Mechanisms of Hamstring Injury in Professional Soccer Players: Video Analysis and Magnetic Resonance Imaging Findings.

OBJECTIVE: To describe the injury mechanisms and magnetic resonance imaging (MRI) findings in acute hamstring injuries of male soccer players using a systematic video analysis. DESIGN: Descriptive case series study of consecutive acute hamstring injuries from September 2017 to January 2022. SETTING: Two specialized sports medicine hospitals. PARTICIPANTS: Professional male soccer players aged between 18 and 40 years, referred for injury assessment within 7 days after an acute hamstring injury, with an available video footage of the injury and positive finding on MRI. INDEPENDENT VARIABLES: Hamstring injury mechanisms (specific scoring based on standardized models) in relation to hamstring muscle injury MRI findings. MAIN OUTCOME MEASURES: Hamstring injury mechanism (playing situation, player/opponent behavior, movement, and biomechanical body positions) and MRI injury location. RESULTS: Fourteen videos of acute hamstring injuries in 13 professional male soccer players were analyzed. Three different injury mechanisms were seen: mixed-type (both sprint-related and stretch-related, 43%), stretch-type (36%), and sprint-type (21%). Most common actions during injury moments were change of direction (29%), kicking (29%), and running (21%). Most injuries occurred at high or very high horizontal speed (71%) and affected isolated proximal biceps femoris (BF) (36%). Most frequent body positions at defined injury moments were neutral trunk (43%), hip flexion 45-90 degrees (57%), and knee flexion <45 degrees (93%). Magnetic resonance imaging findings showed that 79% were isolated single-tendon injuries. CONCLUSIONS: According to a video analysis, most hamstring injuries in soccer occur during high-speed movements. Physicians should suspect proximal and isolated single-tendon-most often BF-hamstring injury, if represented injury mechanisms are seen during game play. In addition to sprinting and stretching, also mixed-type injury mechanisms occur.

Fecal Microbiota Monitoring in Elite Soccer Players Along the 2019-2020 Competitive Season.

Physical exercise affects the human gut microbiota, which in turn influences athletes' performance. The current understanding of how the microbiota of professional athletes changes along with different phases of training is sparse. We aim to characterize the fecal microbiota in elite soccer players along with different phases of a competitive season using 16 S rRNA gene sequencing. Fecal samples were collected after the summer off-season period, the pre-season retreat, the first half of the competitive season, and the 8 weeks of COVID-19 lockdown that interrupted the season 2019-2020. According to our results, the gut microbiota of professional athletes changes along with the phases of the season, characterized by different training, diet, nutritional surveillance, and environment sharing. Pre-season retreat, during which nutritional surveillance and exercise intensity were at their peak, caused a decrease in bacterial groups related to unhealthy lifestyle and an increase in health-promoting symbionts. The competitive season and forced interruption affected other features of the athletes' microbiota, i.e., bacterial groups that respond to dietary fiber load and stress levels. Our longitudinal study, focusing on one of the most followed sports worldwide, provides baseline data for future comparisons and microbiome-targeting interventions aimed at developing personalized training and nutrition plans for performance maximization.

Relationship of regional and whole-body morphology to vertical jump in elite soccer players: a data-driven approach.

BACKGROUND: This study aimed to analyze the relationship of regional and whole body morphology to vertical jump performance and to compare the morphological features outlining high and low performers in professional soccer players. METHODS: Twenty-one male soccer players were recruited. Whole and regional (upper and lower limbs) features were obtained in the form of body dimensional measurements. Then, all players were tested for vertical jump performance. A data-driven approach was used to group players according to their jump performance parameters (high vs. low). RESULTS: The regional morphological features presented higher correlations with vertical jump than whole body features. High and low performers were significantly different among upper- and lower-limb morphology. No differences were observed among whole body features. CONCLUSIONS: These findings indicate that, rather than the whole body, the use of morphological features linked to specific body regions may ensure a better interpretation of the soccer players' physical potential in jump performance.

Two-dimensional tracking and TDI are consistent methods for evaluating myocardial longitudinal peak strain in left and right ventricle basal segments in athletes.

