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1.
Am J Sports Med ; 49(13): 3479-3487, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34623936

RESUMO

BACKGROUND: A new anterior cruciate ligament (ACL) injury after ACL reconstruction is a feared outcome. PURPOSE: To study the risk of new knee injuries in female soccer players 5 to 10 years after primary unilateral ACL reconstruction and to compare players who returned to soccer with (1) players who did not return and (2) knee-healthy soccer players (controls). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Demographic, soccer-specific, and surgical data were recorded at baseline for 317 female soccer players (mean ± SD age, 20.1 ± 2.7 years) 1.6 ± 0.7 years after ACL reconstruction and for 119 matched controls (mean age, 19.5 ± 2.5 years). Data on new knee injuries and soccer-playing status were collected 5 to 10 years after ACL reconstruction via a questionnaire. RESULTS: Among players with ACL reconstruction, 222 (70%) responded at a mean 6.5 ± 1.0 years after primary ACL reconstruction. We compared 3 cohorts: (1) among 163 players with ACL reconstruction who returned to soccer, 68 (42%) sustained 44 reruptures and 29 contralateral ruptures; (2) among 59 players with ACL reconstruction who did not return to soccer, 11 (19%) sustained 9 reruptures and 2 contralateral ruptures; and (3) among 113 knee-healthy controls, 12 (11%) sustained 13 ACL injuries. Players who returned had a >2-fold higher risk of a new ACL injury than players who did not return (risk ratio, 2.24; 95% CI, 1.27-3.93; P = .005) and a 4-fold higher risk than controls (risk ratio, 3.93; 95% CI, 2.23-6.91; P <.001). A new ACL, meniscal, or cartilage injury was the most frequent new knee injury. Among players who returned to soccer, 68% reported a new knee injury, and they had a 2- to 5-times higher risk of any new knee injury and knee surgery than players who did not return and controls. CONCLUSION: Two-thirds of female soccer players with ACL reconstruction who returned to soccer sustained a new knee injury within 5 to 10 years; 42% had a new ACL injury. Their risk of a new knee injury and knee surgery was 2 to 5 times greater than that for players who did not return and for knee-healthy controls. New injury may have negative consequences for long-term knee health and should be a critical consideration in the decision to return to play.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Futebol , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/etiologia , Traumatismos do Joelho/cirurgia , Volta ao Esporte , Adulto Jovem
2.
J Pediatr Orthop ; 41(8): 514-519, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397784

RESUMO

BACKGROUND: Segond fractures (avulsion fractures of the proximal lateral tibia) are highly associated with anterior cruciate ligament (ACL) tears in adult patients. This large case series of pediatric Segond fractures describes the associated intra-articular knee injuries to determine if these fractures have a high incidence of ACL tears or its equivalent injury in young patients. METHODS: Institutional review board approved retrospective study at a tertiary children's hospital of patients under 19 years who were diagnosed with a Segond fracture between 2009 and 2019 was conducted. Demographics, clinical data, imaging features, associated injuries, and treatment information were collected. RESULTS: Fifty-three patients (44 males and 9 females) with median age 15.4 (11.8 to 19) years with Segond fractures of the proximal tibia on radiographic imaging were included. Diagnosis of associated injuries was established based on clinical examination, radiology report, and arthroscopic findings. Median Segond fracture size was 2.0×9.0 mm measured on standard anteroposterior knee radiographs. Magnetic resonance imaging (MRI) was obtained in 49/53 (92.5%) patients. Associated injuries included ACL tears (39 patients, 73.6%), tibial spine fractures (9, 17.0%), and other injuries (5, 9.4%). 37/53 (69.8%) patients had meniscal injury. Three (5.7%) patients sustained multiligament injuries. All associated injuries were confirmed by either MRI/computerized tomography or direct operative examination. Among Segond fractures found with ACL tears, 12 (30.8%) were contact injuries, 30 (76.9%) were sports injuries. In associated tibial spine fractures, 7 (78%) injuries were contact in nature and were sports related. There was a statistically significant difference (P=0.013) in age, patients with tibial spine fractures (median 13.6 y) being younger than those with ACL tears (median 15.4 y). 12/53 (22.6%) had associated articular cartilaginous injuries, 3 of which were treated surgically. Overall, 81.1% of patients were treated operatively for associated intra-articular injuries. CONCLUSIONS: This large case series of Pediatric Segond fractures suggests a high association with intra-articular injuries, specifically, ACL tears and its equivalent injury, that is, tibial spine fractures, the later more common in the younger patient population. An MRI is recommended in patients with a Segond fracture for characterizing the exact intra-articular injury to help plan the appropriate management. LEVEL OF EVIDENCE: Level IV-prognostic.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Fraturas da Tíbia , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Criança , Feminino , Humanos , Incidência , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/epidemiologia , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Tíbia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/epidemiologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-34198965

