Changes in patellar tendon complaints and shear wave velocity patterns among competitive alpine skiers during a 4-year post-growth spurt follow-up.

Patellar tendon (PT) complaints are frequent in competitive alpine skiers and such complaints are characterized by a long-lasting affection. Since PTs are subject to maturation up to 1-2 years after growth spurt, this early career stage may be decisive for the further course of complaints. The aim of this study was to investigate the evolution of PT complaints and shear wave velocity patterns among competitive alpine skiers during a 4-year post-growth spurt follow-up. The PT complaints and SWV patterns of forty-seven skiers were analysed at baseline (i.e., immediately after their peak height growth at 13-15 years of age) and were re-analysed at 4-year follow-up. The PTs were scanned via three-dimensional SWE. Symptomatic skiers were identified based on pain sensation under loading and pressure-induced pain around the PT. The prevalence of PT complaints decreased from 29.8% at baseline to 12.8% at follow-up (Pearson's χ2 = 9.429; p = 0.002). SWV decreased from the baseline assessment to the follow-up in the proximal and distal regions (p < 0.05). SWV coefficient of variation (CV) in the distal and mid-portion regions was greater at baseline than at follow-up (p < 0.05). At the follow-up assessment, compared to "healthy" skiers, "healed" skiers who recovered from PT complaints had lower SWVs in the proximal region (p = 0.020) and greater SWV CVs in the proximal region (p = 0.028). Moreover, symptomatic skiers had significantly greater SWV CVs in the mid-portion region than did "healthy" subjects with no history of PT complaints (p = 0.020). The average SWV was negatively correlated with the SWV (proximal: r = -0.74, p < 0.001; mid-portion: r = -0.37 p = 0.011; and distal: r = -0.58, p < 0.001). The occurrence of PT complaints decreased over a 4-year post-growth spurt follow-up. "Healed" skiers who were symptomatic at baseline had an even greater average decrease in the proximal and mid-portion SWV than "healthy" skiers with no history of PT complaints. This may lead to the hypothesis that PT complaints in adolescent skiers are not self-eliminating towards the end of adolescence, as at least structural irregularities appear to persist for several years after the onset of initial symptoms. Furthermore, "healed" and symptomatic tendons exhibited increased SWV variability, supporting the hypothesis that SWV CV may provide additional valuable information on the mechanical properties of PTs affected by overuse-related complaints.

How useful are indirect radiographic measurements of hip instability in borderline hip dysplasia? An MRI-based comparison to a healthy cohort.

PURPOSE: Symptomatic hips with borderline hip dysplasia (BHD) morphology pose a challenge in differentiating stable from unstable hips. The current study aims to compare indirect radiographic signs of instability in a symptomatic BHD population to those in a healthy cohort. METHODS: The study group consisted of patients with a lateral centre-edge angle (LCEA) with values 18° ≤ LCEA < 25° who underwent corrective periacetabular osteotomy (PAO) and reported an improvement in patient-reported outcome measures (PROMs). The comparison group consisted of a healthy cohort of athletes who did not complain of any hip-related symptoms and who had normal values of their hip morphological parameters (LCEA, acetabular index (AI°), alpha angle (α°), femoral version, acetabular version). Indirect signs of instability consisting of the femoro-epiphyseal acetabular roof index (FEAR), iliocapsularis-to-rectus-femoris (IC/RF) ratio and labral dimensions (height-to-length ratio) were assessed in both groups. Partial Pearson correlation, logistic multiple regression analysis and Receiver-Operating Characteristic (ROC) curve analysis were performed to determine correlations, as well as the sensitivity and specificity of these signs to differentiate between healthy hips and BHD. RESULTS: On binary logistic multiple regression analysis, the FEAR Index was the only independent predictor to differentiate between BHD and healthy hips (p < 0.001). The IC/RF ratio did not achieve significance. The calculated area under the curve (AUC) was 0.93 (0.87 - 0.99, CI 95%, p < 0.001) for the FEAR Index and 0.81 (0.70 - 0.92, CI 95%, p < 0.001) for the height-length ratio. Using the predefined cut-off values (dysplastic-FEAR Index ≥ 5° or labral height-to-length ratio ≤ 0.5), 27% sensitivity/100% specificity and 20% sensitivity/ 100% specificity, were achieved. ROC analysis provided the following new thresholds: FEAR Index ≥ -5° (73% sensitivity/97% specificity); labral height-to-length ratio ≤ 0.8 (70% sensitivity, 79% specificity). CONCLUSION: In our cohort, the FEAR index was an independent parameter that could differentiate between borderline dysplastic and asymptomatic hips. The previously published values for both the FEAR index and labral hypertrophy ratio had a poor sensitivity in differentiating symptomatic unstable BHD from healthy hips. The cut-off values of ≥ -5° (FEAR index) and ≤ 0.8 (labral height-to-length ratio) provided acceptable sensitivity and specificity when comparing to morphological healthy hips.