BACKGROUND: Myocardial contractility can be investigated using longitudinal peak strain. It can be calculated using the Doppler-derived TDI method and the non-Doppler method based on tissue tracking on B-mode images. Both are validated and show good reproducibility, but no comparative analysis of their results has yet been conducted. This study analyzes the results obtained from the basal segments of the ventricular chambers in a group of athletes. METHODS: 30 regularly-trained athletes were submitted to an echocardiography at rest and after handgrip. Starting from the four-chamber view, overall myocardial function and regional velocities were evaluated. The images obtained were processed to determine strain in left and right ventricle basal segments. Strain was calculated using the TDI method and a validated "speckle tracking" or, more correctly, "feature tracking" algorithm. The statistical analysis included a Student's t-test (p < 0.05). RESULTS: The range of strain values obtained is in agreement with the data reported in the literature. In the left ventricle (LV) the average strain values of the basal segments calculated with TDI on IVS and LW at rest and after stress were: -21.05 +/- 3.31; -20.41 +/- 2.99 and -20.05 +/- 2.61; -21.20 +/- 2.37, respectively. In the right ventricle (RV) the same method gave IVS and LW strain values at rest of -22.22 +/- 2.58 ; -24.42 +/- 5.84, and after HG of -22.02 +/- 5.20 ;-23.93 +/- 6.34. The values obtained using feature tracking were: LV at rest -20.48 +/- 2.65 for IVS, and -21.25 +/- 2.85 for LW; LV after HG: -19.48 +/- 3 for IVS and -21.69 +/- 3.85 for LW. In RV at rest: -21.46 +/- 3.25 for IVS and -24.13 +/- 5.86 for LW; RV after HG: -24.79 +/- 7.9 for IVS and -24.13 +/- 7.0 for LW. Tissue Doppler and "feature tracking" methods showed the respective consistency of the results in the basal segments of myocardial ventricle walls. CONCLUSION: Provided that echographic imaging is good, strain can be computed in athletes by both Doppler-derived and tracking methods. It is technically feasible to use both -interchangeably, at least in basal segments.

ACE I/D polymorphism and cardiac adaptations in adolescent athletes.

PURPOSE: The aim of this cross-sectional study was to determine whether there is a correlation between left ventricular hypertrophy (LVH) and angiotensin converting enzyme (ACE) insertion/deletion (I/D) polymorphism in adolescent athletes. METHODS: Seventy-five competitive soccer players (aged 15 +/- 1.2 yr) and 52 untrained control subjects (aged 15 +/- 1.6 yr) were examined with echocardiography (echo) and bioelectrical impedance analysis. The ACE genotype of all subjects was determined by PCR and correlated with left ventricular mass (LVM) indices. RESULTS: Allele frequencies were comparable between athletes and controls. Body surface area (BSA), fat-free mass (FFM), and all mean echo measurements were significantly greater in athletes than in controls. LVM and LVM indices for both BSA and FFM were all significantly greater in athletes than in controls (LVM 195.3 +/- 32 g vs 165.3 +/- 37.6 g; LVM/BSA 115.5 +/- 18.9 g x mq(-1) vs 95 +/- 18.2 g x mq(-1); LVM/FFM 3.5 +/- 0.5 vs 3 +/- 0.54, P < 0.001 for the three variables). Left ventricular hypertrophy was found in 17 (23%) athletes. There was no correlation between ACE I/D polymorphism and athletes with LVH as the II and DD genotype frequencies were identical (41%). However, in athletes with LVH, the presence of the D allele was associated with a greater LVM index than compared to homozygous II genotype (LVM = 145 +/- 7.6 g x mq(-1) in DD+ID group vs 135 +/- 2.9 g x mq(-1) in II group, P = 0.008). CONCLUSIONS: The results of the study show that significant changes occur in cardiac morphology and function in adolescent athletes. Interestingly, the ACE I/D polymorphism was associated with the degree of cardiac hypertrophy but not with the occurrence of LVH itself.

Sarcoidosis in an athlete.

BACKGROUND: Sarcoidosis is a multisystem granulomatous disorder of unknown etiology, characterized by "noncaseating granulomas" in different organs. Clinical signs are variable and dependent on the organ involved. Although it is often asymptomatic in athletes, considering the high level of athletic performance and the related risks due to the potential heart involvement, a particular diagnostic flow-chart to consider some other diagnoses is required. The present case report aimed to focus on the clinical approach in case of a progressive weakness associated with a reduction in global performance of an athlete. CASE PRESENTATION: Since October 2008 a 33-year-old Scandinavian professional soccer player has shown splitting headache, fever and impaired exercise tolerance. Despite some clinical aspects and symptoms that could address diagnosis of granulomatosis according to the current guidelines, the first hypothesis was indicative of a possible viral infection. Therefore, the athlete had received a drug-therapy resolving the headache and fever. However, because of the persisting weakness, several other clinical possibilities were evaluated following a more complete diagnostic flow-chart, blood and instrumental exams. CONCLUSION: This case report focuses on the substantial absence of symptoms during the granulomatosis disease, which makes the differential diagnosis to be often complicating. Indeed, several additional exams are required in order to establish the presence of "Non-evolutive sarcoidosis- stage I", for which the therapy is not mandatory.

The feasibility and usefulness of contrast exercise echocardiography for the assessment of left ventricular function in master athletes.