RESUMO

Karate training, despite the many positive health benefits, carries a risk of injury for participants. The current cross-sectional study aimed to investigate knee injury profiles among Iranian elite karatekas. Participants who attended the national team qualifiers, which included 390 male Kumite karatekas (age 24 ± 3 years old and weight 63 ± 12 kg), participated in this study. Information on knee injuries (injury history, type of injury mechanisms, and effects of knee symptoms on the ability to perform daily activities and recreational activities) were obtained using the Knee Outcome Survey (KOS). Using Pearson's correlation coefficient, the study examined the relationships between different variables, including KOS subscales and levels of self-reported knee joint function. Our findings indicated that 287 karatekas (73.6%) experienced knee injuries. The anterior cruciate ligament (ACL) rupture (6.9%), articular cartilage (5.4%), and meniscus damage (3.8%) were the main typology of injury. In addition, there were no differences in knee injuries between the non-dominant and dominant legs. Most injuries occurred during the preparatory period (n = 162, 50%), especially during training periods. The KOS subscales scores (Mean ± Sd) for activities of daily living (ADL) and sports activity (SAS) were, respectively, 89 ± 11 and 91 ± 9. The self-reported scores for both the ADL and SAS subscales were, respectively, 89 ± 11 and 90 ± 10. Pearson coefficients of ADL and SAS subscales with their self-reported score were r = 0.761 (p < 0.0001) and r = 0.782 and (p < 0.0001), respectively. The profile of knee injuries in the current investigation is similar to previous surveys that reported lower extremity injury patterns. The findings of this study could be adopted to inform practice aimed at planning interventions for the reduction and prevention of knee injuries among karatekas.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Atividades Cotidianas , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos Transversais , Humanos , Irã (Geográfico)/epidemiologia , Traumatismos do Joelho/epidemiologia , Articulação do Joelho , Masculino , Adulto Jovem
4.
Am J Sports Med ; 49(10): 2651-2658, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34283648

RESUMO

BACKGROUND: Studies investigating biomechanical risk factors for knee injuries in sport-specific tasks are needed. PURPOSE: To investigate the association between change of direction (COD) biomechanics in a 180-degree pivot turn and knee injury risk among youth team sport players. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 258 female and male basketball and floorball players (age range, 12-21 years) participated in the baseline COD test and follow-up. Complete data were obtained from 489 player-legs. Injuries, practice, and game exposure were registered for 12 months. The COD test consisted of a quick ball pass before and after a high-speed 180-degree pivot turn on the force plates. The following variables were analyzed: peak vertical ground-reaction force (N/kg); peak trunk lateral flexion angle (degree); peak knee flexion angle (degree); peak knee valgus angle (degree); peak knee flexion moment (N·m/kg); peak knee abduction moment (N·m/kg); and peak knee internal and external rotation moments (N·m/kg). Legs were analyzed separately and the mean of 3 trials was used in the analysis. Main outcome measure was a new acute noncontact knee injury. RESULTS: A total of 18 new noncontact knee injuries were registered (0.3 injuries/1000 hours of exposure). Female players sustained 14 knee injuries and male players 4. A higher rate of knee injuries was observed in female players compared with male players (incidence rate ratio, 6.2; 95% CI, 2.1-21.7). Of all knee injuries, 8 were anterior cruciate ligament (ACL) injuries, all in female players. Female players displayed significantly larger peak knee valgus angles compared with male players (mean for female and male players, respectively: 13.9°± 9.4° and 2.0°± 8.5°). No significant associations between biomechanical variables and knee injury risk were found. CONCLUSION: Female players were at increased risk of knee and ACL injury compared with male players. Female players performed the 180-degree pivot turn with significantly larger knee valgus compared with male players. However, none of the investigated variables was associated with knee injury risk in youth basketball and floorball players.


Assuntos
Lesões do Ligamento Cruzado Anterior , Basquetebol , Traumatismos do Joelho , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/etiologia , Fenômenos Biomecânicos , Criança , Estudos de Coortes , Feminino , Humanos , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/etiologia , Articulação do Joelho , Masculino , Adulto Jovem
5.
J Sports Med Phys Fitness ; 61(8): 1117-1124, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34327976

RESUMO

BACKGROUND: Injury prevention strategies should be built upon data about the more frequent injuries in each specific sport. Therefore, this study aimed to describe the lifetime prevalence and characteristics of severe knee injuries among world-class karatekas. METHODS: A retrospective study based on a face-to-face survey was conducted. Participants were athletes who competed in World Karate Senior Championships in Madrid 2018, which was a tournament with the highest value to rank athletes to the Tokyo Olympic Games. A questionnaire was used to collect retrospective information on the prevalence and characteristics of severe knee injuries that occurred along elite karatekas sport careers. Odds Ratio (OR) were calculated to identify the association of sex and karate modality (kata / kumite) with severe knee injury risk. RESULTS: Out of the 293 athletes surveyed (23.4±4.0 years; 137 female), 71 (24.2%) had suffered a serious knee injury at some point of their careers, without a statistically significant difference between male and female athletes. There was no difference between the percentage of injuries that took place during training (54.9%) or during competition (45.1%) both in male and female athletes. Kumite athletes suffered more knee injuries during competition than training. The most common injury mechanism for both genders was a pivoting or dodging movement (36.4% in males and 39.5% in females). CONCLUSIONS: The information presented in this study about the prevalence and characteristics (mechanism, anatomical location, moment, time off) of the severe knee injuries in elite karatekas could be useful to design prevention programs to be implemented among karate athletes.


