Clarifying the relationship between physical injuries and risk for suicide attempt in a Swedish national sample.

INTRODUCTION: The Interpersonal-Psychological Theory of Suicide proposes that capability for suicide is acquired through exposure to painful and provocative events (PPEs). Although there is robust evidence for a positive association between aggregate measures of PPEs and risk for suicidal behavior, little is known about the contributions of physical injuries. The present study investigated the relationship between injuries and risk of subsequent suicide attempt (SA). METHODS: Data were from Swedish population-based registers. All individuals born in Sweden between 1970 and 1990 were included (N = 1,011,725 females and 1,067,709 males). We used Cox regression models to test associations between 10 types of injuries (eye injury; fracture; dislocation/sprain/strain; injury to nerves and spinal cord; injury to blood vessels; intracranial injury; crushing injury; internal injury; traumatic amputation; and other or unspecified injuries) and risk for later SA. Analyses were stratified by sex and adjusted for year of birth and parental education. Additional models tested for differences in the pattern of associations based on age group and genetic liability for SA. In co-relative models, we tested the association between each injury type and risk for SA in relative pairs of varying genetic relatedness to control for unmeasured familial confounders. RESULTS: All 10 injury types were associated with elevated risk for SA (hazard ratios [HRs] = 1.2-7.0). Associations were stronger in the first year following an injury (HRs = 1.8-7.0), but HRs remained above 1 more than 1 year after injury exposure (HRs = 1.2-2.6). The strength of associations varied across injury type, sex, age, and genetic liability for SA. For example, the magnitude of the association between crushing injury and risk for SA was larger in females than males, whereas other injuries showed a similar pattern of associations across sex. Moreover, there was evidence to support positive additive interaction effects between several injury types and aggregate genetic liability for SA (relative excess risk due to interaction [RERI] = 0.1-0.3), but the majority of these interactions became non-significant or changed direction after accounting for comorbid psychiatric and substance use disorders. In co-relative models, the pattern of associations differed by injury type, such that there was evidence to support a potential causal effect of eye injury, fracture, dislocation/sprain/strain, intracranial injury, and other and unspecified injuries on risk for SA. For the remaining injury types, HRs were not significantly different from 1 in monozygotic twins, which is consistent with confounding by familial factors. CONCLUSIONS: Injuries are associated with increased risk for subsequent SA, particularly in the first year following an injury. While genetic and familial environmental factors may partly explain these associations, there is also evidence to support a potential causal effect of several injury types on future risk for SA.

Comparative Efficacy of Micro-Needle-Knife Therapy and Acupuncture in Acute Ankle Sprains: A Randomized Controlled Trial.

BACKGROUND Micro-needle knife (MNK) therapy releases the superficial fascia to alleviate pain and improve joint function in patients with acute ankle sprains (AAS). We aimed to evaluate the efficacy and safety of MNK therapy vs that of acupuncture. MATERIAL AND METHODS This blinded assessor, randomized controlled trial allocated 80 patients with AAS to 2 parallel groups in a 1: 1 ratio. The experimental group received MNK therapy; the control group underwent conventional acupuncture treatment at specified acupoints. Clinical efficacy differences between the 2 groups before (time-point 1 [TP1]) and after treatment (TP2) were evaluated using the visual analogue scale (VAS) and Kofoed ankle score. Safety records and evaluations of adverse events were documented. One-month follow-up after treatment (TP3) was conducted to assess the intervention scheme's reliability. RESULTS VAS and Kofoed ankle scores significantly improved in both groups. No patients dropped due to adverse events. At TP1, there were no significant differences between the 2 groups in terms of VAS and Kofoed scores (P>0.05). However, at TP2, efficacy of MNK therapy in releasing the superficial fascia was significantly superior to that of acupuncture treatment (P<0.001). At TP3, no significant differences in scores existed between the groups (P>0.05). CONCLUSIONS This study demonstrates that 6 sessions of MNK therapy to release the superficial fascia safely and effectively alleviated pain and enhanced ankle joint function in patients with AAS, surpassing the efficacy of conventional acupuncture treatment. Future studies should increase the sample size and introduce additional control groups to further validate the superior clinical efficacy of this intervention.

