Optimised return to play: high treatment success rate in core muscle injury with surgical release of the anterior tendon of the rectus abdominis muscle and proximal tenotomy of the adductor longus muscle.

OBJECTIVES: Core muscle injury is a debilitating condition that causes chronic groin pain in athletes, particularly common in soccer players. The condition is characterised by pain in the inguinal region and can lead to a significant number of absences from high-intensity physical activity. It is caused by repetitive overload without proper counterbalance from the abdominal muscles, hip flexors, and adductors in susceptible athletes. Surgical indications for core muscle injury consider cases where non-surgical treatments have not provided sufficient relief. The aim of this study was to assess the results of surgical intervention for core muscle injury using the technique employed by the Sports Medicine Group of (Institute of Orthopedics and Traumatology of Hospital das Clínicas - Universidade de São Paulo). The procedure involves releasing the anterior portion of the tendon of the rectus abdominis muscle near the pubic symphysis, along with proximal tenotomy of the adductor longus muscle tendon. METHODS: This study utilised a consecutive historical cohort analysis of the medical records of 45 male athletes, of which, 75.6% were professional soccer players, who underwent surgical treatment between January 1, 2002, and December 31, 2021. The participants included active athletes aged between 18 and 40 years, with a mean age of 23.9 years, and were diagnosed with myotendinous core muscle injury. These athletes experienced pain in the pubic symphysis and adductor tendon region and had previously undergone medical treatment and physical therapy for a duration of three to six months without significant improvement. RESULTS: The average time for athletes to return to sport after surgery was 135 days, with a majority of participants being soccer and futsal players. The surgical intervention yielded promising results, with a positive correlation between unilateral injuries and the time taken to return to sport. The complication rate was low, at 6.7%. Notably, the rate of symptom resolution was high, at 93.3%. Furthermore, the analysis indicated that the player's position on the field significantly influenced the discharge period, suggesting that the game position plays a role in the recovery process. CONCLUSION: The combined surgical procedure involving the release of the rectus abdominis tendon and adductor longus muscle tenotomy demonstrates favourable outcomes for athletes with core muscle injury. This study provides strong support for the effectiveness of this surgical approach in managing the condition and offers a potential path to recovery and return to sports activities. STUDY DESIGN: Cross-sectional study.

4-domain sports prom translation and cultural adaptation into portuguese / 4-domain sports prom: traducción y adaptación cultural al portugués / 4-domain sports prom: tradução e adaptação cultural para a língua portuguesa

ABSTRACT Introduction: The literature presents several scientifically validated and cross-culturally adapted questionnaires in the area of orthopedics and Sports Medicine scientifically validated and cross-culturally adapted. However, they are anatomically specific, and do not consider the specific needs of athletes. The "4-Domain PROM for Orthopedic and Sports Medicine" (4-Domain Sports PROM) is the first questionnaire, in the literature (International Journal of Sports Medicine - 2021), designed to assess athletes and highly active sports practitioners, and their specificities. physical and psychological. It comprises four domains: athlete without injury, after sports injury, expectation of treatment, athlete's assessment of the treatment received. Objectives: This work aims to carry out the translation and cross-cultural adaptation (TCA) to the Portuguese language. Methods: The questionnaire was self-administered by 50 participants, regular physical and sports activities practitioners. The translation and cultural adaptation process involved six steps: translation; synthesis; back translation; pre-test; review by the Expert Committee, clinical application and author approval of the original version. The Equivalence of translation and relevance of questionnaire items were evaluated. RESULTS: The Portuguese version of the 4-DOMAIN SPORTS PROM had a translation equivalence of 0.94, and item relevance was 0.98, while the percentage of agreement between patients for understanding was 0.98. Conclusion: The translation and cross-cultural adaptation of the 4 Domain Sports PROM into the Portuguese version proved to be understandable and reproducible in all questionnaire domains (agreement above 90% and content validity index of 100%) to assess the treatment of the population of athletes and regular sports practitioners. Level of Evidence II; A cross-sectional qualitative study.

RESUMEN Introducción: La literatura presenta varios cuestionarios científicamente validados y transculturalmente adaptados en el área de la ortopedia y Medicina del Deporte. Sin embargo, son anatómicamente específicos y no consideran las necesidades específicas de los atletas. El "4-Domain PROM for Orthopaedic and Sports Medicine" (4-Domain Sports PROM) es el primer cuestionario, en la literatura (International Journal of Sports Medicine - 2021), diseñado para evaluar atletas y practicantes de deportes altamente activos, y sus especificidades físicas y psicológicas. Comprende cuatro dominios: atleta sin lesión, después de una lesión deportiva, expectativa de tratamiento, evaluación del atleta sobre el tratamiento recibido. Objetivos: El objetivo de este trabajo es realizar la traducción y adaptación transcultural (TCA) a la lengua portuguesa. Métodos: El cuestionario fue autoadministrado por 50 participantes, practicantes habituales de actividades físicas y deportivas. El proceso de traducción y adaptación cultural involucró seis pasos: traducción; síntesis; traducción inversa; prueba previa; revisión por el comité de expertos; aplicación clínica y aprobación del autor de la versión original. Se evaluaron la equivalencia de traducción y la relevancia de los ítems del cuestionario. Resultados: La versión portuguesa del 4-DOMAIN SPORTS PROM tuvo una equivalencia de traducción de 0,94 y la relevancia de los ítems fue de 0,98, mientras que el porcentaje de acuerdo entre los pacientes para la comprensión fue de 0,98. Conclusión: La traducción y adaptación transcultural del 4-DOMAIN SPORTS PROM al portugués amplía las posibilidades de evaluar los diferentes momentos que involucran el tratamiento de lesiones deportivas, ya que este cuestionario fue diseñado para capturar datos sobre la percepción de los pacientes antes de la lesión, después de la lesión, expectativa y evaluación del trato recibido en deportistas y practicantes habituales de actividad física. Nivel de Evidencia II; Estudio Cualitativo Transversal.

