Incidence of injury based on sports participation in high school athletes

Objectives: Youth participation in competitive athletics has significantly increased in the past two decades. There has also been a recent rise in the number of sports injuries that physicians are seeing in young athletes. The objective of this study was to assess the likelihood of sports injuries based on several risk factors in a general sample of athletes at a suburban-area high school.

Methods: This was a cross-sectional study. An online survey was distributed to 2,200 student-athletes at a local high school with a mean age of 15.9 years. Four hundred eighty four (22%) complete responses were received. Data collected in the survey included demographics, frequency of sports participation, level of participation, types of sports played, participation in cross-training, injuries incurred, use of non-steroidal anti-inflammatory drugs, and treatment for sports injuries.

Results: Athletes played an average of 1.6 different sports. The average number of hours of participation in sports annually was 504.3 ± 371.6 hours. The average total number of sports injuries experienced by athletes in our study was 1.7 per participant. 80.8% of respondents reported having sustained at least one sports injury.

A higher total number of hours per year of sports participation and playing a contact sport were significantly associated with more reported lifetime sports injuries. Older age, playing a contact sport, and playing on a travel/club team were associated with students using NSAIDs for sports injuries. Older age, playing a contact sport, and doing cross training are also associated with having had surgery for a sports injury.

Conclusions: Although more hours of participation and playing a contact sport may lead to an increased number of injuries, this risk must be weighed against the myriad of benefits that sports provide for young athletes.     

The drill wobble effect: oversizing the femoral tunnel during ACL reconstruction

Objectives: In ACL reconstruction, autologous tendon graft can be attached to the femur, within a boney tunnel, using an Endobutton device. The ultimate aim being to achieve biological fixation and incorporation into the bone. Accurate bone tunnel diameter to match the tendon graft is vital to biologic incorporation and strength. The common technique of in sequence passing a guide wire, a cannulated 4.5 mm Endobutton drill, then a cannulated femoral socket drill causes the guidewire to lose cortical fixation and stability before the femoral socket drill is passed.

The Objective of this study is to analyze this common technique of femoral socket creation and determine if it results in unintentionally oversizing the femoral socket due to femoral socket drill-wobble over a destabilised guide wire.

Methods: 12 cadaveric femoral pairs equally divided between two groups underwent femoral socket creation in one of the two following sequences.

Group 1: Guidewire, 4.5 mm endobutton drill, 8 mm femoral socket drill. Group 2: Guidewire, 8 mm femoral socket drill, 4.5 mm endobutton drill. The created femoral tunnels apertures and calibres were measured and then compared for accuracy between the two groups.

Results: Passing the 4.5 mm drill before the 8 mm socket drill results in oversized tunnel apertures and calibres when compared to passing an 8 mm socket drill after the 4.5 mm drill has been passed (p<0.0001).

Conclusion: To most precisely create an 8 mm femoral socket in ACL reconstruction, the 8 mm femoral socket reamer followed by the 4.5 mm should be passed over the guide wire to prevent guide wire destabilization and drill-wobble.     

Reduction of anterior glenohumeral dislocations: a new closed reduction technique

Objective: A new closed reduction technique for anterior glenohumeral dislocations and tuberosity fracture dislocations is introduced.

Methods: Forty-one consecutive patients with an acute anterior glenohumeral dislocation or tuberosity fracture dislocation underwent closed reduction by an orthopaedic surgeon employing this new method.

Results: Closed reduction was successful in 88% of patients using the reduction maneuver. Associated fracture with glenohumeral dislocation did not influence the success rate of the reduction maneuver. An assistant was needed in 15% of cases. No complications related to the reduction maneuver were noted amongst the cohort.

Conclusion: This novel reduction technique is safe demonstrating excellent success rates both for anterior shoulder dislocations and tuberosity fracture-dislocations.     

What are the trends and demographics in sports-related pediatric spinal cord injuries?

Objectives: Pediatric spinal cord injury (PSCI) is a devastating injury that can cause significant long-term consequences. The purpose of this study is to calculate and report the prevalence of PSCI, identify risk factors for sports-related PSCI, and evaluate associated factors.

