Collegiate rugby union injury patterns in New England: a prospective cohort study.

OBJECTIVE: To establish injury profile of collegiate rugby union in the USA. DESIGN/ SETTING: 31 men's and 38 women's collegiate rugby union teams prospectively recorded injuries during games and practice during the 2005-06 season. Three teams withdrew before data collection. An injury was defined as one: (1) occurring in an organised intercollegiate game or practice; and (2) requiring medical attention during or after the game or practice, or (3) resulting in any restriction of the athletes' participation for >or=1 day(s) beyond the day of injury, or in a dental injury. MAIN OUTCOME MEASURES: In total, 847 injuries (447 in men; 400 in women) during 48,026 practice (24,280 in men; 23,746 in women) and 25,808 game (13,943 in men; 11,865 in women) exposures were recorded. RESULTS: During games, injury rates of 22.5 (95% CI 20.2 to 25.0) and 22.7 (20.2 to 25.5) per 1000 game athletic exposures or 16.9 (15.1 to 18.9) and 17.1 (15.1 to 19.1) per 1000 player game hours were recorded for men and women, respectively. Over half of all match injuries were of major severity (>7 days' absence) (men 56%; women 51%) and the tackle was the game event most often associated with injury (men 48%; women 53%). CONCLUSIONS: Collegiate game injury rates for rugby were lower than rates recorded previously in men's professional club and international rugby and lower than reported by the National Collegiate Athletic Association Injury Surveillance System for American football, but similar to rates reported for men's and women's soccer in 2005-06.

Injuries in martial arts: a comparison of five styles.

OBJECTIVE: To compare five martial arts with respect to injury outcomes. METHODS: A one year retrospective cohort was studied using an injury survey. Data on 263 martial arts participants (Shotokan karate, n = 114; aikido, n = 47; tae kwon do, n = 49; kung fu, n = 39; tai chi, n = 14) were analysed. Predictor variables included age, sex, training frequency (3 h/week), experience (<3 years v >or=3 years), and martial art style. Outcome measures were injuries requiring time off from training, major injuries (>or=7 days off), multiple injuries (>or=3), body region, and type of injury. Logistic regression was used to determine odds ratios (OR) and confidence intervals (CI). Fisher's exact test was used for comparisons between styles, with a Bonferroni correction for multiple comparisons. RESULTS: The rate of injuries, expressed as percentage of participants sustaining an injury that required time off training a year, varied according to style: 59% tae kwon do, 51% aikido, 38% kung fu, 30% karate, and 14% tai chi. There was a threefold increased risk of injury and multiple injury in tae kwon do than karate (p<0.001). Subjects >or=18 years of age were at greater risk of injury than younger ones (p<0.05; OR 3.95; CI 1.48 to 9.52). Martial artists with at least three years experience were twice as likely to sustain injury than less experienced students (p<0.005; OR 2.46; CI 1.51 to 4.02). Training >3 h/week was also a significant predictor of injury (p<0.05; OR 1.85; CI 1.13 to 3.05). Compared with karate, the risks of head/neck injury, upper extremity injury, and soft tissue injury were all higher in aikido (p<0.005), and the risks of head/neck, groin, and upper and lower extremity injuries were higher in tae kwon do (p<0.001). No sex differences were found for any of the outcomes studied. CONCLUSIONS: There is a higher rate of injury in tae kwon do than Shotokan karate. Different martial arts have significantly different types and distribution of injuries. Martial arts appear to be safe for young athletes, particularly those at beginner or intermediate levels.

Autologous chondrocyte implantation of the knee: multicenter experience and minimum 3-year follow-up.