RESUMO Introdução: A literatura apresenta diversos questionários cientificamente validados e adaptados transculturalmente na área de na Ortopedia e Medicina Esportiva validados cientificamente e adaptados transculturalmente. Entretanto, eles são anatomicamente específicos, e não consideram as necessidades especificas dos atletas. O "4-Domain PROM for Orthopedic and Sports Medicine" (4-Domain Sports PROM) é o primeiro questionário, na literatura (International Journal of Sports Medicine - 2021), concebido para avaliar atletas e praticantes de esportes altamente ativos, e suas especificidades físicas e psicológicas. Ele compreende quatro domínios: atleta sem lesão, após lesão esportiva, expectativa do tratamento, avaliação do atleta sobre o tratamento recebido. Objetivos: O objetivo deste trabalho é realizar a tradução e a adaptação transcultural (TCA) à língua portuguesa. Métodos: O questionário foi autoadministrado por 50 participantes, praticantes regulares de atividades físicas e esportivas. O processo de tradução e adaptação cultural envolveu seis etapas: tradução; síntese; retrotradução; pré-teste; revisão pelo comitê de experts; aplicação clínica e aprovação do autor da versão original. Foi avaliado a Equivalência da tradução e relevância de itens do questionário. Resultados: A versão em português do 4-DOMAIN SPORTS PROM apresentou equivalência da tradução de 0,94 e relevância dos itens foi de 0,98, enquanto a porcentagem de concordância entre os pacientes para compreensão foi de 0,98. Conclusão: A tradução e adequação cultural do 4-DOMAIN SPORTS PROM para língua portuguesa mostrou-se compreensível e reprodutibilidade adequada em todos os domínios do questionário (concordância acima de 90% e Índice de Validade de Conteúdo de 100%) para avaliar o tratamento de população de indivíduos atletas e praticantes regulares de esportes. Nível de Evidência II; Estudo Qualitativo Transversal.

ANTEROMEDIAL OR CENTRAL ANATOMIC ACL RECONSTRUCTION? A CADAVERIC HIP-TO-TOE STUDY.

Objective: To compare anatomic anterior cruciate ligament (ACL) reconstruction between two tunnel positions in knees with isolated ligament tears. Methods: Anatomic ACL reconstruction was performed, from hip-to-toe, on 15 fresh cadaveric specimens. No associated lesions were created to enhance knee instability. The protocol was conducted in three states: (1) complete isolated ACL deficiency; (2) anatomic femoral and tibial anteromedial ACL reconstruction (AM REC); and (3) anatomic femoral and tibial central ACL reconstruction (Central REC). The reconstruction protocols were randomly assigned. The continuous mechanized pivot-shift test was recorded dynamically with a tracking system. Results: The Central REC group showed a smaller degree of internal rotation (0.6° ± 0.3° vs. 1.8° ± 0.3°, respectively, P < 0.05) and no difference in anterior translation (4.7 mm ± 0.4 mm vs. 4.5 mm ± 0.4 mm, respectively, P > 0.05) in the pivot-shift test, compared with the AM REC group. Conclusion: The central anatomic ACL reconstruction resulted in greater restriction of internal rotation than the anteromedial anatomic ACL reconstruction. Experimental Study on Cadaver.

Objetivo: Comparar a reconstrução anatômica do ligamento cruzado anterior (LCA) entre duas posições de túnel em joelhos com lesões isoladas do ligamento. Métodos: A reconstrução anatômica do LCA foi realizada, do quadril aos pés, em 15 peças anatômicas de cadáveres frescos. Não foram criadas lesões associadas para intensificar a instabilidade do joelho. O protocolo foi realizado em três estados: (1) deficiência isolada completa do LCA; (2) reconstrução anatômica femoral e anteromedial tibial do LCA (AM REC); e (3) reconstrução anatômica femoral e central tibial do LCA (Central REC). Os protocolos de reconstrução foram atribuídos aleatoriamente. O teste de pivot-shift mecanizado contínuo foi registrado dinamicamente com um sistema de rastreamento. Resultados: O grupo Central REC apresentou menor grau de rotação interna (0,6° ± 0,3° vs. 1,8° ± 0,3°, respectivamente, p < 0,05) e nenhuma diferença na translação anterior (4,7 mm ± 0,4 mm vs. 4,5 mm ± 0,4 mm, respectivamente, p > 0,05) no teste de pivot-shift, comparado ao grupo AM REC. Conclusão: A reconstrução anatômica central tibial do LCA resultou em maior restrição da rotação interna do que a reconstrução anteromedial tibial do LCA. Estudo em Cadáver Experimental.

Anteromedial or central anatomic acl reconstruction? a cadaveric hip-to-toe study / Reconstrução anatômica anteromedial ou central do lca? estudo em cadáver completo

ABSTRACT Objective: To compare anatomic anterior cruciate ligament (ACL) reconstruction between two tunnel positions in knees with isolated ligament tears. Methods: Anatomic ACL reconstruction was performed, from hip-to-toe, on 15 fresh cadaveric specimens. No associated lesions were created to enhance knee instability. The protocol was conducted in three states: (1) complete isolated ACL deficiency; (2) anatomic femoral and tibial anteromedial ACL reconstruction (AM REC); and (3) anatomic femoral and tibial central ACL reconstruction (Central REC). The reconstruction protocols were randomly assigned. The continuous mechanized pivot-shift test was recorded dynamically with a tracking system. Results: The Central REC group showed a smaller degree of internal rotation (0.6° ± 0.3° vs. 1.8° ± 0.3°, respectively, P < 0.05) and no difference in anterior translation (4.7 mm ± 0.4 mm vs. 4.5 mm ± 0.4 mm, respectively, P > 0.05) in the pivot-shift test, compared with the AM REC group. Conclusion: The central anatomic ACL reconstruction resulted in greater restriction of internal rotation than the anteromedial anatomic ACL reconstruction. Experimental Study on Cadaver.

