Return to sport after surgical repair of the Achilles tendon.

Achilles tendon rupture is among the most common sports injuries. In patients with high functional demands, surgical repair is preferred to facilitate early return to sporting function. This article reviews the literature and provides evidence-based guidance for return to sport after operative management of Achilles tendon rupture. A search was performed using PubMed, Embase and Cochrane Library for all studies reporting on return to sport after operative management of Achilles tendon rupture. The review included 24 studies reporting on 947 patients, and found that 65-100% of patients were able to return to sport between 3 and 13.4 months post-injury, with incidence of rupture recurrence 0-5.74%. These findings will help patients and healthcare professionals plan a recovery timeline, discuss athletic functionality post-recovery, and understand complications of repair and risk of tendon re-rupture.

Successful Repair of M. obliquus Internus Abdominis Avulsion at the Iliac Crest-Operative Technique in Professional Soccer Players.

OBJECTIVE: Sports related injuries to the anterolateral abdominal wall have been described as side strain injuries or hip pointer. So far, only a few cases of avulsion injuries of the m. obliquus internus abdominis muscle from the iliac crest have been described. All were treated conservatively. The aim of this study is to present the surgical technique. METHODS: This report presents three cases of professional soccer players who were treated surgically with transosseous reattachment to the iliac crest. These male players were 23, 25, and 29 years old. Two of them suffered a direct contusion and one an indirect injury. The diagnosis was suspected based on the patient's history and clinical examination and confirmed by MRI. In each case, the fibrocartilaginous layer of the m. obliquus internus was separated 2 cm from the iliac crest. All three players were operated by aponeurotic m. obliquus internus refixation to the lateral iliac crest (three transosseous drill holes). Return to play was 55, 60, and 122 days postoperatively. Functional limitations, symptoms, sports/recreational activities, and quality of life in terms of occupational, social, emotional, and lifestyle concerns were measured using the iHOT 12 instrument at 11.1 and 9.7 years postoperatively. RESULTS: Six weeks postoperatively, sport-specific training was started. After 2 to 4 months, all three patients were fully reintegrated into their elite sports and unrestricted sports ability was achieved. Long-term follow-up was performed using the German version of the iHOT-12 questionnaire and 92.7% and 99.9% were calculated for the two German speaking soccer players. CONCLUSIONS: Our cases demonstrate that transosseous suture reattachment was a successful procedure that allowed a safe and predictable return to sport. Full performance and excellent, long lasting treatment results were achieved.

Minimum 10-Year Clinical Outcomes After Arthroscopic Capsulolabral Repair for Isolated Posterior Shoulder Instability.

BACKGROUND: Arthroscopic capsulolabral repair for posterior shoulder instability has been shown to improve patient-reported outcomes and return to sport at short-term and midterm follow-up, but long-term outcomes are unknown. PURPOSE: To determine the objective and subjective clinical outcomes of shoulder function after arthroscopic posterior shoulder stabilization at a minimum 10-year follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 53 patients (55 shoulders) with unidirectional recurrent posterior shoulder instability who underwent arthroscopic capsulolabral repair were evaluated at a mean follow-up of 15.4 years. Outcomes such as the American Shoulder and Elbow Surgeons (ASES) shoulder score, Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score, and subjective strength, stability, range of motion, and pain were evaluated preoperatively and postoperatively at a minimum 10-year follow-up. Outcomes from the same patient cohort were previously collected at 3.0-year follow-up and were evaluated for longitudinal analysis. Subgroup analyses for sport type (contact vs noncontact), position (thrower vs nonthrower), and revision versus nonrevision were performed. Risk factors for revision surgery based on magnetic resonance imaging findings, patient characteristics, and surgical findings were investigated. RESULTS: Arthroscopic capsulolabral repair for posterior shoulder instability led to a statistically significant improvement on all outcome measures, with similar values at short-term (3.0-year) and long-term (15.4-year) follow-up. Across the total population, patients with 19 of 55 shoulders (35%) returned to sport at the same preinjury level, and patients with 33 of 55 shoulders (60%) returned to sport at some level. At long-term follow-up, patients with only 22% of shoulders were involved in the primary sport in which the injury was sustained, with patients with 28% of shoulders discontinuing sporting participation because of ongoing shoulder issues. Throwers trended toward lower Kerlan-Jobe Orthopaedic Clinic scores than nonthrowers both preoperatively (36.5 ± 22.8 vs 48.7 ± 22.9, respectively; P = .10) and postoperatively (57.4 ± 27.0 vs 73.5 ± 26.8, respectively; P = .09) but had similar improvements. Contact and noncontact athletes had similar preoperative and postoperative values, with equal improvements after surgery. With failure defined as revision surgery, an ASES score <60, or a stability value >5, 19 of 55 shoulders (35%) met failure criteria at final follow-up. Overall, 7 of 55 shoulders (13%) underwent revision surgery. At long-term follow-up, patients who underwent revision surgery had worse outcomes than those who did not undergo revision (ASES score: 53.1 ± 25.9 vs 81.8 ± 19.4, respectively; P < .001). An acute injury in the postoperative period (P < .001) and a smaller glenoid bone width on magnetic resonance imaging (P = .02) were the only identified risk factors for revision surgery. CONCLUSION: Arthroscopic capsulolabral repair for posterior shoulder instability was a durable treatment option that improved long-term shoulder pain and function and facilitated return to sport in the majority of patients at a mean follow-up of 15.4 years, although a notable proportion of patients met various criteria for failure.