Tumor-Like Distal Femoral Cortical Irregularities of the Knee in Adolescent Competitive Alpine Skiers: Longitudinal Assessment Over 48 Months.

BACKGROUND: Tumor-like distal femoral cortical irregularities (DFCIs) are a frequent incidental finding on knee magnetic resonance imaging (MRI) and are common in young competitive athletes. PURPOSE: To assess and compare the morphology and prevalence of DFCIs in competitive alpine skiers over 48 months during adolescence. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Adolescent competitive alpine skiers were prospectively recruited in 2018 and received bilateral 3-T MRI of the knee at baseline and after 48 months. All MRIs were evaluated for the presence and location of DFCIs, which were marked at 1 of 3 anatomic positions: (1) the femoral attachment of the medial head of the gastrocnemius muscle, (2) the lateral head of the gastrocnemius muscle, or (3) the attachment of the adductor magnus aponeurosis. The size of the DFCI was measured by 2 radiologists independently. The measurements were compared using the Wilcoxon signed-rank test, the interclass correlation coefficient (ICC), and Cohen Kappa. RESULTS: A total of 63 athletes (mean age at follow-up, 19.6 ± 1.2 years; n = 25 female) were included in the study. At baseline, DFCIs were detected in 84 out of 126 knees (67%). At the 48-month follow-up, DFCIs were found in 88 out of 126 knees (70%), with multiple DFCIs in 3 knees and no significant difference between male and female patients (n = 24 male, n = 19 female; P = .71). No significant increase was detected for the number (P = .21) and size of the DFCIs between the baseline and the 48-month follow-up (mean size: baseline, 3.7 ± 0.8 mm; 48-month follow-up: 3.6 ± 0.9 mm; P = .66). The interrater agreement for the mean size measurements of DFCIs was good to excellent (ICC 0.88). CONCLUSION: DFCIs remain a frequent finding on knee MRI in competitive alpine skiers after skeletal maturation and do not disappear during adolescence. The DFCI size was constant in athletes aged between 15 and 19 years. Moreover, DFCIs should not be mistaken for a pathologic finding.

Long-term CT follow-up of patients with lumbar spondylolysis reveals low rate of spontaneous bone fusion.

OBJECTIVES: Knowledge about the long-term outcome of patients with lumbar spondylolysis (LS) is limited. This study assessed the frequency of bone fusion in conservatively treated lumbar spondylolysis with photon counting detector computed tomography. METHODS: Patients with lumbar spondylolysis diagnosed with CT or MRI were prospectively enrolled and underwent CT 5-10 years after initial imaging. Image assessment included evaluation of Meyerding grade, listhesis size, measurement of the lysis gap, and disc integrity on the lysis level. Comparisons were made between bone fusion as the primary endpoint and sex, body mass index, age at diagnosis, follow-up interval, size of listhesis, Meyerding grade, size of the lysis gap, sports activity, and presence of pain. RESULTS: A total of 39 patients (26.0 ± 3.1 years, 15 female) with lumbar spondylolysis on 41 levels were included after a mean follow-up period of 9.1 ± 2.2 years. Nine patients (22.0%, four female) showed complete fusion of the lysis gap. Patients with bone fusion of the lysis gap had a significantly lower Meyerding grade (p = 0.01), smaller size of the listhesis (p = 0.019), and smaller anterior and posterior lysis gap size (p = 0.046 and p = 0.011, respectively). Unilateral lyses showed significantly higher fusion rates than bilateral lyses (40.0% vs. 16.1%, p = 0.01). No statistically significant difference was found for pain at follow-up between patients with and without bone fusion (p = 0.253). CONCLUSION: Bone fusion occurred in about a fifth of conservatively treated lumbar spondylolysis after a follow-up period of 9 years. Factors associated with a successful fusion were a lower Meyerding grade, minimal listhesis, and a small lysis gap.

Superolateral Hoffa fat pad edema in adolescent competitive alpine skiers: temporal evolution over 4 years and risk factors.

