The effect of repeated concussions on clinical and neurocognitive symptom severity in different contact sports.

INTRODUCTION: The potential consequences of repeated concussions in sport are well documented. However, it remains unclear whether the cumulative impact of sports-related concussions differs between different contact sports. Therefore, the aim of the current study was to investigate the cumulative effects of sports-related concussions on clinical and neurocognitive health in different contact sports. MATERIALS AND METHODS: In a prospective multicenter study, we examined 507 (74 females) active professional athletes between 18 and 40 years of age from five different contact sports (soccer, handball, American football, basketball, and ice hockey). Data collection involved concussion history, clinical symptom evaluation, neurocognitive assessment, and the collection of other sports-related information. Composite scores were built for clinical symptoms (such as neck pain and balance disturbances) and for neurocognitive symptoms (such as memory and attention impairments). RESULTS: Athletes having suffered 3+ concussions in the past showed disproportionally higher clinical symptom severity than athletes with less than three concussions across all sports. The level of clinical symptom burden in athletes with 3+ concussions indicated mild impairment. The number of past concussions did not affect neurocognitive performance. DISCUSSION: Repeated sports-related concussions appear to have a cumulative impact on clinical-but not cognitive-symptom severity. Although clinical symptom burden in athletes with 3+ concussions in the past was not alarmingly high yet in our sample, increased caution should be advised at this point. Despite few exceptions, results are similar for different contact sports, suggesting a similar multidisciplinary concussion management across all types of sport.

Contact allergy in Swedish professional ice hockey players.

BACKGROUND: Professional ice hockey players may contract irritant and allergic contact dermatitis. AIMS: To investigate the presence of contact allergy (CA) in professional ice hockey players in Sweden. METHODS: Ten teams from the two top leagues were assessed for potential occupational exposure to sensitizers. Exactly 107 players were patch tested with an extended baseline series and a working series, in total 74 test preparations. The CA rates were compared between the ice hockey players and controls from the general population and dermatitis patients. RESULTS: One out of 4 players had at least one contact allergy. The most common sensitizers were Amerchol L 101, nickel and oxidized limonene. CA was as common in the ice hockey players as in dermatitis patients and significantly more common than in the general population. Fragrances and combined sensitizers in cosmetic products (fragrances + preservatives + emulsifier) were significantly more common in ice hockey players compared with the general population. CONCLUSION: The possible relationship between CA to fragrances and cosmetic products on the one hand and the presence of dermatitis on the other should be explored further.

Lateral extra-articular tenodesis at primary ACL reconstruction increases career length in professional rugby players.

PURPOSE: To assess the effect of preoperative and surgical factors on return to play (RTP) rates and career longevity of professional rugby athletes after primary anterior cruciate ligament (ACL) reconstruction (ACL-R). METHODS: A retrospective review of a consecutive cohort of professional rugby players undergoing primary ACL-R by the senior author between 2005 and 2019 was undertaken. Athletes were included if they were under contract with a professional rugby team at the time of injury and had a minimum of 2-year follow-up. Univariate and multivariate analyses were performed to determine significant predictors of RTP rate, time and career longevity. RESULTS: One hundred and eighteen rugby players with 125 ACL-Rs were identified. Return to professional rugby was achieved in 115/125 (92%) of cases at an average of 9.6 months and those athletes participated at the professional level for 5.9 ± 3.4 years after ACL-R. Younger age (p = 0.006) and ACL-R with a concomitant lateral extra-articular tenodesis (LET) (p = 0.013) were predictors of a longer career. A Cox proportional hazards model that controlled for age revealed that athletes who underwent ACL-R with an LET had increased career longevity compared to those with an ACL-R without LET (hazard ratio = 2.74, p = 0.021). No factors were significantly associated with RTP rate or RTP time. CONCLUSION: In professional rugby players undergoing primary ACL-R, those having ACL-R with a concomitant LET and younger age predicted increased career longevity. Rugby players who underwent LET at the time of ACL-R had an 18% greater chance of still playing professionally at 5 years compared to those who underwent ACL-R alone. LEVEL OF EVIDENCE: Level III.