Horse-related injury patterns: a single center report.

BACKGROUND: For ages, humankind and horses have been closely related to occupational and recreational activities. The dangers of engaging with horses have been previously reported. Among sporting activities, horse riding is well-known for its risks. Despite multiple recommendations to wear protective gear, horse-related activities still comprise the risk of severe injuries. This study aimed to examine: (1) if specific mechanisms are correlated to particular injury patterns and (2) if injury types are related to patient demographics. METHODS: From one level I trauma center, between July 2019 and July 2022 (3 years) all emergency reports and discharge letters were retrospectively reviewed by full-text search regarding horse-related injuries. Patient demographics, body mass index, trauma mechanism, injury types, and initiated treatment were extracted from medical records and analyzed. RESULTS: During the study period, 95 patients with 99 horse-related injuries were included. The overwhelming majority of the patients was female (93.7%). Age averaged 35.3 years (range 6 to 71). BMI was 23.6 kg/m2. Inpatient treatment was required in 60.6%. Length of hospital stay averaged 10 days. Surgical treatment was performed in 55 patients (55.6%). Open reduction and internal fixation was the most common procedure (74.5%). Trauma mechanism was fall from a horse followed by being hit by a horse (60.6% and 23.2%, respectively). Injured upper extremities counted up for 52.5% followed by spinal and pelvic injuries (23.2%). Spinal and pelvic injuries were related to fall from a horse (p < 0.001). Injuries to the lower extremities were predominantly caused by a kick of the horse when the rider was unmounted (p = 0.001) and negatively related to a fall from a horse (p = 0.002). Ten patients got their fingers tangled while holding the reins and suffered from injuries to the upper extremity (p < 0.001). Three of them required an amputation (30%). CONCLUSION: Despite the fact that patients are young and healthy, horse related injuries must not be underestimated. In our study, almost two-thirds of the patients required inpatient treatment and 50% underwent surgery. We could show that patient age was related to injury severity according to the Abbreviated Injury Scale (AIS). Spinal and pelvic injuries were significantly related to a fall from a horse with a significantly greater trauma impact according to the AIS. Therefore, these severe entities need to be ruled out in such events. Accidents caused by holding the reins, may result in serious injuries to the hand with 30% requiring an amputation. Doctors need to be aware of possible horse-related injury patterns to reduce morbidity.

Elbow Ulnar Collateral Ligament Tears: A Modified Consensus Statement.

PURPOSE: To establish consensus statements on the treatment of ulnar collateral ligament (UCL) injuries and to investigate whether consensus on these distinct topics could be reached. METHODS: A modified consensus technique was conducted among 26 elbow surgeons and 3 physical therapists/athletic trainers. Strong consensus was defined as 90% to 99% agreement. RESULTS: Of the 19 total questions and consensus statements 4 achieved unanimous consensus, 13 achieved strong consensus, and 2 did not achieve consensus. CONCLUSIONS: There was unanimous agreement that the risk factors include overuse, high velocity, poor mechanics, and previous injury. There was unanimous agreement that advanced imaging in the form of either magnetic resonance imaging or magnetic resonance arthroscopy should be performed in a patient presenting with suspected/known UCL tear that plans to continue to play an overhead sport, or if the imaging study could change the management of the patient. There was unanimous agreement regarding lack of evidence for the use of orthobiologics in the treatment of UCL tears as well as the areas pitchers should focus on when attempting a course of nonoperative management. The statements that reached unanimous agreement for operative management were regarding operative indications and contraindications for UCL tears, prognostic factors that should be taken into consideration in when performing UCL surgery, how to deal with the flexor-pronator mass during UCL surgery, and use of an internal brace with UCL repairs. Statements that reached unanimous agreement for return to sport (RTS) were regarding portions of the physical examination should be considered when determining whether to allow a player to RTS; unclear how velocity, accuracy, and spin rate should be factored into the decision of when players can RTS and sports psychology testing should be used to determine whether a player is ready to RTS. LEVEL OF EVIDENCE: V, expert opinion.