Biceps femoris long head muscle and aponeurosis geometry in males with and without a history of hamstring strain injury.

OBJECTIVES: Hamstring strain injuries (HSIs) commonly affect the proximal biceps femoris long head (BFlh) musculotendinous junction. Biomechanical modeling suggests narrow proximal BFlh aponeuroses and large muscle-to-aponeurosis width ratios increase localized tissue strains and presumably risk of HSI. This study aimed to determine if BFlh muscle and proximal aponeurosis geometry differed between limbs with and without a history of HSI. METHODS: Twenty-six recreationally active males with (n = 13) and without (n = 13) a history of unilateral HSI in the last 24 months underwent magnetic resonance imaging of both thighs. BFlh muscle and proximal aponeurosis cross-sectional areas, length, volume, and interface area between muscle and aponeurosis were extracted. Previously injured limbs were compared to uninjured contralateral and control limbs for discrete variables and ratios, and along the relative length of tissues using statistical parametric mapping. RESULTS: Previously injured limbs displayed significantly smaller muscle-to-aponeurosis volume ratios (p = 0.029, Wilcoxon effect size (ES) = 0.43) and larger proximal BFlh aponeurosis volumes (p = 0.019, ES = 0.46) than control limbs with no history of HSI. No significant differences were found between previously injured and uninjured contralateral limbs for any outcome measure (p = 0.216-1.000, ES = 0.01-0.36). CONCLUSIONS: Aponeurosis geometry differed between limbs with and without a history of HSI. The significantly larger BFlh proximal aponeuroses and smaller muscle-to-aponeurosis volume ratios in previously injured limbs could alter the strain experienced in muscle adjacent to the musculotendinous junction during active lengthening. Future research is required to determine if geometric differences influence the risk of re-injury and whether they can be altered via targeted training.

Diffusion tensor imaging of hamstring muscles after acute strain injury and throughout recovery in collegiate athletes.

OBJECTIVE: To identify the region of interest (ROI) to represent injury and observe between-limb diffusion tensor imaging (DTI) microstructural differences in muscle following hamstring strain injury. MATERIALS AND METHODS: Participants who sustained a hamstring strain injury prospectively underwent 3T-MRI of bilateral thighs using T1, T2, and diffusion-weighted imaging at time of injury (TOI), return to sport (RTS), and 12 weeks after RTS (12wks). ROIs were using the hyperintense region on a T2-weighted sequence: edema, focused edema, and primary muscle injured excluding edema (no edema). Linear mixed-effects models were used to compare diffusion parameters between ROIs and timepoints and limbs and timepoints. RESULTS: Twenty-four participants (29 injuries) were included. A significant ROI-by-timepoint interaction was detected for all diffusivity measures. The edema and focused edema ROIs demonstrated increased diffusion at TOI compared to RTS for all diffusivity measures (p-values < 0.006), except λ1 (p-values = 0.058-0.12), and compared to 12wks (p-values < 0.02). In the no edema ROI, differences in diffusivity measures were not observed (p-values > 0.82). At TOI, no edema ROI diffusivity measures were lower than the edema ROI (p-values < 0.001) but not at RTS or 12wks (p-values > 0.69). A significant limb-by-timepoint interaction was detected for all diffusivity measures with increased diffusion in the involved limb at TOI (p-values < 0.001) but not at RTS or 12wks (p-values > 0.42). Significant differences in fractional anisotropy over time or between limbs were not detected. CONCLUSION: Hyperintensity on T2-weighted imaging used to define the injured region holds promise in describing muscle microstructure following hamstring strain injury by demonstrating between-limb differences at TOI but not at follow-up timepoints.

The 11+ injury prevention programme decreases rate of hamstring strain injuries in male collegiate soccer players.

