Results of a tri-national online survey on the current status of sports injury prevention among members of the German-Speaking Orthopaedic Sports Medicine Society (GOTS).

OBJECTIVES: To assess the current opinions and state of knowledge in primary sports injury prevention among members of the German-Speaking Society for Orthopaedic and Traumatologic Sports Medicine (GOTS). METHODS: On 21 August 2019, a web-based questionnaire was sent to the members of the tri-national society GOTS (Austria, Germany and Switzerland). The survey was online until 21 November 2019 and included twenty-two questions, which were divided into five sections: 1) general importance of prevention (n = 4), 2) specifications of the study population (n = 3), 3) implementation of prevention (n = 8), 4) improvement opportunities in prevention (n = 4) and 5) future research areas (n = 3). RESULTS: A total of 272 participants completed the survey, representing a total survey participation of 17.7 % of all members. The study population consisted of orthopaedic surgeons (55 % with surgical and 21 % with non-operative orientation), medical students (10 %), physical therapists (8 %) and sports scientists (4 %). Ninety-four percent of all participants stated that they considered the importance of sports injury prevention to be "very high" (68 %) or "high" (26 %). However, almost 70 % of all participants stated that they spend less than one hour per week on injury prevention work. The term "prevention" was clearly defined and practicable for only 40 %, understandable but difficult to implement for 51 %, and unclear and difficult to implement for 9 % of the participants. Seventy-two percent of respondents were aware of existing prevention programs such as "Stop-X" or "FIFA 11 +", whereas 28 % of participants were uninformed regarding these programs. CONCLUSIONS: A strong divergence was identified between participants' perception of the importance of sports injury prevention and the existing implementation of preventive measures. Future funding of prevention programs, expansion of research strategies for injury prevention and better financial reimbursement are of utmost importance.

Abnormal landing strategies after ACL reconstruction.

The objective was to analyze muscle activity and movement patterns during landing of a single leg hop for distance after anterior cruciate ligament (ACL) reconstruction. Nine (six males, three females) ACL-reconstructed patients 6 months after surgery and 11 (eight males, three females) healthy control subjects performed the hop task. Electromyographic signals from lower limb muscles were analyzed to determine onset time before landing. Biomechanical data were collected using an Optotrak Motion Analysis System and force plate. Matlab was used to calculate kinetics and joint kinematics. Side-to-side differences in ACL-reconstructed patients and healthy subjects as well as differences between the patients and control group were analyzed. In ACL-reconstructed limbs, significantly earlier onset times were found for all muscles, except vastus medialis, compared with the uninvolved side. The involved limbs had significantly reduced knee flexion during the take-off and increased plantarflexion at initial contact. The knee extension moment was significantly lower in the involved limb. In the control group, significantly earlier onset times were found for the semitendinosus, vastus lateralis and medial gastrocnemius of the non-dominant side compared with the dominant side. Muscle onset times are earlier and movement patterns are altered in the involved limb 6 months after ACL reconstruction.

Nonoperative treatment of muscle injuries - recommendations from the GOTS expert meeting.

BACKGROUND: Muscle injuries are some of the most common injuries in sports; they have a high recurrence rate and can result in the loss of ability to participate in training or competition. In clinical practice, a wide variety of treatment strategies are commonly applied. However, a limited amount of evidence-based data exists, and most therapeutic approaches are solely based on "best practice". Thus, there is a need for consensus to provide strategies and recommendations for the treatment of muscle injuries. METHODS: The 2016 GOTS Expert Meeting, initiated by the German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), focused on the topic of muscle and tendon injuries and was held in Spreewald/Berlin, Germany. The committee was composed of twenty-two medical specialists. Nine of them were delegated to a subcommittee focusing on the nonoperative treatment of muscle injuries. The recommendations and statements that were developed were reviewed by the entire consensus committee and voted on by the members. RESULTS: The committee reached a consensus on the utility and effectiveness of the management of muscle injuries. MAIN RESULTS: the "PRICE" principle to target the first inflammatory response is one of the most relevant steps in the treatment of muscle injuries. Haematoma aspiration may be considered in the early stages after injury. There is presently no clear evidence that intramuscular injections are of use in the treatment of muscle injuries. The ingestion of non-steroidal anti-inflammatory drugs (NSAIDs) should be regarded critically because there is currently no hard evidence to support their use, although they are appropriate in exceptional cases. CONCLUSIONS: The present work provides a structured overview of the various nonoperative treatment strategies of muscle injuries and evaluates their effectiveness with respect to the existing scientific evidence and clinical expertise in the context of basic science on the healing process of muscle injuries. The committee agreed that there is a compelling need for further studies, including high-quality randomized investigations to completely evaluate the effectiveness of the existing therapeutic approaches. The given recommendations may be updated and adjusted as further evidence will be generated.

