Changes in circulating microRNAs following head impacts in soccer.

AIM: To explore the short-term effects of accidental head impacts and repetitive headers on circulating microRNAs, accounting for the effects of high-intensity exercise alone. METHODS: Blood samples were collected from professional soccer players at rest. Repeat samples were drawn 1 h and 12 h after three conditions: (1) accidental head impacts in a match, (2) repetitive headers during training, and (3) high-intensity exercise. 89 samples were screened to detect microRNAs expressed after each exposure. Identified microRNAs were then validated in 98 samples to determine consistently deregulated microRNAs. Deregulated microRNAs were further explored using bioinformatics to identify target genes and characterize their involvement in biological pathways. RESULTS: Accidental head impacts led to deregulation of eight microRNAs that were unaffected by high-intensity exercise; target genes were linked to 12 specific signaling pathways, primarily regulating chromatin organization, Hedgehog and Wnt signaling. Repetitive headers led to deregulation of six microRNAs that were unaffected by high-intensity exercise; target genes were linked to one specific signaling pathway (TGF-ß). High-intensity exercise led to deregulation of seven microRNAs; target genes were linked to 31 specific signaling pathways. CONCLUSION: We identified microRNAs specific to accidental head impacts and repetitive headers in soccer, potentially being useful as brain injury biomarkers.

Medial patellofemoral ligament reconstruction is superior to active rehabilitation in protecting against further patella dislocations.

PURPOSE: Isolated reconstruction of the medial patellofemoral ligament (MPFL-R) has become the predominant stabilizing procedure in the treatment of recurrent lateral patellar dislocation (LPD). To minimize the risk of re-dislocations, isolated MPFL-R is recommended in patients with no significant trochlea dysplasia and tibial tuberosity trochlear groove distance < 20 mm on computed tomography (CT). Incidentally, these criteria are the same that are used to identify first time LPD patients where conservative treatment is recommended. The purpose of this study was therefore to compare MPFL-R with active rehabilitation for patients with recurrent LPD (RLPD) in absence of the above mentioned underlying anatomical high-risk factors for further patellar dislocations. METHODS: RLPD-patients aged 12-30 without underlying anatomical high-risk factors for further LPD were randomized into treatment either with isolated MPFL-R or active rehabilitation provided and instructed by a physiotherapist. All patients underwent diagnostic arthroscopy for concomitant problems. The main outcome measure was persistent patellar instability at 12 months. Knee function at baseline and 12 months was asses using the following patient reported outcomes measures (PROMS); KOOS, Kujala, Cincinnati knee rating, Lysholm score and Noyes sports activity rating scale. RESULTS: Between 2010 and 2019, 61 patients were included in the study (MPFL-R, N = 30, Controls, N = 31). Persistent patellar instability at 12 months was reported by 13 (41.9%) controls, versus 2 (6.7%) in the MPFL-group (RR 6.3 (95% CI 1.5-25.5). No statistically significant differences in activity level were found between the MPFL-group and the Controls at neither baseline nor follow up. The patients with persistent instability at 12 months did not score significantly lower on any of the PROMs compared to their stable peers, regardless of study group. CONCLUSION: Patients with recurrent patellar dislocations have a six-fold increased risk of persistent patellar instability if treated with active rehabilitation alone, compared to MPFL-R in combination with active rehabilitation, even in the absence of significant anatomical risk factors. Active rehabilitation of the knee without MPFL-R improves patient reported knee function after one year, but does not protect against persistent patellar instability.

Neurofilament light and tau in serum after head-impact exposure in soccer.

Introduction: Blood-based biomarkers can provide valuable information on the effects of repetitive head impacts in sports. This study investigated if repetitive headers or accidental head impacts in soccer could cause structural brain injury, detected as an increase in serum neurofilament light (NfL) or tau.Methods: NfL and tau were measured in professional soccer players in pre-season. Then, the effect of three short-term exposures on biomarker levels was assessed: (1) high-intensity exercise, (2) repetitive headers, and (3) head impacts in a match.Results: We analyzed 354 samples and observed no effects on NfL from any of the three short-term exposures. Tau levels rose significantly from baseline to 1 h after (1) high-intensity exercise (Δ0.50 pg/mL, 95% CI 0.19-0.81, p < .01); the same was observed after (2) repetitive headers (Δ0.29 pg/mL, 95% CI 0.10-0.48, p < .01), but not after (3) accidental head-impact incidents (Δ0.36 pg/mL, 95% CI -0.02-0.74, p = .06). The highest absolute values were seen 1 h after high-intensity exercise (mean±SD, 1.92 ± 0.83 pg/mL).Conclusion: NfL and tau in serum were unaffected by head impacts in soccer. Importantly, tau levels seem to rise in response to exercise, emphasizing the need for control groups. Our findings highlight important characteristics and limitations when using these biomarkers in sports.

Recurrent lateral patella dislocation affects knee function as much as ACL deficiency - however patients wait five times longer for treatment.