RESUMO Objetivo: Comparar a reconstrução anatômica do ligamento cruzado anterior (LCA) entre duas posições de túnel em joelhos com lesões isoladas do ligamento. Métodos: A reconstrução anatômica do LCA foi realizada, do quadril aos pés, em 15 peças anatômicas de cadáveres frescos. Não foram criadas lesões associadas para intensificar a instabilidade do joelho. O protocolo foi realizado em três estados: (1) deficiência isolada completa do LCA; (2) reconstrução anatômica femoral e anteromedial tibial do LCA (AM REC); e (3) reconstrução anatômica femoral e central tibial do LCA (Central REC). Os protocolos de reconstrução foram atribuídos aleatoriamente. O teste de pivot-shift mecanizado contínuo foi registrado dinamicamente com um sistema de rastreamento. Resultados: O grupo Central REC apresentou menor grau de rotação interna (0,6° ± 0,3° vs. 1,8° ± 0,3°, respectivamente, p < 0,05) e nenhuma diferença na translação anterior (4,7 mm ± 0,4 mm vs. 4,5 mm ± 0,4 mm, respectivamente, p > 0,05) no teste de pivot-shift, comparado ao grupo AM REC. Conclusão: A reconstrução anatômica central tibial do LCA resultou em maior restrição da rotação interna do que a reconstrução anteromedial tibial do LCA. Estudo em Cadáver Experimental.

INCREASED RISK OF SPORTS INJURIES AMONG MEDICAL STUDENTS: CROSS-SECTIONAL STUDY.

Objective: To evaluate the nature and rate of sports injuries in medical students, as well as the risk factors at these events. Methods: All student-athletes (218) from a Medical School, integrated in at least one of the six team sport modalities (soccer, rugby, indoor soccer, handball, basketball, and volleyball) in 2017, were included. Injuries affecting their performance, regardless of time loss, were included. Athlete-exposure (A-E) was defined as one student-athlete participating in one practice or game. Results: Injury rates were significantly higher in junior medical students (1st - 3rd year) (7.58 per 1000 A-E, 95%CI = 6.11-9.06) than in senior medical students (4th - 6th year) (4.49 per 1000 A-E, 95%CI = 3.26-5.73) (p < 0.001). Multi-sports athletes had higher injury rates (10.69 per 1000 A-E, 95%CI = 8.22-13.17) than single-sport athletes (4.49 per 1000 A-E, 95%CI = 3.51-5.47) (p = 0.002). More than 60% of reported injuries occurred in the lower limbs and the mechanism that accounted for most injuries in games was player contact (51%); whereas in practice, it was non-contact (53%). Conclusion: Junior medical students present a higher injury rate than seniors. Medical students practicing more than one modality had a higher injury rate than those involved in just one sport modality. Level of Evidence IV, Cross-Sectional Study.

Objetivo: Avaliar a incidência e as características das lesões esportivas em alunos de medicina, assim como os fatores de risco envolvidos. Métodos: Todos os alunos (218) da Faculdade de Medicina da Universidade de São Paulo que integravam seis modalidades esportivas (futebol, rugby, futsal, handebol, basquete e vôlei) em 2017 foram incluídos. Foram incluídas as lesões que afetaram a performance, independente do tempo de afastamento. Uma exposição-atleta (E-A) foi definida como a participação de um aluno em um jogo ou treino. Resultados: A taxa de lesão foi maior em alunos do 1º ao 3º ano (7,58 por 1000 E-As 95% IC = 6,11-9,06) do que em alunos do 4º ao 6º ano (4,49 por 1000 E-As 95% IC = 3,26-5,73) (p < 0.001).Alunos praticantes de mais de uma modalidade apresentaram maior taxa de lesão (10,69 por 1000 E-As, 95% IC 8,22-13,17) do que alunos praticantes de apenas uma modalidade (4.49 por 1000 E-As, 95% IC 3,51-5,47) (p = 0.002). Mais de 60% daslesões ocorreram nos membros inferiores e o principal mecanismo em jogos foi contato com outro jogador (51%), e em treinos foi lesão sem contato (53%). Conclusão: Alunos do 1 ˚ ao 3 ˚ ano apresentaram maior taxa de lesão do que alunos do 4º ao 6º ano. Alunos praticantes de mais de uma modalidade apresentaram maior taxa de lesão do que alunos praticantes de apenas uma modalidade. Nível de Evidência IV, Estudo Transversal.

Muscle Injury: Pathophysiology, Diagnosis, and Treatment.

Skeletal muscle tissue has the largest mass in the human body, accounting for 45% of the total weight. Muscle injuries can be caused by bruising, stretching or laceration. The current classification divides these injuries into mild, moderate and severe. The signs and symptoms of grade I lesions are edema and discomfort; grade II, loss of function, gaps and possible ecchymosis; and grade III, complete rupture, severe pain and extensive hematoma. The diagnosis can be confirmed by ultrasound, which is dynamic and cheap, but examiner dependent; and magnetic resonance imaging (MRI), which provides better anatomical definition. The initial phase of the treatment consists in protection, rest, optimal use of the affected limb, and cryotherapy. Nonsteroidal anti-inflammatory drugs (NSAIDs), ultrasound therapy, strengthening and stretching after the initial phase and range of motion without pain are used in the clinical treatment. On the other hand, surgery has precise indications: hematoma drainage and muscle-tendon reinsertion and reinforcement.