Assuntos
Traumatismos em Atletas , Traumatismos do Joelho , Artes Marciais , Atletas , Traumatismos em Atletas/epidemiologia , Feminino , Humanos , Traumatismos do Joelho/epidemiologia , Masculino , Estudos Retrospectivos , Tóquio
6.
Biomed Res Int ; 2021: 8875643, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34189140

RESUMO

Background: Almost every sector in the health care is affected by the COVID-19 pandemic. Many studies already investigated the effect on different aspects in orthopedic and trauma care. However, the current literature lacks data regarding the consequence on daily surgical business. Thus, the aim of the present study was to analyze the development of knee-related pathologies and surgical procedures in a German university level-one trauma center during the lockdown phase and early lockdown phase to investigate the impact of the COVID-19 lockdown on orthopedic and trauma knee surgery. Material and Methods. The amount of knee joint surgeries performed during the high-peak COVID-19 crisis in the period of January to May 2020 was evaluated retrospectively and compared to the corresponding time periods of the previous years (2017-2019). Results: The COVID-19 lockdown led to a significant decrease in the number of knee injuries in March and April 2020 by 83.3%. Surgical procedures were reduced by 84.8% during the same period. In May 2020, the number of knee joint procedures returned to an almost prepandemic level. The distribution of urgent and elective knee surgery changed to predominantly acute trauma care at the beginning of the COVID-19 lockdown and persisted through to May 2020. Conclusion: The COVID-19 pandemic had a high impact on emergency and elective knee surgery in a level-one trauma center in Germany during the lockdown phase. It also showed that a level-one trauma center in the German healthcare system is able to handle urgent trauma and orthopedic operations during a worldwide medical crisis and to return to a prepandemic level within a short phase.


Assuntos
COVID-19 , Traumatismos do Joelho , Procedimentos Ortopédicos , Quarentena , SARS-CoV-2 , Centros de Traumatologia , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Alemanha/epidemiologia , Humanos , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Ortop Traumatol Rehabil ; 23(3): 181-192, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34187936

RESUMO

BACKGROUND: Traumatic musculoskeletal injuries are more and more frequently regarded as an important health, social and economic problem. According to WHO statistics, injuries are a major present-day health problem. The main aim of the study is to identify the number of new patients who sustained knee structure injuries during a year and to classify them based on data on services provided under National Health Fund agreements. MATERIAL AND METHODS: Information on the number of patients with a knee injury was obtained in a three stage process. First an inventory of relevant diagnoses was determined. Then, the National Health Fund data from 2016-2019 was queried in accordance with the adopted methodology and assumptions. The analysis was based on the report submitted by the NHF in response to the query. RESULTS: According to the NHF reporting data, knee injuries affect approx. 244,000 people per year. There are slightly more men (approx. 52%) than women (48%). People aged 11-20 years constitute the most numerous group of patients with knee injuries, with approx. 41,342 cases per year. The most frequently reported diagnoses in both groups were S80.0 Contusion of knee (approx. 30%), S83.6 Sprain and tear of other and unspecified parts of knee (approx. 21%) and M23.8 Other internal derangements of knee (approx. 9%). According to available data, the overall rate of knee injuries in 2019 was 6.4 per 1000 population. CONCLUSIONS: 1. Knee injuries pose a major health problem. In Poland, according to the reporting data, approx. 244,000 knee injuries occur every year. 2. Knee injuries are more common among men than women, and people aged 11-20 years constitute the most numerous group of patients. 3. The National Health Fund reporting data is a very valuable source of information on the magnitude of the problem of injuries.


Assuntos
Traumatismos do Joelho , Projetos de Pesquisa , Feminino , Humanos , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/epidemiologia , Masculino , Polônia/epidemiologia
8.
J Sports Sci Med ; 20(2): 204-215, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33948098

RESUMO

Knowledge about prevalence and etiology of running-related injuries (RRIs) is important to design effective RRI prevention programs. Mental aspects and sleep quality seem to be important potential risk factors, yet their association with RRIs needs to be elucidated. The aims of this study are to investigate the epidemiology of RRIs in recreational runners and the association of mental aspects, sleep, and other potential factors with RRIs. An internet-based questionnaire was sent to recreational runners recruited through social media, asking for personal and training characteristics, mental aspects (obsessive passion, motivation to exercise), sleep quality, perceived health, quality of life, foot arch type, and RRIs over the past six months. Data were analyzed descriptively and using logistic regression. Self-reported data from 804 questionnaires were analyzed. Twenty-five potential risk factors for RRIs were investigated. 54% of runners reported at least one RRI. The knee was the most-affected location (45%), followed by the lower leg (19%). Patellofemoral pain syndrome was the most-reported injury (20%), followed by medial tibial stress syndrome (17%). Obsessive passionate attitude (odds ratio (OR):1.35; 95% confidence interval (CI):1.18-1.54), motivation to exercise (OR:1.09; CI:1.03-1.15), and sleep quality (OR:1.23; CI:1.15-1.31) were associated with RRIs, as were perceived health (OR:0.96; CI:0.94-0.97), running over 20 km/week (OR:1.58; CI:1.04-2.42), overweight (OR:2.17; CI:1.41-3.34), pes planus (OR:1.80; CI:1.12-2.88), hard-surface running (OR:1.37; CI:1.17-1.59), running company (OR:1.65; CI:1.16-2.35), and following a training program (OR:1.51; CI:1.09-2.10). These factors together explained 30% of the variance in RRIs. A separate regression analysis showed that mental aspects and sleep quality explain 15% of the variance in RRIs. The association of mental aspects and sleep quality with RRIs adds new insights into the multifactorial etiology of RRIs. We therefore recommend that besides common risk factors for RRI, mental aspects and sleep be incorporated into the advice on prevention and management of RRIs.