The increasing medicolegal cost in the care of high-level athletes.

BACKGROUND: Medical malpractice represents a significant economic cost in health care. Increasingly large damage claims by professional athletes against physicians have raised concerns about the medicolegal challenges in caring for high-level athletes. METHODS: An online proprietary legal research database was queried for lawsuits related to malpractice in the care of professional and amateur athletes from 1992 to 2023. Demographics of plaintiffs and defendants, details of lawsuit filings, and damages claimed were recorded for all cases, settlements, and jury verdicts. Descriptive statistics, linear regression, as well as univariate analysis of demographic factors and damage claims in inflation-adjusted 2023 dollars was performed. RESULTS: Eighty-eight lawsuits were recorded from 1992 to 2023. The sum of indemnities exceeded 186 million in 2023 inflation-adjusted United States Dollars. Football players were the most commonly represented athletes (n = 26) and represented 49% of total financial awards. Fourteen cases (16%) involved treatment of the upper extremity. Professional and collegiate level of play was associated with higher damages in favor of plaintiffs when compared to other levels of play. No other demographic was associated with higher financial awards. Linear regression showed a significant positive trend with an increasing inflation-adjusted compensation for plaintiff verdicts in the last 30 years. CONCLUSIONS: There is an increasing medicolegal financial risk associated with the care of athletes. This is higher in collegiate and professional levels of play. As physicians, insurers and institutions adjust to these financial risks, care must be taken to avoid ramifications on the availability and quality of care provided to athletes. Shoulder and elbow surgeons may consider additional preoperative counseling, legal waiver forms regarding malpractice claims, and advocacy for medical malpractice reforms in the care of athletes with high earning potential to mitigate these increasing financial risks.

Changes in Circulating MicroRNA Levels as Potential Indicators of Training Adaptation in Professional Volleyball Players.

The increasing demand placed on professional athletes to enhance their fitness and performance has prompted the search for new, more sensitive biomarkers of physiological ability. One such potential biomarker includes microRNA (miRNA) small regulatory RNA sequences. The study investigated the levels of the selected circulating miRNAs before and after a 10-week training cycle in 12 professional female volleyball players, as well as their association with cortisol, creatine kinase (CK), and interleukin 6 (IL-6), using the qPCR technique. Significant decreases in the miR-22 (0.40 ± 0.1 vs. 0.28 ± 0.12, p = 0.009), miR-17 (0.35 ± 0.13 vs. 0.23 ± 0.08; p = 0.039), miR-24 (0.09 ± 0.04 vs. 0.05 ± 0.02; p = 0.001), and miR-26a (0.11 ± 0.06 vs. 0.06 ± 0.04; p = 0.003) levels were observed after training, alongside reduced levels of cortisol and IL-6. The correlation analysis revealed associations between the miRNAs' relative quantity and the CK concentrations, highlighting their potential role in the muscle repair processes. The linear regression analysis indicated that miR-24 and miR-26a had the greatest impact on the CK levels. The study provides insights into the dynamic changes in the miRNA levels during training, suggesting their potential as biomarkers for monitoring the adaptive responses to exercise. Overall, the findings contribute to a better understanding of the physiological effects of exercise and the potential use of miRNAs, especially miR-24 and miR-26a, as biomarkers in sports science and medicine.

Return to play of young and adult professional athletes after COVID-19: A scoping review.