Joint position statement of the International Federation of Sports Medicine (FIMS) and European Federation of Sports Medicine Associations (EFSMA) on the IOC framework on fairness, inclusion and non-discrimination based on gender identity and sex variations.

The IOC recently published its framework on fairness, inclusion and non-discrimination based on gender identity and sex variations. This framework is drafted mainly from a human rights perspective, with less consideration for medical/scientific issues. The framework places the onus for gender eligibility and classification entirely on the International Federations (IFs), even though most will not have the capacity to implement the framework. The position of no presumption of advantage is contrary to the 2015 IOC consensus. Implementation of the 2021 framework will be a major challenge for IFs that have already recognised the inclusion of trans and women athletes with differences of sexual development (DSD) using a scientific/medical solution. The potential consequences for sports that need to prioritise fairness or safety could be one of two extremes (1) exclusion of all transgender or DSD athletes on the grounds of advantage or (2) self-identification that essentially equates to no eligibility rules. Exclusion of all transgender or DSD athletes is contrary to the Olympic charter and unlawful in many countries. While having no gender eligibility rules, sport loses its meaning and near-universal support. Athletes should not be under pressure to undergo medical procedures or treatment to meet eligibility criteria. However, if an athlete is fully informed and consents, then it is their free choice to undergo carefully considered or necessary interventions for gender classification for sport to compete fairly and safely in their chosen gender. Free choice is a fundamental human right, but so is the right to fair and safe competition.

Muscle Injury: Pathophysiology, Diagnosis, and Treatment / Lesão muscular: Fisiopatologia, diagnóstico e tratamento

Abstract Skeletal muscle tissue has the largest mass in the human body, accounting for 45% of the total weight. Muscle injuries can be caused by bruising, stretching or laceration. The current classification divides these injuries into mild, moderate and severe. The signs and symptoms of grade I lesions are edema and discomfort; grade II, loss of function, gaps and possible ecchymosis; and grade III, complete rupture, severe pain and extensive hematoma. The diagnosis can be confirmed by ultrasound, which is dynamic and cheap, but examiner dependent; and magnetic resonance imaging (MRI), which provides better anatomical definition. The initial phase of the treatment consists in protection, rest, optimal use of the affected limb, and cryotherapy. Nonsteroidal anti-inflammatory drugs (NSAIDs), ultrasound therapy, strengthening and stretching after the initial phase and range of motion without pain are used in the clinical treatment. On the other hand, surgery has precise indications: hematoma drainage and muscle-tendon reinsertion and reinforcement.

Resumo O tecido muscular esquelético possui a maior massa do corpo humano, correspondendo a 45% do peso total. As lesões musculares podem ser causadas por contusões, estiramentos ou lacerações. A atual classificação separa as lesões entre leves, moderadas e graves. Os sinais e sintomas das lesões grau I são edema e desconforto; grau II, perda de função, gap e equimose eventual; grau III, rotura completa, dor intensa e hematoma extenso. O diagnóstico pode ser confirmado por ultrassom (dinâmico e barato, porém examinador-dependente); e ressonância magnética (RM) (maior definição anatômica). A fase inicial do tratamento se resume à proteção, ao repouso, ao uso otimizado do membro afetado e crioterapia. Anti-inflamatórios não hormonais (AINHs), ultrassom terapêutico, fortalecimento e alongamento após a fase inicial e amplitudes de movimento sem dor são utilizados no tratamento clínico. Já o cirúrgico possui indicações precisas: drenagem do hematoma, reinserção e reforço musculotendíneos.

Increased risk of sports injuries among medical students: cross-sectional study / Elevado risco de lesões esportivas em alunos de medicina: estudo transversal

ABSTRACT Objective: To evaluate the nature and rate of sports injuries in medical students, as well as the risk factors at these events. Methods: All student-athletes (218) from a Medical School, integrated in at least one of the six team sport modalities (soccer, rugby, indoor soccer, handball, basketball, and volleyball) in 2017, were included. Injuries affecting their performance, regardless of time loss, were included. Athlete-exposure (A-E) was defined as one student-athlete participating in one practice or game. Results: Injury rates were significantly higher in junior medical students (1st - 3rd year) (7.58 per 1000 A-E, 95%CI = 6.11-9.06) than in senior medical students (4th - 6th year) (4.49 per 1000 A-E, 95%CI = 3.26-5.73) (p < 0.001). Multi-sports athletes had higher injury rates (10.69 per 1000 A-E, 95%CI = 8.22-13.17) than single-sport athletes (4.49 per 1000 A-E, 95%CI = 3.51-5.47) (p = 0.002). More than 60% of reported injuries occurred in the lower limbs and the mechanism that accounted for most injuries in games was player contact (51%); whereas in practice, it was non-contact (53%). Conclusion: Junior medical students present a higher injury rate than seniors. Medical students practicing more than one modality had a higher injury rate than those involved in just one sport modality. Level of Evidence IV, Cross-Sectional Study.

