Atlantic Coast Conference Mandatory College Football Medical Observer. A Necessary Addition to the Preexisting Medical Team?

Background: Some NCAA conferences now require a press box-based Medical Observer for all football games to identify injuries missed by on-field providers. The objective of this study was to determine whether a Medical Observer identified injuries missed by the on-field medical personnel. Methods: This was a comparative observational study of injury identification methods which was done at nine NCAA football games. The athletes on a single institution's varsity football team participated. Eight games and one bowl game were studied. Observers were sports medicine Fellows (Orthopaedic, Primary Care). Injury logs were kept by the Medical Observer to document game day injuries. The athletic training staff collected injury reports in the days following games. These were compared with game day injury logs to identify any injuries that were not reported to the medical staff during competition. Results: A total of 41 game injuries were identified (4.56 injuries/ game). 29 injuries (29/41; 71%) were identified by both the sideline medical providers and the Observer, 12 (12/41; 29%) were identified by only the sideline medical providers and no injuries were identified by only the Observer. A total of 95 game-related injuries were evaluated in the training room on the day after each game. 27 injuries (27/95; 28%) had been identified during the game (9 [33%] by the sideline medical team and 18 [67%] by both the sideline medical team and the Observer). Fourteen game injuries were not severe enough to require care the following day. There were 68 (68/95; 72%) delayed self-reported injuries treated by the training room staff the next day. Conclusions: A press box-based Medical Observer did not identify any injuries missed by the on-field medical staff. This study did, however, identify a large number of unreported game-day injuries that were treated the following day.Level of Evidence: II.

Thermo-mechanical behavior and structure of melt blown shape-memory polyurethane nonwovens.

New processing methods for shape-memory polymers allow for tailoring material properties for numerous applications. Shape-memory nonwovens have been previously electrospun, but melt blow processing has yet to be evaluated. In order to determine the process parameters affecting shape-memory behavior, this study examined the effect of air pressure and collector speed on the mechanical behavior and shape-recovery of shape-memory polyurethane nonwovens. Mechanical behavior was measured by dynamic mechanical analysis and tensile testing, and shape-recovery was measured by unconstrained and constrained recovery. Microstructure changes throughout the shape-memory cycle were also investigated by micro-computed tomography. It was found that increasing collector speed increases elastic modulus, ultimate strength and recovery stress of the nonwoven, but collector speed does not affect the failure strain or unconstrained recovery. Increasing air pressure decreases the failure strain and increases rubbery modulus and unconstrained recovery, but air pressure does not influence recovery stress. It was also found that during the shape-memory cycle, the connectivity density of the fibers upon recovery does not fully return to the initial values, accounting for the incomplete shape-recovery seen in shape-memory nonwovens. With these parameter to property relationships identified, shape-memory nonwovens can be more easily manufactured and tailored for specific applications.

Case series of first metatarsophalangeal joint injuries in division 1 college athletes.

CONTEXT: Injuries of the first metatarsophalangeal (hallux MP) joint can be debilitating in the athletic population. Turf toe and plantar plate injuries are typically diagnosed similarly. However, variance in injury mechanism as well as compromised integrity of soft tissue and ligamentous structures make it difficult to accurately diagnose specific hallux MP injuries. Recent literature has supported the use of both radiographic imaging and the Lachman test as reliable indicators of joint instability in the presence of hallux MP injuries. To date, research supporting specific rehabilitation interventions and return-to-play decision making for hallux MP injuries has been limited to case studies and suggested guidelines from literature reviews. There is limited evidence suggesting specific criteria for surgical and nonsurgical decision making in conjunction with rehabilitation progressions to return an athlete to sport when managing hallux MP injuries. EVIDENCE ACQUISITION: A literature search was performed using Medline, PubMed, and Google Scholar to find and review articles from 1970 to 2013 that addressed the basic anatomy of the plantar plate, injuries to this anatomical structure, and the evaluation, diagnosis, surgical and nonsurgical management, and rehabilitation of these injuries, specifically in the athletic population. Medical information for each case was gathered from electronic medical records from the individual athletes cited in this case series, which included imaging reports, rehabilitation documentation, and both evaluation and surgical reports. No statistical analysis was used. STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 4. RESULTS: Treatment plans for each case varied depending on surgical and nonsurgical intervention and rehabilitation outcomes. However, each athlete was able to return to sports-specific activities. CONCLUSION: Successful outcomes for hallux MP injuries are contingent on thorough evaluation, appropriate clinical decision making with regard to surgical versus nonsurgical treatment planning, and a multidisciplinary team approach for ensuring a safe return to sport. STRENGTH-OF-RECOMMENDATION TAXONOMY SORT: C.