = 6; 15%) (p < 0.0001). Distinctly abnormal ECG patterns, suggestive of cardiac disease, were also more common in blacks (n = 76; 6%) than whites (n = 11; 2%) (p = 0.0005). In multivariable analysis, black race was an independent predictor of abnormal ECGs (risk ratio [RR] 2.03, 95% confidence interval [CI] 1.56 to 2.64, p < 0.0001), including patterns judged distinctly abnormal (RR 2.59, 95% CI 1.18 to 5.67, p = 0.02). Abnormal ECGs were also related to player position: most frequent in wide receivers (n = 91; 35%) and least common in quarterbacks (n = 16; 14%) and place kickers (n = 8; 11%). Echocardiograms, obtained in 203 athletes (10%), did not show structural cardiac abnormalities. CONCLUSIONS: Electrocardiographic abnormalities were 2-fold more common in black than in white highly-trained male American football players, with race an independent determinant of ECG pattern. These findings have important implications for pre-participation cardiovascular screening of athletes with ECGs.

Treatment outcomes of autologous chondrocyte implantation for full-thickness articular cartilage defects of the trochlea.

BACKGROUND: The treatment of trochlear cartilage lesions is challenging given the likely presence of other patellofemoral joint pathologies, the topography of the area, and the limited available treatment options. Only 1 other study has examined the effectiveness of autologous chondrocyte implantation for lesions of the patellofemoral joint. HYPOTHESIS: Patients treated with autologous chondrocyte implantation for moderate to large isolated lesions located on the trochlea will report improvement in the modified overall condition scale score of the Cincinnati Knee Rating System at a minimum 2-year follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Using modified scales of the Cincinnati Knee Rating System, 40 Cartilage Repair Registry patients rated their overall condition and symptoms at baseline and at a mean follow-up of 59 +/- 18 months. Factors likely to affect outcomes also were analyzed. RESULTS: At baseline, patients were between ages 16 to 48 years, had a mean total defect size of 4.5 cm(2), and reported an overall condition score of 3.1 points (poor). Many failed a prior marrow-stimulation procedure (48%). Other procedures performed before baseline included tibiofemoral osteotomy in 23% and lateral release or Fulkerson for patella maltracking in 13%. Forty-three percent were receiving workers' compensation at baseline. Patients reported statistically significant improvement in their mean overall condition (3.1 points preoperatively to 6.4 points postoperatively), pain (2.6 to 6.2 points), and swelling (3.9 to 6.3 points) scores. Eleven patients experienced 17 subsequent procedures, and no patients had a failed implantation. CONCLUSION: Autologous chondrocyte implantation appears to improve function and reduce symptoms in young to middle-aged patients with symptomatic, full-thickness articular cartilage lesions of the trochlea.

Articular cartilage defects of the distal femur in children and adolescents: treatment with autologous chondrocyte implantation.

PURPOSE: Procedures aimed at biologically repairing cartilage injuries may have the greatest potential benefit in young patients because of their long-life expectancy and high-functional demands. Most cartilage-repair studies focus on older patient populations. This study assesses the outcomes of patients who were treated with autologous chondrocyte implantation before the age of 18. STUDY DESIGN: This is a Registry-based, multicenter, observational, cohort study of 37 patients from whom follow-up data was prospectively collected. Patient-rated assessments of overall condition, pain, and swelling were measured using modified, 10-point scales of the Cincinnati Knee Rating System. RESULTS: Mean age was 16 years (11-17); 22 boys and 15 girls. Twenty-three patients underwent at least 1 cartilage repair procedure before the cartilage harvest, including 11 who had a marrow stimulation procedure. Fourteen patients were diagnosed with osteochondritis dessicans lesions. Thirty-five patients had single defects (mean size, 5.4 cm). Thirty-two patients completed self-evaluations at a minimum of 2 years after implantation (mean follow-up = 4.3 years). The mean change in scale scores measuring overall condition, pain, and swelling were 3.8, 4.1, and 3.4 points, respectively. One patient had an implantation that failed. CONCLUSIONS: Results highlight significant clinical improvements from baseline to follow-up for 32 patients who submitted follow-up data, including 28 patients who reported a minimum 1-point improvement in the overall condition score. CLINICAL RELEVANCE: These results suggest that autologous chondrocyte implantation may be an effective option for children and adolescents with large symptomatic chondral lesions of the distal femur.

Autologous chondrocyte implantation versus debridement for treatment of full-thickness chondral defects of the knee: an observational cohort study with 3-year follow-up.

BACKGROUND: Studies that compare the effectiveness of different cartilage repair treatments are needed to update treatment algorithms. HYPOTHESIS: Autologous chondrocyte implantation provides greater improvement in overall condition score than does debridement at a minimum of 3 years' follow-up. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Cohorts for debridement and autologous chondrocyte implantation each included 58 Cartilage Repair Registry patients who met study criteria. A retrospective analysis was performed on prospectively collected baseline and follow-up data. RESULTS: Patients in the autologous chondrocyte implantation and debridement groups had similar demographics and chondral lesions at baseline. However, more autologous chondrocyte implantation patients failed a previous debridement or marrow stimulation procedure than did debridement patients. Follow-up outcome assessments were completed by 54 autologous chondrocyte implantation patients and 42 debridement patients. Eighty-one percent of the autologous chondrocyte implantation patients and 60% of the debridement patients reported median improvements of 5 points and 2 points, respectively, in the overall condition score. Autologous chondrocyte implantation patients also reported greater improvements in the median pain and swelling scores than did debridement patients. The treatment failure rate was the same for both autologous chondrocyte implantation and debridement patients. Eighteen autologous chondrocyte implantation patients and 1 debridement patient had at least 1 subsequent operation. CONCLUSION: Although patients treated with debridement for symptomatic, large, focal, chondral defects of the distal femur had some functional improvement at follow-up, patients who received autologous chondrocyte implantations obtained higher levels of knee function and had greater relief from pain and swelling at 3 years.

Clinical outcome of autologous chondrocyte implantation at 5 years in US subjects.

UNLABELLED: Peterson's pioneering experience with the first clinical application of autologous chondrocyte implantation showed improvement in clinical outcomes, durable as much as 11 years, for a difficult patient population. An assessment of the general applicability of this technology in the United States requires long-term, multicenter followup. The purpose of this multicenter cohort study was to assess the clinical outcomes of patients treated with autologous chondrocyte implantation for lesions of the distal femur. Modified 10-point scales of the Cincinnati knee rating system were used to measure outcomes assessments at baseline and at 5 years. Eighty-seven percent (87 of 100) of patients completed 5-year followup assessments. Patients were an average 37 years of age, had a mean total defect size of 4.9 cm2, and had low baseline overall condition scores. At least one prior cartilage repair procedure had failed in 70% of the patients. At followup, 87 patients reported a mean improvement of 2.6 points in the overall condition score, including 62 with improved conditions, six with no change in condition, and 19 with worsened conditions. Of the 62 patients who improved, the mean overall condition score improved 4.1 points at followup. Patients treated with autologous chondrocyte implantation for large cartilage defects in the distal femur reported improvement in outcome scores at 5 years followup. LEVEL OF EVIDENCE: Therapeutic study, Level II-1 (prospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.