Background/objective: Given the persistence of COVID-19 under various facets and mutations, there is an urgent need to understand the debate on a safe return to play for professional athletes (young and adults) recovering from the infection. This work offers a scoping and comprehensive review on the topic during the first two years of the pandemic event by providing an identification of main clusters of research, relevant gaps and significant insights for future investigation. Methods: The literature is selected using the search engines of: PubMed®, SCIENCEDIRECT, and SCOPUS. Further criteria for selection are: Time range of 2020-2022; Scope: Return to play of professional athletes recovering from COVID-19 infection; 3) Types of publications: Research papers, reviews, practice guidelines, case reports; 4) Language: English. Two independent researchers performed a quality check on a random sample (n = 30%) of publications. Results: Main results reveal four research clusters deepening the analysis on: myocarditis, cardiac diseases and return to play, training and rehabilitation, mass screening and risk assessment, and sport and bio-psycho-social sphere for a safe return to play. Major collaborations occur between UK-South Africa, UK-USA, USA-Canada, and USA-Australia. Conclusions: Important gaps refer to a lack of investigation on a safe return to play for female athletes in mostly all sports disciplines; on the other hand, sport and the bio-psycho-social sphere of the athlete is a fast-growing topic. Both deserve further attention in the immediate future to improve ad-hoc sport and exercise practices.

High revision arthroscopy rate after ACL reconstruction in men's professional team sports.

PURPOSE: The study analysed unique data on anterior cruciate ligament (ACL) injuries among German professional male team sports over five consecutive seasons with the aim of improving medical outcomes in the future. Sport-specific differences in injury occurrence, concomitant injuries, timing of ACL reconstruction, graft type selection and short-term complications were examined. METHODS: This retrospective study analysed trauma insurance data on all complete ACL tears from players with at least one competitive match appearance in the two highest divisions of German male basketball, ice hockey, football and handball. Each complete ACL tear registered by clubs or physicians between the 2014/15 and 2018/19 seasons with the German statutory accidental insurance for professional athletes (VBG) as part of occupational accident reporting was included. RESULTS: In total, 189 out of 7517 players (2.5%) sustained an ACL injury, mainly in handball (n = 82; 43.4%) and football (n = 72; 38.1%) followed by ice hockey (n = 20; 10.6%) and basketball (n = 15; 7.9%).Seventeen players (9.0%) also sustained a second ACL injury. Thus, 206 ACL injuries were included in the analysis. The overall match incidence of ACL injuries was 0.5 per 1000 h and was highest in handballs (1.1 injuries per 1000 h). A total of 70.4% of ACL injuries involved concomitant injury to other knee structures, and 29.6% were isolated ACL injuries. The highest rate of isolated ACL injuries was seen in ice hockey (42.9%). All ACL injuries, except for one career-ending injury, required surgery. In the four analysed team sports, hamstring tendons (71.4%) were the most commonly used grafts for ACL reconstruction; football had the highest percentage of alternative grafts (48.7%). During rehabilitation, 22.9% of all surgically treated ACL injuries (n = 205) required at least two surgical interventions, and 15.6% required revision arthroscopy. The main cause of revision arthroscopy (n = 32; 50.0%) was range-of-motion deficit due to arthrofibrosis or cyclops formation. CONCLUSION: The present study shows an overall high rate of revision arthroscopy after ACLR (15.6%), which should encourage surgeons and therapists to evaluate their treatment and rehabilitation strategies in this specific subpopulation. Hamstring tendon grafts are most commonly used for ACL reconstruction but have the highest revision and infection rates. Handball shows the highest ACL injury risk of the four evaluated professional team sports. Concomitant injuries occur in the majority of cases, with the highest share of isolated ACL injuries occurring in ice hockey. LEVEL OF EVIDENCE: Level III.

The Effect of Chronic Endurance Exercise on Serum Levels of MOTS-c and Humanin in Professional Athletes.