OBJECTIVES: To longitudinally assess and correlate the prevalence of superolateral Hoffa fat pad (SHFP) edema with changes in features of the knee extensor mechanism in adolescent competitive alpine skiers over 48 months. METHODS: Competitive alpine skiers were prospectively enrolled in 2018 and underwent bilateral knee MRI at baseline and after 48 months. MRI was assessed for the prevalence of SHFP edema. Features of the knee extensor mechanism were assessed by measuring the trochlear sulcus angle and depth, lateral and medial trochlear inclination, trochlear angle, patella tilt, Insall‒Salvati ratio (ISR), and patellar ligament to lateral trochlear facet (PL-T) distance. Separate logistic regression models were used to calculate the odds ratios between each measurement and the presence of SHFP edema at both time points. RESULTS: Sixty-three athletes were included in the study (mean age 15.3 ± 1.3 years, 25 women). At baseline, 23 knees had SHFP edema, increasing to 34 knees at the 48-month follow-up. At baseline, knees with measurements in the highest quartile for ISR and lowest quartile for trochlear depth and PL-T were 9.3, 5.1, and 7.7 times more likely to show SHFP edema, respectively. At follow-up, these correlations were confirmed and additionally, knees with measurements in the highest quartile for trochlear sulcus angle and the lowest quartile for lateral trochlear inclination were 4.1 and 3.4 times more likely to show SHFP edema. CONCLUSION: An increased prevalence of SHFP edema in competitive alpine skiers during adolescence was associated with persistent high-riding patella, reduced patellar ligament to trochlear distance, and flattened lateral trochlear facet. CRITICAL RELEVANCE STATEMENT: In clinical routine, assessment of the mechanical properties of the knee extensor mechanism, together with anatomical developments during adolescence, may improve the understanding and management of patellofemoral instability. KEY POINTS: • Superolateral Hoffa fat pad (SHFP) edema is a frequent cause of anterolateral knee pain but the role of predisposing factors is still debated. • A higher prevalence of SHFP edema was associated with high-riding patella, reduced patellar ligament to trochlear distance, and flattened lateral trochlear facet. • Understanding of the mechanical interaction and the anatomical development of the knee during adolescence provides further insight into the development of SHFP edema.

Health problems occurring in national-level female soccer players are different between leagues and throughout the season: a 6-month prospective cohort study.

Objectives: This study investigated the prevalence and severity of health problems in national-level female soccer players with respect to league and seasonality. Methods: In a prospective cohort study, 46 female soccer players aged 22.8±3.9 years playing in the three highest leagues in Switzerland were surveyed biweekly using the Oslo Sports Trauma Research Centre health problem (OSTRC-H) questionnaire. All definitions and measures followed the OSTRC-H-specific recommendations. The 6-month observation period included parts of the off-season and one half of the match season. Results: The average 2-weekly health problem prevalence was 37.3% (illnesses: 8.8%; sudden onset injuries-both acute and repetitive mechanisms: 19.7%; repetitive gradual onset injuries: 12.4%) and 25.1% for substantial problems as defined in the OSTRC-H context (7.3%; 12.0% and 7.3%, respectively). The absolute injury rates amounted to 148 injuries per 100 players per half season, of which 96 injuries per 100 players per half season were substantial. Female players in the 2nd and 3rd highest national leagues showed more gradual onset injuries (p<0.001) and fewer illnesses than those in the top league (p<0.05). At the same time, there were no league-specific differences in sudden onset injuries. Such injuries had a higher cumulative severity score than gradual onset injuries. Among sudden onset injuries, the ankle was the most affected body part, while the thigh was affected by for gradual onset injuries. The average 2-weekly health problem prevalence values steadily increased during the match season. Conclusion: Among national-level female soccer players, the risk of health problems is relatively high and differs between leagues and across seasons.

Altered regional 3D shear wave velocity patterns in youth competitive alpine skiers suffering from patellar tendon complaints - a prospective case-control study.

Patellar tendon (PT) complaints are frequent throughout the population, with increased occurrence in athletes and, particularly, in youth competitive alpine skiers. Timely detection and treatment might improve prospects of recovery. Diagnostic modalities in clinical use to date rely on pain symptoms, manual palpation, and potentially, magnetic resonance imaging (MRI); however, MRI-based imaging yields limited sensitivity. Quantitatively measuring the morphological and mechanical properties of PTs by means of B-mode ultrasound and shear wave elastography (SWE), instead, may allow improved diagnosis or even early detection. We performed B-mode scans and three-dimensional ultrasound shear wave velocity (SWV) mapping and MRI of the PT in 106 youth skiers. A prospective one-year survey on health problems combined with clinical assessments served to categorize symptomatic and asymptomatic youth skiers. Skiers suffering from distal or proximal tendon complaints showed lower SWV in the respective tendon region than asymptomatic skiers (p = 0.035 and p = 0.019, respectively). Youth skiers with distal tendon complaints additionally exhibited decreased SWV in the proximal region compared to asymptomatic counterparts (p = 0.020). Cross-validated analysis of retrospective prediction indicated sensitivity and specificity in detecting tendon complaints in the range of 0.606-0.621 and 0.536-0.650, respectively. MRI detected distal tendon complaints with a sensitivity of 0.410 (12/29) but failed to detect any proximal cases. This study agrees with the most recent literature in that SWE holds promise as a valuable adjunct modality for the diagnosis of PT complaints or even the detection of subclinical prestages. However, to evaluate its prospective predictive value, long-term studies are warranted.Highlights Patellar tendon complaints are a frequent complaint in athletes, particularly in youth competitive alpine skiers, but timely quantitative detection of related tendon properties remains challenging.Quantitative B-mode US and three-dimensional ultrasound shear wave elastography assessments and magnetic resonance imaging were performed in youth competitive alpine skiers.Three-dimensional shear wave elastography was able to discern symptomatic from asymptomatic patellar tendons both in the distal and proximal tendon regions, whereas magnetic resonance imaging failed to detect any proximal cases.