Leg kinematics and kinetics in landing from a single-leg hop for distance. A comparison between dominant and non-dominant leg.

BACKGROUND: Anterior cruciate ligament (ACL) deficiency can be a major problem for athletes and subsequent reconstruction of the ACL may be indicated if a conservative regimen has failed. After ACL reconstruction signs of abnormality in the use of the leg remain for a long time. It is expected that the landing after a single-leg hop for distance (horizontal hop) might give insight in the differences in kinematics and kinetics between uninjured legs and ACL-reconstructed legs. Before the ACL-reconstructed leg can be compared with the contralateral leg, knowledge of differences between legs of uninjured subjects is needed. METHODS: Kinematic and kinetic variables of both legs were measured with an optoelectronic system and a force plate and calculated by inverse dynamics. The dominant leg (the leg with biggest horizontal hop distance) and the contralateral leg of nine uninjured subjects were compared. FINDINGS: No significant differences were found in most of the kinematic and kinetic variables between dominant leg and contralateral leg of uninjured subjects. Only hop distance and hip extension angles differed significantly. INTERPRETATION: This study suggests that there are no important differences between dominant leg and contralateral leg in healthy subjects. As a consequence, the uninvolved leg of ACL-reconstructed patients can be used as a reference. The observed variables of this study can be used as a reference of normal values and normal differences between legs in healthy subjects.

A critical analysis of limb symmetry indices of hop tests in athletes after anterior cruciate ligament reconstruction: A case control study.

BACKGROUND: Hop tests are frequently used to determine return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). Given that bilateral deficits are present after ACLR, this may result in a falsely high limb symmetry index (LSI), since LSI is calculated as a ratio between the values of the limbs. HYPOTHESIS: Athletes after ACLR would achieve LSI>90% for the hop test. Secondly, athletes after ACLR demonstrate decreased jump distance on the single hop for distance (SLH) and triple leg hop for distance (TLH) and decreased number of hops for the side hop (SH) for both involved and uninvolved limbs compared to normative data of sex, age and type of sports matched healthy athletes. MATERIALS AND METHODS: Fifty-two patients (38 males mean age 23.9±3.5years; 14 females mean age 21.7±3.5 years) who had undergone an ACLR participated in this study. Patients performed the 3 hop tests at a mean time of 7 months after ACLR. Hop distance, number of side hops and LSI were compared with normative data of 188 healthy athletes. RESULTS: The differences between the involved limb and the uninvolved limb were significant in all hop tests (SLH P=0.003, TLH P=0.003, SH P=0.018). For females, only significant between limb differences were found in the SLH (P=0.049). For both the SLH and the TLH, significant differences were found between the involved limb and the normative data (males; SLH P<0.001, TLH P<0.001; females; SLH P<0.001, TLH P=0.006) and between the uninvolved limb and the normative data for both males and females (males; SLH P<0.001, TLH P<0.001; females; SLH P=0.003, TLH P=0.038). For the SH, only significant differences were found between the involved limb and the normative values in males (P=0.033). CONCLUSION: Athletes who have undergone an ACLR demonstrate bilateral deficits on hop tests in comparison to age and sex matched normative data of healthy controls. Using the LSI may underestimate performance deficits and should therefore be analyzed with caution when used as a criterion for RTS after ACLR. LEVEL OF EVIDENCE: III, case control study.