Methods: The data sets of the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID) from 2000–2012 were analyzed using ICD-9-CM external cause of injury codes to identify the mechanism of injury contributing to PSCI hospitalization. We then extracted demographic data on each admission including age, gender, race, and year of admission. We further stratified the data by sports-related cases of injury. Multivariate logistic regression analyses were used to identify independent risk factors.

Results: Of our study population, 0.8% had a documented diagnosis of spinal cord injury (SCI). The most common documented external cause of injury code was motor vehicle accidents, representing roughly half of all cases in patients 0–9 years-old (p = 0.001). PSCI due to sports as an external cause of injury was more prevalent in patients 10–17 years old, and was especially prevalent in the 10–13 year-old age category in which sports-related PSCI reached a high of 25.6%. Risk factors for traumatic PSCI after a sports-related external cause included being of older age, male, and white.

Conclusions: The prevalence of SCI increased with age. Given the popularity of youth sports in the United States, parents and sports officials should be aware of the increased risk of sports-related PSCI among patients 10–17 years old.

Level of evidence: Level III, retrospective cohort study     

Effects of kinesiotaping versus non-steroidal anti-inflammatory drugs and physical therapy for treatment of pes anserinus tendino-bursitis: A randomized comparative clinical trial

Objective: Pes anserinus tendino-bursitis is a condition caused by repetitive friction over the bursa or direct trauma to knee joint and it presents with proximal medial tibial pain and swelling. The aim of this study is to determine the effects of kinesiotaping in comparison with naproxen and physical therapy in treatment of pes anserinus tendino-bursitis.

Methods: In a randomized comparative clinical trial 56 patients with clinical diagnosis of pes anserinus tendino-bursitis were randomly assigned to kinesiotaping and naproxen/physical therapy (28 patients in each group). Kinesiotaping on the tender area in the form of space-correction (lifting) technique was used and repeated for three times with a one-week interval. Another group received naproxen (250mg TID for 10 days) and ten sessions of daily physical therapy. The visual analog scale (VAS) was used for evaluation of pain. The depth of swelling of the area was measured with sonography before and after treatment. Wilcoxon signed ranks test has been used for determining the influence of interventions on pain (VAS) and swelling scores in each group. The ANCOVA (Analysis of covariance) test was applied for comparing the influence of interventions on VAS and swelling scores after adjustment for co-variables.

Results: At end of the study, 27 patients remained in the kinesiotaping group and 19 patients in naproxen/physical therapy group. Treatment with kinesiotaping significantly decreased the pain (P=0.0001) and swelling scores (P=0.0001) in comparison with naproxen/physical therapy after adjustment for baseline characteristics. Kinesiotaping was safe without any complications except for a mild local skin irritation in one patient.

Conclusion: Kinesiotaping is more effective than naproxen plus physical therapy in reduction of pain and swelling in patients with pes anserinus tendino-bursitis.

Clinical trial registration: www.ClinicalTrials.gov identifier is NCT01680263     

Risk factors for shoulder and elbow pain in youth baseball players

Objectives: This study sought to quantify the 1-year cumulative incidence of shoulder and elbow pain among youth baseball players and identify risk factors associated with the occurrence of shoulder and elbow pain.

Methods: In total, 900 youth baseball players (aged 7–11 years) were enrolled in a 1-year prospective follow-up study. One year later, the players were asked whether they had experienced episodes of shoulder or elbow pain and the following risk factors for such pain were investigated: age, position, length of baseball experience, training hours per week, and history of shoulder or elbow pain. Data for the groups with and without shoulder or elbow pain were analyzed using multivariate logistic regression models.

Results: Episodes of shoulder pain were reported by 18.3% of players and episodes of elbow pain were reported by 35.2% of players. Multivariate analysis showed that shoulder pain was associated with pitcher position, catcher position, longer training hours per week, and history of shoulder and elbow pain, and that elbow pain was associated with age, pitcher position, catcher position, longer training hours per week, and history of elbow pain. Length of baseball experience was not associated with shoulder or elbow pain.

Conclusion: History of elbow pain, pitcher position, catcher position, and longer training hours per week were associated with both types of pain. History of shoulder pain was associated with shoulder pain but not elbow pain. Age was associated with elbow pain but not shoulder pain.     