OBJECTIVES: To investigate if the 11+ injury prevention programme decreases the risk of hamstring injury and improves recovery time and determine whether compliance with the 11+ affects hamstring injury risk. METHODS: This study is a secondary analysis from a prospective cluster randomised controlled trial that included 65 National Collegiate Athletic Association (NCAA) division I and II men's soccer teams over the fall 2012 season. Thirty-one teams were randomised to the intervention group that were using the 11+ as their warm-up and 35 teams to the control group that continued to use their traditional warm-up. Each certified athletic trainer (ATC) collected data on demographics, hamstring injury (HSI), mechanism of injury, position, playing surface, time lost due to injury and compliance to the 11+ programme. RESULTS: The 11+ decreased the risk of HSI by 63% compared with the control group (RR=0.37, 95% CI 0.21 to 0.63). Difference in return to play after HSI between the control (9.4±11.2 days) and intervention groups (10.2±11.3 days) was not significant (p=0.8). High compliance (>2 or more doses on average per week) reduced the risk of HSI by 78% (RR=0.22, 95% CI 0.06 to 0.87) compared with low compliance (<1 dose on average per week), and moderate compliance (1 to <2 doses on average per week) decreased the risk of HSI by 67% (RR=0.33, 95% CI 0.11 to 0.97) compared with low compliance. There was no significant difference between high and moderate compliance. CONCLUSION: The 11+ decreased the risk of HSI by 63% but did not improve recovery time. High to moderate compliance is essential and makes the programme more effective at reducing HSI.

Effectiveness of photobiomodulation therapy in the treatment of patients with an ankle sprain: a systematic review and meta-analysis.

BACKGROUND: Photobiomodulation therapy (PBMT) is widely used in the treatment of patients with musculoskeletal and sports disorders with a lack of significance in patients with sprain ankle. PURPOSE: This review investigated the effect of PBMT on pain, oedema, and function in patients with an ankle sprain. METHODS: A systematic search of the databases (MEDLINE, PubMed, EBSCO, Web of Science, Wiley Online Library, Science Direct, Physiotherapy Evidence (PEDro), and the Cochrane Databases) was performed from inception to the end of 2023 to identify any clinical study investigating the effect of PBMT on ankle sprain. PBMT parameters and measured outcomes were extracted. The primary measured outcome was pain and function, and oedema were secondary measured outcomes. Methodological quality was assessed using the PEDro scale. The level of evidence was determined by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A random effect meta-analysis with forest plot was used to calculate standardized mean difference (SMD) at a 95% confidence interval and the overall effect size (ES). RESULTS: Six studies (598 patients) were included in the review and five studies in the meta-analysis. There were two fair-quality and four good-quality studies, with a moderate level of evidence on pain, and a low level of evidence on oedema and function. The meta-analysis revealed a significant overall effect of PBMT on pain with high ES [SMD - 0.88 (-1.76, -0.00), p = 0.05], with a non-significant effect on oedema and function with a medium ES [SMD - 0.70 (-1.64, 0.24), p = 0.14] on oedema and low ES on function [SMD - 0.22 (-0.69, 0.24), p = 0.35]. Significant heterogeneity was observed in all measured outcomes with high heterogeneity (I2 > 75%) in pain and oedema and moderate heterogeneity in function. CONCLUSION: PBMT is quite effective for patients with an ankle sprain. PBMT showed high effect size with a moderate level of evidence on pain intensity. The lack of significant effects of PBMT on function and edema with low level of evidence limit the confidence to the current results and recommend further large high-quality studies with higher PBMT intensity and fluency for standardisation of the irradiation parameters and treatment protocol. REGISTRATION: PROSPERO registration number (CRD42021292930).

An Epidemiologic Comparison of Injuries to Skiers and Snowboarders Treated at United States Emergency Departments, 2000-2019.

Skiing and snowboarding are popular competitive and recreational sports that can be associated with significant injury. Previous studies of skiing and snowboarding injuries have been conducted, but studies evaluating injury types and patterns over long periods of time are needed to drive effective injury prevention efforts. We hypothesized that injury patterns would differ among snowboarders and skiers and that the number of injuries remained constant over time. This is a retrospective study of patients presenting with skiing or snowboarding injuries to the United States emergency departments from 2000 to 2019. A total of 34,720 injured skiers (48.0%) and snowboarders (52.0%) presented to US emergency departments over a 20-year period, representing an estimated 1,620,576 injuries nationwide. There is a decreasing trend of the number of injuries over the study period (p=0.012). Males represented the majority (65.7%) of injuries. Skiers were older than snowboarders (mean 30.1 vs. 20.0 years; p<0.001) and patients aged<18 represented more snowboarding (57.0%) than skiing (43.0%) injuries (p<0.001). Common diagnoses included fractures (33.0%) and sprains/strains (26.9%). Snowboarders primarily presented with upper extremity injuries, meanwhile, skiers primarily presented with lower extremity injuries. Most patients (93.2%), were treated and discharged from the emergency departments. Understanding the epidemiology of injuries presenting to emergency departments can help guide prehospital care and medical coverage allocation for resorts and event organizers, as well as identifying areas for targeted injury prevention efforts.