Lumbar Multifidus Morphology in Youth Competitive Alpine Skiers and Associated Sex, Age, Biological Maturation, Trunk Stability, and Back Complaints.

BACKGROUND: The lumbar multifidus (LMF), as a dynamic stabilizer of the lumbar spine, may play an important role in the prevention of overuse-related back complaints. HYPOTHESIS: LMF morphology is associated with trunk stability and differs between symptomatic and asymptomatic skiers. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 85 youth skiers (28 females, mean age, 14.7 ± 0.7 years; 57 males, mean age, 14.9 ± 0.5 years) underwent anthropometric assessments, an estimation of biological maturation, a magnetic resonance imaging- and ultrasound-based examination of LMF morphology, and a biomechanical quantification of deadbug bridging stabilization performance. Athletes were categorized as symptomatic if they had registered at least 1 significant overuse-related back complaint episode in the 12 months before the main examination. RESULTS: Male skiers showed a greater LMF size (ie, anatomical cross-sectional area [ACSA]) than female skiers, except for vertebral body L5, where no difference was found (8.8 ± 1.8 cm2 vs 8.3 ± 1.4 cm2, P = 0.18). Conversely, female skiers displayed longer fascicles than male skiers (5.8 ± 0.8 cm vs 5.4 ± 0.8 cm, P = 0.03). Skiers aged under 16 years (U16) skiers had greater values for LMF size and fascicle length than U15 skiers. Maturity offset was associated with L5 LMF size (R2 = 0.060, P = 0.01), fascicle length (R2 = 0.038, P = 0.04), and muscle thickness (R2 = 0.064, P = 0.02). L5 LMF size was associated with trunk stability (R2 = 0.068, P = 0.01). Asymptomatic skiers showed on average a 12.8% greater value for L5 LMF size compared with symptomatic skiers (P = 0.04). CONCLUSION: There are sex- and age-related differences in LMF morphology in youth competitive alpine skiers. Moreover, the ACSA at the level of the lumbar vertebral body L5 undergoes changes during biological maturation, shows a small, but significant association with trunk stability, and differs between symptomatic and asymptomatic skiers with back complaints. CLINICAL RELEVANCE: The observed association of muscle structure (ie, L5 LMF ACSA) with functional aspects (ie, trunk stabilization capacity) and clinical representation (ie, overuse-related back complaints) further highlights the important role of the multifidus muscle for training and injury prevention in youth competitive alpine skiers around the growth spurt.

A stabilizing factor?-Video gaming among elite athletes during the first lockdown of the COVID-19 pandemic.

Objectives: Little is known about the extent of video gaming among elite athletes, specifically under stressful conditions like those induced by the current COVID-19 pandemic. The aim of this study was to evaluate the intensity and extent of video gaming in the context of the COVID-19 pandemic, during which the usual daily routine of many athletes was disrupted. Methods: Overall, 203 elite athletes from Switzerland who participated in Olympic sports or in "International Olympic Committee"-approved disciplines were interviewed using an online questionnaire. They were questioned on their video game consumption during the first Swiss lockdown during the COVID-19 pandemic as well as on their athletic performance and economic circumstances. Additionally, mental and physical health were assessed by standardized questionnaires. From this questionnaire data, predictors of gaming time were evaluated using multivariable analysis. Results: Before the lockdown, 21% of the participating athletes played video games regularly. The average playing time was 15.8 h per month within the gamer group. During the first lockdown, 29% of athletes reported gaming regularly, and within the gamer group the average gaming time increased significantly, by 164%. The mental health burden showed significant differences between gamers and non-gamers regarding existential fears during the lockdown, the ability to cope with governmental measures due to COVID-19 and total sleeping time. However, there was no statistical difference in respect to standardized scales for depressive symptoms, sleep behavior, and anxiety. Higher video gaming time during the lockdown was significantly associated with male gender and previous gaming before the COVID-19 lockdown. Conclusion: Video gaming time increased significantly during the first lockdown. Whether video gaming among elite athletes hereby functions as an effective coping behavior remains to be shown and requires more research.

Training load, sports performance, physical and mental health during the COVID-19 pandemic: A prospective cohort of Swiss elite athletes.