Assuntos
Extremidade Inferior/lesões , Corrida/lesões , Corrida/psicologia , Sono , Tendão do Calcâneo/lesões , Adulto , Atitude Frente a Saúde , Estudos Transversais , Feminino , Pé/anatomia & histologia , Humanos , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/prevenção & controle , Traumatismos do Joelho/psicologia , Traumatismos da Perna/epidemiologia , Traumatismos da Perna/prevenção & controle , Traumatismos da Perna/psicologia , Masculino , Motivação , Prevalência , Análise de Regressão , Fatores de Risco , Autorrelato , Distribuição por Sexo
9.
J Electromyogr Kinesiol ; 58: 102552, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33930804

RESUMO

We investigated whether adaptations of quadriceps muscle activity to fatiguing exercise differs between sexes. Fifteen healthy men (age, mean ± SD; 22. ± 2.4 yr, body mass 70.5 ± 11.4 kg, height 1.72 ± 0.06 m) and 15 healthy women (age, mean ± SD; 21 ± 1.8 yr, body mass 60 ± 7.5 kg, height 1.62 ± 0.07 m), all right leg dominant, participated in the study. Participants performed a submaximal isometric knee extension contraction at 50% of the maximum voluntary contraction (MVC) sustained until task failure before and after a fatiguing exercise. Surface electromyography (EMG) was simultaneously recorded from nine regions distributed over the medial, middle and lateral locations of the quadriceps muscles in a longitudinal direction corresponding to the vastus medialis, rectus femoris (RF) and vastus lateralis muscle, respectively. A significant reduction in maximal force and time to task failure were observed after fatiguing exercise for both sexes (P < 0.001). However, women displayed greater myoelectric manifestations of fatigue specifically for the RF during the post-fatigue sustained contraction (P < 0.05). The RF is more susceptible to fatiguing exercise in women compared to men which may partly explain the higher risk of knee injuries among female athletes during competitive sports.


Assuntos
Adaptação Fisiológica , Traumatismos em Atletas/epidemiologia , Traumatismos do Joelho/epidemiologia , Fadiga Muscular , Músculo Quadríceps/fisiologia , Adulto , Feminino , Humanos , Contração Isométrica , Joelho/fisiologia , Masculino , Fatores Sexuais
10.
J ISAKOS ; 6(1): 35-45, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33833044

RESUMO

The meniscus is important for load distribution, shock absorption and stability of the knee joint. Meniscus injury or meniscectomy results in decreased function of the meniscus and increased risk of knee osteoarthritis. To preserve the meniscal functions, meniscal repair should be considered as the first option for meniscus injury. Although reoperation rates are higher after meniscal repair compared with arthroscopic partial meniscectomy, long-term follow-up of meniscal repair demonstrated better clinical outcomes and less severe degenerative changes of osteoarthritis compared with partial meniscectomy. In the past, the indication of a meniscal repair was limited both because of technical reasons and due to the localised vascularity of the meniscus. Meanwhile, it spreads today as the development of the concept to preserve the meniscus and the improvement of meniscal repair techniques. Longitudinal vertical tears in the peripheral third are considered the 'gold standard' indication in terms of meniscus healing. Techniques for meniscal repair include 'inside-out', 'outside-in' and 'all-inside' strategies. Surgical decision-making depends on the type, size and location of the meniscus injury. Meniscal root tears substantially affect meniscal hoop function and accelerate cartilage degeneration; therefore, meniscus root repair is necessary to prevent the progression of osteoarthritis change. For symptomatic meniscus defects after meniscectomy, transplantation of allograft or collagen meniscus implant may be indicated, and acceptable clinical results have been obtained. Recently, meniscus extrusion has attracted attention due to increased interest in early osteoarthritis. The centralisation techniques have been proposed to reduce the meniscus extrusion by suturing the meniscus-capsule complex to the edge of the tibial plateau. Long-term clinical outcomes of this procedure may change the strategy of treating meniscus extrusion. When malalignment of the lower leg is accompanied with meniscus pathologies, knee osteotomies are a reasonable option to protect the repaired meniscus by unloading the pathological compartment. Advancements in biological augmentation such as bone marrow stimulation, fibrin clot, platelet-rich plasma, stem cell therapy and scaffolds have also expanded the indications for meniscus surgery. In summary, improved repair techniques and biological augmentation have made meniscus repair more appealing to treat that had previously been considered irreparable. However, further research would be necessary to validate the efficacy of these specialised technique.


