Sports injury prevention programmes from the sports physical therapist's perspective: An international expert Delphi approach

ObjectiveTo provide consensus on how to plan, organize and implement exercise-based injury prevention program (IPP) in sports.DesignDelphi.SettingLimeSurvey platform.ParticipantsExperienced sports physical therapists from the International Federation of Sports Physical Therapy member countries.Main outcome measuresFactors related to sports IPP planning, organization and implementation.ResultsWe included 305 participants from 32 countries. IPP planning should be based on an athlete's injury history, on pre-season screening results, and on injury rates (respectively, 98%, 92%, 89% agreement). In total 97% participants agreed that IPP organization should depend on the athlete's age, 93% on the competition level, and 93% on the availability of low-cost materials. It was agreed that IPP should mainly be implemented in warm-up sessions delivered by the head or strength/conditioning coach, with physical training sessions and individual physical therapy sessions (respectively, 94%, 92%, 90% agreement).ConclusionStrong consensus was reached on (1) IPP based on the athlete's injury history, pre-season screening and evidence-based sports-specific injury rates; (2) IPP organization based on the athlete's age, competition level, and the availability of low-cost materials and (3) IPP implementation focussing on warm-up sessions implemented by the strength/conditioning coach, and/or individual prevention sessions by the physical therapist.     

Arthroscopic excision of juxtaarticular cancellous osteoid osteoma in the talar neck

Cancellous osteoid osteoma of the talus near the subtalar joint is rare, and the treatment is very challenging. We present the first case of arthroscopic excision of juxtaarticular cancellous osteoid osteoma in the talar neck near the subtalar joint. After confirming the nidus of the osteoid osteoma with computer tomography, the lesion was completely removed with a motorized bur under arthroscopy, and the patient’s pain disappeared immediately after surgery. This case report demonstrates that a cancellous osteoid osteoma in the talar neck near the subtalar joint can be treated by arthroscopic excision and good results could be obtained. Level of evidence IV.     

Does the anterolateral ligament protect the anterior cruciate ligament in the most common injury mechanisms? A human knee model study

BackgroundAnterior cruciate ligament (ACL) reconstruction still has a risk of re-rupture and persisting rotational instability. Thus, extra-articular structures such as the anterolateral ligament (ALL) are increasingly treated. The ALL however prevents the internal rotation of the tibia and it must be doubted that the ALL protects the ACL in other common injury mechanisms which primarily include tibial external rotation. In this study we aimed to evaluate which extra-articular structures support the ACL in excessive tibial internal and external rotation using a knee finite element (FE) model.MethodsInternal and external rotations of the tibia were applied to an FE model with anatomical ACL, posterior cruciate ligament (PCL), lateral collateral ligament (LCL), medial collateral ligament (MCL) and intact medial and lateral meniscus. Three additional anatomic structures (anterolateral ligament, popliteal tendon and posterior oblique ligament) were added to the FE model separately and then all together. The force histories within all structures were measured and determined for each case.ResultsThe ACL was the most loaded ligament both in tibial internal and external rotation. The ALL was the main stabilizer of the tibial internal rotation (46%) and prevented the tibial external rotation by only 3%. High forces were only observed in the LCL with tibial external rotation. The ALL reduced the load on the ACL in tibial internal rotation by 21%, in tibial external rotation only by 2%. The POL reduced the load on the ACL by 8%, the PLT by 6% in tibial internal rotation. In tibial external rotation the POL and PLT did not reduce the load on the ACL by more than 1%.ConclusionThe ALL protects the ACL in injury mechanisms with tibial internal rotation but not in mechanisms with tibial external rotation. In injury mechanisms with tibial external rotation other structures that support the ACL need to be considered.     

Surgical Treatment of Trochanteric and Cervical Hip Fractures in the United States: 2000–2009

The objective of this study was to evaluate the most common treatments performed for hip fractures over the last decade in the United States. The leading treatment for trochanteric fractures was internal fixation, accounting for 96%–98% of surgical treatments each year. For cervical fractures, hemiarthroplasty (HA), total hip arthroplasty (THA), and internal fixation were performed nearly 61%, 5%, and 33% of the time, respectively, each year without any sign of change during the period assessed. The surgical choice for cervical fractures varied greatly by patient age. In 2009, two-thirds of patients younger than 60 years underwent internal fixation while two-thirds of patients 60 years or older underwent HA. Regardless of patient age, HA was performed more often than THA for cervical hip fractures.     

Leukotrap,a device for white cell poor platelets quality control studies In vitro and In vivo