BACKGROUND: The COVID-19 pandemic and associated restrictions have led to abrupt changes in the lives of elite athletes. OBJECTIVES: The objective of this prospective cohort study was to examine training load, subjective sports performance, physical and mental health among Swiss elite athletes during a 6-month follow-up period starting with the first Swiss lockdown. METHODS: Swiss elite athletes (n = 203) participated in a repeated online survey evaluating health, training, and performance related metrics. After the first assessment during the first lockdown between April and May 2020, there were monthly follow-ups over 6 months. RESULTS: Out of 203 athletes completing the first survey during the first lockdown, 73 athletes (36%) completed all assessments during the entire 6-month follow-up period. Sports performance and training load decreased during the first lockdown and increased again at the beginning of the second lockdown in October 2020, while symptoms of depression and financial fears showed only a transient increase during the first lockdown. Self-reported injuries and illnesses did not change significantly at any timepoint in the study. Stricter COVID-19 restrictions, as measured by the Government Stringency Index (GSI), were associated with reduced subjective sports performance, as well as lower training intensity, increased financial fears, poorer coping with restrictions, and more depressive symptoms, as measured by the 9-item module of the Patient Health Questionnaire-9 (PHQ-9). CONCLUSION: This study revealed a negative impact of the COVID-19 restrictions on sports performance, training load and mental health among Swiss elite athletes, while the rate of self-reported injuries and illnesses remained unaffected.

Biceps femoris long head morphology in youth competitive alpine skiers is associated with age, biological maturation and traumatic lower extremity injuries.

Lower extremity injuries are common in competitive alpine skiers, and the knee and lower leg are often affected. The hamstring muscles, especially the biceps femoris long head (BFlh), can stabilize the knee and the hip and may counteract various adverse loading patterns during typical mechanisms leading to severe lower extremity injuries. The aim of the present study was to describe BFlh morphology in youth competitive alpine skiers in relation to sex, age and biological maturation and to investigate its association with the occurrence of traumatic lower extremity injuries in the upcoming season. 95 youth skiers underwent anthropometric measurements, maturity offset estimations and ultrasound assessment, followed by 12-months prospective injury surveillance. Unpaired t tests showed that the two sexes did not differ in BFlh morphology, including fascicle length (Lf), pennation angle (PA), muscle thickness (MT) and average anatomical cross-sectional area (ACSAavg). In contrast, U16 skiers had longer fascicles than U15 skiers (9.5 ± 1.3 cm vs 8.9 ± 1.3 cm, p < 0.05). Linear regression analyses revealed that maturity offset was associated with Lf (R 2 = 0.129, p < 0.001), MT (R 2 = 0.244, p < 0.001) and ACSAavg (R 2 = 0.065, p = 0.007). No association was found between maturity offset and PA (p = 0.524). According to a binary logistic regression analysis, ACSAavg was significantly associated with the occurrence of traumatic lower extremity injuries (Chi-square = 4.627, p = 0.031, RNagelkerke 2 = 0.064, Cohen f = 0.07). The present study showed that BFlh morphology is age- and biological maturation-dependent and that BFlh ACSAavg can be considered a relevant modifiable variable associated with lower extremity injuries in youth competitive alpine skiers.

Breaking new grounds in injury risk screening in soccer by deploying unsupervised learning with a special focus on sex and fatigue effects.

In injury prevention, a vertical drop jump (DJ) is often used for screening athletes at risk for injury; however, the large variation in individual movement patterns might mask potentially relevant strategies when analysed on a group-based level. Two movement strategies are commonly discussed as predisposing athletes to ACL injuries: a deficient leg axis and increased leg stiffness during landing. This study investigated the individual movement pattern of 39 female and male competitive soccer players performing DJs at rest and after being fatigued. The joint angles were used to train a Kohonen self-organising map. Out of 19,596 input vectors, the SOM identified 700 unique postures. Visualising the movement trajectories and adding the latent parameters contact time, medial knee displacement (MKD) and knee abduction moment allow identification of zones with presumably increased injury risk and whether the individual movement patterns pass these zones. This information can be used, e.g., for individual screening and for feedback purposes. Additionally, an athlete's reaction to fatigue can be explored by comparing the rested and fatigued movement trajectories. The results highlight the ability of unsupervised learning to visualise movement patterns and to give further insight into an individual athlete's status without the necessity of a priori assumptions.

Cortical Bone Thickness, Base Osteophyte Occurrence and Radiological Signs of Osteoarthritis in the Fingers of Male Elite Sport Climbers: A Cross-Sectional 10-Year Follow-Up Study.