Performance following a first professional concussion among National Basketball Association players

Objectives: Basketball is a physical game played on a hardwood floor among high-jumping athletes at risk for injury. It is currently unknown how sport-related concussion (SRC) affects player performance after injury among professional basketball players. The objective of this study was to explore the impact of SRC on basketball performance among National Basketball Association (NBA) players.

Methods: A retrospective, archival cohort study was performed that compared NBA player performance following concussion to pre-concussive performance. A comprehensive NBA injury database, compiled from publically available sources, was queried for NBA players who suffered concussion from 2005–06 to 2014–15 (10 seasons). Intra-and inter-player analyses were performed against a matched control group of players who missed playing time for personal reasons.

Results: Following application of inclusion/exclusion criteria and a matching process, 51 concussed players and 51 control players were included in analysis. There were no statistically significant decrements in baseline to post-concussion performance metrics in intra-player or player vs. controls after 5 return games.

Conclusions: Our findings suggest that at the NBA level, an athlete’s performance in the initial 5 games following injury does not suffer from the after-effects of concussive injury. These results may be useful in counseling professional athletes following a concussion.     

Is it necessary to perform prehabilitation exercise for patients undergoing total knee arthroplasty: meta-analysis of randomized controlled trials

Objectives: This study was designed to test whether it is necessary to perform prehabilitation exercise for patients undergoing total knee arthroplasty (TKA).

Methods: Literatures were identified from Pubmed, Clinicaltrials, Cochrane library, and SpringerLink. All studies that compared a prehabilitation exercise group with control group before TKA were included. The primary outcome was length of hospital stay. Secondary outcomes were quadriceps strength and functional ability in short term (1.5 to 3 months) after TKA.

Results: There was significant difference in the length of hospital stay, knee range of motion (ROM) and sit-to-stand test (P＜0.05). No statistical differences were found in quadriceps strength, 6-minute walk, ROM, knee extension, knee flexion, WOMAC pain, WOMAC function, WOMAC stiffness between the two groups in short term after TKA (P＞0.05).

Conclusions: Our meta-analysis found that prehabilitation exercise was effective in reducing length of hospital stay. Importantly, it was an effective method for improving knee ROM and sit-to-stand test after TKA. However, there was no effect of prehabilitation exercise on the improvement of quadriceps strength, 6-minute walk, pain and functional recovery following TKA.     

Effect of Exposure Type and Timing of Injuries in Division I College Football: A 4-year Single Program Analysis

Background: Football players compete with a high risk of injury due to the sport. With the recent efforts to improve safety, the National Collegiate Athletic Association (NCAA) established new terminology to clearly define exposure types and reduce the number of high contact exposures.

Objectives: To compare football injury rates (IR) with a focus on game versus practice, time in season of injury, mechanism of injury and utilizing recent exposure types defined by the NCAA (live contact, full-pads and non-contact).

Methods: Licensed medical professionals monitored a college football program regular season from 2012–2015. Each injury was classified by timing of the injury, mechanism of injury, and whether it occurred in game or practice. Player attendance and type of exposure (non-contact, full-pad or live contact, which involves live tackling to the ground and/or full-speed blocking and can occur in full-pad or half-pad (‘shell’) equipment) was documented. IR were calculated per 1000 athlete-exposures (AE). Mid-exact P tests compared rates between variables.

Results: The game IR was over three times as high as the practice IR (p < .001). Live contact exposures had the greatest IR of 5.702/1000 AE and were seven times more likely to produce an injury compared to non-contact exposures (p < .001); whereas, live contact exposures were about two times more likely to produce an injury compared to full-pad exposures (p = .004). The majority of injuries observed occurred from a contact mechanism (IR: 2.508/1000 AE). The highest IR during the fall football season occurred in the pre-season at 5.769/1000 AE.

Conclusion: Overall IR observed in this cohort were lower than prior studies published before recent NCAA rule changes and guideline implementation to improve athlete safety. Athletes in this cohort were at significantly increased risk of injury from live contact exposures.     

