Video Analysis of Anterior Cruciate Ligament Injuries in Male Professional Basketball Players: Injury Mechanisms, Situational Patterns, and Biomechanics.

Background: Improving our understanding of the situations and biomechanics that result in an anterior cruciate ligament (ACL) injury in basketball players may support the design of more effective programs to mitigate the risk of injury. Purpose: To (1) describe the mechanisms, situational patterns, and gross biomechanics (kinematics) of ACL injuries in professional basketball matches using video analysis and (2) document the distribution of ACL injuries according to player position, phase of the match, and location on the court. Study Design: Case series; Level of evidence, 4. Methods: A total of 38 ACL injuries in professional male European basketball leagues from the 2013-2014 to 2019-2020 seasons were identified. There were 36 (95%) injury videos analyzed for injury mechanisms and situational patterns, while biomechanical analysis was possible in 32 cases. Overall, 3 independent reviewers evaluated each video. Data according to player position (n = 38), phase of the match (n = 38), and location on the court (n = 36) were evaluated. Results: More injuries occurred while attacking (n = 25 [69%]) than defending (n = 11 [31%]). There was 1 (3%) direct contact injury, 21 (58%) indirect contact injuries, and 14 (39%) noncontact injuries. Most injuries (83%) occurred during 3 main situations: offensive cut (n = 17 [47%]), landing from a jump (n = 8 [22%]), and defensive cut (n = 5 [14%]). Injuries generally involved knee flexion (with minimal hip/trunk flexion and reduced plantarflexion) in the sagittal plane and knee valgus loading in most cases (75%). A similar number of injuries occurred during the first (53%) and second (47%) halves of the match, with a higher prevalence in the second (37%) and fourth (34%) quarters. Half of the injuries occurred during the first 10 minutes of effective playing time. More injuries occurred in guards (58%), and 73% of all injuries occurred in the scoring zone. Conclusion: Indirect contact was the main injury mechanism found in male professional basketball players. The offensive cut was the most common situational pattern. Biomechanical analysis confirmed a multiplanar mechanism, with knee loading in the sagittal plane accompanied by dynamic valgus. More injuries occurred in the first 10 minutes of a player's effective playing time, within the scoring zone, and among guards.

Groin Pain Syndrome Italian Consensus Conference update 2023.

Groin pain syndrome (GPS) is a controversial topic in Sports Medicine. The GPS Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athletes was organized by the Italian Society of Arthroscopy in Milan, on 5 February 2016. In this Consensus Conference (CC) GPS etiology was divided into 11 different categories for a total of 63 pathologies. The GPS Italian Consensus Conference update 2023 is an update of the 2016 CC. The CC was based on a sequential, two-round online Delphi survey, followed by a final CC in the presence of all panelists. The panel was composed of 55 experts from different scientific and clinical backgrounds. Each expert discussed 6 different documents, one of which regarded the clinical and imaging definition of sports hernias, and the other 5 dealt with 5 new clinical situations thought to result in GPS. The panelists came to an agreement on the definition of a sports hernia. Furthermore, an agreement was reached, recognizing 4 of the 5 possible proposed pathologies as causes to GPS. On the contrary, the sixth pathology discussed did not find consensus given the insufficient evidence in the available scientific literature. The final document includes a new clinical and imaging definition of sports hernia. Furthermore, the etiology of GPS was updated compared to the previous CC of 2016. The new taxonomic classification includes 12 categories (versus 11 in the previous CC) and 67 pathologies (versus 63 in the previous CC).

Managing Lower Limb Muscle Reinjuries in Athletes: From Risk Factors to Return-to-Play Strategies.

