Alterations in knee sensorimotor brain functional connectivity contributes to ACL injury in male high-school football players: a prospective neuroimaging analysis.

OBJECTIVE: This study's purpose was to utilize a prospective dataset to examine differences in functional brain connectivity in male high school athletes who suffered an anterior cruciate ligament (ACL) injury relative to their non-injured peers. METHODS: Sixty-two male high school football players were evaluated using functional magnetic resonance imaging prior to their competitive season to evaluate resting-state functional brain connectivity. Three athletes later experienced an ACL injury and were matched to 12 teammates who did not go on to sustain an ACL injury (controls) based on school, age, height, weight, and year in school. Twenty-five knee-motor regions of interest (ROIs) were created to identify differences in connectivity between the two groups. Between-subject F and t tests were used to identify significant ROI differences using a false discovery rate correction for multiple comparisons. RESULTS: There was significantly less connectivity between the left secondary somatosensory cortex and the left supplementary motor area (p = 0.025), right pre-motor cortex (p = 0.026), right supplementary motor area (p = 0.026), left primary somatosensory cortex (superior division; p = 0.026), left primary somatosensory cortex (inferior division; p = 0.026), and left primary motor cortex (p = 0.048) for the ACL-injured compared to the control subjects. No other ROI-to-ROI comparisons were significantly different between the groups (all p > 0.05). CONCLUSION: Our preliminary data indicate a potential sensorimotor disruption for male football players who go on to experience an ACL injury. Future studies with larger sample sizes and complementary measures of neuromuscular control are needed to support these findings.

Incidence of injury among male Brazilian jiujitsu fighters at the World Jiu-Jitsu No-Gi Championship 2009.

CONTEXT: Brazilian jiujitsu is a modern combat martial art that uses joint locks to submit an opponent and achieve victory. This form of martial art is a relatively young but rapidly growing combat sport worldwide. OBJECTIVE: To determine the cumulative injury incidence and risk of injury by belt rank and body region at an international-level Brazilian jiujitsu tournament. DESIGN: Descriptive epidemiology study. SETTING: World Jiu-Jitsu No-Gi Championship 2009 in Long Beach, California. PATIENTS OR OTHER PARTICIPANTS: We monitored 951 athletes (age range, 18-50 years) enrolled to compete in the World Jiu-Jitsu No-Gi Championship 2009. INTERVENTION(S): Fighters were categorized by belt level for group comparisons (belt experience). Incidence rates per 1000 athlete-exposures (AEs) and incidence rate ratios were compared by belt rank. MAIN OUTCOME MEASURE(S): Incidence rates and incidence rate ratios. RESULTS: During the tournament, 1606 AEs and 62 total injuries were reported. Of these injuries, 40 affected the joints, for an overall incidence rate of 24.9 per 1000 AEs. The joint incidence rate by belt rank was 21.5 per 1000 AEs for blue, 21.3 per 1000 AEs for purple, 25.2 per 1000 AEs for brown, and 35.1 per 1000 AEs for black. We found no differences for incidence rate ratios of joint injury among individual belt groups (P > .05). More experienced (brown belt and black belt) competitors had a higher injury risk than the less experienced (blue belt and purple belt) competitors; however, the difference was not significant (incidence rate ratio = 1.65, 95% confidence interval = 0.9, 2.9; P = .06). The incidence of joint injury was highest at the knee (7.5 per 1000 AEs) and elbow (7.5 per 1000 AEs). CONCLUSIONS: The data from this international Brazilian jiujitsu tournament indicated that the risk of joint injury was similar among belt ranks or experience during this Brazilian jiujitsu competition. The knee and elbow were the joints most susceptible to injury. Future investigation of injury mechanism is warranted to develop strategies to reduce potential risk factors attributed to injury.

Juvenile idiopathic arthritis and athletic participation: are we adequately preparing for sports integration?

Children with juvenile idiopathic arthritis (JIA) now have well-controlled disease due to improved therapies and management strategies. Children with JIA are more active than in the past and often participate in dynamic, high-loading sports. Standard measures of disease control include examination findings, laboratory values, and patient-directed surveys. However, these standards do not address the subtle deficits in biomechanics and neuromuscular control, which could place affected joints at higher risk for injury. Currently, there are limited evidence-based guidelines to structure conditioning recommendations as to the fitness and mechanics needed to provide safe integration into sports in this population; therefore, tools that objectively measure function with high accuracy and precision may be warranted. Previous work using 3-dimensional motion analysis demonstrated usefulness in guiding physical therapy treatment to correct these deficits. The use of a multidisciplinary team, including physical therapy, rheumatology, and sports medicine, is crucial for preparing these children to return to play. We suggest that the child transition into a sport preparatory-conditioning program to address any underlying deficits. A pediatric exercise specialist who is sensitive to the needs of this population can work with a physical therapist to then appropriately integrate the child safely into sport. Encouraging an active lifestyle is vital to the management of JIA and does not worsen the symptoms associated with childhood arthritis.