Cardiovascular sequel of neck irradiation in head and neck cancer patients

Purpose: The baroreflex is an important afferent mechanism controlling autonomic functions. As afferent nerves course through the neck, they are susceptible to damage by neck irradiation in head and neck cancer patients. With increased survival of head and neck cancer patients because of improved therapy, the cardiovascular morbidity and mortality in them have become apparent and this is of clinical concern. There are few case reports of baroreflex failure as a chronic sequel to neck irradiation.

Objectives: The present study evaluated the changes in cardio-autonomic tone and postural cardiovascular reflex in neck-irradiated patients.

Methods: Head and neck cancer patients who had received neck irradiation (n?=?15) and healthy controls (n?=?15) were evaluated for heart rate variability with time domain analysis of 5?min ECG recording. Postural cardiovascular reflexes were studied with changes in blood pressure and heart rate in the lying to standing test.

Results: Our results suggest that there is a reduction in overall time domain measures of heart rate variability and weakened postural reflexes in neck-irradiated patients.

Conclusion: Decreased heart rate variability in neck-irradiated patients reflects an independent risk of cardiovascular morbidity. The early detection of cardiovascular impairment in such patients may help healthcare professionals in providing better care. Furthermore, the dose delivered to the carotid sinus should be monitored and restricted.     

The effects of exercise on mastalgia

Objective: Mastalgia is often ignored by physicians although it is the most common breast-related complaint among women. The effectiveness of exercise therapy for mastalgia is unclear. The aim of this study is to investigate the effects of exercise on mastalgia.

Methods: A randomized controlled trial was conducted with twenty women with complaints of mastalgia fulfilling the inclusion and exclusion criteria. Patients were randomly assigned to the control group and to the exercise group. Sports brassiere, refraining from caffeine- and methylxanthine-containing foods, and simple analgesics were recommended for two groups. In the exercise group, an exercise program was conducted three times a week for 6 weeks. Participants in both groups were evaluated for breast pain and using the Short-Form Health Survey (SF-36) questionnaire before and six weeks after study. Serum cytokine levels were also collected and analyzed.

Results: No significant differences were detected with respect to age, body mass index, menopausal status, psychiatric condition, and existence of unexplained pain syndromes between the groups. Total breast pain scores were similar in both groups. The sensory component of breast pain questionnaire and visual analogue scale values significantly improved via exercise in only exercise group (p = 0.012 and p = 0.016). There was no significant difference between groups in serum levels of cytokines. SF-36 subscale scores for general health and social functioning significantly improved in the control group and scores for role physical, bodily pain, and social functioning improved in exercise group.

Conclusions: Based on our preliminary findings, exercise treatment is beneficial for patients with mastalgia and it can be suggested by clinicians.     

Efficacy and safety assessment of acute sports-related traumatic soft tissue injuries using a new ibuprofen medicated plaster: results from a randomized controlled clinical trial

Objective: To investigate the efficacy and safety of a recently developed ibuprofen medicated plaster in the treatment of acute sports impact injuries/contusions.

Methods: In this double-blind, multi-center, placebo-controlled, parallel group, phase 3 study (EudraCT Number: 2012–003257-2) patients (n = 132; ages 18 to 60 years) diagnosed with acute sports-related traumatic blunt soft tissue injury/contusion to the upper or lower limbs were randomized to receive either ibuprofen 200 mg plaster (n = 64) or placebo plaster (n = 68). Plasters were administered once daily for five consecutive days. The primary assessment was the area under the curve (AUC) of the visual analogue scale (VAS) of pain on movement (POM) over 0 to 72 h (VAS_0-72).

Results: The ibuprofen medicated plaster was associated with a reduction in pain on movement (POM) based on lower VAS AUC_0-72h (2399.4 mm*h) compared with placebo (4078.9 mm*h) (least squares mean difference: – 1679.5 mm*h; P < 0.0001). The reduction in AUC of POM was also significantly greater for the ibuprofen medicated plaster compared with placebo at 12, 48, 24, and 120 h (P < 0.0001). Algometry/tenderness measurements found that the ibuprofen medicated plaster was associated with greater reduction in tenderness/pain than placebo at each timepoint (P values <0.0001). Seven patients experienced drug-related adverse events (n = 1 [1.6%] for the ibuprofen plaster, and n = 6 [8.8%] for placebo). All drug-related AEs were administration site reactions and were mild in intensity.