Background: Sport climbing places high mechanical loads on fingers. In 2012, our research group demonstrated adaptations of climbers' cortical bones with the presence of osteophytes compared to non-climbing controls. Objectives: 1) To investigate 10-year changes in cortical bone thickness, base osteophyte occurrence and radiological signs of osteoarthritis in the fingers of elite male sport climbers with more than 25 years of climbing history and 2) to compare cortical bone thickness, base osteophyte occurrence and radiological signs of osteoarthritis between male sport climbers and age-matched controls at the 10-year follow-up. Methods: All 31 elite sport climbers who participated in both the baseline and 10-year follow-up assessments (follow-up rate 100%) were examined by means of X-rays. Cortical bone thickness, presence of osteophytes and signs of osteoarthritis according to Kellgren-Lawrence were obtained and compared to the baseline values 10 years earlier and to age-matched controls at the follow-up (n = 15). Results: Significantly increased cortical bone thickness over the past 10 years was observed in climbers (mean absolute difference with 95% CI:0.98 mm (0.77 mm, 1.19 mm); p <0.001). Moreover, compared to age-matched controls, climbers had significantly thicker cortical bone at the 10-year follow-up (mean absolute difference with 95% CI:0.86 mm (0.61 mm, 1.12 mm); p <0.001). In climbers, osteophytes and clear signs of osteoarthritis were mainly seen in DIP joints. Signs of osteoarthritis according to Kellgren-Lawrence were more prevalent than 10 years before in most joints. In lateral radiographs, base osteophytes were not significantly more prevalent than 10 years before in most of the joints. The percentage of climbers who had osteophytes in any DIP (PIP) joint increased from 93.5% (67.7%) at baseline to 100% (74.2%) at the 10-year follow-up. The percentage of climbers who had clear signs of osteoarthritis according to Kellgren-Lawrence in any DIP (PIP) joint increased from 12.9% (9.7%) at baseline to 74.2% (64.5%) at 10-year follow-up. Only a few such degenerative changes were found in age-matched controls. Conclusion: An accumulation of repetitive climbing-related stress to the fingers of elite sport climbers over the career may induce lifelong mechano-adaptation of the cortical bone thickness of all phalanges. At the 10-year follow-up, a further significant increase in radiographic signs of osteoarthritic changes was observed.

Training Patterns and Mental Health of Bodybuilders and Fitness Athletes During the First Lockdown of the COVID-19 Pandemic-A Cross-Sectional Study.

Background: Government restrictions during the first COVID-19 lockdown, such as the closure of gyms and fitness centers, drastically limited the training opportunities of bodybuilders and fitness athletes (BoFA) who rely on indoor training facilities. This provided a unique situation to investigate the effect of training limitations on the training patterns, training adaptive strategies and mental health of BoFAs. Objectives: The primary aim of this study was to investigate differences in the training patterns and the mental health of BoFA before and during the first COVID-19 lockdown. The secondary aim was to assess whether BoFA who exhibited features of muscle dysmorphia were affected differently from the group that did not. Methods: A cross-sectional study was conducted with 85 BoFAs by means of an online questionnaire asking about sports activity, intensity, subjective physical performance, and economic status, including primary or secondary occupations before (from memory) and during lockdown, current physical health problems and financial fears, symptoms of depression, sleep disorders, anxiety (trait and state), muscle dysmorphia, coping mechanisms and actions during the first lockdown in Switzerland. Results: Training patterns and mental health of BoFA were influenced by the COVID-19 pandemic and first lockdown. During lockdown, the physical activity on the BoFA dropped significantly from 2.3 ± 0.8 h per day to 1.6 ± 0.9 h per day (p < 0.001), the subjective training intensity decreased significantly from 85.7 ± 13.2% to 58.3 ± 28.3% (p < 0.001) and the subjective performance declined significantly from 83.4 ± 14.3% to 58.2 ± 27.8% (p < 0.001) of maximal performance. In comparison to those without risk for body dysmorphia, participants at risk rated their maximal performance significantly lower and scored significantly higher for depression, sleep disorders and anxiety. Conclusion: This study showed the significant changes on the training patterns of BoFA before and during the first COVID-19 lockdown and poor mental health scores of BoFA during the lockdown itself, with those at risk of muscle dysmorphia scoring statistically worse regarding mental health than those with no risk of muscle dysmorphia. To better understand the particularities of BoFA, further investigation is needed to understand their psychology and in particular the effect of training restrictions on it.

The ISPA Int Injury Prevention Programme for Youth Competitive Alpine Skiers: A Controlled 12-Month Experimental Study in a Real-World Training Setting.