Assuntos
Lesões do Menisco Tibial/patologia , Lesões do Menisco Tibial/cirurgia , Artroplastia do Joelho/estatística & dados numéricos , Artroscopia/métodos , Doenças das Cartilagens/epidemiologia , Humanos , Traumatismos do Joelho/epidemiologia , Meniscectomia/efeitos adversos , Meniscos Tibiais/patologia , Meniscos Tibiais/cirurgia , Osteoartrite do Joelho/epidemiologia , Osteotomia/métodos , Plasma Rico em Plaquetas , Reoperação/estatística & dados numéricos , Ruptura Espontânea/cirurgia , Transplante Homólogo/métodos
11.
Clin J Sport Med ; 31(3): 289-294, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33882544

RESUMO

OBJECTIVE: To determine the incidence of all-cause injury and concussion in the National Football League (NFL) over a 5-season time span (2012-2016). DESIGN: Prospective descriptive epidemiological study. SETTING: National Football League Injury Report data from 2012 to 2016. PARTICIPANTS: National Football League players. INTERVENTIONS: None (descriptive study). MAIN OUTCOME MEASURES: Injury report data were collected prospectively for all NFL injuries from 5 seasons (2012-2016). The incidences of reported concussions, knee injuries, and all-cause injury were compared across the 5 seasons using the Kruskal-Wallis rank-sum test. RESULTS: A total of 10 927 injuries were identified across the 5 seasons, including 752 (6.9%) concussions. The top 3 most injured areas included the knee (17.2%), ankle (13.6%), and shoulder (8.8%). Defensive backs consistently had the highest number of all-cause injuries per season. When comparing across years, there was a significant decrease in all-cause injury in 2016 compared with 2015, a significant decrease in knee injuries in 2016 compared with 2015, and a significant increase in concussion in 2015 compared with 2014 (P < 0.05). CONCLUSIONS: Reported all-cause injury incidence and knee injury incidence is currently on the decline. However, reported concussion incidence has recently increased, perhaps due to increased awareness and rule changes implemented to aid in the detection and treatment of concussion. Strategies to reduce injury and improve injury awareness should continue to be explored.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Futebol Americano , Traumatismos do Joelho , Traumatismos em Atletas/epidemiologia , Concussão Encefálica/epidemiologia , Futebol Americano/lesões , Humanos , Incidência , Traumatismos do Joelho/epidemiologia , Estudos Prospectivos
12.
Knee ; 29: 557-563, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33774589

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI) is one of the most widely used investigations for knee pain as it provides detailed assessment of the bone and soft tissues. The aim of this study is to report the frequency of each diagnosis identified on MRI scans of the knee and explore the relationship between MRI results and onward treatment. METHODS: Consecutive MRI reports from a large NHS trust performed in 2017 were included in this study. The hospital electronic system was consulted to identify whether a patient underwent x-ray prior to the MRI, attended an outpatient appointment or underwent surgery. RESULTS: 4466 MRI knees were performed in 2017 with 71.2% requested in primary care and 28.1% requested in secondary care. The most common diagnosis was signs of arthritis (55.2%), followed by meniscal tears (42.8%) and ACL tears (8.3%). 49.4% of patients who had an MRI attended outpatients and 15.6% underwent surgery. The rate of knee surgery was significantly higher for patients who had their scans requested in secondary care (32.9% vs 8.9%, p < 0.001). CONCLUSION: The rate of surgical intervention following MRI is low and given these results it seems unlikely that the scan changes practice in most cases. The rate of surgery and outpatient follow up was significantly higher in scans requested by secondary care. We urge clinicians avoid wasteful use of MRI and recommend the use of plain radiography prior to MRI where arthritis may be present.


Assuntos
Artrite/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Joelho/diagnóstico por imagem , Adulto , Idoso , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artrite/epidemiologia , Feminino , Humanos , Joelho/cirurgia , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medicina Estatal/estatística & dados numéricos , Reino Unido
13.
Knee Surg Sports Traumatol Arthrosc ; 29(8): 2701-2708, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33772603

RESUMO

PURPOSE: Anterior cruciate ligament (ACL) tears have a major impact on the individual and society. Long term effects may be mediated by injuries that occur concurrently to the ACL tear. The purpose of this study was to describe in a nationwide cohort the traumatic meniscal injuries and bone marrow lesions concomitant to ACL tears, their age and sex distribution and the rate any association with ACL reconstruction. METHODS: All ACL tears in Iceland from 2006 to 2011 and their concomitant bone marrow lesions and meniscal injuries were identified from MRI reports. These injuries were further classified by location, sex and age. The cohort was divided into under 17, 17-29, 30-49 and above 50 to reflect likely differences in the mechanisms of injury and risk factors that may vary with age. Data from the Icelandic Social Insurance Administration were used identify all those who were operated. Descriptive analysis was performed to show the proportion of ACL injured knees sustaining concomitant injuries and how these injuries varied with age, sex, and subsequent treatment RESULTS: 1365 knees with ACL ruptures were included. Only 13% of knees had no concomitant injury identified. Overall, 57% of knees had a bone marrow lesion in at least one location and 70% of knees had at least one traumatic meniscal injury. A greater number of combined lateral tibial and femoral bone marrow lesion was seen in younger age groups (χ2 (3) = 113.32, p < 0.0001). Bruises in the medial compartment were the least common concomitant injuries. More injuries were related to higher chances of ACL reconstruction (OR 1.6, 95% CI 1.4-1.7). Age was associated with risk of all injury types and locations with older age generally being associated with fewer injuries. CONCLUSION: In an ACL ruptured cohort, the overall incidence of BMLs may be lower and meniscus injuries higher than previously reported. However, these injuries are more prevalent in the younger cohort potentially resulting in a poorer long-term prognosis. Knowledge of the association between age and concomitant injuries will help guide rehabilitation. LEVEL OF EVIDENCE: II.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Lesões do Menisco Tibial , Idoso , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Tíbia , Lesões do Menisco Tibial/epidemiologia , Lesões do Menisco Tibial/cirurgia
14.
Orv Hetil ; 162(162 Suppl 1): 54-60, 2021 03 28.
Artigo em Húngaro | MEDLINE | ID: mdl-33774609