[Sports injuries : What type of imaging is required?] / Sportverletzungen : Welche Bildgebung ist erforderlich?

BACKGROUND: Imaging is of great importance in sports injuries, since the indication for conservative and surgical therapy depends on precise knowledge of the extent of the damage. OBJECTIVES: Typical sports injuries and their imaging requirements are to be presented as examples. CONCLUSIONS: In order to detect the often subtle pathologies, imaging must be adapted to the clinical diagnosis that is specifically suspected.

Pectoralis Major Muscle Belly Rupture in a 17-Year-Old Female Softball Player: A Case Report.

CASE: We report the case of a healthy 17-year-old female softball player with a subacute full-thickness intramuscular tear of the pectoralis major (PM) muscle. A successful muscle repair was obtained using a modified Kessler technique. CONCLUSIONS: Despite initially being a rare injury pattern, the incidence of PM muscle rupture is likely to increase as interest in sports and weight training increases, and although this injury pattern is more common in men, it is becoming more common in women as well. Furthermore, this case presentation provides support for operative treatment of intramuscular ruptures of the PM muscle.

Osteochondral impression fracture of the patella after sports collision injury.

This article reports a case of a teenager who suffered a frontal collision sports injury. Computed Tomography (CT) revealed a fracture of the inferior pole of the patella without obvious displacement and retro patellar cortical impression with 5 mm step off. Surgical intervention was performed using ß-tricalcium phosphate (ß-TCP) and 3.0 cannulated screw fixation.At 3-month follow-up, the wound showed good healing. No pain was observed. The patient was able to flex up to 100° with full extension. There were no signs of hydrops with full stability of the knee.Good postoperative results can be obtained in osteochondral impression fractures of the patella using surgical intervention to elevate the osteochondral fragment, graft it with ß-TCP and raft it with 3.0 cannulated screws.

Clinical characteristics of patients with snow sports trauma transported to a trauma care center: A retrospective observational study.

BACKGROUND: Snow sports are a popular recreational activity; however, the incidence of injury of snow sports can be high for skiers and snowboarders. Our hospital receives severe trauma cases from snow resorts and hospitals throughout the region. This study aimed to determine whether the risk of snow sports-related major trauma that requires emergency surgery under general anesthesia varies by the equipment and injury mechanism. METHODS: This retrospective cohort study included patients with snow sports trauma referred to Gifu University Hospital, Japan between November 2010 and March 2020. We analyzed the need for emergency operation under general anesthesia within 24 h using Fisher's exact test. We identified 106 patients: (1) 90 in the snowboarders' group and 16 in the skiers' group or (2) 46 in the fall after jumping group (jumping group), 27 in the collide with other people and obstacle group (collision group), and 33 in the fall during gliding group (gliding group). RESULTS: Snowboarders were nearly twice as likely as skiers to require emergency surgery under general anesthesia (44% vs. 25%; p = 0.236]. No significant associations were found between emergency surgery under general anesthesia and injury mechanism, but half of the patients in the jumping group required emergency surgery. CONCLUSIONS: Snowboard as equipment and falls after jumping as a mechanism of injury tended to be associated with emergency surgery under general anesthesia, with no significant differences. In order to provide adequate resources for snow sports trauma, the cause of the patient's injury is strongly related to the urgency of the condition, and transport to a trauma center should be actively considered. Further studies are warranted with respect to the effects of personal protective equipment and skill level.

London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport.

Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.

The Role of the Hand Surgery Consultant in the Management of the High School and Collegiate Athlete.

For the purpose of this article, we will not use individual sports as the primary delineator; however, the two different levels of play: High School and Collegiate. We plan to share insight that we have gained through decades of practice treating High School sports and collegiate athletes. This article offers readers reliable guidance on not only treating the athlete's hand but understanding the person as a whole and the struggles at each level of play.