Evidence-based injury prevention programmes for youth competitive alpine skiers are widely absent. The aims of this controlled 12-month experimental study were to introduce a novel injury prevention programme targeted to the injury patterns of youth skiers, called ISPAInt , and to compare the differences in injury occurrence between an intervention group (IG) additionally performing the ISPAInt programme and an independent, historical control group (CG) following their regular training routines. None of the skiers of the CG were part of the IG and vice versa. The study was directly conducted within the real-world youth development structures of skiers competing at the under 16 years (U16) level in Switzerland. Seventy-one skiers (aged 14.4 ± 0.3 years) assigned to the IG were compared to 58 age- and gender-matched controls. The IG was offered the ISPAInt programme with the recommendation to perform it at least once per week. Skiers' adherence to this recommendation was surveyed but not enforced. Injuries were recorded using the Oslo Sports Trauma Research Centre Questionnaire. Primary outcomes were the absolute injury rates (number of injuries/100 athletes per season) and epidemiological incidence proportion (number of injured athletes/100 athletes per season). The secondary outcome was the average 2-weekly prevalence of traumatic knee, knee overuse, and lower back overuse injuries. There were lower absolute rates of all traumatic injuries [rate/risk difference, RD: -57.1 (-98.1, -16.0); rate/risk ratio, RR: 0.665 (0.485, 0.884)] and overuse injuries [RD: -35.9 (-71.0, -0.7); RR: 0.699 (0.493, 0.989)] in the IG than in the CG. Likewise, the epidemiological incidence proportion for all overuse injuries was smaller in the IG [RD: -28.4 (-44.8, -12.0); RR: 0.598 (0.435, 0.822)], while the proportion of skiers suffering from traumatic injuries did not significantly differ between the groups. Notably, the IG particularity differed from the CG in the average 2-weekly prevalence of knee trauma, knee overuse, and lower back overuse complaints, three of the major injury-related hot spots in youth skiers. Based on these promising results, the ISPAInt programme may have great potential to prevent injuries in youth competitive alpine skiers, and the underlying exercises should be considered complementary training content at the U16 level.

Swiss-Ski Power Test Results in Youth Competitive Alpine Skiers Are Associated With Biological Maturation and Skiing Performance.

PURPOSE: To explore reasonable application purposes and potential confounders of the Swiss-Ski Power Test (SSPT) that is, since 2004, annually performed by all youth competitive alpine skiers of the under-16-years age category in Switzerland. METHODS: Preseason SSPT results (8 individual tests on anaerobic and aerobic capacity, muscle strength, and speed and coordination) of 144 skiers (57 female and 87 male) age 14.5 (0.7) years were analyzed along with anthropometry and biological age. Skiing performance was quantified as the actual performance points according to the Swiss national ranking. After the SSPT tests, skiers were prospectively monitored over 12 months using the Oslo Trauma Research Center questionnaire. Data were analyzed using multivariate analysis of variance, Pearson correlations, and multiple linear/binary logistic regression models. RESULTS: Biological maturation and SSPT results differed between sexes and age (P < .05). For males, SSPT results in the subdisciplines Swiss Cross, 1-leg 5-hop, and standing long jump were correlated to maturity offset, while for females only the obstacle run was related. High box jump and Swiss Cross scores were associated with skiing performance (P < .05). However, none of the SSPT subdisciplines was related to traumatic and overuse injuries (P < .05). CONCLUSIONS: The SSPT is a broadly implementable and cost-effective field test providing a general fitness profile of youth skiers. Around the growth spurt, differences in biological maturation should be considered. While SSPT results showed association with skiing performance, the test in its current form is limited for identifying injury-relevant physical deficiencies. Consequently, more specific tests may be required.

Outcomes of Tibialis Anterior Tendon Reconstruction with Autograft or Allograft.

BACKGROUND: In cases of tibialis anterior tendon (TAT) ruptures associated with significant tendon defect, an interposition graft is often needed for reconstruction. Both auto- and allograft reconstructions have been described in the literature. Our hypothesis was that both graft types would have a good integrity and provide comparable outcomes. METHODS: Patients who underwent TAT reconstruction using either an auto- or allograft were identified. Patient-reported outcomes (PROs) were collected using the 12-Item Short Form Health Survey (SF-12) questionnaire, the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, the Foot Function Index (FFI), and the Karlsson-Peterson score. Functional outcome was assessed by isokinetic strength measurement. Outcomes were further assessed with magnetic resonance imaging (MRI) evaluation of graft integrity. All measurements were also performed for the contralateral foot. RESULTS: Twenty-one patients with an average follow-up of 82 months (20-262 months), comprising 12 allograft and 9 autograft TAT reconstructions, were recruited. There were no significant differences in patient-reported outcomes between allograft reconstructions and autografts: SF-12 (30.7 vs 31.1, P = .77); AOFAS (83 vs 91.2, P = .19); FFI (20.7% vs 9.5%, P = .22); and Karlsson-Peterson (78.9 vs 87.1, P = .23). All grafts (100%) were intact on MRI with a well-preserved integrity and no signs of new rupture. There were no major differences in range of motion and functional outcomes as measured by strength testing between the operative and nonoperative side. CONCLUSION: Reconstructions of TAT achieved good PROs, as well as functional and imaging results with a preserved graft integrity in all cases. There were no substantial differences between allograft and autograft reconstructions. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Long-term evolution of cartilage abnormalities and osteophytes in the fingers of elite sport climbers: A cross-sectional 10-year follow-up study.

