Prevalence of hip femoroacetabular impingement deformities in high-level (La Liga) male professional football players.

BACKGROUND: Femoroacetabular impingement (FAI) is considered one of the main causes of hip osteoarthritis in young adults, especially in athletes. In recent years, morphological changes in FAI in the hip have been linked to early and intense sports participation, but studying top-level athlete samples is not easy. This paper presents the prevalence of FAI radiological markers in 120 active white male professional football players in the Spanish First Division League (La Liga) and compares the morphological changes with those of a control group of healthy individuals without significant sport activity. METHODS: The precontract medical evaluation hip X-rays of 120 white male professional football players from four different First Division Spanish football teams were prospectively filed and retrospectively reviewed by a dedicated skeletal radiologist. The footballers' hip X-rays were compared with those of a control group of 80 healthy individuals (age-sex matched) without significant sport activity (obtained from routine work medical checks). RESULTS: The femoral head-neck deformity associated with the Cam type of femoroacetabular impingement was observed in 61.6% of professional football players and only in 11.6% of the control group (p <0.01). The presence of "herniation pit" (11.6%) and os acetabuli (13.3%) also reached statistical significance in the professional football players group. In the other analyzed parameters, no statistically significant differences between the groups were observed. CONCLUSIONS: White professional top-level football players have an increased incidence of abnormal lateral epiphyseal extension ("pistol grip deformity"), os acetabuli and herniation pits.

Quadriceps tendon autograft and platelet rich plasma injection to treat chronic Achilles tears-a minimum two-year follow-up.

BACKGROUND: The possibility of using a bone-tendon quadriceps tendon graft and platelet rich plasma (PRP) injection to enhance healing capability, to solve the defect created by stump retraction in chronic Achilles tendon ruptures was studied in a series of 8 patients. METHODS: A series of 8 patients studied prospectively and followed for more than 24 months is presented. Results were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score, and evaluating pain, level of activity, footwear restrictions, and satisfaction. Statistical analysis was done by the sign test for matched pairs and Wilcoxon signed-rank test. Alpha error was set at 0.05. RESULTS: Preoperatively, patients showed an average AOFAS score of 77.25 (range, 67-88). After surgery, AOFAS score showed a marked improvement in all the cases, with an average of 95.6 (range, 87-100). Improvement in AOFAS score results was statistically significant, both for sign test for matched pairs (P=0.008) and for Wilcoxon signed-rank test (P=0.012). All of the patients were satisfied with the results of the procedure, and would undergo it again. CONCLUSIONS: Autologous quadriceps tendon graft (in bone-tendon configuration) has proved as a simple technique that offers good results to patients with tissue defects in the Achilles tendon.

Midterm outcomes of bone grafting in glenoid defects treated with reverse shoulder arthroplasty.

BACKGROUND: Large glenoid defects are a difficult reconstructive problem for shoulder surgeons. The purpose of this study was to determine the complications, rate of healing, and functional results of glenoid bone grafting in primary or revision surgery with reverse shoulder arthroplasty. METHODS: We retrospectively reviewed 23 patients with glenoid bone loss who underwent primary or revision surgery using a glenoid bone graft with a minimum follow-up of 2 years. Range of motion and the Constant, American Shoulder and Elbow Surgeons, and visual analog scale scores were obtained from preoperative assessment and the latest follow-up visit. Radiographic evaluation included analysis of plain radiographs as well as preoperative and follow-up computed tomography. RESULTS: Three patients were excluded from the study. Allografts were used in 13 cases and autografts in 7 cases. The mean Constant score improved from 30.7 ± 9.4 to 51.3 ± 13.4 (P < .001). At a mean follow-up of 26 months, computed tomography imaging revealed that the glenoid bone graft was fully incorporated in 95% of cases. No statistically significant differences were found on analysis of the clinical and radiographic outcomes related to the graft source. There was a 20% postoperative complication rate: 1 case of aseptic glenoid component loosening, 1 surgical wound hematoma, 1 acromial fracture, and a symptomatic grade 3 scapular notching. CONCLUSIONS: The use of bone grafts in glenoid defects is a useful technique by which, in the majority of cases, single-stage reconstruction surgery may be performed, even in the presence of severe bone loss. Incorporation rates are high, with satisfactory clinical outcome.

Low Risk of Injuries in Young Adolescents Participating in Top-Level Karate Competition.