Background: Humanin and the mitochondrial open reading frame of the 12S rRNA-c (MOTS-c) are mitochondrial encoded peptides involved in energy metabolism, cytoprotection, longevity, insulin sensitivity and their expression decrease with age. Levels of these molecules have been shown to respond to acute exercise, however little is known about their modulation under different chronic exercise conditions. In this study, we aim to compare levels of Humanin and MOTS-c in non-athletes vs professional (moderate and high endurance) athletes. Methods: Serum samples were collected from 30 non-athlete controls and 75 professional athletes (47 low/moderate endurance and 28 high endurance athletes). Levels of Humanin and MOTS-c were measured by the enzyme linked immunosorbent aaasy (ELISA) and linear models were generated to compare the effect of different levels of endurance exercise on these factors in different age groups. Spearman correlation was used to assess the correlation between these factors in athletes and non-athletes. Results: We showed that professional athletes had lower levels of MOTS-c and higher levels of Humanin than sedentary controls. Within the athletic groups, high endurance athletes had lower levels of Humanin than low/moderate endurance athletes of the same gender/age groups, whereas MOTS-c levels did not change between the subgroups. Humanin and MOTS-c levels were highly correlated in athletes, but not in sedentary controls. Conclusions: This pilot data suggests that serum levels of the mitochondrial proteins MOTS-c and Humanin change in response to chronic exercise with implications on energy metabolism and performance.

Therapeutic Exercise and Conservative Injection Treatment for Early Knee Osteoarthritis in Athletes: A Scoping Review.

Background and Objectives: Recent evidence highlighted a higher prevalence of knee osteoarthritis (kOA) among young and former ex-professional athletes. Although the practice of a highly demanding sport is considered a predisposing factor for the knee joint cartilage degeneration, articular cartilage seems to positively respond to a moderate load increase. We aim to investigate recent evidence on the conservative management of early kOA in athletes, with a particular emphasis on therapeutic exercise and injection treatment, in order to highlight whether there are any indications that can influence clinical and rehabilitation practice. Materials and Methods: A scoping review was conducted, screening MEDLINE and PEDro databases for studies published over the past twenty years on the topic. Studies in English, with accessible abstracts, were included in the review. The PICO framework was used (P-patient: athletes, I-Intervention: conservative treatment with therapeutic exercise or injection therapies, C-Comparison: not needed, O-Outcomes: clinical outcomes). Clinical trials, randomized controlled trials, and longitudinal studies were considered. Results: Four studies were finally included in the review. Therapeutic exercise seems to have beneficial effects on prevention of cartilage degeneration, on pain reduction, and on physical function enhancement. On the other hand, in mild to moderate stages of kOA the intra-articular viscosupplementation with Hyaluronic Acid showed a medium to long-term improvement in joint pain and function. The Platelet Rich Plasma treatment also showed a significant improvement in pain and function up to 12 months. Conclusions: Despite the heterogeneity of the studies considered, a multimodal treatment combining therapeutic exercise and moderate aerobic activity (such as running) should be indicated to prevent kOA development. In cases of symptomatic kOA it may be indicated to add minimally invasive injection therapy that seems to contribute to the improvement of motor function and symptomatology.

Mortality from mental disorders and suicide in male professional American football and soccer players: A meta-analysis.

OBJECTIVE: To determine the risk of mortality from mental disorders and suicide in professional sports associated with repeated head impacts. METHODS: A systematic search was performed in PubMed, Web of Science, Scopus, and SPORTDiscus (since inception to June 8, 2021) to find studies comparing the incidence of mortality from mental disorders or suicide in former or active professional athletes of sports characterized by repeated head impacts vs athletes with no such exposure or the general non-athletic population. RESULTS: Seven retrospective studies of moderate-to-high quality that included data from boxers and from basketball, ice hockey, soccer, and National Football League (NFL) players, respectively (total = 27 477 athletes, 100% male) met all inclusion criteria. Former male NFL players (n = 13 217) had a lower risk of mortality from mental disorders (standard mortality rate [SMR] = 0.30; 0.12-0.77; p = 0.012) and suicide (SMR = 0.54; 0.37-0.78; p < 0.001) than the general population. This finding was also corroborated in male soccer players (n = 13,065; SMR = 0.55; 0.46-0.67; p < 0.001). Male athletes participating in sports associated with repeated head impacts (n = 18,606) had also a lower risk of all-cause, cardiovascular disease (CVD), and cancer mortality (all p < 0.01) than the general population. CONCLUSIONS: Participation of male athletes in American football or soccer at the professional level might confer a certain protective effect against mortality from mental disorders or suicide, besides its association with a lower risk of all-cause, CVD, or cancer-related mortality.