Most febrile transfusion reactions are due to leucoagglutinins. Cutter's Leukotrap platelet pooling bag has a distal conic pouch for depleting the platelets of white blood cells by centrifugation. We tested 33 Leukotraps each containing six platelet units in vitro and 32 in vivo. The mean in vitro platelet count was 3.7 ± 0.5 × 10¹¹ platelets before, and 3.0 ± 0.5 × 10¹¹ after spinning, representing a platelet recovery of 80.2 ± 9.6% Mean white blood cells were 3.8 ± 0.6 × 10⁸ before, and 0.6 ± 0.1 × 10⁸ after centrifugation, this constituting a white cell removal of 83.5 ± 7.7%. pH ranged from 7.37 for 24-h platelets to 7.19 for 96-h platelets. 24-h after platelet pooling, all Leukotraps were sterile. Platelet aggregation with physiologic agents showed little change compared to individual platelet units. Glucose ranged between 418 and 336 mg/dL, pCO₂ between 27.8 and 19.1 mmHg, but pO₂ dropped drastically from 74.8 mmHg to 11.6 mmHg. Hypotonic osmotic recovery was satisfactory. In vivo studies were carried out with pooled, leucocyte-poor platelets which were transfused to six bone marrow transplant patients with no splenomegaly or septicemia at the outset. These patients had all demonstrated febrile transfusion reactions to standard donor units. The mean platelet increment was 16.8 × 10⁹/L. A single febrile transfusion reaction witnessed in one patient, was accompanied by an adequate platelet response. Hence Leukotrap is a useful clinical tool for reducing febrile transfusion reactions related to white blood cells.     

Predictors of the outcome of physiotherapy following a meniscus tear: A systematic review

BackgroundPhysiotherapy is indicated for treatment of a painful degenerative knee meniscus tear. Predicting the outcome remains uncertain.ObjectiveThe purpose of this systematic review was to identify which predictive factors are associated with the outcome of physiotherapy for degenerative knee meniscus tear.MethodsA systematic electronic literature search was undertaken of PubMed, CINAHL, Medline with AMED and EMBASE via Ovid from inception to July 2021. Studies of adults receiving physiotherapy which presented data on the association of baseline variables and the treatment outcome were included. Study quality was assessed using CASP (Critical Appraisal Skills Programme) tools. Data were narratively analysed.Results1051 titles were retrieved and screened for eligibility. Fifteen studies met the inclusion criteria. Nine studies investigated just degenerative tears. The evidence-base was of low/moderate quality. Across all studies, seven and five studies (100%) reported no association between mechanical symptoms or gender respectively (p > 0.05). There was no association with osteoarthritis in 80%, age in 71%, or body mass index in 60% of studies (p > 0.05). Four studies (80%) reported that higher baseline pain was associated with cross-over to surgery, greater improvement with surgery or less improvement in pain score (p > 0.05).ConclusionPatient demographic characteristics provide minimal association with outcome following physiotherapy for degenerative meniscus tear. The evidence-base is limited in size and quality. A large adequately powered prospective cohort study investigating a broad range of predictive factors is warranted to develop a predictive model to better stratify those most likely to benefit from physiotherapy.     

Delaying ACL reconstruction beyond 6 months from injury impacts likelihood for clinically significant outcome improvement

BackgroundThe effect of surgical latency on outcomes of anterior cruciate ligament reconstruction (ACLR) is a topic that is heavily debated. Some studies report increased benefit when time from injury to surgery is decreased while other studies report no benefit. The purpose of our analysis was to compare achievement of clinically significant outcomes (CSOs) in patients with greater than six months of time from injury to ACLR to those with less than or equal to six months of time to surgery.MethodsPatients undergoing primary ACLR between January 2017 and January 2018 with minimum one year follow-up were included. International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) were collected. Multivariate logistic regression was performed for outcome achievement and risk of revision ACLR and Weibull parametric survival analysis was performed for relative time to outcome achievement. The level of significance was set at α = 0.05.Results379 patients were included of which, 140 patients sustained ACL injury greater than six months prior to surgery. This group of patients experienced reduced likelihood to achieve patient-acceptable symptomatic state (PASS) on the IKDC (p = 0.03), KOOS Pain (p = 0.01) and a greater likelihood to undergo revision ACLR (p = 0.001). There was no impact of surgical timing on minimal clinically important difference (MCID).ConclusionPatients with greater than 6 months from injury to ACLR reported reduced likelihood to achieve CSOs, delayed achievement of CSOs, and increased rates of revision surgery.     

Self‐reported previous knee injury and low knee function increase knee injury risk in adolescent female football

Knee injuries are common in adolescent female football. Self‐reported previous knee injury and low Knee injury and Osteoarthritis Outcome Score (KOOS) are proposed to predict future knee injuries, but evidence regarding this in adolescent female football is scarce. The aim of this study was to investigate self‐reported previous knee injury and low KOOS subscale score as risk factors for future knee injuries in adolescent female football. A sample of 326 adolescent female football players, aged 15–18, without knee injury at baseline, were included. Data on self‐reported previous knee injury and KOOS questionnaires were collected at baseline. Time‐loss knee injuries and football exposures were reported weekly by answers to standardized text‐message questions, followed by injury telephone interviews. A priori, self‐reported previous knee injury and low KOOS subscale scores (< 80 points) were chosen as independent variables in the risk factor analyses. The study showed that self‐reported previous knee injury significantly increased the risk of time‐loss knee injury [relative risk (RR): 3.65, 95% confidence (CI) 1.73–7.68; P < 0.001]. Risk of time‐loss knee injury was also significantly increased in players with low KOOS subscale scores (< 80 points) in Activities of Daily Living (RR: 5.0), Sport/Recreational (RR: 2.2) and Quality of Life (RR: 3.0) (P < 0.05). In conclusion, self‐reported previous knee injury and low scores in three KOOS subscales significantly increase the risk of future time‐loss knee injury in adolescent female football.     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.