BACKGROUND: Prospective studies on injuries in martial arts competition are scarce, especially those involving young practitioners, but the upsurge of children and adolescents taking part in organized training and competition in these sports requires clarification of the injury risk that they represent for youths. HYPOTHESIS: Top-level karate competition for young adolescents (cadets, or 14- to 15-year-olds) has a low injury rate and can be safely promoted. STUDY DESIGN: Descriptive epidemiological study. METHODS: Prospective recording of the injuries resulting from all bouts in 3 consecutive World Karate Championships (2009, 2011, and 2013) for cadets was performed. Data were collected prospectively in situ with checklists that described competitor sex, bout category, and weight as well as injured area, diagnosis, mechanism of injury, severity, and treatment. RESULTS: A total of 1020 bouts were reviewed, 671 in the male category and 349 in the female category. A total of 61 injuries were recorded. Of those, only 3 were time-loss injuries. During the 2009 and 2011 championships, there was 1 injury per 25.6 fights, while during the 2013 championship the number of injuries increased, with 1 injury per 10 fights (P = .003). There was no statistical difference in the total injury rate between the male and female categories (P = .71), with an odds ratio of 1.16 (95% CI, 0.52-2.55). CONCLUSION: The injury rate for cadet top-level karate competition found in this prospective study is much lower than the rates previously published for karate or other martial arts competitions, but there seems to be a marked increase as more championships are held, which is a matter of concern.

Lesiones de estrés de la línea fisaria en jóvenes deportistas / Physeal stress injuries in young athletes

El crecimiento óseo es un proceso complejo que se lleva a cabo en un elemento altamente especializado, que es la fisis o cartílago de crecimiento, y que puede sufrir lesiones por sobreuso igual que cualquier otro tejido del aparato locomotor. Estas lesiones suelen manifestarse por dolor sin un desencadenante evidente, aunque coincidiendo con épocas de incremento de la carga de entrenamiento y brotes de crecimiento. Las imágenes radiográfi cas pueden ser muy poco expresivas en las fases iniciales, pero la RMN muestra un ensanchamiento característico de la fi sis, que puede ser local o global, y que ayuda a realizar un diagnóstico precoz. El incremento de la actividad deportiva organizada y específica desde edades tempranas hace que sea fundamental que el médico que atiende a los deportistas en edad de crecimiento conozca estas lesiones y pueda -además de proceder a su tratamiento si ocurren- realizar la labor preventiva precisa para evitar los trastornos potenciales del crecimiento que pueden derivarse de estas lesiones. Como caso clínico típico, se presenta el de un joven paciente de 13 años de edad, practicante habitual de fútbol y fútbol sala con un cuadro de dolor de aproximadamente 1 mes de evolución en la región anterior de su tobillo derecho. El dolor había comenzado de manera progresiva, sin un evento desencadenante claro, y lo obligaba a cojear. El estudio de RMN mostraba las alteraciones típicas de una lesión pro estrés de la fisis tibial distal, por lo que se pautó un periodo de descarga tras el cual se normalizaron los hallazgos clínicos y radiológicos, y el paciente retomó su actividad deportiva de manera progresiva sin volver a presentar molestias en la zona, completando su crecimiento sin alteraciones

Growth is a complex process that takes place in a highly specialized skeletal area, the physis or growth cartilage. The physis could suffer stress injuries, as any other part of the locomotor apparatus. The injury usually starts with localized pain without a clear cause, although usually this injury happens during growing spurts and training load increase periods. Although XRay images can appear quite innocent at the beginning of the symptoms, MRI shows a characteristic physeal widening. The widening could be either local (or 'tongue-like'), or global, and helps to perform an early diagnosis. The increase in organized and specific sport activities since very young age in children makes it basic to the medical specialist who takes care after the young athletes to understand these to not only treat them once they take place but also perform the preventive task necessary to avoid the potential growth alterations that might follow these injuries. As an illustrativer typical situation, the clinical case of a 13 year old patient is presented: the young athlete (an avid football and indoor football player) was seen at the outpatient clinic complaining of pain in the anterior face of his right ankle. The pain had started one month ago, without a clear traumatic previous event, in a progressive manner. When the patient was seen, he had a limp due to pain. An MRI study of the ankle showed the typical alterations of a stress physeal injury in the distal tibialphysis, and a protected weight bearing period was prescribed, using crutches. After 3 months, pain had resolved and the radiological findings were back to normal. The patient progressively resumed his sporting activity, and has not shown new pain episodes, without growth disturbances during follow-up

The injury profile of Karate World Championships: new rules, less injuries.

The aim of this paper is to document the injury rate in high-level modern competitive karate after a change of competition rules was implemented in the year 2000, and to compare it with the injury rate found before the rules were changed. A prospective recording of the injuries resulting from 2,762 matches in three consecutive World Karate Championships (representing 7,425 min of active fighting) was performed, and compared with the results from 2,837 matches from the three last World Karate Championships (representing 7,631 min of active fighting) held before the change of competition rules. In total, 497 injuries were recorded, with an incidence of 0.180 injuries per match or 6.7 per 100 min of active fighting. There were 1,901 male category fights (in which 383 injuries were recorded), and 861 female category fights (in which 114 injuries were recorded). The global injury incidence was almost double with the old rules compared to the one with the new rules [OR 1.99, 95% CI (1.76-2.26); p < 0.00001]. In male category, the risk of injury was higher before the rules were changed [OR 1.81, 95% CI (1.56-2.09); p < 0.00001], and also in female category [OR 2.71; 95% CI (2.64-2.80); p < 0.00001]. The rate of severe injuries was not different before and after the change of rules. The implementation of the new competition rules in competitive karate has been associated with a significant reduction in injury rate, making competition safer for athletes.