OBJECTIVE: To determine clinical outcome and graft survivorship in patients undergoing autologous chondrocyte implantation (ACI) for the repair of chondral defects of the knee. DESIGN: Prospective cohort study. SETTING: 19 centers in the United States. PATIENTS: 50 patients (37 males, 13 females). Mean age was 36 years (range: 19-53). Defects were grade III or IV with a mean size of 4.2 cm 2. All patients had a minimum of 36 months postoperative follow-up. MAIN OUTCOME MEASUREMENTS: Clinician and patient evaluation based on the modified Cincinnati Knee Rating System. Graft failure was defined as replacement or removal of the graft due to mechanical symptoms or pain. RESULTS: Clinician and patient evaluation indicated median improvements of 4 and 5 points, respectively, at 36 months following ACI (p < 0.001). Previous treatment with marrow stimulation techniques and size of defect did not impact the results with ACI. The most common adverse events reported were adhesions and arthrofibrosis and hypertrophic changes. Three patients had graft failure and required reimplantation or treatment with alternative cartilage repair techniques. Kaplan-Meier estimated freedom from graft failure was 94% at 36 months postoperatively (95% CI = 88-100%). CONCLUSIONS: These results of this study indicate excellent graft survivorship using ACI as well as substantial improvement in functional outcome.

Common athletic injuries in adolescent girls.

Teenaged girls constitute the fastest growing segment of children and adolescents participating in organized athletics. Adolescent girls appear to have similar injury rates as boys in comparable activities but different injury patterns. To properly diagnose and manage athletic injuries in adolescent girls, pediatric health care providers must be aware of these differences, especially as the literature and their knowledge base may be skewed to the traditional predominance of males in sport. This review identifies athletic injuries that are unique to or especially common in adolescent girls, including apophyseal injuries; breast and pelvic injuries; scoliosis and spondylolysis; multidirectional shoulder instability and "gymnast's wrist"; anterior cruciate ligament injuries and patellofemoral pain syndrome; chronic exertional lower-leg compartment syndrome, ankle sprains, and reflex sympathetic dystrophy; and stress fractures. It also briefly discusses possible risk factors for these injuries, emphasizing the female athlete triad.

Elbow arthroscopy in the pediatric and adolescent population.

PURPOSE: The purpose of this study was to show the diagnostic and therapeutic benefits of elbow arthroscopy in athletically active pediatric patients. We describe our techniques for elbow arthroscopy in young patients. TYPE OF STUDY: Case series of 47 patients. METHODS: We reviewed 49 cases of elbow arthroscopies performed in 47 pediatric and adolescent patients retrospectively over a 16-year period. Charts were reviewed to identify the age of patients at the time of surgery, side involved, hand dominance, diagnosis, complications, the primary sport involved, and the average volume of loose bodies if surgical removal was performed. Each patient was contacted after a minimum of 2 years after surgery and a modified Andrews elbow scoring system was used to rate elbow function. RESULTS: The average age of this group was 14.0 years (range, 3.5 to 17.0 years) with an average follow-up of 4.7 years. Elbow arthroscopy was performed for osteochondritis dissecans (58%), arthrofibrosis and joint contracture (20%), synovitis (10%), acute trauma (10%), and posterior olecranon impingement syndrome (5%). Based on a modified Andrews elbow scoring system, 85% of patients had good or excellent result with 90% of the children returning to sports without limitation. No patient experienced nerve injury, infection, or loss of elbow motion as a postoperative complication. CONCLUSIONS: This series shows that elbow arthroscopy has a safe and effective role in the treatment of selective elbow pathologies in the pediatric and adolescent population when performed by experienced small joint arthroscopists.

Functional and radiographic outcome of juvenile osteochondritis dissecans of the knee treated with transarticular arthroscopic drilling.

Management of juvenile osteochondritis dissecans is controversial. The purpose of this study was to evaluate the functional and radiographic outcomes of transarticular arthroscopic drilling for isolated stable, juvenile osteochondritis dissecans lesions of the medial femoral condyle with an intact articular surface after 6 months of nonoperative management had failed. We reviewed 30 affected knees in 23 skeletally immature patients (mean age, 12.3 years; range, 8.5 to 16.1) at an average follow-up of 3.9 years (range, 2.0 to 7.2). Functional outcome was determined using the Lysholm score and radiographic outcome was determined using lesion size, and the radiographic score of Rodegerdts and Gleissner. There was significant improvement in the mean Lysholm score (from 58 to 93). There was significant improvement in the mean lesion size on anteroposterior (4.5 +/- 5.8 mm decrease) and lateral (8.4 +/- 8.1 mm decrease) radiographs. There was also significant improvement in the mean radiographic score (from 3.0 to 1.9). Radiographic healing was achieved in all patients at an average of 4.4 months after drilling (range, 1 to 11 months). Linear regression analysis revealed that younger age was an independent, multivariate predictor of Lysholm score improvement. There were no apparent surgical complications.