RESUMO Objetivo: Avaliar a incidência e as características das lesões esportivas em alunos de medicina, assim como os fatores de risco envolvidos. Métodos: Todos os alunos (218) da Faculdade de Medicina da Universidade de São Paulo que integravam seis modalidades esportivas (futebol, rugby, futsal, handebol, basquete e vôlei) em 2017 foram incluídos. Foram incluídas as lesões que afetaram a performance, independente do tempo de afastamento. Uma exposição-atleta (E-A) foi definida como a participação de um aluno em um jogo ou treino. Resultados: A taxa de lesão foi maior em alunos do 1º ao 3º ano (7,58 por 1000 E-As 95% IC = 6,11-9,06) do que em alunos do 4º ao 6º ano (4,49 por 1000 E-As 95% IC = 3,26-5,73) (p < 0.001). Alunos praticantes de mais de uma modalidade apresentaram maior taxa de lesão (10,69 por 1000 E-As, 95% IC 8,22-13,17) do que alunos praticantes de apenas uma modalidade (4.49 por 1000 E-As, 95% IC 3,51-5,47) (p = 0.002). Mais de 60% das lesões ocorreram nos membros inferiores e o principal mecanismo em jogos foi contato com outro jogador (51%), e em treinos foi lesão sem contato (53%). Conclusão: Alunos do 1 ˚ ao 3 ˚ ano apresentaram maior taxa de lesão do que alunos do 4º ao 6º ano. Alunos praticantes de mais de uma modalidade apresentaram maior taxa de lesão do que alunos praticantes de apenas uma modalidade. Nível de Evidência IV, Estudo Transversal.

A biomechanical comparison of matched four-strand and five-strand semitendinosus-gracilis grafts / Estudo biomecânico comparativo entre enxertos quádruplos e quíntuplos pareados de tendões dos músculos semitendíneo e grácil / Estudio biomecânico comparativo entre injertos de tendones semitendinoso e gracilis cuádruple e quíntuple

ABSTRACT Introduction: Recent studies have shown that the likelihood of semitendinosus-gracilis graft rupture is inversely correlated to its diameter. A graft can be prepared in a five-strand or four-strand fashion to increase its diameter. However, the biomechanical superiority of five-strand semitendinosus-gracilis grafts is still under debate. Objective: This study aimed to evaluate the biomechanical characteristics of matched four-strand and five-strand human semitendinosus-gracilis grafts. Methods: We evaluated semitendinosus-gracilis tendons harvested from ten fresh human male and female cadavers, aged 18-60 years. Four-strand or five-strand grafts were prepared with the tendons and fixed to wooden tunnels with interference screws. Each graft was submitted to axial traction at 20 mm/min until rupture; the tests were donor matched. Data were recorded in real time and included the analysis of the area, diameter, force, maximum deformation and stiffness of the grafts. Results: The diameter, area and tunnel size were significantly greater in the five-strand grafts than in the four-strand grafts. There were no significant differences in biomechanical properties. The area and diameter of the graft were positively correlated to stiffness, and inversely correlated to elasticity. There was no significant correlation between graft size and maximum force at failure, maximum deformation or maximum tension. Conclusion: Five-strand hamstring grafts have greater area, diameter and tunnel size than four-strand grafts. There were no significant differences in biomechanical properties. In this model using interference screw fixation, the increases in area and diameter were correlated with an increase in stiffness and a decrease in elasticity. Level of evidence V; biomechanical study.

RESUMEN Introducción: Estudios recientes demostraron que la probabilidad de ruptura de los injertos semitendinoso y gracilis (STG) durante el pos operatorio de reconstrucción de ligamento cruzado anterior (LCA) está inversamente correlacionada a su diámetro. Un injerto puede ser preparado para obtener cuatro o cinco hebras para aumentar su diámetro, pero la superioridad biomecanica de los injertos STG de cinco hebras aún se mantiene en discusión. Objetivo: Evaluar las características biomecánicas de los injertos STG de humanos de cuatro o cinco hebras por pares. Métodos: Fueron evaluados tendones STG de diez cadaveres masculinos y diez cadaveres femeninos frescos, entre los 18 y 60 años. Los injertos de cuatro y cinco hebras fueron fijados en túneles de madera con tornillos de interferencia. Cada injerto fue sometido a una tracción axial de 200mm/min hasta su ruptura; estos tendones fueron separados por pares de acuerdo con sus donadores. Los datos fueron registrados en tiempo real y incluyeron el análisis del área del injerto, diámetro, fuerza, deformación máxima y rigidez. Resultados: Los resultados sobre el diámetro, el área y el tamaño del túnel fueron significativamente mayores en los injertos de cinco hebras que en los de cuatro. No existieron diferencias significativas en las propiedades biomecánicas. El área y el diámetro del injerto fueron correlacionados positivamente con la rigidez e inversamente con la elasticidad. No existió correlación significativa entre el tamaño del injerto y la fuerza máxima al momento de la falla, Máxima deformación o máxima tensión. Conclusión: Los injertos de isquiotibiales de cinco hebras tienen una área, diámetro y tamaño de túnel más grande que los injertos de cuatro hebras. No hubieron diferencias biomecánicas significativas. Los aumentos de área y diámetro en este modelo con la fijación de tornillo de interferencia fueron correlacionados con aumento de en la rigidez y una disminución en la elasticidad. Nivel de evidencia V; estudio biomecánico.