Sex differences in workload-indexed blood pressure response and vascular function among professional athletes and their utility for clinical exercise testing.

PURPOSE: Sex differences in blood pressure (BP) regulation at rest have been attributed to differences in vascular function. Further, arterial stiffness predicts an exaggerated blood pressure response to exercise (BPR) in healthy young adults. However, the relationship of vascular function to the workload-indexed BPR and potential sex differences in athletes are unknown. METHODS: We examined 47 male (21.6 ± 1.7 years) and 25 female (21.1 ± 2 years) athletes in this single-center pilot study. We assessed vascular function at rest, including systolic blood pressure (SBP). Further, we determined the SBP/W slope, the SBP/MET slope, and the SBP/W ratio at peak exercise during cycling ergometry. RESULTS: Male athletes had a lower central diastolic blood pressure (57 ± 9.5 vs. 67 ± 9.5 mmHg, p < 0.001) but a higher central pulse pressure (37 ± 6.5 vs. 29 ± 4.7 mmHg, p < 0.001), maximum SBP (202 ± 20 vs. 177 ± 15 mmHg, p < 0.001), and ΔSBP (78 ± 19 vs. 58 ± 14 mmHg, p < 0.001) than females. Total vascular resistance (1293 ± 318 vs. 1218 ± 341 dyn*s/cm5, p = 0.369), pulse wave velocity (6.2 ± 0.85 vs. 5.9 ± 0.58 m/s, p = 0.079), BP at rest (125 ± 10/76 ± 7 vs. 120 ± 11/73.5 ± 8 mmHg, p > 0.05), and the SBP/MET slope (5.7 ± 1.8 vs. 5.1 ± 1.6 mmHg/MET, p = 0.158) were not different. The SBP/W slope (0.34 ± 0.12 vs. 0.53 ± 0.19 mmHg/W) and the peak SBP/W ratio (0.61 ± 0.12 vs. 0.95 ± 0.17 mmHg/W) were markedly lower in males than in females (p < 0.001). CONCLUSION: Male athletes displayed a lower SBP/W slope and peak SBP/W ratio than females, whereas the SBP/MET slope was not different between the sexes. Vascular functional parameters were not able to predict the workload-indexed BPR in males and females.

Proximal adductor avulsions are rarely isolated but usually involve injury to the PLAC and pectineus: descriptive MRI findings in 145 athletes.

PURPOSE: The purpose of the study is to review the MRI findings in a cohort of athletes who sustained acute traumatic avulsions of the adductor longus fibrocartilaginous entheses, and to investigate related injuries namely the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC). Associated muscle and soft tissue injuries were also assessed. METHODS: The MRIs were reviewed for a partial or complete avulsion of the adductor longus fibrocartilage, as well as continuity or separation of the adductor longus from the pyramidalis. The presence of a concurrent partial pectineus tear was noted. Demographic data were analysed. Linear and logistic regression was used to examine associations between injuries. RESULTS: The mean age was 32.5 (SD 10.9). The pyramidalis was absent in 3 of 145 patients. 85 of 145 athletes were professional and 52 competed in the football Premier League. 132 had complete avulsions and 13 partial. The adductor longus was in continuity with pyramidalis in 55 athletes, partially separated in seven and completely in 81 athletes. 48 athletes with a PLAC injury had a partial pectineus avulsion. Six types of PLAC injuries patterns were identified. Associated rectus abdominis injuries were rare and only occurred in five patients (3.5%). CONCLUSION: The proximal adductor longus forms part of the PLAC and is rarely an isolated injury. The term PLAC injury is more appropriate term. MRI imaging should assess all the anatomical components of the PLAC post-injury, allowing recognition of the different patterns of injury. LEVEL OF EVIDENCE: Level III.