Decreased posterior tibial slope is a risk factor for primary posterior cruciate ligament rupture and posterior cruciate ligament reconstruction failure: A systematic review.

PURPOSE: To determine bony knee morphological factors associated with primary posterior cruciate ligament (PCL) rupture or PCL graft failure after PCL reconstruction. METHODS: Three databases, namely MEDLINE, PubMed and EMBASE, were searched on 30th May 2023. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data such as receiver operating characteristic curve parameters, as well as p-values for comparisons of values between patients with PCL pathology and control patients, were recorded. RESULTS: Nine studies comprising 1054 patients were included. Four studies reported that patients with PCL injury had flatter medial posterior tibial slopes (MTS) than controls, with mean values of 4.3 (range: 3.0-7.0) and 6.5 (range: 5.0-9.2) degrees, respectively. Two studies reported an MTS cutoff value ranging below 3.90-3.93° being a significant risk factor for primary PCL rupture or PCL graft failure. Two studies reported that shallow medial tibial depths were associated with primary PCL rupture, with mean values of 2.1 (range: 2.0-2.2) and 2.6 (range: 2.4-2.7) mm in PCL injury and control groups, respectively. Stenotic intercondylar notches and femoral condylar width were not consistently associated with PCL injuries. CONCLUSION: Decreased MTS is associated with primary PCL rupture and graft failure after PCL reconstruction with values below 3.93° being considered as a significant risk factor. Less common risk factors include shallow medial tibial depth, while femoral condylar width and parameters with regards to the intercondylar notch, such as notch width, notch width index and intercondylar notch volume, demonstrated conflicting associations with primary or secondary PCL injuries. LEVEL OF EVIDENCE: Level III.

Smart Shelf System for Customer Behavior Tracking in Supermarkets.

Transactional data from point-of-sales systems may not consider customer behavior before purchasing decisions are finalized. A smart shelf system would be able to provide additional data for retail analytics. In previous works, the conventional approach has involved customers standing directly in front of products on a shelf. Data from instances where customers deviated from this convention, referred to as "cross-location", were typically omitted. However, recognizing instances of cross-location is crucial when contextualizing multi-person and multi-product tracking for real-world scenarios. The monitoring of product association with customer keypoints through RANSAC modeling and particle filtering (PACK-RMPF) is a system that addresses cross-location, consisting of twelve load cell pairs for product tracking and a single camera for customer tracking. In this study, the time series vision data underwent further processing with R-CNN and StrongSORT. An NTP server enabled the synchronization of timestamps between the weight and vision subsystems. Multiple particle filtering predicted the trajectory of each customer's centroid and wrist keypoints relative to the location of each product. RANSAC modeling was implemented on the particles to associate a customer with each event. Comparing system-generated customer-product interaction history with the shopping lists given to each participant, the system had a general average recall rate of 76.33% and 79% for cross-location instances over five runs.

Prognostic Values of Clinical and Anthropometric Characteristics in Lateral Ankle Sprain Following Physiotherapy.