RESUMO Introdução: Estudos recentes demonstraram que a probabilidade de ruptura do enxerto dos tendões do semitendíneo e do grácil (STG) é correlacionada inversamente com seu diâmetro. Um enxerto pode ser preparado de forma quádrupla ou quíntupla para se aumentar o diâmetro. No entanto, a superioridade biomecânica dos enxertos STG quíntuplos ainda está em debate. Objetivo: Este estudo teve como objetivo avaliar as características biomecânicas dos enxertos STG humanos quádruplos ou quíntuplos pareados. Métodos: Foram avaliados tendões STG retirados de dez cadáveres masculinos e femininos frescos, com idades entre 18 e 60 anos. Os enxertos quádruplos ou quíntuplos foram preparados com os tendões e fixados em túneis de madeira com parafusos de interferência. Cada enxerto foi submetido à tração axial a 20 mm/min. até a ruptura; os testes foram pareados de acordo com os doadores. Os dados foram registrados em tempo real e incluíram a análise de área, diâmetro, força, deformação máxima e rigidez dos enxertos. Resultados: O diâmetro, a área e o tamanho do túnel foram significativamente maiores nos enxertos quíntuplos do que nos enxertos quádruplos. Não houve diferenças significativas nas propriedades biomecânicas. A área e o diâmetro do enxerto foram correlacionados positivamente com a rigidez e inversamente com a elasticidade. Não houve correlação significativa entre o tamanho do enxerto e a força máxima na falha, deformação máxima ou tensão máxima. Conclusão: Os enxertos quíntuplos dos músculos isquiotibiais têm maior área, diâmetro e tamanho do túnel do que os enxertos quádruplos. Não houve diferenças significativas nas propriedades biomecânicas. Neste modelo de fixação com parafuso de interferência, aumentos da área e do diâmetro foram correlacionados com o aumento da rigidez e a diminuição na elasticidade. Nível de evidência V; Estudo Biomecânico.

Epidemiology of hip pain in brazilian bodybuilders / Epidemiologia da dor no quadril em fisiculturistas brasileiros

ABSTRACT Objective: To determine the frequency of hip pain in competitive bodybuilders over three different bodybuilding competitions. Methods: This study evaluated bodybuilders recruited from three competitions during the year of 2016. All participants provided their informed consent and the study received IRB approval. Training routine, health condition, level of success on competitions, history of hip pain and physical examination of the hip were evaluated. Results: 113 bodybuilders were evaluated, mean age was 30.5 ± 8.65 years and mean BMI was 25.2 ± 3.65 kg/m2. Mean values for hip flexion, adduction, abduction, internal rotation, external rotation and distance between the knee and the table (FABER distance) were 116 ± 13, 23 ± 8, 71 ± 12, 40 ± 10, 36 ± 9 and 19 ± 4, respectively. Eight (7%) participants presented hip pain within the week prior to examination and only 2 (1,7%) presented with anterior impingement sign. None of the athletes who reported hip pain interrupted their physical training or performance. Conclusion: Symptomatic athletes continued their training program under the presence of hip pain. The frequency of hip pain among bodybuilders is high and may be underestimated in this study. Level of Evidence IV, Case series.

RESUMO Objetivo: Determinar a frequência de dor no quadril em atletas fisiculturistas durante três competições de fisiculturismo. Métodos: Este estudo avaliou fisiculturistas recrutados em três competições de fisiculturismo durante o ano de 2016. Termo de consentimento foi obtido de todos os participantes, e também foi obtido a aprovação do CEP. Rotina de treinos, condição de saúde, nível de sucesso nas competições, antecedente de dor no quadril ao exame físico foram avaliados. Resultados: Um total de 113 fisiculturistas foram avaliados, com idade e IMC médio de 30.5 ± 8.65 anos e 25.2 ± 3.65 kg/m2, respectivamente. O valor médio de flexão, adução, abdução, rotação interna, rotação externa do quadril, e distância entre o joelho e a mesa de exame (distância FABERE) foi de 116 ± 13, 23 ± 8, 71 ± 12, 40 ± 10, 36 ± 9 e 19 ± 4, respectivamente. Oito (7%) participantes apresentavam dor no quadril dentro da última semana antes de serem examinados, e apenas dois (1.7%) apresentavam sinal do impacto anterior do quadril à manobra de flexão adução e rotação interna. A dor no quadril não afetou o treinamento físico e a performance dos atletas que reportaram dor no quadril. Conclusão: Atletas sintomáticos continuaram o programa de treinamento mesmo na presença de dor no quadril. A frequência de dor no quadril de atletas fisiculturistas é alta e pode ter sido subestimada neste estudo. Nível de Evidência IV, Série de casos.

Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis.

BACKGROUND: There have been conflicting results about the theoretical advantages of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. PURPOSE: To evaluate the clinical and functional outcomes comparing anatomic single- versus double-bundle techniques, anatomic versus nonanatomic techniques, and transportal versus outside-in tunnel drilling for ACL reconstruction. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: A search was performed in the MEDLINE and EMBASE databases up to August 2018 for clinical trials comparing anatomic ACL reconstruction (with tunnel positioning demonstrated using gold standard radiologic techniques) with another technique, with a minimum functional and biomechanical follow-up of 6 months. A meta-analysis was performed to compare clinical and functional outcomes between anatomic single- versus double-bundle reconstruction and between anatomic versus nonanatomic techniques, using the risk difference or the mean difference. Risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies and the Cochrane Risk of Bias tool and Jadad Score for randomized controlled trials. RESULTS: Included were 15 studies comprising 1290 patients (follow-up, 12-36 months). No significant differences favoring anatomic double-bundle over anatomic single-bundle reconstruction or outside-in over transportal techniques were found. The meta-analyses showed significant differences in the International Knee Documentation Committee (IKDC) objective score (risk difference, -0.14; 95% confidence interval, -0.27 to -0.01) favoring anatomic over nonanatomic reconstruction. No statistically significant differences were found between anatomic and nonanatomic surgical techniques on other functional scores or clinical examination outcomes, including the IKDC subjective score, Lysholm score, Tegner score, KT-1000 arthrometer test, or pivot-shift test. CONCLUSION: Double-bundle reconstruction was not superior to the single-bundle technique in clinical and functional outcomes. Anatomic ACL reconstruction shows significantly superior results over nonanatomic ACL reconstruction, reinforcing the anatomic technique as the gold standard choice for clinical practice.