[Current concepts in the diagnosis and rehabilitation of the shoulder in overhead athletes]. / Uberlegungen zur Diagnostik und Rehabilitation des Schultergelenkes bei Uberkopfsportlern.

The purpose of this paper is to present the general guidelines, including implementation of principles of motor learning in the course of the rehabilitation of the shoulder in overhead athletes. The focus is on treating the most common injury pattern of overhead athletes being rotator cuff pathology with secondary bursitis and finally microtraumatic instability. Specific criteria are discussed to determine when the athlete can return to unrestricted sport participation.

Effect of fatigue on landing performance assessed with the landing error scoring system (less) in patients after ACL reconstruction. A pilot study.

BACKGROUND: Fatigue has been shown to affect performance of hop tests in patients after anterior cruciate ligament reconstruction (ACLR) compared to uninjured controls (CTRL). This may render the hop test less sensitive in detecting landing errors. The primary purpose of this study was to investigate the effect of lower extremity fatigue on landing performance assessed with the Landing Error Scoring System (LESS) in patients after ACLR compared to a CTRL group. It is plausible that fatigue would have an effect on confidence and risk appraisal in the ACLR group. The secondary purpose was to determine the relationship between psychological responses and LESS scores after fatigue. METHODS: Twelve patients following ACLR (6 males, 6 females) who were tested at 10 ± 2.4 months after surgery participated in the current study and were compared to 10 subjects in the control group (5 males, 5 females). Subjects performed a jump-landing task and the landing was assessed using the Landing Error Scoring System (LESS) both before and after fatigue. Digital video camcorders recorded frontal and sagittal plane views of the subject performing the task. The LESS was scored using video replay. Psychological responses in the ACLR group were assessed with the ACL-RSI questionnaire. RESULTS: Patients after ACLR had a median LESS of 6.5 which reflects a poor result (LESS >6) in the pre-fatigue condition compared to controls who had a LESS of 2.5 which is considered excellent (≤4). In the post-fatigue condition, median LESS in patients after ACLR increased to 7.0 whereas in the control group the LESS increased to 6.0 both of which reflect a poor result. The median increase in LESS was larger in the control (2.0) group compared to patients after ACLR (1.0) but the difference was not significant (p=0.165). CONCLUSIONS: Patients after ACLR have higher LESS scores at baseline compared to a control group. Fatigue resulted in an increase in scores on the LESS in both groups. LEVEL OF EVIDENCE: 3b.

Return of normal gait as an outcome measurement in acl reconstructed patients. A systematic review.

BACKGROUND: Current clinical outcome measurements may overestimate the long term success of anterior cruciate ligament reconstruction (ACLR). There is a need to understand biomechanics of the knee joint during daily activities. This systematic review provides a comprehensive overview of the literature related to gait in patients following ACLR. The purpose of this systematic review was to investigate the available literature and provide a comprehensive overview of kinematic and kinetic variables that present during gait in patients after ACLR. METHODS: A literature search was performed in AMED, CINAHL, EMBASE, Medline and Scopus between January 2000 and October 2012. Inclusion criteria included articles written in English, German or Dutch, and those reporting on gait analysis in patients after ACLR. Kinematic and/or kinetic data of the uninjured and ACLR knee and healthy controls (CTRL) were outcome measurements of interest. Each study's methodological quality was assessed using the Critical Appraisal Skills Programme critical appraisal tool. RESULTS: Twenty two studies fulfilled the inclusion criteria. A total of 479 patients with a mean age of 27.3 were examined. Time between the injury and surgery and ranged from 3 weeks to 5.7 years. Gait analysis was done at a mean of 29.3 months after surgery. Gait was found to be altered in the sagittal, frontal and transverse planes after ACLR and may take months or years to normalize, if normalization occurs at all. CONCLUSION: Patients after ACLR have altered gait patterns that can persist for up to five years after surgery. It is imperative that rehabilitation techniques are examined in order to minimize changes in knee biomechanics during gait, as they have the potential to impact on the development of osteoarthritis. LEVEL OF EVIDENCE: 3a.