[Musculoskeletal laboratory diagnostics in competitive sport]. / Muskuloskelettale Labordiagnostik im Leistungssport.

BACKGROUND: Laboratory diagnostics represent a valuable tool for the optimization and assessment of the performance and regeneration ability in professional athletes. Blood parameters play an important role in the prevention, diagnosis and rehabilitation of injuries and physical overload. OBJECTIVES: The aim of this article is to present an overview of musculoskeletal laboratory parameters and to provide relevant information for the medical care of competitive athletes. METHODS: Literature search and narrative review. RESULTS: The laboratory assessment of bone metabolism includes vitamin D, calcium and bone turnover and aims to provide a preventive benefit with respect to skeletal complications (e.g., to minimize the risk of bone stress injuries). In addition, muscular serum markers, such as lactate dehydrogenase (LDH), creatine kinase (CK), myoglobin and aspartate aminotransferase (AST) can be used to monitor metabolic adaptation to physical exercise and to obtain information about the muscular workload and potential damage. The energy availability can be estimated and optimized by appropriate balancing and laboratory determination of macro- and micronutrients. CONCLUSIONS: Laboratory diagnostics have a clinical relevance across different sport disciplines. They are intended to support athletes and medical staff on their way to the highest possible performance and help to ensure the optimal prevention of bone and muscle injuries. Parameters with deficiency results (e.g., vitamin D) should be adequately compensated. A periodization of the laboratory tests, with at least two tests per year, and the establishment of individual variability and reference ranges can improve the assessment.

[Results of minimally invasive lumbar fusion in professional athletes: a single-center retrospective study]. / Rezul'taty minimal'no invazivnogo poyasnichnogo spondilodeza u professional'nykh sportsmenov: odnotsentrovoe retrospektivnoe issledovanie.

Professional athletes have a high basic level of physical fitness and significant motivation for returning to previous rhythm of functional activity within the shortest period after trauma without deterioration of baseline level of sportsmanship. Despite the well-presented results of lumbar spine fusion in general population, these data among professional athletes are not well understood. OBJECTIVE: To analyze the results of minimally invasive lumbar fusion in professional athletes. MATERIAL AND METHODS: A retrospective study included 27 athletes (19 men and 8 women) aged 29 (26; 34) years after minimally invasive lumbar spine decompression and fusion via anterior, lateral and posterior approaches. Total lumbar lordosis, degenerative changes in adjacent segment, area of multifidus muscle, perioperative complications and timing of sports rehabilitation were analyzed within 3-5 (mean 4) years after surgery. RESULTS: We found an increase of total lumbar lordosis from 35.2° to 44.1° (p=0.02), no significant muscle atrophy (<30%) and degeneration of adjacent segment (p>0.05). There were 5 perioperative complications (18.5%). Mean period of sports rehabilitation was 14 (9; 17) weeks. One (3.7%) patient did not return to his previous sports career. CONCLUSION: Minimally invasive short-segment lumbar interbody fusion in professional athletes is characterized by low risk of fixation element failure, no significant degeneration of adjacent level and postoperative muscle atrophy. This procedure ensures early rehabilitation and returning to sports.

A Cohort Analysis on the Career Life Cycles of Players of the LPGA of Japan Tour.

The purpose of this study is to investigate the patterns of professional career paths of the players of the Ladies Professional Golf Association of Japan (JLPGA) Tour. Using the athletes' professional career life cycle model as the theoretical framework, this study will analyze the career development of elite players of the JLPGA from their rookie year to the point of retirement. The year of each JLPGA tournament win by selected players will be examined for the players' entire careers. The players' money ranking for each year of their careers is also analyzed to determine the stages of the players' career life cycles. The tournament win span, i.e., the number of years between a player's first and last JLPGA tournament win, will be computed. The career life cycles of players of different cohorts will be compared to determine whether or not there was any transformation in the structure of career stages of the players over time. The career development patterns of Japanese-born players will be compared with those of the international players of the JLPGA.