Muscle injuries and subsequent reinjuries significantly impact athletes, especially in football. These injuries lead to time loss, performance impairment, and long-term health concerns. This review aims to provide a comprehensive overview of the current understanding of muscle reinjuries, delving into their epidemiology, risk factors, clinical management, and prevention strategies. Despite advancements in rehabilitation programs and return-to-play criteria, reinjury rates remain alarmingly high. Age and previous muscle injuries are nonmodifiable risk factors contributing to a high reinjury rate. Clinical management, which involves accurate diagnosis, individualized rehabilitation plans, and the establishment of return-to-training and return-to-play criteria, plays a pivotal role during the sports season. Eccentric exercises, optimal loading, and training load monitoring are key elements in preventing reinjuries. The potential of artificial intelligence (AI) in predicting and preventing reinjuries offers a promising avenue, emphasizing the need for a multidisciplinary approach to managing these injuries. While current strategies offer some mitigation, there is a pressing need for innovative solutions, possibly leveraging AI, to reduce the incidence of muscle reinjuries in football players. Future research should focus on this direction, aiming to enhance athletes' well-being and performance.

Injury mechanisms and situational patterns of severe lower limb muscle injuries in male professional football (soccer) players: a systematic video analysis study on 103 cases.

OBJECTIVE: The objective of this study is to describe the mechanism of injury and situational patterns (based on ball possession and playing action leading to injury) of severe (lay-off time >28 days) lower limb muscle injuries in professional male football (soccer) players during match play. METHODS: Players experiencing a severe muscle injury of the lower limb during Italian first (Serie A) division male football matches over three consecutive seasons (2018-2021) were identified. Video footage was obtained and three raters independently categorised injury mechanism and situational patterns using a standardised checklist. Injury epidemiology (month), timing of injuries within the match and location of injuries on the pitch were also examined. RESULTS: We identified 121 lower limb severe muscle injuries. Videos of sufficient quality were available for 103 (85%) cases, including 61 (60%) hamstring, 17 (16%) calf, 16 (15%) adductor and 9 (9%) quadricep muscle injuries. Nearly two-thirds of injuries involved the dominant/kicking leg (n=65, 63%). Eighty-five (83%) injuries were non-contact and 18 (17%) indirect contact. Four main situational patterns were identified and accounted for 88% of injuries: (1) running/acceleration (n=35, 34%); (2) closed kinetic chain stretching (n=21, 20%); (3) open kinetic chain stretching (n=19, 18%) and (4) kicking (n=16, 16%), with differences between muscle groups. 71% of injuries occurred in the first half of the match (p<0.01), with a gradual increase through the first half. CONCLUSION: Most severe muscle injuries during football matches were non-contact and occurred in the first half during running/acceleration, open and closed kinetic chain stretching, or kicking.

Are Football Players More Prone to Muscle Injury after COVID-19 Infection? The "Italian Injury Study" during the Serie a Championship.

INTRODUCTION: Football was the first sport to resume competitions after the coronavirus disease 2019 (COVID-19) lockdown and promptly the hypothesis was raised of a potential relationship between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and musculoskeletal injuries in athletes. This study aimed to confirm the association between SARS-CoV-2 infection and muscle strain injury in a large population of elite football players and to investigate if the COVID-19 severity level could affect the risk of injury. METHODS: A retrospective cohort study involving 15 Italian professional male football teams was performed during the Italian Serie A 2020-2021 season. Injuries and SARS-CoV-2 positivity data were collected by team doctors through an online database. RESULTS: Of the 433 included players, we observed 173 SARS-CoV-2 infections and 332 indirect muscle strains. COVID-19 episodes mostly belonged to severity level I and II. The injury risk significantly increased after a COVID-19 event, by 36% (HR = 1.36, CI95% 1.05; 1.77, p-value = 0.02). The injury burden demonstrated an 86% increase (ratio = 1.86, CI95% 1.21; 2.86, p-value = 0.005) in the COVID-19 severity level II/III versus players without a previous SARS-CoV-2 infection, while level I (asymptomatic) patients showed a similar average burden (ratio = 0.92, CI95% 0.54; 1.58, p-value = 0.77). A significantly higher proportion of muscle-tendon junction injuries (40.6% vs. 27.1%, difference = 13.5%, CI95% 0.002%; 26.9%, p-value = 0.047) was found when comparing level II/III versus Non-COVID-19. CONCLUSIONS: This study confirms the correlation between SARS-CoV-2 infection and indirect muscle injuries and highlights how the severity of the infection would represent an additional risk factor.

Maturation Selection Biases and Relative Age Effect in Italian Soccer Players of Different Levels.