BACKGROUND: Surgical treatment of young patients with recurrent lateral patella dislocation (RLDP) is often recommended because of loss of knee function that compromises their level of activity or even their daily life functioning. This situation is comparable to young patients with an anterior cruciate ligament (ACL) rupture. The purpose of this study was therefore to explore the time from injury to surgery and the pre-operative symptoms and knee function of young RLPD patients scheduled for stabilizing surgery and compare this group to age and sex-matched ACL-deficient patients. METHOD: Forty-seven patients with unilateral RLPD listed for isolated medial patellofemoral ligament reconstruction were included in the study (RLPD-group). This group was compared to an age, sex and BMI matched ACL patient group obtained from the Norwegian knee ligament registry (ACL-group) for the following outcome measures: the knee injury and osteoarthritis outcome score (KOOS) assessed on the day of surgery and time from injury to surgery. RESULTS: The RLPD-group scored significantly lower than the ACL-group for the three KOOS subscales "Pain" (73.6 vs. 79.8, p < 0.05), "Symptoms" (71.7 vs. 79.3, p < 0.05) and "ADL" (84.7 vs 89.5, p < 0.05). The lowest KOOS values were found for Sports/Recreation (53.5 vs. 51.3, p = 0.65) and Quality of life (37.6 vs. 36.7, p = 0.81). The average time from primary injury to surgery was 6 months for the ACL group and 31 months for the RLPD group. CONCLUSION: RLPD affected knee function as much as ACL deficiency, and was associated with more pain. Still the RLDP patients waited on average 5 times longer for surgery. TRIAL REGISTRATION: The patients with RLPD consisted of patients who were examined for possible recruitment for a concurrent prospective randomized controlled trial comparing conservative treatment and isolated surgical medial patellofemoral ligament (MPFL) reconstruction (Clinical trials no: NCT02263807 , October 2014).

Utility and effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury - a prospective cohort study.

BACKGROUND: In 2013 the Scandinavian Neurotrauma Committee (SNC) published updated guidelines for the initial management of minimal, mild and moderate traumatic head injuries (MTHI) that included serum analysis of protein S100B as a marker for brain tissue damage. This study reviews the effectiveness of the new guidelines in a clinical setting. METHODS: For all patients admitted to Akershus University Hospital (AHUS) from June 30th 2014 to December 15th 2014 with MTHI a separate form was filled in recording the time, indication and result of any S100B sampling and/or head computer tomography (CT) examinations. Data from these forms were compared to information derived from the electronic patient records for patients with MTHI and related diagnoses and data from the laboratory for all patients that had undergone the S100B analysis within the same period. RESULTS: Five hundred seventy-five patients were identified with MTHI, S100B sampling was indicated for 223 (38.8%) patients and carried out for 188 (84.3%) of these patients. 69 (36.7%) of the patients had a negative S100B test, but a head CT scan was still performed in 31 cases despite the negative S100B test. In total the guidelines were followed for 362 of 575 patients (63.0%). 180 (31.3%) of the MTHI cases were discharged without further observation or CT examinations, including 38 (21.1%) as a direct result of S100B testing. No re-admissions or missed initial traumatic brain injuries were observed. CONCLUSION: The implementation of the updated SNC guidelines resulted in direct discharge of more than one third of the MTHI cases without further observation or CT examinations. One in five of these discharges was a direct result of S100B testing. However, compliance to the guidelines were poor and the guidelines were only followed in 40%. While this study showed benefits of implementing SNC guidelines to reduce the number of CT scans, additional training is needed for optimal use.

Association between single leg hop tests and patient reported outcome measures and patellar instability in patients with recurrent patellar dislocations.

Objectives: To assess the associations between the single leg hop tests at two premises; baseline and the change after 12 months, and change in patient reported outcome measures and persistent instability after 12 months in patients with recurrent lateral patellar dislocation (RLPD). Methods: 61 RLPD patients aged 12-30 with a mean (±SD) of 19.2 (±5.3) were assessed at baseline, and at 12 months after treatment with either active rehabilitation alone, or medial patellofemoral ligament reconstruction and active rehabilitation. Single leg hop for distance, triple hop for distance, crossover hop for distance and 6-metre timed hop were performed for both legs, and the Limb Symmetry Index (LSI) was calculated. Persistent patellar instability was self-reported as 'Yes' or 'No' at 12-month follow-up. Knee function in sport and recreational activities and knee-related quality of life were assessed at baseline and 12 months follow-up using the Knee injury and Osteoarthritis Outcome Score (KOOS). Results: LSI for the baseline single leg hop for distance and the triple hop for distance was significantly associated with persistent patellar instability at 12 months follow-up with an OR of 0.94 (95% CI 0.88 to 0.99) and OR of 0.91 (95% CI 0.84 to 0.99), respectively. No other statistically significant associations were detected. Conclusion: Individuals with higher LSI values for the single leg hop for distance and triple hop for distance conducted at baseline had lower odds for persistent patellar instability at 12 months follow-up. Clinicians can use results from these hop tests to assess the risk of future recurrent patellar instability prior to treatment. Study design: Retrospective cohort study. Trial registration number: NCT02263807.

Minor head trauma in soccer and serum levels of S100B.

OBJECTIVE: To compare the serum levels of S100B after head trauma with the effect of heading, high-intensity exercise, and playing in a league match. Heading and head trauma in soccer have been suspected to cause brain impairment. The protein S100B is a marker of acute neuronal tissue damage. METHODS: Baseline S100B was measured in 535 Norwegian professional soccer players. Two hundred twenty-eight head impacts were registered from 352 league matches. Three teams (n = 48) performed a high-intensity exercise session without heading and a low-intensity session with heading exercises. A blood sample was drawn from each participant within 1 hour (B1) after the session, and another sample (B12) was drawn after a match or training session. The players were assigned to four groups: Head Impact (n = 65), Match Control (match participants without head impact, n = 49), High-intensity Exercise (n = 35), and Heading (n = 36). RESULTS: Serum S100B increased from baseline to B1 for all groups. The increase for the match groups (Head Impact and Match Control) was significantly higher than for both training groups. However, no significant differences between the Head Impact and Match Control groups or between the two training groups were found. A total of 39 players (33.9%) had elevated B1 values (>/=0.12 ng/ml) after a match, but these findings were equally distributed between the Match Control and Head Impact groups. CONCLUSION: Both soccer training and soccer matches cause a transient increase in S100B. There is a possible additive effect of activity with high intensity and heading, but minor head impacts do not seem to cause an additional increase.