Diagnostic performance of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents.

To determine the diagnostic performances of clinical examination and selective magnetic resonance imaging in the evaluation of intraarticular knee disorders in children and adolescents we compared them with arthroscopic findings in a consecutive series of pediatric patients (< or = 16 years old). Stratification effects by patient age and magnetic resonance imaging center were examined. There were 139 lesions diagnosed clinically, 128 diagnosed by magnetic resonance imaging, and 135 diagnosed arthroscopically. There was no significant difference between clinical examination and magnetic resonance imaging with respect to agreement with arthroscopic findings (clinical examination, 70.3%; magnetic resonance imaging, 73.7%), overall sensitivity (clinical examination, 71.2%; magnetic resonance imaging, 72.0%), and overall specificity (clinical examination, 91.5%; magnetic resonance imaging, 93.5%). Stratified analysis by diagnosis revealed significant differences only for sensitivity of lateral discoid meniscus (clinical examination, 88.9%; magnetic resonance imaging, 38.9%) and specificity of medial meniscal tears (clinical examination, 80.7%; magnetic resonance imaging, 92.0%). For magnetic resonance imaging, children younger than 12 years old had significantly lower overall sensitivity (61.7% versus 78.2%) and lower specificity (90.2% versus 95.5%) compared with children 12 to 16 years old. There was no significant effect of magnetic resonance imaging center. In conclusion, selective magnetic resonance imaging does not provide enhanced diagnostic utility over clinical examination, particularly in children, and should be used judiciously in cases where the clinical diagnosis is uncertain and magnetic resonance imaging input will alter the treatment plan.

Strength training for children and adolescents.

Strength, or resistance, training for young athletes has become one of the most popular and rapidly evolving modes of enhancing athletic performance. Early studies questioned both the safety and the effectiveness of strength training for young athletes, but current evidence indicates that both children and adolescents can increase muscular strength as a consequence of strength training. This increase in strength is largely related to the intensity and volume of loading and appears to be the result of increased neuromuscular activation and coordination, rather than muscle hypertrophy. Training-induced strength gains are largely reversible when the training is discontinued. There is no current evidence to support the misconceptions that children need androgens for strength gain or lose flexibility with training. Given proper supervision and appropriate program design, young athletes participating in resistance training can increase muscular strength and do not appear to be at any greater risk of injury than young athletes who have not undergone such training.

Back injuries in the young athlete.

The diagnosis of back pain in the young athlete should be specific and not attributed to nonspecific, mechanical causes. Risk factor identification and intervention are required. Treatment is then initiated in a specific pattern, addressing flexibility and muscular imbalances. Bracing is often used to allow healing of growth tissue. The lumbosacral orthosis may be molded in a lordotic posture to unload the disc or antilordotic posture to relieve the posterior column; however, customizing the lordosis to the individual biomechanics may be required. Spinal stabilization is initiated with therapy for strengthening isolated weaknesses and progressing to coactivation and proprioceptive techniques, such as the balance ball. Returning to competition is preceded with sport-specific training.

The young dancer.

The injuries that are prevalent in and unique to dancers have their origins inextricably linked to faulty technique or poor biomechanics, combined with other risk factors. It is this combination of factors that must be addressed when considering diagnosis, treatment, and rehabilitation. For the dancer to return to full activity with minimal risk of recurrent injury, neuromuscular re-education is mandatory. This process best entails using a team approach, accessing the resources of healthcare professionals and those who train the dancer on a daily basis. In some cases, parents also may need to be involved. Communication, interaction, and mutual understanding among these groups will assist the dancer in regaining and maintaining health.

The prevention of sports injuries in children.

With the explosion of the number of youth participating in sports activities has come an epidemic of injuries. Myriad factors make their prevention a great challenge for society. This article presents an overview of statistics, factors contributing to sports injuries, a review of significant prevention efforts, barriers to prevention, and recommendations for the future.

Upper extremity injuries in the paediatric athlete.

Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.