BACKGROUND: The number of competitive master athletes (MA, over 40 years) has been rising. Since the incidence of coronary artery disease (CAD) is increasing in this population, cardiovascular pre-participation screening, including a maximum exercise test, is recommended. In this context the addition of contrast to echo could be useful because wall thickening and motion are better markers of myocardial function when the whole endocardial border (EB) is visible. OBJECTIVE: To evaluate the feasibility and usefulness of rest and exercise contrast echo for the assessment of LV wall motion in competitive master athletes with suboptimal acoustic windows. METHODS: Forty consecutive MA underwent echo and contrast echo both at rest and during exercise. Contrast-enhanced images were achieved at rest and at peak exercise after administration of SonoVue (BR1), using apical 4 and 2-chamber views divided into 6 myocardial segments (MS). The EB resolution for each segment was graded as: 0=not visible, 1=barely visible, 2=well-delineated. RESULTS: In the baseline at-rest echo 17/40 (45%) patients were graded as score 0, 22/40 (55%) were graded as score 1 and only 1 athlete has reached score 2. In at-rest echo contrast 28/40 (70%) athletes have reached score 1 and 12/40 (30%) score 2. Nobody was graded as score 0. At the same time in the baseline peak-exercise echo 12/40 (30%) athletes were graded as score 0, 24/40 (60%) athletes reached score 1 and 4/40 (10%) score 2, while using contrast at peak-exercise echo 28/40 (70%) were grated as score 1 and 12/40 (30%) reached score 2. The differences about the grading of the score between the two groups with and without contrasts, at rest and at peak exercise, are statistically significant (p<0.001). Considering the whole of the MS analyzed in the majority of the athletic population studied, we can see that at-rest echo, 64/480 MS (13.3%) were graded as 0, 156/480 MS (32.5%) as 1 and 260/480 MS (54.2%) were graded 2, while in the peak-exercise 96/480 MS (20%) were graded as 0, 235/480 MS (48.9%) as 1 and 209/480 MS (43.5%) were graded 2. On the other hand, using contrast, in at-rest echo, 480/480 MS (100%) were graded as 2 while in the peak-exercise echo 460/480 MS (95.9%) were graded as 2 and 20/480 MS (4.1%) as 1. The percentage of the MS graded as 2 reach almost the whole number of the analyzed MS with a percentage increment in the at-rest and peak-exercise echo of 85% and 120%, respectively. CONCLUSIONS: Our results show that the use of contrast echo improves the visibility of the EB in a way that the two groups of competitive athletes show at rest and after exercise a significant increment of the score 2 compatible with a better visibility of the EB. These results suggest that contrast echo, both at rest and during exercise, is a better method for EB analysis to understand the behaviour of the wall motion in subjects with suboptimal acoustic windows, and could be suitable for cardiovascular screening in master athletes.

Microvolt T-wave alternans as predictor of electrophysiological testing results in professional competitive athletes.

BACKGROUND: Several studies have confirmed the equivalence of the microvolt T-wave alternans (mTWA) and the electrophysiology (EPS) tests in cardiac disease. No data are available in populations of competitive athletes with arrhythmias that might jeopardize the pursuit of their professional career. METHODS: We prospectively studied 100 trained competitive athletes, including elite types (72/100), (mean age +/- standard deviation: 26.1 +/- 4.5 years). Forty-eight of them were wholly normal (Group A, mean age: 24.5 +/- 8.5 years) and 52 of them had severe arrhythmias (Group B, mean age: 28.2 +/- 11.5 years) and were symptomatic in 85% of cases for prolonged palpitations and syncope, but lacked any overt structural heart disease at standardized cardiological screening. All athletes were evaluated with the microvolt T-wave alternans exercise-stress test, using the Heart Wave System with Microvolt Sensors. Group B underwent EPS to evaluate inducibility to sustained ventricular tachycardia (VT) during programmed electrical stimulation. RESULTS: In Group A, the mTWA outcome was determinate in 45 subjects (94%) and indeterminate in 3 (6%). No symptomatic event was reported in a follow-up of 36.1 months. In Group B, the mTWA test was positive in 7 symptomatic subjects (15%), indeterminate in 3 (7%), and negative for the remaining 42 subjects (76%). Forty-one of 42 negative mTWA subjects were also negative in the EPS test, without any syncope or sustained VT during 25.3 months of follow-up. In the positive mTWA test subjects, 5 (72%) were positive for inducibility of rapid sustained monomorphic VT in EPS, 1 was positive for severe sustained atrial tachyarrhythmias, and 1 refused EPS. We were able to pronounce a correct diagnosis of lymphocytic myocarditis for only 1 mTWA and EPS-positive subject. For the other 4 positive patients with arrhythmogenic micropathology, severe arrhythmic events were revealed in the follow-up and aggressive hybrid treatment was necessary. CONCLUSION: Microvolt-TWA study seems to be a useful, noninvasive, and feasible tool for evaluating arrhythmic risk in the athletic population. The mTWA test showed a high negative predictive value, using both EPS and the follow-up observation for severe arrhythmic cardiac events as an endpoint. The positive predictive value was present in a limited number of cases that were, however, subjects with a high risk of sudden arrhythmic death.