Soccer is a sport practiced all over the world, in which players are expected to show specific physical and technical skills. Soccer academies look for young talented individuals to develop promising players. Although several parameters could affect the players' performance, the relative age effect (RAE) and the maturity status appeared debated. Therefore, this study compared the differences in RAE and biological maturity among the players of two Italian soccer teams of different levels and to understand their interaction effects with the competition level on youth players' physical characteristics and abilities. One hundred and sixty-two young soccer players from the U12 to U15 age categories of the elite (n = 98) and non-elite (n = 64) teams were recruited. The prevalence of maturity status and RAE was observed. Many anthropometric parameters, BIA vectors, and motor tests (CMJ, Sprint, RSA) were carried out. The maturity status had a greater effect on several anthropometric characteristics and on 15 m sprint, while it affected the CMJ only in U12 (F = 6.187, p ≤ 0.01). Differently, the RAE seemed to priorly affect the U13 and U15 categories in body composition, whereas its effect appeared on the 15-m sprint (F(3, 45) = 4.147, p ≤ 0.01) and the RSA (F(3, 45) = 3.179, p ≤ 0.05) in the U14 category. In addition, early matured players or those who were born in the first six months presented cellular characteristics similar to adult elite players. Soccer professionals should be encouraged to monitor the maturity status to better interpret changes in the physical performance of young soccer players to guide adequate training plans.

Assessment of Body Composition and Physical Performance of Young Soccer Players: Differences According to the Competitive Level.

Soccer is a multifactorial sport, in which players are expected to possess well developed physical, psychological, technical, and tactical skills. Thus, the anthropometric and fitness measures play a determinant role and could vary according to the competitive level. Therefore, the present study aimed to verify differences in body composition and physical performance between two soccer team. 162 young soccer players (from the Under 12 to Under 15 age categories; age: 13.01 ± 1.15 years) of different competitive levels (elite­n = 98 and non-elite­n = 64) were recruited. Anthropometric characteristics (height, weight, lengths, widths, circumferences, and skinfold thicknesses (SK)), bioelectrical impedance, physical performance test as countermovement jump (CMJ), 15 m straight-line sprints, Yo-Yo Intermittent Recovery Test Level 1 (Yo-Yo), and 20 + 20 m repeated-sprint ability (RSA)) were carried out. In addition, Body mass index (BMI), body composition parameters (percentage of fat mass (%F), Fat mass (FM, kg), and Fat-free mass (FFM, kg)) and the areas of the upper arm, calf and thigh were calculated, and the Bioelectric Impedance Vector Analysis (BIVA) procedures were applied. In addition, a linear discriminant analysis was assessed to determine which factors better discriminate between an elite and non-elite football team. Many differences were observed in body composition between and within each football team's category, especially in triceps SK (p < 0.05), %F (p < 0.05), and all performance tests (p < 0.01). The canonical correlation was 0.717 (F(7,128) = 19.37, p < 0.0001), and the coefficients that better discriminated between two teams were 15 m sprint (−2.39), RSA (1−26), suprailiac SK (−0.5) and CMJ (−0.45). Elite soccer team players present a better body composition and greater physical efficiency. In addition, BIVA outcome could be a relevant selection criterion to scout among younger soccer players.

Systematic Video Analysis of Anterior Cruciate Ligament Injuries in Professional Male Rugby Players: Pattern, Injury Mechanism, and Biomechanics in 57 Consecutive Cases.