[Autologous chondrocyte transplantation for treatment of cartilage defects of the knee joint. Clinical results]. / Die autologe Chondrozyten-Transplantation zur Behandlung von Knorpeldefekten des Kniegelenkes. Klinische Ergebnisse.

Cartilage defects in the knee joint are common and have a bad tendency for healing due to the limited regeneration of hyaline cartilage. Surgeons have an ample choice of various operative treatment measures. Especially for the treatment of larger lesions first results of autologous chondrocyte transplantation (ACT) were published in 1994 [3]. Autologous chondrocytes are isolated from an arthoscopically harvested cartilage biopsy, cultured in vitro and implanted in the defect under a periostal flap in a second procedure. In an international multicenter study 1,051 patients treated with ACT between 6/95 and 12/98 were documented with follow-up examinations after 12 months (588 patients), 24 months (220 patients) and 36 months (40 patients). The majority of the defects (61.2%) were localized on the medial femoral condyle, measuring 4.6 cm2 and mostly described as grade III/IV lesions. The clinical evaluation was performed using a modified Cincinnati knee rating system independently for clinician and patient. Evaluations showed an increase from 3.35 to 6.25 after 24 months and from 3.10 to 6.77 in a scale from 1 (bad) to 10 (excellent). ACT favours defects of the femur with an improvement rate of 85%. Adverse events possibly related to ACT were described in 4.8% of the patients. Diagnostic second-look arthroscopies are included in the reoperation rate of 5.1%. The presented data indicate autologous chondrocyte transplantation as an effective and safe option for the treatment of large full thickness cartilage defects in the knee joint.

Safety recommendations in Shotokan karate.

OBJECTIVE: To study risk factors for injury in karate and to establish safety recommendations. DESIGN: Cross-sectional survey of karate injuries. SETTING: Shotokan karate clubs in Boston, Massachusetts, Dallas, Texas, and Winnipeg, Manitoba, Canada. PARTICIPANTS: All athletes training at each club received surveys. A total of 114 surveys were analyzed (74% response rate). MAIN OUTCOME MEASURES: Presence of injuries (requiring any time off from practice), major injuries (requiring at least 7 days off), and multiple injuries (3 or more injuries). RESULTS: No statistically significant differences were found with respect to sex. For all outcomes, karateka younger than 18 years of age had fewer injuries. The number of karateka with injuries and with multiple injuries increased with belt rank until brown belt, then reached a plateau. Brown and black belts had a greater frequency of major injuries than the lower ranks. Training more than 3 hours per week correlated with an increase in injuries, major injuries, and multiple injuries. CONCLUSION: Shotokan karate appears to be a safe sport, especially for those younger than 18 years of age. Risk of injury increases significantly when younger karateka of any rank or older karateka of lower ranks train more than 3 hours per week; therefore, to reduce the risk of injury to less than 50%, weekly training should be limited to a maximum of 3 hours in these groups.

Karate injuries in children and adolescents.

OBJECTIVES: To identify risk factors for injury and to establish safety guidelines for children in Uechi-Ryu karate. DESIGN: A 1-year retrospective survey of injuries. SETTING: A private karate school (Uechi-Ryu style) in Plymouth, MA. PATIENTS: A total of 68 athletes (age 6-16 years; mean age 10 years) who participated in karate during the 1995-1996 season. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The presence or absence of injury, with grading of injuries as major, moderate or minor. The types of injuries and body region involved were also analyzed. RESULTS: Twenty eight percent of athletes sustained at least one injury. All injuries were minor, with no time off from training required. The injuries consisted primarily of bruises (11 of 19). Other injuries included mild sprains or strains (5 of 19) and having their 'wind knocked out' (3 of 19). Most injuries were localized to the extremities. Logistic regression analysis identified risk factors for injury. Risk of injury increased with number of years of training (odds ratio 2.95; 95% confidence interval 1.81-4.82; P<0.0001), number of hours per week (odds ratio 2.12; CI 1.15-4.21; P = 0.016) and rank, specifically brown belt versus lower belts (odds ratio 6.56; CI 2.02-21.26; P = 0.006). CONCLUSIONS: Karate is a relatively safe sport for children and adolescents when properly taught. Risk of injury increases with experience; therefore, greater supervision is required of higher ranks. Injury increases with weekly training; however, 3 h a week or less appears to be associated with a low risk of significant injury in this age group.