Association of 25-hydroxy vitamin D level with the blood pressure response to a maximum exercise test among professional indoor athletes.

PURPOSE: Low vitamin D levels have been associated with elevated blood pressure (BP) in the general population. However, whether there is an association of vitamin D insufficiency with BP changes during maximum exercise in athletes is currently unclear. METHODS: A total of 120 male professional indoor athletes (age 26 ± 5 years) were examined. BP was measured at rest and during a graded cycling test. We assessed the BP response (BPR) during maximum exercise and the respective load. BP and BPR (peak-baseline BP) were analysed with respect to 25-OH vitamin D levels, with levels < 30 ng/mL defining vitamin D insufficiency. RESULTS: 35 athletes were classified as being vitamin D insufficient. BP was not different between sufficient and insufficient vitamin D groups (122 ± 10/75 ± 7 vs. 120 ± 12/77 ± 9 mmHg). At maximum exercise, however, systolic BP (198 ± 17 vs. 189 ± 19, p = 0.026) and the pulse pressure (118 ± 18 vs. 109 ± 21 mmHg, p = 0.021) were higher in the sufficient group; the BPR was not different between groups (76 ± 20/5 ± 6 vs. 69 ± 22/3 ± 6 mmHg, p = 0.103). Athletes with sufficient levels had a higher maximum power output (3.99 ± 0.82 vs. 3.58 ± 0.78 W/kg, p = 0.015) and achieved higher workloads (367 ± 78 vs. 333 ± 80 W, p = 0.003). The workload-adjusted BPR (maximum systolic BP/MPO) was not different between athletes with sufficient and insufficient vitamin D levels (51 ± 10 vs. 56 ± 14 mmHg × kg/W, p = 0.079). CONCLUSION: Athletes with sufficient vitamin D achieved a higher maximum systolic BP and a higher maximum power output. The workload-adjusted BPR was not different between groups, which suggests that this finding reflects a better performance of athletes with sufficient vitamin D.

[Osteitis pubis or symphysitis pubis]. / Osteitis pubis oder Symphysitis pubis.

CLINICAL/METHODICAL ISSUE: Osteitis pubis is one of the most common causes of chronic groin pain in many professional athletes. Symphysitis pubis with instability of the joint due to softening of the joint capsule and muscular imbalance of the corresponding muscles increases the instability of the sympyseal region, thus, resulting in a vicious cycle. STANDARD RADIOLOGICAL METHODS: Magnetic resonance imaging (MRI). METHODICAL INNOVATIONS: Optimized MRI sequence protocol with oblique (axial oblique) layers parallel to the linea arcuata of iliac bone together with large image field for depiction of the entire pelvis and high-resolution sequences focused on the symphysis pubis. PERFORMANCE: Recently, the correlation between MRI signs of osteitis pubis and long-term clinical outcome in a group of professional soccer players was examined. In particular, edema in the peri-osseous tissue and isolated muscle lesions around the symphysis at the onset of symptoms were associated with partial recovery of the athletes. Furthermore, a significant association of increased normalized signal intensity in the pubic bone on STIR (short-tau inversion recovery) sequences (corresponding presence and signal intensity of bone marrow edema) and a poor complete clinical improvement was observed. ACHIEVEMENTS: An optimized MRI protocol allows the diagnosis of osteitis pubis and provides important prognostic information. PRACTICAL RECOMMENDATIONS: In case of clinical suspicion on osteitis pubis, MR imaging with an optimized sequence protocol should be performed.

Return to play, performance, and career duration after anterior cruciate ligament rupture: A case-control study in the five biggest football nations in Europe.