BACKGROUND: Anterior cruciate ligament (ACL) injuries represent a significant burden to rugby players. Improving our understanding of the patterns and biomechanics that result in ACL injury may aid in the design of effective prevention programs. PURPOSE: To describe, using video analysis, the mechanisms, situational patterns, and biomechanics of ACL injuries in professional rugby matches. Further aims were to document injuries according to pitch location and timing within the match. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 62 ACL injuries were identified in players of the 4 most important rugby leagues across 4 consecutive seasons. We analyzed 57 (92%) injury videos for injury mechanism and situational patterns; biomechanical analysis was performed on indirect and noncontact ACL injuries only (38 cases available). Three reviewers independently evaluated each video. RESULTS: More injuries occurred while attacking than defending (41 [72%] vs 16 [28%]; P < .01). Regarding mechanism, 18 (32%) injuries were direct contact; 15 (26%), indirect contact; and 24 (42%), noncontact. Most direct contact injuries involved being tackled directly to the knee (n = 10). Three situational patterns were identified for players who had a noncontact or indirect contact injury: offensive change of direction (COD) (n = 18), being tackled (n = 10), and pressing/tackling (n = 8). Injuries generally involved a knee-loading strategy in the sagittal plane, which was accompanied by knee valgus loading in most cases (94%). Overall, 73% of injuries occurred during the first 40 minutes of effective playing time. CONCLUSION: Most ACL injuries in professional male rugby players happened through a noncontact or indirect contact mechanism (68%). Three situational patterns were described, including offensive change of direction, being tackled, and pressing/tackling. Biomechanical analysis confirmed a multiplanar mechanism, with a knee-loading pattern in the sagittal plane accompanied by dynamic valgus. As most injuries occurred in the first 40 minutes, accumulated fatigue appears not to be a major risk factor for ACL injury.

Recommendations for Hamstring Function Recovery After ACL Reconstruction.

It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). This requires in part more high-quality original research, but also an approach to translate existing research into practice to overcome the research to implementation barriers. This includes research on ACLR athletes, but also research on other pathologies, which with some modification can be valuable to the ACLR patient. One important consideration after ACLR is the recovery of hamstring muscle function, particularly when using ipsilateral hamstring autograft. Deficits in knee flexor function after ACLR are associated with increased risk of knee osteoarthritis, altered gait and sport-type movement quality, and elevated risk of re-injury upon return to sport. After ACLR and the early post-operative period, there are often considerable deficits in hamstring function which need to be overcome as part of the functional recovery process. To achieve this requires consideration of many factors including the types of strength to recover (e.g., maximal and explosive, multiplanar not just uniplanar), specific programming principles (e.g., periodised resistance programme) and exercise selection. There is a need to know how to train the hamstrings, but also apply this to the ACLR athlete. In this paper, the authors discuss the deficits in hamstring function after ACLR, the considerations on how to restore these deficits and align this information to the ACLR functional recovery process, providing recommendation on how to recover hamstring function after ACLR.

Italian consensus statement (2020) on return to play after lower limb muscle injury in football (soccer).

Return to play (RTP) decisions in football are currently based on expert opinion. No consensus guideline has been published to demonstrate an evidence-based decision-making process in football (soccer). Our aim was to provide a framework for evidence-based decision-making in RTP following lower limb muscle injuries sustained in football. A 1-day consensus meeting was held in Milan, on 31 August 2018, involving 66 national and international experts from various academic backgrounds. A narrative review of the current evidence for RTP decision-making in football was provided to delegates. Assembled experts came to a consensus on the best practice for managing RTP following lower limb muscle injuries via the Delphi process. Consensus was reached on (1) the definitions of 'return to training' and 'return to play' in football. We agreed on 'return to training' and RTP in football, the appropriate use of clinical and imaging assessments, and laboratory and field tests for return to training following lower limb muscle injury, and identified objective criteria for RTP based on global positioning system technology. Level of evidence IV, grade of recommendation D.

Muscle Injuries: A Brief Guide to Classification and Management.

Muscle injuries are frequent in athletes. Despite their high incidence, advances in clinical diagnostic criteria and imaging, their optimal management and rehabilitation strategies are still debated in literature. Furthermore, reinjury rate is high after a muscle lesion, and an improper treatment or an early return to sports can increase the rate of reinjury and complications. Most muscle injuries are managed conservatively with excellent results, and surgery is normally advocated only for larger tears. This article reviews the current literature to provide physicians and rehabilitation specialists with the necessary basic tools to diagnose, classify and to treat muscle injuries. Based on anatomy, biomechanics, and imaging features of muscle injury, the use of a recently reported new classification system is also advocated.

Arthroscopic meniscus allograft transplantation in male professional soccer players: a 36-month follow-up study.