Conclusions: The results of this study indicate that ibuprofen medicated plaster results in rapid and clinically relevant reduction of pain in patients suffering from blunt musculoskeletal injuries or recurrent pain. The ibuprofen medicated plaster was well tolerated.     

Radiotherapy of meningioma: a treatment in need of radiobiological research

Purpose: Meningiomas account for one third of primary intracranial tumors; nevertheless information on meningioma cell lines and in vivo models is scant. Although radiotherapy is one of the most relevant therapeutic options for the treatment of patients with meningioma, radiobiological research to understand tumor response to this treatment is far from being thoroughly figured out. The aim of this report is to provide a comprehensive picture of the current literature on this field, so as to foster research in this regard.

Methods: We carried out a review of meningioma radiobiology based on a peer-reviewed PubMed search.

Results: Our findings confirm that the main limitation of radiobiological research into meningioma is the paucity of robust in vitro and in vivo models. Alternative approaches to overcome the already identified problems, and to allow better understanding of the entire histopathological spectrum of meningiomas have been explored.

Conclusions: A radiobiological perspective of meningioma may help to improve clinical results both in terms of tumor control and healthy tissue sparing. Although we are far from drawing any conclusions, this review can lead researchers to identify some clues for future areas of study.     

Resveratrol ameliorates ionizing irradiation-induced long-term immunosuppression in mice

Purpose: Ionizing radiation has been associated with adverse effects on the immune system. Currently, there are no effective treatment options to ameliorate these effects. The aim of the present study was to investigate the protective effects of resveratrol against radiation-induced long-term immunosuppression in mice.

Materials and methods: Mice were exposed to total body irradiation and treated with resveratrol or vehicle. Several immune parameters were measured, including thymus and spleen weights, T-lymphocyte and B-lymphocyte count in peripheral blood, concanavalin A and lipopolysaccharide induced lymphocyte proliferation. To explore the mechanism, we investigated intracellular ROS level of lymphocytes and mice plasma cytokine levels.

Results: Treatment with resveratrol ameliorated TBI-induced atrophy of the thymus and spleen, reduction of lymphocyte count and decline of lymphocyte proliferation. TBI exhibited significantly reduced level of IL-2, IL-4, IL-7 and IFN-γ compared with the control mice and treatment with resveratrol attenuated the reduction.

Conclusion: The results of the present study suggest that treatment with resveratrol could ameliorate irradiation induced long-term immune malfunction at least partly via modulation of plasma cytokine.     

Increasing levels of saliva alpha amylase in electrohypersensitive (EHS) patients

Purpose: To assess the level of various salivary and urinary markers of patients with electromagnetic hypersensitivity (EHS) and to compare them with those of a healthy control group.

Materials and methods: We analyzed samples from 30 EHS individuals and a matched control group of 25 individuals (non-EHS) aged between 22 and 66. We quantified cortisol both in saliva and urine, alpha amylase (sAA), immunoglobulin A and C Reactive Protein levels in saliva and neopterin in urine (uNeopterin).

Results: sAA was found to be significantly higher (p?<?0.005) in the EHS group. uNeopterin and sAA analysis showed a significant difference based on the duration of EHS.

Conclusion: Higher levels of sAA in EHS participants may suggest that the sympathetic adrenal medullar system is activated. However, most of the analyzed markers of the immune system, sympathetic activity and circadian rhythm did not vary significantly in the EHS group. There is a trend to the higher levels of some variables in subgroups according to the EHS duration.     

Proteome analysis of irradiated endothelial cells reveals persistent alteration in protein degradation and the RhoGDI and NO signalling pathways

Purpose: Epidemiological studies indicate that radiation doses as low as 0.5?Gy increase the risk of cardiovascular disease decades after the exposure. The aim of the present study was to investigate whether this radiation dose causes late molecular alterations in endothelial cells that could support the population-based data.

Materials and methods: Human coronary artery endothelial cells were irradiated at 0.5?Gy (X-ray) and radiation-induced changes in the proteome were investigated after different time intervals (1, 7 and 14 d) using ICPL technology. Key changes identified by proteomics and bioinformatics were validated by immunoblotting and ELISA.