Lateral ankle sprain (LAS) is a common injury in sports and daily activities. The present study aimed to determine the prognostic value of clinical and anthropometric parameters in predicting LAS recovery after physiotherapy. Twenty-seven patients with acute LAS were included in this cohort study. First, prognostic factors and anthropometric variables were assessed, along with the time elapsed since the injury, pain score on a visual analogue scale (VAS), navicular drop, ankle range of motion (ROM), and ambulation status. Second, patients received physiotherapy, and their recovery status was assessed using the foot and ankle outcome score (FAOS) questionnaire immediately (first evaluation) and one month after physiotherapy (second evaluation). Univariate regression analysis and stepwise regression were used to evaluate the association between prognostic factors and outcome predictability. The results of this paper have shown that ambulation status was significantly correlated with all FAOS subscales in both the first and second evaluations, except for the FAOS-symptoms (FAOS-Sx) and FAOS-quality of life (FAOS-QOL) subscales in the first evaluation. The eversion ROM was significantly correlated with the FAOS-Sx and FAOS-Sports and Recreational activities (FAOS-Sport/Rec) subscales in the first evaluation. Additionally, age, height, and VAS were significantly correlated with FAOS-activity of daily living (FAOS-ADL) in the first evaluation, so this means that ambulation status is a valuable predictor of treatment success immediately and one month after physiotherapy intervention and compared to other FAOS subscales, the FAOS-QOL subscale is a more reliable predictor of the effectiveness of physiotherapy.

[Clinical characteristics of posterior malleolus fracture in adults].

Objective: To explore the latest clinical characteristics and development trends of posterior malleolus fracture. Methods: Clinical information of inpatients with posterior malleolus fracture in Shanghai Tongji Hospital and Karamay Central Hospital from January 2014 to December 2022 were reviewed and collected. The imaging data of patients were acquired using the Picture Archiving and Communication Systems. A statistical analysis was performed as to gender, current age, year of admission, injury mechanism, fracture type, and posterior malleolus fracture classification. Moreover, a comparative analysis was conducted on the injury mechanisms and morphological differences of posterior malleolus fracture at different periods, regions, and age groups. Results: A total of 472 patients (210 patients from Shanghai Tongji Hospital and 262 patients from Karamay Central Hospital) with posterior malleolus fracture with a mean age of (48.7±15.6) years were included in this study. The peak of posterior malleolus fracture occurs in the age group of 50-59 years. The injury mechanisms mainly involve low-energy fall and sprain (411 cases, 87.1%), followed by traffic accidents (52 cases, 11.0%), and fall injury from height (9 cases, 1.9%). The number of cases according to different fracture types showed the following descending order: trimalleolar fracture-supination extorsion (335 cases, 71.0%), bimalleolar fracture (60 cases, 12.7%), trimalleolar fracture-pronation extorsion (43 cases, 9.1%), posterior malleolus+tibial shaft fracture (19 cases, 4.0%), simple posterior malleolus fracture (15 cases, 3.2%). The numbers of cases corresponding to the Haraguchi Ⅰ, Ⅱ and Ⅲ type of posterior malleolus fractures was 369 (78.2%), 49 (10.4%), and 54 (11.4%), respectively. The Tongji ⅡA type represented the highest number of cases (249 cases, 52.8%), followed by the ⅡB type (120 cases, 25.4%), Ⅰ type (54 cases, 11.4%), ⅢB type (36 cases, 7.6%), and ⅢA type (13 cases, 2.8%). However, no obvious statistical difference was observed in the injury mechanism, Haraguchi classification, and Tongji classification of posterior malleolus fractures among different years and regions from the year of 2014 to 2022 (all P>0.05). Conclusions: The injury mechanism of posterior malleolus fracture mainly involves low-energy fall and sprain cases. The trimalleolar fracture-supination extorsion, Haraguchi Ⅰ type and Tongji ⅡA type of posterior malleolus fracture are predilection fracture types, and all present an obvious incidence peak in the age group of 50-59 years. There has been no significant change in the development trend of clinical characteristics of posterior malleolus fractures in recent years.

Strengthening exercise and motor control among football players with ankle sprain: A scoping review.

INTRODUCTION: The ankles and feet of footballers are the most commonly affected areas by acute and chronic injuries, especially sprains. The durability of changes in motor control for the sprained injury strongly suggests that central motor commands have been reorganized and restructured involving the sensorimotor system. Indirectly, providing strength training improves muscular strength and benefits cardiometabolic health, coordination, sensorimotor, and motor performance. Thus, this study aimed to identify the effects of strengthening exercises on motor control among footballers with sprained ankles. MATERIALS AND METHODS: This scoping review selected studies published from January 2002 to November 2022. The articles were searched through PubMed Central, BMJ Journal, Science Direct, and Scopus using "motor control", "ankle sprain" and "strengthening exercise" as the keywords. After finding the articles, the information extracted included author, year of publication, country, objective, type of study, and motor control analysis summary. The literature search strategy used Preferred Reporting Items for Systematic Review and a meta-analysis (PRISMA) where studies that are related to strengthening exercise and motor control were selected. RESULTS: From the initial search, 50 articles were found. After processing, only ten articles were further reviewed. The findings demonstrated strengthening exercises provide changes in neurophysiological parameters with motor performance, improved motor control, strength, balance, pain, and functional movement in footballers with sprained ankles. CONCLUSION: This review suggests the application of strengthening exercise interventions not only improves motor control, but strength, balance, pain, and functional performance among footballers with sprained ankles.