Incorporating Biologics Into Your Sports Medicine Practice: Who, What, When, Why, and How?

Orthobiologic techniques can be used in the treatment of a variety of sports medicine pathologies, using an evidence-based approach focused on the value of all available approaches. The orthopaedic surgeon should be aware of the indications for and any technical pearls and pitfalls related to the use of orthobiologic agents as treatment for, or as an adjunct to management of, common sports medicine injuries and pathologies. Expected outcomes, including return to sport/activity, as well as potential complications and how to avoid them, should be considered. Although promising results have been reported, significant lack of high-level studies, inconsistent findings, and variability among current research make it challenging to reach a definitive conclusion about application, target populations, and overall effectiveness.

The Role of the Hand Surgery Consultant in the Care of the Hockey Athlete.

Ice hockey is a high-speed sport played on a slippery ice surface, using sharp skate blades, rigid sticks with a hard rubber puck, and allowing full-force physical contact that includes body checking and fighting. Although many of the same injuries to the hand and wrist occur that are seen in other sports, there is a higher frequency of certain injuries in the hockey athlete due to the forces involved, the way the hockey stick is gripped, torqued, and used, and the fact that players can slash one another with their sticks. Beyond timely and accurate management of the injury itself, the role of the consultant hand surgeon in hockey encompasses mastery of the intangible skills in the art and humanity of medical care. Injury to the hockey athlete sets in motion a dynamic process that involves many stakeholders who each require your knowledge of how this will affect the hockey athlete's immediate and long-term health, how long they may be out of competition, and the kind of treatments, splints and equipment modifications that could help foster the earliest return-to-play in a safe manner. The consultant hand surgeon needs the ability to communicate information at a high level to team physicians and trainers while remaining nimble enough to simplify that information for general managers, coaches, agents, and athletes. The role demands commitment in time and flexibility, remaining open to gray areas in treatment options, possessing a creative mindset for problem-solving, and the ability to quickly assimilate vast amounts of information to provide a risk assessment of short and long-term implications the injury presents to both the player and the team.

Return to sport after conservative versus surgical treatment for pubalgia in athletes: a systematic review.

BACKGROUND: To assess the time required to return to sport (RTS) after conservative versus surgical treatment in athletes for pubalgia. METHODS: The PRISMA guidelines were followed. Pubmed, SportDiscus and Web of Science were last accessed on September 2022. All the studies investigating the time to RTS after conservative versus surgical treatment in athletes for pubalgia. RESULTS: In total, 33 studies were selected for full text assessment, and 10 studies were included in the qualitative analysis. Seven studies reported data on conservative management, two on surgical management and one compared both. A total of 468 subjects were included for analysis. 58.7% (275 of 468) were soccer players, 5.9% (28 of 468) runners, and 3.8% (18 of 468) hockey players. Two studies did not specify the type of sport. The quality of the studies detailing the results of conservative management was higher than surgical procedures. CONCLUSION: This review highlights that individuals undergoing surgery for pubalgia may return to sport earlier than those receiving conservative treatment. However, conservative management should be considered before surgical treatment is indicated.

Using Motion Analysis in the Evaluation, Treatment & Rehabilitation of Pediatric & Adolescent Knee Injuries: A Review of the Literature.

Three-dimensional motion capture systems may improve evaluation, treatment, and rehabilitation of knee injuries, because quantitative assessment of the knee improves understanding of biomechanical mechanisms. The benefit of using motion analysis in pediatric sports medicine is that it allows closer and more focused evaluation of sports injuries using kinematics, kinetics, and electromyogram with physical and imaging to determine what is happening dynamically during sports. Future research investigating knee injuries should focus on identifying risk factors, assessing the effectiveness of surgical and nonsurgical interventions, and developing return to sport/rehabilitation protocols. The literature is focused on motion capture in adults with knee injuries.

Postoperative MR Imaging of the Elbow.

Elbow injuries are a growing problem particularly among overhead athletes, because more children and adolescents are participating in sporting activities. The goal of surgical management of elbow injuries is to restore the capsuloligamentous and osseous contributions to stability. However, postoperative MR imaging evaluation is difficult because of the variety of surgical techniques available, and the lack of postoperative MR imaging for suspected complications because many are diagnosed clinically and a revision may be performed without imaging. This article reviews some of the commonly performed surgical techniques for select elbow injuries, with their postoperative MR imaging findings and complications.