Idiopathic scoliosis and spondylolysis in the female athlete. Tips for treatment.

Idiopathic scoliosis and spondylolysis can be common back problems in female athletes. Diagnosis and treatment can be difficult. With the notable trend toward increasing participation of women and girls in organized sports, it is necessary to know which sports carry additional risks for participants to have these two conditions develop and to determine treatment modalities. In general, idiopathic scoliosis is more prevalent in females and even may be higher in the athletes. Treatment options may include observation, the use of a brace, and surgery. In determining treatment, the type of sport and caliber of athlete must be considered in conjunction with the severity of the curve. Spondylolysis or a stress fracture of the posterior vertebral elements can be a common cause of back pain in an athlete. In many sports that are dominated by females (gymnastics, dancing, figure skating), the athletes carry a high risk of having spondylolysis or a stress fracture. Knowing the risk factors permits precise diagnosis and appropriate treatment. Treatment options include the use of a brace and surgery. In the current study, an extensive review of the literature in conjunction with the extensive experience of a well-established sports medicine clinic at the authors' institution is presented.

Chronic recurrent subluxation of the peroneal tendons in a pediatric patient. Surgical recommendations.

Numerous surgical and non-operative approaches have been used to treat chronic recurrent subluxation of the peroneal tendons in adult athletes. There have been no published reports of surgical repair in children. In this report on a skeletally immature patient a modification of the Chrisman-Snook procedure (previously described for lateral ligament reconstruction) is described to correct recurrent subluxation of the peroneal tendons, child.

Malleolar bursitis in figure skaters. Indications for operative and nonoperative treatment.

Figure skaters are unique athletes who must train for extended periods of time performing motions and routines that create excessive compressive and shear forces between their malleoli and boots. As a result, they are susceptible to the development of a painful adventitious malleolar bursitis. Most often these patients will relate a recent increase in their training schedule or the purchase of a new pair of skating boots. This condition usually responds favorably to nonoperative measures including stretching of the boot over the affected area and protective padding placed around the inflamed bursa. If the swelling is marked, then an aspiration, subsequent injection with cortisone, and a compressive wrap may be indicated. This treatment regimen will enable the majority of figure skaters to continue skating. If the symptoms continue or increase despite nonoperative measures, then cessation of skating for a brief period must be considered. If this is not a viable option for the skater, surgical excision of the bursa may be warranted. If septic bursitis occurs, immediate surgical debridement and intravenous antibiotics are indicated. A Staphyloccocus aureus organism is most often responsible and should be treated with appropriate antibiotics. These patients may return to skating when there is no sign of further infection, the soft tissues have fully healed, and there is no sign of residual inflammatory bursa, usually at 4 to 6 weeks after surgery.

Anterior cruciate ligament reconstructive surgery in adolescent soccer and basketball players.

OBJECTIVE: To evaluate trends in the frequency of anterior cruciate ligament (ACL) tears among adolescent soccer and basketball players resulting in reconstructive surgery, and to assess differences between female and male adolescent athletes. DESIGN: A retrospective review of ACL reconstructive surgeries performed from 1992 through 1997 and annual statewide participation rates obtained from the National Federation of State High School Associations. SETTING: Children's Hospital, Boston, Massachusetts, U.S.A. PATIENTS: Adolescent athletes 13 to 19 years of age (78 girls, 31 boys) admitted for ACL reconstruction due to soccer or basketball injuries. MAIN OUTCOME MEASURES: Number of ACL reconstructive surgeries and number of Massachusetts participants in high school soccer and basketball. RESULTS: A total of 69 soccer (49 girls, 20 males) and 40 basketball (29 girls, 11 males) players underwent ACL reconstruction. A greater proportion of girls underwent ACL surgery in both sports. The frequency increased over time for both sexes in both sports. Soccer-related surgeries increased at a faster rate among girls than boys. Basketball-related surgeries increased at a similar rate for both sexes, although in any given year more surgeries were performed on girls. CONCLUSION: The frequency of ACL surgery at our institution has increased among high school soccer and basketball players in a manner consistent with trends in sports participation. In our study, ACL surgery was more common among girls than boys.