EPIDEMIOLOGY OF HIP PAIN IN BRAZILIAN BODYBUILDERS.

OBJECTIVE: To determine the frequency of hip pain in competitive bodybuilders over three different bodybuilding competitions. METHODS: This study evaluated bodybuilders recruited from three competitions during the year of 2016. All participants provided their informed consent and the study received IRB approval. Training routine, health condition, level of success on competitions, history of hip pain and physical examination of the hip were evaluated. RESULTS: 113 bodybuilders were evaluated, mean age was 30.5 ± 8.65 years and mean BMI was 25.2 ± 3.65 kg/m2. Mean values for hip flexion, adduction, abduction, internal rotation, external rotation and distance between the knee and the table (FABER distance) were 116 ± 13, 23 ± 8, 71 ± 12, 40 ± 10, 36 ± 9 and 19 ± 4, respectively. Eight (7%) participants presented hip pain within the week prior to examination and only 2 (1,7%) presented with anterior impingement sign. None of the athletes who reported hip pain interrupted their physical training or performance. CONCLUSION: Symptomatic athletes continued their training program under the presence of hip pain. The frequency of hip pain among bodybuilders is high and may be underestimated in this study. Level of Evidence IV, Case series.

OBJETIVO: Determinar a frequência de dor no quadril em atletas fisiculturistas durante três competições de fisiculturismo. MÉTODOS: Este estudo avaliou fisiculturistas recrutados em três competições de fisiculturismo durante o ano de 2016. Termo de consentimento foi obtido de todos os participantes, e também foi obtido a aprovação do CEP. Rotina de treinos, condição de saúde, nível de sucesso nas competições, antecedente de dor no quadril ao exame físico foram avaliados. RESULTADOS: Um total de 113 fisiculturistas foram avaliados, com idade e IMC médio de 30.5 ± 8.65 anos e 25.2 ± 3.65 kg/m2, respectivamente. O valor médio de flexão, adução, abdução, rotação interna, rotação externa do quadril, e distância entre o joelho e a mesa de exame (distância FABERE) foi de 116 ± 13, 23 ± 8, 71 ± 12, 40 ± 10, 36 ± 9 e 19 ± 4, respectivamente. Oito (7%) participantes apresentavam dor no quadril dentro da última semana antes de serem examinados, e apenas dois (1.7%) apresentavam sinal do impacto anterior do quadril à manobra de flexão adução e rotação interna. A dor no quadril não afetou o treinamento físico e a performance dos atletas que reportaram dor no quadril. CONCLUSÃO: Atletas sintomáticos continuaram o programa de treinamento mesmo na presença de dor no quadril. A frequência de dor no quadril de atletas fisiculturistas é alta e pode ter sido subestimada neste estudo. Nível de Evidência IV, Série de casos.

Integrating Transwomen and Female Athletes with Differences of Sex Development (DSD) into Elite Competition: The FIMS 2021 Consensus Statement.

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport's governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete's unique makeup.

During the coronavirus (covid-19) pandemic, does wearing a mask improve or worsen physical performance? / Durante a pandemia de coronavírus (covid 19), o uso de máscara melhora ou piora o desempenho físico? / ¿durante la pandemia de coronavirus (covid 19) el uso de la máscara mejora o empeora el desempeño físico?

ABSTRACT A mask is a simple device yet it provides high levels of protection. As the virus affects mainly the respiratory tract - the nose, mouth, and lungs - it is highly contagious when people sneeze or cough, or exchange respiratory droplets with other people. This exchange is also promoted when a person is performing physical exercise. Although a mask provides some protection, it does not eliminate the need for social distancing. Around 25% of people infected with the new coronavirus may show no symptoms, yet still transmit the virus. One of the main problems with wearing a mask is that it hinders breathing, with the mask gradually becoming damp, increasing its resistance to air intake. Wearing a mask while performing physical activity requires a period of adaptation, as the flow of air to the lungs is reduced, requiring a reduction in the normal rhythm until the wearer has managed to adapt to it. Vigorous and intense exercise can cause inflammatory activity to increase, and should be minimized in order to protect the immune system. Secretory immunoglobulin A (IgA) is an antibody protein used by the immune system to neutralize pathogens, including viruses, and decreases with intense exercise. Exercise is considered intense when it is necessary to breathe through the mouth to eliminate the higher concentrations of CO2, but mouth breathing is associated with infections of the upper respiratory tract. Preference should be given to light to moderate exercise, around three times a week. Wearing a mask, and training in nasal breathing are the best and safest ways to reduce the entry of particles, and should be encouraged during this COVID-19 pandemic. Level of evidence V; Opinion of the specialist.