BACKGROUND: Meniscus allograft transplantation (MAT) is an option for symptomatic patients who have undergone subtotal meniscectomy and can potentially result in pain relief and increased function. HYPOTHESIS: Professional soccer players would benefit from arthroscopic MAT in terms of pain, knee function, and return to play at 36-month follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twelve male patients who had undergone MAT (6 medial, 6 lateral) were prospectively evaluated at 12- and 36-month follow-up. The mean age at the time of surgery was 24.5 ± 3.6 years (range, 19-29 years), and the mean time from meniscectomy to surgery was 37 ± 31 months (range, 2-82 months). The transplantation was performed in patients who had undergone subtotal meniscectomy using an arthroscopic bone plug-free technique with a single tibial tunnel plus "all-inside" meniscus sutures. The anterior horn of the transplanted meniscus was sutured to the capsule and to the remnant of the anterior horn of the native meniscus. Seven patients (58%) underwent concurrent procedures. All patients were evaluated at follow-up by the Tegner, Lysholm, International Knee Documentation Committee (IKDC) subjective, IKDC objective, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and visual analog scale (VAS) for pain scores. Information regarding rehabilitation, return to play, and return to official competition was recorded. RESULTS: Eleven of the 12 patients (92%) returned to play soccer. At 36-month follow-up, 9 patients (75%) were still playing as professionals (Tegner score of 10), whereas 2 patients (17%) were playing as semiprofessionals (Tegner score of 9). The mean time from surgery to the end of rehabilitation was 7.5 ± 2 months, whereas the mean time to official competition was 10.5 ± 2.6 months. Patients demonstrated significant improvements on the median Tegner score from 8 (interquartile range, 3-10) to 10 (interquartile range, 9-10) (P = .0391); the mean Lysholm score from 67 ± 14 to 92 ± 10 (P = .0021); the mean IKDC subjective score from 61.8 ± 16.3 to 85.3 ± 9.8 (P = .0026); the mean IKDC objective score from 1 A, 8 B, 1 C, and 2 D to 7 A and 5 B (P = .0077); the mean WOMAC score from 77.1 ± 15.9 to 92.2 ± 9.1 (P = .0242); and the mean VAS score from 61 ± 16 to 29 ± 32 (P = .0029) at 12-month follow-up. There were no significant improvements in these outcomes at 36-month follow-up. One patient developed a knee infection after MAT plus anterior cruciate ligament allograft reconstruction. This complication was successfully treated, but the patient stopped playing soccer (Tegner score of 3 at 36-month follow-up), and this was considered a failure (8%). CONCLUSION: Arthroscopic MAT in professional soccer players allowed a return to play at the same level (Tegner score of 10) in 75% of the cases at 36-month follow-up.

ISMuLT Guidelines for muscle injuries.

Muscle injuries are frequent in high demand sports. No guidelines are available in the scientific literature. ISMuLT, the "Italian Society of Muscles, Ligaments and Tendons", in line with its multidisciplinary mission, is proud to cover this gap.

Clinical Outcomes and Return-to-Sports Participation of 50 Soccer Players After Anterior Cruciate Ligament Reconstruction Through a Sport-Specific Rehabilitation Protocol.

BACKGROUND: Rehabilitation of soccer players after anterior cruciate ligament reconstruction is usually performed without sport-specific guidelines, and the final phases are often left to the team coaches. The possibility of changing this approach has not yet been investigated. STUDY DESIGN: Case series. HYPOTHESIS: A specific rehabilitation protocol for soccer players, with direct control of the last on-field rehabilitation phases, may lead to complete functional recovery. METHODS: Fifty competitive soccer players who followed a sport-specific rehabilitation protocol for soccer were evaluated during the recovery period until their return to competition. The assessment of the functional outcomes was performed using the Knee Outcome Survey-Sports Activity Scale and isokinetic and aerobic fitness tests. RESULTS: The average start of on-field rehabilitation was 90 ± 26 days after surgery; the average time to return to the competitions was 185 ± 52 days. The improvement in the Knee Outcome Survey-Sports Activity Scale during on-field rehabilitation was significant (P < 0.01; from 79 ± 15% to 96 ± 7%). The isokinetic and aerobic fitness tests showed a significant improvement of muscle strength (knee extensors, +55%, P < 0.01; knee flexors, +86%, P < 0.01) and aerobic threshold (+23%, P < 0.01) from the beginning to the end of on-field rehabilitation. CONCLUSIONS: Adding on-field rehabilitation to the traditional protocols after anterior cruciate ligament reconstruction may safely lead to complete functional recovery in soccer players.