Postoperative MR Imaging of the Pubic Symphysis and Athletic Pubalgia.

MR imaging evaluation can be valuable in patients with prior surgery for athletic pubalgia presenting with new, recurrent, or persistent groin pain. The clinical and interventional history as well as comparison with preoperative imaging is essential for imaging interpretation. Imagers should be aware of expected and unexpected postoperative findings. MR imaging findings concerning for infection, new injury, contralateral injury, or concomitant sources of symptoms (such as hip pathology) should be reported when present.

[Anesthesia management of athletes' operation in Beijing Olympic Winter Games].

According to literature reports, the injury rate of the athletes in Olympic Winter Games recent years was as high as 10%-14%. Combined with the background of corona virus disease 2019 (COVID-19), the medical insurance work of the 24th Olympic Winter Games held in Beijing had put forward more complicated requirements and more severe challenges. In order to better optimize anesthesia management, this article summarized the perioperative treatment of athletes in Olympic Winter Games, the safety protection strategy of medical staff under general anesthesia, and the potential impact of peri-operative drugs on athletes. Anesthesiologists, as the core members of the rescue team, should be familiar with the particularity of operative anesthesia of athletes, sum up relevant experience to ensure the safety of perioperative patients. So all kinds of technical measures should be taken in the process of operation to minimize the indoor pollution caused by the patient's cough. For example, all the patients should wear N95 masks from the ward to the operating room, and after the operation, wear the N95 masks back to the ward. Although the International Olympic Committee had banned more than 200 drugs for participants and athletes who had to strictly follow International Olympic Committee requirements during anesthesia, the athletes were no longer participating in this Olympic Winter Games, so opioids (sufentanil and remifentanil) and glucocorticoid (dexamethasone) could be used according to the actual needs of surgery and anesthesia. Five athletes in Yanqing competition area underwent surgical anesthesia in Peking University Third Hospital Yanqing Hospital. All the five patients received general anesthesia, of whom four underwent orthopaedic surgery and one underwent laparoscopic cholecystectomy. General anesthesia with laryngeal mask airway was the first choice in the five patients. And the pain after orthopaedic surgery was severe and nerve block technique could effectively relieve the pain after surgery. Three patients received ultrasound-guided nerve block analgesia, the postoperative analgesia lasted 36 h. After the operation, non-steroidal anti-inflammatory drug (NSAID) was infused intravenously in the ward and all the patients recovered uneventfully. As the core member of the trauma rescue team, anesthesiologists should be familiar with the particularity of the athletes' surgical anesthesia, do a good job in medical security, and summarize relevant experience to ensure the life safety of the perioperative patients.

Feedforward Control Combined with 4F Management on Postoperative Nursing Effects and Motor Function of Meniscus Sports Injuries: Based on a Prospective Case Analysis.

Background: Because active functional training and management after knee cartilage sports injury is the key to treatment, care of patients after an operation with knee cartilage sports injury is critical. Aims: To explore the effect of feedforward control combined with 4F management and after an operation nursing effect on patients with knee cartilage sports injury. Materials and Methods: According to the random number table method, 100 patients with knee cartilage sports injury who were nursed in our hospital from June 2019 to June 2021 were selected as the research objects and divided into the control group and the instance of watching, noticing, or making a statement group with 50 cases in each group according to the different nursing order. Among them, the control group adopted 4F management combined with feedforward control nursing mode: all-weather, whole-process, whole-system, and all-around services for patients. On this basis, the instance of watching, noticing, or making a statement group cooperated with early healing/repairing training to compare fear and stress-related self-test of the two groups of patients after an operation. Knee function and quality of care are scored using tables. Results: After nursing, the knee joint function score of the instance of watching, noticing, or making a statement group was higher than that of the control group, while the pain after the operation, sleep quality, fear, and stress self-rating scale scores were significantly lower than the control group (P < 0.05). The whole-process management, body position placement, risk evaluation, repairing training, all-weather service, whole-system management, and comprehensive service of the two groups of patients were very much improved. The nursing quality of watching, noticing, or making a statement group was significantly higher than the control group (P < 0.05). Conclusion: Feedforward control combined with 4F management combined with early repairing training can effectively reduce the fear and stress after an operation pain and sleep quality of knee cartilage sports injury and help increase the recovery of knee combined function in a good way.