RESUMO A máscara é um dispositivo simples, mas oferece altos níveis de proteção. Como o vírus afeta principalmente o trato respiratório - nariz, boca e pulmões - é altamente contagioso quando as pessoas espirram, tossem ou trocam gotículas respiratórias com outras pessoas. Essa troca também é promovida quando a pessoa está realizando exercícios físicos. Embora a máscara forneça alguma proteção, ela não elimina a necessidade de distanciamento social. Cerca de 25% das pessoas infectadas com o novo coronavírus podem não apresentar sintomas, mas mesmo assim, transmitem o vírus. Um dos principais problemas do uso de máscara é que ela dificulta a respiração, pois gradualmente fica úmida e aumenta a resistência à entrada de ar. É necessário um período de adaptação para a atividade física com máscara, pois o fluxo de ar para os pulmões é reduzido, exigindo a diminuição do ritmo normal até que a adaptação ocorra. Exercícios vigorosos e intensos podem aumentam a atividade inflamatória e devem ser minimizados para proteger o sistema imunológico. A imunoglobulina secretora A (IgA) é uma proteína anticorpo usada pelo sistema imunológico para neutralizar patógenos, incluindo vírus, e diminui com exercícios intensos. O exercício é considerado intenso quando é necessário respirar pela boca para eliminar a maior concentração de CO2, mas a respiração bucal está associada a infecções do trato respiratório superior. A preferência deve ser pelos exercícios leves a moderados, realizados cerca de três vezes por semana. Usar a máscara e treinar a respiração nasal são os modos melhores e mais seguros de reduzir a entrada de partículas e precisam ser incentivados durante a pandemia de COVID-19. Nível de evidência V; Opinião do especialista.

RESUMEN La máscara es un dispositivo simple, pero ofrece altos niveles de protección. Debido a que el virus afecta principalmente el tracto respiratorio (nariz, boca y pulmones) es muy contagioso cuando las personas estornudan, tosen o intercambian gotitas respiratorias con otros. Aunque la máscara proporciona cierta protección, no elimina la necesidad del distanciamiento social. Alrededor del 25% de las personas infectadas con el nuevo coronavirus pueden no tener síntomas, pero aun así transmiten el virus. Uno de los principales problemas de la máscara es que dificulta la respiración, ya que gradualmente se humedece y aumenta la resistencia a la entrada del aire. Es necesario un período de adaptación para la actividad física con una máscara, ya que reduce el flujo de aire a los pulmones, lo que requiere una disminución del ritmo normal hasta que se produzca la adaptación. El ejercicio vigoroso e intenso puede aumentar la actividad inflamatoria y debe minimizarse para proteger el sistema inmunitario. La inmunoglobulina secretora A (IgA) es una proteína anticuerpo utilizada por el sistema inmunitario para neutralizar los patógenos, incluidos los virus, y disminuye con el ejercicio intenso. El ejercicio se considera intenso cuando es necesario respirar por la boca debido la mayor concentración de CO2, pero la respiración bucal se asocia con infecciones del tracto respiratorio superior. La preferencia debe ser para la realización de ejercicios leves a moderados aproximadamente tres veces por semana. Usar la máscara y entrenar la respiración nasal es mejor y más seguro para reducir la entrada de partículas y deben estimularse durante la pandemia de COVID-19. Nivel de evidencia V; Opinión de expertos.

Comparing the Aerobic Fitness of Professional Male Soccer Players and Soccer Referees.

We looked to compare the aerobic performance between professional soccer referees and players. Fifty male soccer referees and 61 male soccer players were tested on a treadmill. The referees and players possessed 15 ± 7 years and 7 ± 3 years of experience in soccer, respectively. Significant differences were observed between the referees and players with regards to: age (34.8 ± 4.6 years vs 20.8 ± 2.7 years; P < 0.001, maximum oxygen uptake (54.7 ± 5.4 mL·kg·min vs 58.8 ± 4.4 mL·kg·min; P < 0.001), and maximal heart rate in peak exercise (184 ± 11 bpm vs 192 ± 9 bpm, P < 0.001). Less significant differences also were observed and included; running speed at the maximum oxygen uptake (16.6 ± 1 km·h vs 16.4 ± 1.1 km·h), running speed at the ventilatory threshold (213.5 ± 1.1 km·h vs 13.2 ± 0.9 km·h), and percentage of maximal oxygen uptake at the ventilatory threshold (285.1% ± 3.2% vs 84.1% ± 6.2%). The effect size of most comparative variables between the two groups was small (<0.6). Older elite-level soccer referees are able to reach and maintain aerobic physical fitness levels similar to professional soccer players. Aerobic physical fitness may be a measurable factor for maintaining elite-level soccer licensure rather than age alone.

>Imaging Assessment of the Pubis in Soccer Players.

Objective To compare the accuracy of ultrasound (US) with that of magnetic resonance imaging (MRI) in the detection of aponeurosis lesions of the rectus abdominis/adductor longus muscles, to study the characteristics of the athletes and imaging findings associated with pubalgia, and to demonstrate the importance of each method in evaluating this condition. Materials and methods The present study was conducted from 2011 to 2016 with 39 professional soccer players: 15 with pubalgia and 24 without pubalgia. Age, field position, body mass index (BMI), weekly training load, career length, and history of thigh/knee injury and lower back pain were recorded. The following tests were performed: radiographs (anteroposterior view of the pelvis in standing and flamingo positions) to evaluate hip impingement, sacroiliac joint, and pubic symphysis instability; US to analyze the common aponeurosis of the rectus abdominis/adductor longus muscles and inguinal hernias; and MRI for pubic bone degenerative alterations and edema, and lesions in the adductor and rectus abdominis muscles and their aponeurosis. Results There was an association between pubalgia, high BMI ( p = 0.032) and muscle alterations ( p < 0.001). Two patients with pubalgia had inguinal hernias and one patient with pubalgia and two controls had sports hernias. Pubic degenerative changes were frequent in both groups. Aponeurosis lesions were more frequent in patients with pain. The US detection had 44.4% sensitivity and 100% specificity. Conclusion The evaluation of athletic pubalgia should be performed with radiography, US, and MRI. High BMI, muscle injuries, geodes, and osteophytes are findings associated with pubalgia; US has low sensitivity to detect injuries of the common aponeurosis of the rectus abdominis/adductor longus muscles.