RESUMO

Összefoglaló. Bevezetés: A térd és a lábszár sérülései jelentos terhet jelentenek az egyén és a társadalom számára. Célkituzés: Elemzésünk célja volt a térd- és lábszársérülés okozta éves epidemiológiai és egészségbiztosítási betegségteher vizsgálata Magyarországon. Adatok és módszerek: Az elemzésben felhasznált adatok a Nemzeti Egészségbiztosítási Alapkezelo (NEAK) finanszírozási adatbázisából származnak, és a 2018. évet fedik le. Vizsgáltuk az éves egészségbiztosítási kiadásokat, azok megoszlását, az éves betegszámot, valamint a 100 000 lakosra vetített prevalenciát korcsoportok és nemek szerinti bontásban. A térd és a lábszár sérülései kórképeket a Betegségek Nemzetközi Osztályozása (BNO, 10. revízió) szerinti S80-S89-es kóddal azonosítottuk. Eredmények: A legköltségesebb ellátási forma az aktívfekvobeteg-szakellátás volt, amelynek országos betegszáma összesen 18 398 fo (9868 fo férfi, 8530 fo no) volt. Az aktívfekvobeteg-szakellátás betegforgalmi adatai alapján a 100 000 fore eso prevalencia a férfiaknál 211,2 fo, a noknél 167,0 fo, együtt 188,1 fo volt. A NEAK 8,808 milliárd Ft-ot költött 2018-ban a térd- és lábszársérülések kezelésére, ami 32,59 millió USD-nak, illetve 27,62 millió EUR-nak felelt meg. Az aktívfekvobeteg-szakellátás a teljes egészségbiztosítási kiadás 61,4%-ával volt a legmeghatározóbb költségelem. A kiadások 52,0%-a férfiaknál, míg 48,0%-a noknél jelent meg. A 49. életévig a férfiak, míg az 50. életév feletti korosztályban a nok sérüléseibol származó ellátások betegszámai és költségei a magasabbak. Következtetés: Az aktívfekvobeteg-szakellátás bizonyult a fo költségtényezonek. A betegség elofordulási gyakorisága 26%-kal volt magasabb a férfiak esetében, mint a noknél. Orv Hetil. 2021; 162(Suppl 1): 54-60. INTRODUCTION: Injuries to the knee and lower leg pose a great burden for the individual and society. OBJECTIVE: The aim of our study was to determine the annual epidemiological disease burden and the health insurance treatment cost of knee and lower leg injuries in Hungary. DATA AND METHODS: Data were derived from the financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018. The data analysed included annual health insurance costs and their distribution and annual patient numbers and prevalence per 100 000 population calculated for age groups and sex. Patients with knee and lower leg injuries were identified with the following code of the International Classification of Diseases, 10th revision: S80-S89. RESULTS: The most expensive insurance treatment category was acute inpatient care, presenting 18 398 patients in total (9868 men, 8530 women). Based on patient numbers in acute inpatient care, the prevalence in 100 000 population among men was 211.2 patients, among women 167.0 patients, in total 188.1 patients. In 2018, NHIFA spent 8.808 billion HUF on the treatment of patients with knee and lower leg injuries (32.59 million USD, 27.62 million EUR). Acute inpatient care with 61.4% of the total health insurance expenditure was the main cost driver. 52.0% of the costs was spent on the treatment of male, while 48.0% on female patients. Until the age of 49, the number of patients and their costs were higher for men, while those over the age of 50 were higher for women. CONCLUSION: Acute inpatient care was the major cost driver. The prevalence of the disease was by 26% higher in men compared to women. Orv Hetil. 2021; 162(Suppl 1): 54-60.


Assuntos
Efeitos Psicossociais da Doença , Traumatismos do Joelho , Traumatismos da Perna , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Hungria/epidemiologia , Seguro Saúde/economia , Traumatismos do Joelho/economia , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/terapia , Traumatismos da Perna/economia , Traumatismos da Perna/epidemiologia , Traumatismos da Perna/terapia , Masculino
15.
Dtsch Arztebl Int ; 118(4): 49-55, 2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33759745