Return to official Italian First Division soccer games within 90 days after anterior cruciate ligament reconstruction: a case report.

STUDY DESIGN: Case report. BACKGROUND: To present the rehabilitative course, decision-making, and clinical milestones that allowed a top-level professional soccer player to return to full competitive activity 90 days after surgery. CASE DESCRIPTION: The patient was a 35-year-old forward player who sustained an isolated complete tear of the left anterior cruciate ligament (ACL) in the midst of the competitive 2001-2002 season. He was in contention for a position on the Italian World Cup Team that was to be played 135 days after his injury, only if he demonstrated that he could return to play at the highest level before the team was selected. The patient underwent an arthroscopically assisted ACL reconstruction with a double-loop semitendinosus-gracilis autograft 4 days after the injury. Eight days after surgery he began rehabilitation at a rate of 2 sessions a day, 5 days a week, plus 1 session every Saturday morning. These sessions were performed in a pool for aquatic exercises, in a gymnasium for flexibility, coordination, and strength exercises, and on a soccer field for recovery of technical and tactical skills, with continuous monitoring of training intensity. OUTCOMES: The surgical technique and the progressive rehabilitation program allowed the patient to play for 20 minutes in an official First Division soccer game 77 days after surgery and to play a full game 90 days after surgery. Eighteen months postsurgery, the player had participated in 62 First Division matches, scoring 26 times, and had received no further treatment for his knee. DISCUSSION: This case report suggests that early return to high-level competition after ACL reconstruction is possible in some instances. Some factors that may have favored the early return include optimal physical fitness before surgery, a strong psychological determination, an isolated ACL lesion, a properly placed and tensioned graft, a personalized progression of volume and intensity of exercise loads, and an appropriate density of rehabilitative training consisting of a mix of gymnasium, pool, and field exercises.

Epidemiología de las lesiones del ligamento cruzado anterior en el futbolista profesional / Epidemiology of anterior cruciate ligament injuries in professional football players

La rotura del ligamento cruzado anterior (LCA) es una importante lesión ya que necesita de tratamiento quirúrgico y aleja al futbolista del campo por un periodo mínimo de 3-4 meses. Presentamos dos casuísticas realizadas sobre jugadores de fútbol en el ámbito profesional, con la intención de contribuir a clarificar algunos aspectos de la epidemiología de las lesiones del LCA en el futbolista. En la primera casuística, los ocho equipos de fútbol europeos tenían un total de 504 jugadores durante el periodo estudiado. En las cinco temporadas (1995-96 al 1999-2000) cada equipo ha tenido como media 69ñ7 jugadores diferentes. Los datos confirman que la mayor parte de las lesiones de la rodilla en el jugador de fútbol corresponden a lesiones del LCA y del ligamento lateral interno (LLI).La incidencia media del fútbol profesional masculino es de 6 lesiones del LCA por cada 100 jugadores en un periodo de cinco años. Las lesiones del LCA se producen prevalentemente por trauma indirecto (67 por ciento). La distribución de las lesiones parece ser independiente de la función en el campo, aunque exista una mener incidencia en los guardametas (2 por ciento). Los jugadores lesionados siguen un tratamiento quirúrgico que actualmente presenta preferencia por la reparación con tendón rotuliano autólogo (56 por ciento) con respecto al semitendinoso y grácil autólogo (44 por ciento). Existe una tendencia al aumento de las intervenciones quirúrgicas de reconstrucción con semitendinoso y grácil efectuado en las últimas dos temporadas en el 53 por ciento de los casos. Esta tendencia es clara en los equipos italianos, mientras en los otros equipos los casos estudiados son demasiado pocos como para definirlo como una tendencia. Los jugadores operados regresan al campo de juego como media después de 6,1 ñ 2,2 meses, con un rango de tiempo bastante amplio (3-14 meses) que depende probablemente de la presencia de lesiones asociadas o de la aparición complicaciones (AU)