A media-based collection and further analysis of relative return to play (RTP) rates and the corresponding quality of play after anterior cruciate ligament (ACL) rupture in top-level football was the aim of our study. In the 5-year case-control study, male players from the first two leagues of the five top leagues in Europe, who sustained a total ACL rupture during the season 2010/11 and/or 2011/12, were included. For them and a matched control sample (ratio 1:2), data were retrieved from the publicly available and validated media-based platforms (transfermarkt.de & whoscored.com) until the end of season 2016/17. Injury and return to play-specific data were calculated as rate ratios (RR) to compare the injured and matched control athletes rates and as a survival analysis (log-rank test; career duration). Overall, 132 ACL-injuries in 125 players occurred. The RTP rate was 98.2%, and the RTP to the same level was 59.4%. Five years post-RTP, 69.9% of the ACL group were still engaged in football (RR = 87%), 40.9% at the same level (RR = 72%). Survival analysis revealed a systematic group difference in career duration compared to controls (Cox-Mantel's χ2  = 5.8; P = 0.016). Game performance (scoring points, P < 0.001; rates/number of completed passes, P = 0.048; and minutes played, P < 0.001) was lower in the ACL athletes than in the matching group in the RTP and post-RTP seasons. Although absolute and relative RTP rates after ACL reconstruction are high in professional football, career duration and game performance are lower than in the reference group.

Return to play after shoulder instability in National Football League athletes.

HYPOTHESIS: We hypothesized that National Football League (NFL) players sustaining a shoulder destabilizing injury could return to play (RTP) successfully at a high rate regardless of treatment type. METHODS: We identified and evaluated 83 NFL players who sustained an in-season shoulder instability event while playing in the NFL. NFL RTP, incidence of surgery, time to RTP, recurrent instability events, seasons/games played after the injury, and demographic data were collected. Overall RTP was determined, and players who did and did not undergo operative repair were compared. RESULTS: Ninety-two percent of NFL players returned to NFL regular season play at a median of 0.0 weeks in those sustaining a shoulder subluxation and 3.0 weeks in those sustaining a dislocation who did not undergo surgical repair (P = .029). Players who underwent operative repair returned to play at a median of 39.3 weeks. Forty-seven percent of players had a recurrent instability event. For players who were able to RTP, those who underwent surgical repair (31%) had a lower recurrence rate (26% vs. 55%, P = .021) and longer interval between a recurrent instability event after RTP (14.7 vs. 2.5 weeks, P = .050). CONCLUSION: There is a high rate of RTP after shoulder instability events in NFL players. Players who sustain shoulder subluxations RTP faster but are more likely to experience recurrent instability than those with shoulder dislocations. Surgical stabilization of the shoulder after an instability event decreases the chances of a second instability event and affords a player a greater interval between the initial injury and a recurrent event.

Treatment of muscle injuries in football.

Muscle injuries are frequent and represent one of the most substantial medical problems in professional football. They can have both traumatic and overuse causes with direct practical consequence due to differences in terms of the post-primary care regimen and prognosis. An accurate diagnosis is the first step towards a specific treatment and usually allows to predict return to play (RTP). Current treatment principles have no firm scientific basis; they are practiced largely as empirical medicine due to a lack of prospective randomised studies. Immediate treatment usually follows the PRICE-principle (protection, rest, ice, compression, elevation). Depending on the type of the muscle injury, specific physical and physiotherapeutical procedures as well as rehabilitative exercises and gradual training therapy are used to recondition the injured structure, to restore coordination and proprioception, and to normalise movement patterns. Injection therapy with various substances is frequently used, with positive results empirically, but evidence in form of prospective randomised studies is lacking. A precise rehabilitation plan should be developed for every muscle injury, including recommendations for sport-specific training with increasing intensity. Since there are no guidelines regarding safe RTP, regular follow-up examinations on the current muscle status are crucial to evaluate the progress made in terms of healing and to determine when the injured muscle can be exposed to the next step of load. This narrative review describes the various factors that a medical team should consider during assessment, treatment and rehabilitation of a muscle injury with particular focus on professional football.