RESUMO

BACKGROUND: We address the question whether professional soccer players with and without macroinjury of the knee joint are at an elevated risk for knee osteoarthritis. METHODS: A systematic review with meta-analyses was conducted. The study protocol was prospectively registered (registration number CRD42019137139). The MEDLINE, EMBASE, and Web of Science databases were searched for relevant publications; in addition, forward searching was performed, and the listed references were considered. All steps of the process were undertaken independently by two reviewers, and any discordances were resolved by consensus. For all publications whose full text was included, the methods used were critically evaluated. The quality of the evidence was judged using the GRADE criteria. RESULTS: The pooled odds ratio for objectively ascertained osteoarthrosis of the knee was 2.25 (95% confidence interval [1.41-3.61], I2 = 71%). When only radiologically ascertained knee osteoarthrosis was considered, the odds ratio was 3.98 [1.34; 11.83], I2 = 58%). The pooled risk estimator in studies in which knee joint macroinjury was excluded was 2.81 ([1.25; 6.32], I2 = 71%). CONCLUSION: A marked association was found between soccer playing and knee osteoarthritis in male professional soccer players. For female professional soccer players, the risk of knee osteoarthritis could not be assessed because of the lack of data. Knee injuries seem to play an important role in the development of knee osteoarthritis in professional soccer players.


Assuntos
Traumatismos do Joelho , Osteoartrite do Joelho , Futebol , Feminino , Humanos , Traumatismos do Joelho/epidemiologia , Articulação do Joelho , Masculino , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/epidemiologia
16.
Scand J Med Sci Sports ; 31(6): 1324-1334, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33560529

RESUMO

A better insight into injuries in elite-youth football may inform prevention strategies. The purpose of this prospective cohort study was to investigate the frequency, incidence, and pattern of time-loss injuries in an elite male football academy, exploring injuries in relation to age and maturation status. Across four consecutive playing seasons, playing exposure and injuries to all academy players (U'9 to U'21) were recorded by club medical staff. Maturation status at the time of injury was also calculated for players competing in U'13 to U'16 aged squads. Time-loss injury occurrence and maturation status at time of injury were the main outcome measures. A total of 603 time-loss injuries were recorded, from 190 different players. Playing exposure was 229 317 hours resulting in an overall injury rate of 2.4 p/1000 h, ranging from 0.7 p/1000 h (U'11) to 4.8 p/1000 h (U'21). Most injuries were traumatic in mechanism (73%). The most common injury location was the thigh (23%), and the most common injury type was muscle injury (29%) combining to provide the most common injury diagnosis; thigh muscle injury (17%). In U'13-U'16 players, a higher number of injuries to early-maturing players were observed in U'13-U'14 players, while more injuries to U'15-U'16 players occurred when classed as "on-time" in maturity status. Maturation status did not statistically relate to injury pattern; however, knee bone (not-fracture) injuries peaked in U'13 players while hip/groin muscle injuries peaked in U'15 players.


Assuntos
Absenteísmo , Futebol/lesões , Esportes Juvenis/lesões , Adolescente , Fatores Etários , Traumatismos do Tornozelo/epidemiologia , Atletas , Inglaterra/epidemiologia , Virilha/lesões , Crescimento/fisiologia , Lesões do Quadril/epidemiologia , Humanos , Incidência , Escala de Gravidade do Ferimento , Traumatismos do Joelho/epidemiologia , Masculino , Músculo Esquelético/lesões , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Ruptura/epidemiologia , Estações do Ano , Futebol/fisiologia , Futebol/estatística & dados numéricos , Entorses e Distensões/epidemiologia , Estatísticas não Paramétricas , Coxa da Perna/lesões , Fatores de Tempo , Esportes Juvenis/fisiologia , Esportes Juvenis/estatística & dados numéricos
17.
Sci Rep ; 11(1): 3642, 2021 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-33574469

RESUMO

The degeneration of radial tie fibres of the central meniscal layer, and thinning of its lamellar layer results in increased intensity signals on magnetic resonance imaging, making it difficult to differentiate from true meniscal tear. This study aimed to assess the rate of encountered MRI grades 1 and 2 intrasubstance meniscal changes, and to set guidelines to report these changes based on predicted clinical outcome. A systematic review approach was employed using search engines, libraries, and databases (Google Scholar, ERIC, PubMed, and Medline) to search for scholarly sources on meniscal lesions and their significance in MRI published between 1 January 2000 and 30 June 2019. It retrieved 2750 abstracts, out of which 2738 were excluded and 13 studies meeting inclusion criteria were meta-analysed. It found an association between intrasubstances meniscal changes and outcomes. It resulted that intrasubstance meniscal changes were preservable through the protective functioning of the meniscus. Other than weight gain, no other significant risk factor of developing true meniscal tears later in life was found. It is important to examine intrasubstance meniscal change when patients suffer from mechanical meniscal symptoms especially in old age.


Assuntos
Traumatismos do Joelho/fisiopatologia , Meniscos Tibiais/fisiopatologia , Menisco/diagnóstico por imagem , Lesões do Menisco Tibial/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Artroscopia/métodos , Feminino , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/epidemiologia , Imageamento por Ressonância Magnética , Masculino , Meniscos Tibiais/diagnóstico por imagem , Menisco/fisiopatologia , Pessoa de Meia-Idade , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/epidemiologia
18.
Knee Surg Sports Traumatol Arthrosc ; 29(11): 3892-3898, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33521890