Don't Miss Me: Midfoot Sprains, A Point-of-Care Review.

Athletes practicing high-contact sports are exposed to an increased risk of midfoot injuries, namely midtarsal sprains. The complexity of reaching an accurate diagnosis is clearly depicted in the reported incidence of midtarsal sprains, ranging from 5% to 33% of ankle inversion injuries. Because the focus of the treating physician and physical therapist is on lateral stabilizing structures, midtarsal sprains are missed at initial evaluation in up to 41% of patients, with delayed treatment as a result.Detecting acute midtarsal sprains requires a high degree of clinical awareness. Radiologists must become familiar with the characteristic imaging findings of normal and pathologic midfoot anatomy to avoid adverse outcomes such as pain and instability. In this article we describe Chopart joint anatomy, mechanisms of midtarsal sprains, clinical importance, and key imaging findings with a focus on magnetic resonance imaging. A team effort is essential to provide optimal care for the injured athlete.

Ankle Instability Update.

Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with associated lesions of the external complex, deltoid, syndesmosis, and sinus tarsi ligaments are also common. Most ankle sprains respond to conservative treatment. However, up to 20 to 30% of patients can develop chronic ankle pain and instability.New concepts have been recently developed, based on arthroscopic advances, such as microinstability and rotatory ankle instability. These entities could be precursors of mechanical ankle instability and at the origin of frequently associated ankle injuries, such as peroneus tendon lesions, impingement syndromes, or osteochondral lesions.Imaging methods, especially magnetic resonance (MR) imaging and MR arthrography, are key in precisely diagnosing ligament lesions and associated injuries, facilitating an adequate therapeutic approach.

The incidence rate of ACL injuries and ankle sprains in basketball players: A systematic review and meta-analysis.

OBJECTIVE: To quantify the incidence rate of anterior cruciate ligament (ACL) injuries and ankle sprains according to player sex, playing level, and exposure setting (training vs. games) in basketball players. METHODS: PubMed, MEDLINE, Google Scholar, and ScienceDirect were searched. Only studies reporting the number of ACL injuries and/or ankle sprains alongside the number of athlete-exposures (training sessions and/or games) in basketball players were included. RESULTS: Thirty studies (17 reporting ACL injuries and 16 reporting ankle sprains) were included in the meta-analysis. Higher (p < 0.05) ACL injury incidence rates per 1000 athlete-exposures were recorded in females (female: 0.20 95% confidence intervals [0.16-0.25]; male: 0.07 [0.05-0.08]; female-to-male ratio: 3.33 [3.10-3.57]), in players competing at higher playing levels (amateur: 0.06 [0.04-0.09]; intermediate: 0.16 [0.13-0.20]; elite: 0.25 [0.14-0.64]), and in games (games: female, 0.27 [0.21-0.32]; male, 0.06 [0.03-0.08]; training: female, 0.03 [0.02-0.05]; male: 0.01 [0.00-0.02]; game-to-training ratio: 7.90 [4.88-12.91]). Higher (p < 0.05) ankle sprain incidence rates per 1000 athlete-exposures were observed in males (female: 0.82 [0.61-1.03]; male: 0.90 [0.61-1.19]; female-to-male ratio: 0.91 [0.83-0.99]), in players competing at higher playing levels (amateur: 0.54 [0.51-0.57]; intermediate: 1.12 [1.00-1.24]; elite: 1.87 [1.29-2.46]), and in games (games: 2.51 [1.85-3.16]; training: 0.80 [0.52-0.80]; game-to-training ratio: 2.77 [2.35-3.26]). CONCLUSION: According to player sex, ACL injury incidence rate is higher in females, while ankle sprain incidence rate is greater in males. ACL injury and ankle sprain incidence rates are greater in players competing at higher playing levels and during games compared to training.