The sequelae of high mechanical stress to the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of the fingers in elite sport climbers and its contribution to the development of osteoarthritis are still relatively unknown. The purpose of this study was to investigate the evolution of cartilage abnormalities of the PIP and DIP joints, as well as the progress of osteophytes, in the fingers of elite sport climbers with a minimum of 25 years of climbing history over the time period of the last 10 years. Moreover, their actual cartilage abnormalities and osteophyte occurrence were compared to non-climbing age-matched controls. Thirty-one elite male sport climbers and 15 male non-climbers underwent a sonographic examination of the PIP and DIP joint cartilage and osteophyte thickness in the frontal and sagittal plane of digits II-V of both hands. The same cohort had already been measured with an identical protocol 10 years earlier (follow-up rate of 100%). Compared to the baseline assessment 10 years earlier, the cartilage thickness of sport climbers has significantly decreased; however, it was still greater than in age-matched controls. Moreover, sport climbers showed significantly higher relative frequencies of osteophyte occurrence than non-climbers (all fingers and joints). Nevertheless, despite a substantial (and compared to baseline a further increased) occurrence of osteophytes in elite sport climbers, there was no association between the radiological signs of osteoarthritis and pain within the last six months prior the follow-up investigation.

COVID-19 Lockdown 2020 Changed Patterns of Alcohol and Cannabis Use in Swiss Elite Athletes and Bodybuilders: Results From an Online Survey.

Objectives: During the COVID-19 pandemic, increased patterns of substance use have been reported in the general population. However, whether this also applies to athletes is not yet clear. This study aimed to detect changes in alcohol consumption and cannabis use in elite athletes and bodybuilders during the first COVID-19 lockdown in Switzerland. Methods: Between April 25 and May 25, 2020, a cross-sectional online survey was conducted among bodybuilders and Swiss elite athletes who were active in Olympic sports and disciplines approved by the International Olympic Committee (IOC) on at least the national level. The collected data included information on alcohol and cannabis use during the last month (lockdown) and in the year before COVID-19 lockdown (pre-lockdown), daily training times, existential fears on a scale from 1 to 100, Patient Health Questionnaire-9 for depression (PHQ-9), Insomnia Severity Index (ISI), and State-Trait Anxiety Inventory (STAI). Results: N = 275 athletes (elite athletes: n = 193; bodybuilders: n = 82) was included in this study. Both pre-lockdown and during lockdown, more bodybuilders used cannabis (both time points: p < 0.001) than elite athletes, and more elite athletes drank alcohol (pre-lockdown: p = 0.005, lockdown: p = 0.002) compared to bodybuilders. During lockdown, fewer athletes drank alcohol compared to before, but those who continued drinking did so on more days per week (p < 0.001, Eta2 = 0.13). Elite athletes were more likely to increase their drinking with 17.7 vs. 8.2% in bodybuilders. When compared to pre-lockdown measures, the number of athletes using cannabis did not change during lockdown. Only three of 203 elite athletes reported using cannabis during lockdown; this contrasts with 16 of 85 bodybuilders. In a multivariate regression model, existential fears and a lower ISI score were significant predictors for increased alcohol consumption during the lockdown in the entire sample. In a model based on elite athletes only, male sex and a lower ISI score predicted increased alcohol consumption. In a bodybuilder-based model, predictors of increased alcohol consumption were existential fears and trait anxiety. Conclusion: We suggest identifying athletes who are at risk for increased alcohol and cannabis use; we suggest this to be able to professionally support them during stressful times, such as the COVID-19 pandemic.

Prevalence and Risk Factors of Psychiatric Symptoms among Swiss Elite Athletes during the First Lockdown of the COVID-19 Pandemic.

The COVID-19 pandemic and the associated first lockdown measures may have had a relevant impact on the mental health of competitive athletes. This study aimed to evaluate the prevalence of various mental health issues in a Swiss elite athletes' cohort during the first lockdown of the pandemic, and to assess their association with different potential risk factors. Elite athletes from different disciplines were interviewed during the first lockdown in spring 2020 by means of an online questionnaire on symptoms of existing anxieties, depression and sleep disorders, as well as on training circumstances and physical performance before and during the lockdown. Additionally, the economic situation, secondary occupations and current physical health problems were surveyed. A total of 203 (92 female, 111 male) athletes met the inclusion criteria and participated in the survey. Training volume and intensity decreased significantly during lockdown from 3.1 to 2.7 h/day. Financial existential fears increased and were associated with higher training volumes and higher trait anxiety scores. Depressive symptoms and insomnia were present but not exceptionally frequent during the lockdown. Depressive symptoms were associated with higher anxiety scores, higher insomnia severity scores, lower training intensity and worse coping with the measures taken by the authorities against the pandemic. Changes in training and daily habits due to the first lockdown may have affected the mental health of elite athletes. Longitudinal studies should, however, further investigate the long-term effects of the pandemic on mental health.