Results: The radiation-induced alteration of the endothelial proteome was characterized by sustained perturbation of Rho GDP-dissociation inhibitor (RhoGDI) and nitric oxide (NO) signalling pathways. At later time-points, this was accompanied by reduced proteasome activity, enhanced protein carbonylation indicating augmented oxidative stress, and senescence.

Conclusions: These molecular changes are indicative of long-term premature endothelial dysfunction and provide a mechanistic framework to the epidemiological data showing increased risk of cardiovascular disease at 0.5?Gy.     

Immune responses of a wall lizard to whole-body exposure to radiofrequency electromagnetic radiation

Purpose During the last three decades, the number of devices that emit non-ionizing electromagnetic radiation (EMR) at the wireless communication spectrum has rapidly increased and possible effects on living organisms have become a major concern. The purpose of this study was to investigate the effects of radiofrequency EMR emitted by a widely used wireless communication device, namely the Digital Enhanced Communication Telephony (DECT) base, on the immune responses of the Aegean wall lizard (Podarcis erhardii).

Materials and methods Adult male lizards were exposed 24 h/day for 8 weeks to 1880–1900 MHz DECT base radiation at average electric field intensity of 3.2 V/m. Immune reactivity was assessed using the phytohemagglutinin (PHA) skin swelling and mixed lymphocyte reaction (MLR) tests.

Results Our results revealed a noticeable suppression (approximately 45%) of inflammatory responses in EMR-exposed lizards compared to sham-exposed animals. T cell-mediated responses were marginally affected.

Conclusion Daily radiofrequency EMR exposure seems to affect, at least partially, the immunocompetence of the Aegean wall lizard.     

Tai Chi and Kung-Fu practice maintains physical performance but not vascular health in young versus old participants

Objectives: Kung-Fu and Tai Chi along with other martial arts are gaining popularity but studies examining the benefits of martial arts on physical fitness, vascular health, nutrition, and psychological wellness are limited. Aging is associated with declines in these health components. The objectives of this study were to examine whether Tai Chi and Kung-Fu training would maintain physical fitness, vascular health, and psychological wellness components on older versus younger practitioners.

Methods: Seventeen subjects were recruited and divided into Young (age <40 years, n=9) and Old (age 40 years and above, n=8). Participants reported twice for health screens, vascular and nutrition assessment, and fitness tests. Mean differences were compared between groups for all tests using Student’s t-tests.

Results: Age, months of practice, systolic blood pressure, and cardiovascular augmentation index were significantly greater in Old versus Young (p=0.001, p=0.007, p=0.049, and p=0.011, respectively). Psychologically, old practitioners experienced greater sleep interference (p=0.035) and overall pain (p=0.036). No other differences existed for any variable.

Conclusion: Our study indicates that the practice of Tai Chi and Kung-Fu maintains physical fitness in older compared to younger practitioners. However, age associated changes in cardiovascular stiffness, systolic blood pressure, and pain were not prevented.     

Is Heading in Youth Soccer Dangerous Play?

Background: Soccer is among the most popular youth sports with over 3 million youth players registered in the U.S. Soccer is unique in that players intentionally use their head to strike the ball, leading to concerns that heading could cause acute or chronic brain injury, especially in the immature brains of children.

Methods: Pub Med search without date restriction was conducted in November 2014 and August 2015 using the terms soccer and concussion, heading and concussion, and youth soccer and concussion. 310 articles were identified and reviewed for applicable content specifically relating to youth athletes, heading, and/or acute or chronic brain injury from soccer.

Results: Soccer is a low-risk sport for catastrophic head injury, but concussions are relatively common and heading often plays a role. At all levels of play, concussions are more likely to occur in the act of heading than with other facets of the game. While concussion from heading the ball without other contact to the head appears rare in adult players, some data suggests children are more susceptible to concussion from heading primarily in game situations. Contributing factors include biomechanical forces, less developed technique, and the immature brain’s susceptibility to injury.

Conclusions: There is no evidence that heading in youth soccer causes any permanent brain injury and there is limited evidence that heading in youth soccer can cause concussion. A reasonable approach based on U.S. Youth Soccer recommendations is to teach heading after age 10 in controlled settings, and heading in games should be delayed until skill acquisition and physical maturity allow the youth player to head correctly with confidence.