Chronic changes in muscle architecture and aponeurosis structure following calf muscle strain injuries.

BACKGROUND: Muscle strain injuries in the human calf muscles are frequent sports injuries with high recurrence. Potential structural and functional changes in the medial head of the musculus gastrocnemius (GM) and the associated aponeurosis are not well documented. PURPOSE: To test whether a GM muscle strain injury affects muscle fascicle length, pennation angle, and the morphology of the deep aponeurosis at rest and during muscle contraction long time after the injury. Additionally, electromyography (EMG) of the GM and the soleus muscle during a unilateral heel rise was measured in the injured and uninjured calf. METHODS: GM fascicle length, pennation angle, and aponeurosis thickness was analyzed on dynamic ultrasonography (US) recordings in 10 participants with a chronic calf strain. In addition, US images taken across the distal portion and mid-belly of the GM were analyzed at three different ankle positions. EMG recordings were obtained during a unilateral heel rise. RESULTS: The pennation angle of the injured distal GM was significantly larger compared to the uninjured GM in the contracted, but not the relaxed state. Pennation angle increased more in the injured compared to the uninjured GM during contraction. Fascicle length was shorter in the most distal portion of the injured GM. Fascicles at the distal portion of the injured GM showed a pronounced curvilinear shape as the muscle contracted and the aponeurosis was enlarged in the injured compared to the uninjured GM. The ratio between GM and soleus EMG activity showed a significantly higher relative soleus activity in the injured compared to the healthy calf. CONCLUSION: The greater change in pennation angle and curvilinear fascicle shape during contraction suggest that a long-term consequence after a muscle strain injury is that some muscle fibers at the distal GM are not actively engaged. The significantly enlarged aponeurosis indicates a substantial and long-lasting connective tissue involvement following strain injuries.

Effect of the FIFA 11+ injury prevention program in collegiate female football players over three consecutive seasons.

This study aimed to investigate the preventive effects of the FIFA 11+ for one-season and over three consecutive seasons on the injury incidence rates in collegiate female football players in terms of duration of intervention. A total of 763 collegiate female football players from seven teams belonging to Kanto University Women Football Association Division 1 in 2013-2015 seasons were included in the study. At the start of the study, 235 players were assigned to a FIFA 11+ intervention group (four teams, 115 players) and a control group (three teams, 120 players). The intervention period was set to three seasons, and the players were followed up during this period. The one-season effect of the FIFA 11+ was investigated after each season. The effect of continuous intervention was verified in 66 and 62 players from the intervention and control groups who continued the study for all three seasons, respectively. The one-season intervention showed significantly lower total, ankle, knee, sprain, ligament injury, noncontact, moderate and severe injury incidence rates in the intervention group in each season. Regarding the continuous intervention, compared with the first season, the injury incidence rates in lower extremity, ankle, and sprain, decreased in the intervention group by 66.0%, 79.8%, and 82.2%, respectively, in the second season, and by 82.6%, 94.6%, and 93.4%, respectively, in the third season, indicating the persistent effect of the FIFA 11+. In conclusion, the FIFA 11+ is an effective program for lower extremity injury prevention in collegiate female football players, and preventive effects persist with continuation of the program.

Preventive interventions for lateral ankle sprains: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effect of preventive interventions for lateral ankle sprain in the general population. DATA SOURCES: A search of PubMed, EMBASE, Cochrane CENTRAL, Medline, CINAHL, and ClinicalTrials.gov was conducted up to August 2022. REVIEW METHODS: Randomized controlled trials and prospective cohort studies that evaluated any interventions for preventing lateral ankle sprain were included. Two reviewers independently conducted the search, screening, and data extraction. The methodological quality of each study was assessed using the revised Cochrane risk-of-bias tool for randomized trials or using the Cochrane Risk Of Bias In Non-Randomized Studies tool for prospective cohort studies. RESULTS: Seventeen studies met the inclusion criteria. Proprioceptive training exhibited better effects on preventing future lateral ankle sprain compared with the control group (risk ratio = 0.59, p < 0.001), and a stronger preventive effect was observed in participants with a history of lateral ankle sprain in the subgroup analysis (risk ratio = 0.49, p = 0.02). Compared with no bracing, ankle bracing had no significant better effect in preventing lateral ankle sprain (risk ratio = 0.43, p = 0.05). Proprioceptive training and ankle bracing had similar preventive effects (risk ratio = 0.98, p = 0.97). Limited evidence hindered the synthesis of data on pain, swelling, costs, and time loss. CONCLUSION: Proprioceptive training is recommended for preventing lateral ankle sprain, especially for people with a history of lateral ankle sprain. Bracing seems to have an ambiguous preventive effect and requires more further investigation.