RESUMO

PURPOSE: The management of meniscal tears is a widely researched and evolving field. Previous studies reporting the incidence of meniscal tears are outdated and not representative of current practice. The aim of this study was to report the current incidence of MRI confirmed meniscal tears in patients with a symptomatic knee and the current intervention rate in a large NHS trust. METHODS: Radiology reports from 13,358 consecutive magnetic resonance imaging scans between 2015 and 2017, performed at a large UK hospital serving a population of 470,000, were assessed to identify patients with meniscal tears. The hospital database was interrogated to explore the subsequent treatment undertaken by the patient. A linear regression model was used to identify if any factors predicted subsequent arthroscopy. RESULTS: 1737 patients with isolated meniscal tears were identified in patients undergoing an MRI for knee pain, suggesting a rate of 222 MRI confirmed tears per 100,000 of the population aged 18 to 55 years old. 47% attended outpatient appointments and 22% underwent arthroscopy. Root tears [odds ratio (95% CI) 2.24 (1.0, 4.49); p = 0.049] and bucket handle tears were significantly associated with subsequent surgery, with no difference between the other types of tears. The presence of chondral changes did not significantly affect the rate of surgery [0.81 (0.60, 1.08); n.s]. CONCLUSION: Meniscal tears were found to be more common than previously described. However, less than half present to secondary care and only 22% undergo arthroscopy. These findings should inform future study design and recruitment strategies. In agreement with previous literature, bucket handle tears and root tears were significant predictors of subsequent surgery. LEVEL OF EVIDENCE: III.


Assuntos
Traumatismos do Joelho , Lesões do Menisco Tibial , Adolescente , Adulto , Artroscopia , Humanos , Traumatismos do Joelho/diagnóstico , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Imageamento por Ressonância Magnética , Meniscos Tibiais , Pessoa de Meia-Idade , Estudos Retrospectivos , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/epidemiologia , Lesões do Menisco Tibial/cirurgia , Adulto Jovem
19.
Int J Sports Med ; 42(2): 175-182, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32920800

RESUMO

The purpose of this article is to present how predictive machine learning methods can be utilized for detecting sport injury risk factors in a data-driven manner. The approach can be used for finding new hypotheses for risk factors and confirming the predictive power of previously recognized ones. We used three-dimensional motion analysis and physical data from 314 young basketball and floorball players (48.4% males, 15.72±1.79 yr, 173.34±9.14 cm, 64.65±10.4 kg). Both linear (L1-regularized logistic regression) and non-linear methods (random forest) were used to predict moderate and severe knee and ankle injuries (N=57) during three-year follow-up. Results were confirmed with permutation tests and predictive risk factors detected with Wilcoxon signed-rank-test (p<0.01). Random forest suggested twelve consistent injury predictors and logistic regression twenty. Ten of these were suggested in both models; sex, body mass index, hamstring flexibility, knee joint laxity, medial knee displacement, height, ankle plantar flexion at initial contact, leg press one-repetition max, and knee valgus at initial contact. Cross-validated areas under receiver operating characteristic curve were 0.65 (logistic regression) and 0.63 (random forest). The results highlight the difficulty of predicting future injuries, but also show that even with models having relatively low predictive power, certain predictive injury risk factors can be consistently detected.


Assuntos
Traumatismos do Tornozelo/epidemiologia , Traumatismos em Atletas/epidemiologia , Traumatismos do Joelho/epidemiologia , Aprendizado de Máquina , Esportes Juvenis/lesões , Adolescente , Adulto , Criança , Teste de Esforço , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Força Muscular , Fatores de Risco , Adulto Jovem
20.
Br J Sports Med ; 55(12): 676-682, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33046453

RESUMO

OBJECTIVES: The Professional Rugby Injury Surveillance Project is the largest and longest running rugby union injury surveillance project globally and focuses on the highest level of rugby in England. METHODS: We examined match injuries in professional men's rugby over the period 2002/2003 to 2018/2019 and described trends in injuries over this time. RESULTS: Over the period 2002/2003-2018/2019, 10 851 injuries occurred in 1 24 952 hours of match play, equating to a mean of 57 injuries per club per season and one injury per team per match. The mean incidence, severity (days absence) and burden (days absence/1000 hours) of injury were 87/1000 hours (95% CI 82 to 92), 25 days (95% CI 22 to 28) and 2178 days/1000 hours (95% CI 1872 to 2484), respectively. The tackle accounted for 43% injuries with running the second most common activity during injury (12%). The most common injury location was the head/face with an incidence of 11.3/1000 hours, while the location with the highest overall burden was the knee (11.1 days/1000 hours). Long-term trends demonstrated stable injury incidence and proportion of injured players, but an increase in the mean and median severity of injuries. Concussion incidence, severity and burden increased from the 2009/2010 season onwards and from 2011 to 2019 concussion was the most common injury. CONCLUSION: The rise in overall injury severity and concussion incidence are the most significant findings from this work and demonstrate the need for continued efforts to reduce concussion risk as well as a greater understanding of changes in injury severity over time.


Assuntos
Concussão Encefálica/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Faciais/epidemiologia , Futebol Americano/lesões , Traumatismos do Joelho/epidemiologia , Estações do Ano , Inglaterra/epidemiologia , Futebol Americano/estatística & dados numéricos , Futebol Americano/tendências , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Vigilância da População , Volta ao Esporte/estatística & dados numéricos , Risco , Esportes de Equipe , Fatores de Tempo
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