Ancillary findings in distinguishing between anterior cruciate ligament mucoid degeneration and sprain on MRI: a practical approach.

BACKGROUND: Imaging findings of both anterior cruciate ligament (ACL) sprain and mucoid degeneration overlap in some cases, which may cause errors in magnetic resonance imaging (MRI) evaluation. PURPOSE: To determine the ancillary findings on MRI in distinguishing between ACL sprain and mucoid degeneration, and also to obtain a diagnostic scheme. MATERIAL AND METHODS: MRI scans of 77 patients with ACL mucoid degeneration and 77 cases with ACL sprain were retrospectively evaluated to compare with regard to parameters of age, sex, side, the status of posterior cruciate ligament - medial collateral ligament - lateral collateral ligament, bone marrow edema, intraosseous cyst, subchondral sclerosis, chondromalacia, meniscus tear, effusion, and osteochondral body. A decision tree algorithm was created to predict pathology in ACL, whether it was a sprain or mucoid degeneration. RESULTS: The prevalence of female sex, femoral intraosseous cyst, tibial intraosseous cyst, subchondral sclerosis, femoral chondromalacia, tibial chondromalacia, medial meniscus tear, and lateral meniscus tear were significantly higher in the ACL mucoid degeneration group (P < 0.001, P = 0.016, P < 0.001, P = 0.003, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively). The probability of being mucoid degeneration increased 41.2 times (95% confidence interval [CI] = 5.296-321.132) in cases with tibial intraosseous cyst and increased 1.05 times (95% CI = 1.010-1.080) with each one-year increase in age (P < 0.001 and P = 0.011, respectively). The decision tree algorithm had an overall accuracy of 79.2%. CONCLUSION: Ancillary findings are helpful in the diagnosis of suspicious cases for ACL mucoid degeneration and ACL sprain. The decision tree algorithm offers a practical and successful approach to this issue.

Occupational injuries and illnesses among law enforcement officers, 2001-2019: Findings from the Ohio Bureau of Workers' Compensation.

BACKGROUND: Occupational injuries are common among law enforcement officers (LEOs) and can impact an agency's ability to serve communities. Workers' compensation (WC) data are an underutilized source for occupational injury surveillance in the law enforcement field. METHODS: LEOs WC claims from the Ohio Bureau of Workers' Compensation (OHBWC) from 2001 to 2019 were identified based on manual review of the occupation title and injury description. Worker, employer, incident, and injury characteristics were described by claim type-medical-only (MO) and lost-time (8 or more days away from work). Data are presented using injury claim counts. RESULTS: From 2001 to 2019, 50,793 WC claims were identified among Ohio LEOs. Of these, 68% were MO claims (n = 34,622). WC claims significantly decreased over the 19-year period (p < 0.001). Seventy-five percent of WC claims were from a LEO with more than one claim and of these, 34% were from a LEO with five or more claims during the study period. Male officers and those aged 25-54 years incurred the highest proportion of total claims (87.8% & 91.8%, respectively). Violence (n = 17,247; 34%), falls/slips/trips (n = 9079; 17.9%), and transportation events (n = 7977; 15.7%) were the leading events. Among the 50,793 claims, there were 79,637 unique clinical diagnosis groups. The most common injury diagnoses were sprains (n = 32,796; 41.2%) followed by contusions (n = 13,529; 17%). CONCLUSIONS: Results can guide the development or improvement of workplace injury prevention strategies for LEOs. Efforts should be focused on better understanding and preventing violent injury events and sprains among LEOs, as well as preventing multiple injury events.