Meniscal extrusion in young athletes: associated knee joint abnormalities

OBJECTIVE: The objective of our study was to assess the rate of meniscal extrusion and its connection with common meniscal and joint abnormalities. MATERIALS AND METHODS: MR signs of meniscal extrusion were evaluated retrospectively in 24 rugby and soccer players (40 knees) who are currently free of pain in the knee, impaired mobility, and joint swelling. The control group consisted of 23 consecutive active individuals (36 knees) with no history of knee problems. The criterion for extrusion of the meniscus was defined as a distance of 3 mm or more between the peripheral border of the meniscus and the edge of the tibial plateau measured on coronal images. RESULTS: Forty-eight percent of the athletes' knees and 30% of the control subjects' knees showed evidence of meniscal extrusion. Among the athletes, a significant association between meniscal extrusion and joint effusion (11 cases), meniscal tears (seven cases), and anterior cruciate ligament (ACL) tear (four cases) was found (p < or = 0.004). In the control group, no significant association was found between meniscal extrusion and joint effusion (three cases), meniscal tears (four cases), and ACL tears (two cases) (p = 1.00). A significant association was not found between degenerative change and meniscal extrusion in either the athletes (p = 0.23) or the control subjects (p = 1.00). The most commonly associated knee abnormality was joint effusion in 73% of knees with meniscal extrusion in athletes. CONCLUSION: Meniscal extrusion is a common finding on MRI of athletes' knees. Meniscal extrusion in association with meniscal tear and joint effusion is postulated as a significant injury in athletes and its recognition as such in this group is important because it may prompt orthopedic intervention.     

Monitoring of sport participation and injury risk in young athletes

ObjectivesCareful modulation of training characteristics in high-level sports optimizes performance and avoids inappropriate workloads and associated sports injury risk. The aims of this study were to compare sport participation characteristics in different youth sport categories and to investigate their relationship with injury.DesignProspective cohort follow-up.MethodsYoung (12–19 years) high-level athletes (n = 154) from a regional sport school were followed during 41 weeks regarding sport participation characteristics and traumatic and overuse sports injuries (time-loss definition). All data were self-recorded by the athletes in an electronic system “TIPPS” (Training and Injury Prevention Platform for Sports) and subject to a systematic data quality control. Volume and intensity (self-rated perceived exertion) of each sport session were used to compute weekly load, monotony and strain. Sport categories were defined as team, racket, and individual sports.ResultsAll sport participation characteristics were dependent on sport category (p < 0.05). Weekly intensity, load and strain were dependent on age (p < 0.05). Racket and individual sports were associated with lower injury risk (HR = 0.37 and 0.34, p = 0.001 and p < 0.001, respectively) compared to team sports. Average sport participation characteristics were not related to injury according to the survival analysis. However, intensity during the week prior to injury was significantly higher (p < 0.01) compared to that of the 4 preceding weeks.ConclusionsThis study investigated for the first time the relationship between sport participation pattern and injury risk in young athletes. The monitoring method was sensitive to variations according to pertinent variables and might help identify athletes with increased sports injury risk.     

Intensive training in young athletes.

An increasing number of children take part in organized sporting activities, undergoing intensive training and high level competition from an early age. Although intensive training in children may foster health benefits, many are injured as a result of training, often quite seriously. This paper reviews some of the areas of research dealing with intensively trained young athletes, and focuses on physical, cardiovascular and muscular effects, sports injuries and psychological effects of intensive training. It is concluded that measures should be taken to modify present training and competition schemes to avoid the deleterious effects of intensive physical activity on these children.     

Relationship between postconcussion headache and neuropsychological test performance in high school athletes

BACKGROUND: The relevance of headache to outcome after sports-related concussion is poorly understood. HYPOTHESES: High school athletes reporting headache approximately 1 week after injury will have significantly more other concussion symptoms and will perform more poorly on neuropsychological tests than athletes not experiencing headache. STUDY DESIGN: Prospective cohort study. METHODS: Study participants included 109 high school athletes who had sustained concussion and who were divided into two groups: those reporting headache 7 days after injury and those reporting no headaches. The two groups were compared regarding on-field markers of concussion severity at the time of injury and symptoms and neurocognitive test results collected via ImPACT, a computerized neuropsychological test battery and postconcussion symptom scale, at a mean of 6.8 days after injury. RESULTS: Athletes reporting posttraumatic headache demonstrated significantly worse performance on reaction time and memory ImPACT neurocognitive composite scores. These athletes also reported significantly more symptoms other than headache and were more likely to have demonstrated on-field anterograde amnesia. CONCLUSIONS: Findings suggest that any degree of postconcussion headache in high school athletes 7 days after injury is likely associated with an incomplete recovery after concussion.     

Arterial abnormalities of the shoulder in athletes

Vascular lesions of the shoulder may be misinterpreted as one of the more familiar shoulder abnormalities by a treating physician. We are reporting on 13 athletes who were found to have symptoms related to compression of the subclavian or axillary artery or their tributaries. Nine were amateur or professional baseball pitchers. Severe arm fatigue or finger ischemia, secondary to embolization, were presenting symptoms. Arm fatigue was noted in all pitchers. After complete history and physical examination, including auscultation for bruits in functional positions, all athletes were evaluated by noninvasive tests (Doppler and Duplex scanning). Arteriography was performed with positional testing, recreating overhead activity, and complete radiographic visualization of the dye to the digital arteries. Two patients were found to have subclavian artery aneurysm. The remaining athletes were found to have compression of the subclavian artery beneath the anterior scalene muscle (five patients), the axillary artery beneath the pectoralis minor (two patients), both arterial segments (two patients), and one was found to have arterial compromise at the level of the humeral head. Branch artery compression was also noted. One pitcher occluded the posterior circumflex humeral artery with embolization to the digit. The two patients with subclavian aneurysms underwent saphenous vein bypass with cervical rib resection. All of the other athletes except one underwent resection of a 2 to 3 cm segment of the anterior scalene muscle or pectoralis minor muscles. All returned to their previous level of activity except one patient who developed impingement type symptoms and required acromioplasty. He is currently undergoing rehabilitation. Proper recognition of vascular compromise in the upper extremity of athletes is essential to avoid the catastropic complications of arterial thrombosis.     

Arterial abnormalities of the hand in athletes

Vascular lesions of the hand may be seen in athletes exposed to repetitive blunt trauma. Thirteen athletes seen from 1983 to 1988 experienced symptoms related to hand ischemia. Nine were professional baseball catchers. The majority of patients complained of chronic symptoms, including cold hypersensitivity (four patients), finger numbness (one), finger coolness (three), and finger blanching (three). Two patients had acute symptoms with sudden posttraumatic hand ischemia with finger and palmar pain. Diagnosis was established by history and physical examination and confirmed by noninvasive testing. Testing included use of Doppler examination and cold tolerance examination with thermistors. Two athletes required angiographic evaluation because of severe ischemia and continuous pain. All patients in this group were managed nonoperatively. Those with chronic complaints were counseled regarding cold avoidance and instructed to increase their glove padding. The two patients with acute symptoms required vasodilator (papaverine chloride) infusion, followed by intravenous heparin and dextran. All baseball catchers returned to their sport with dissipation of symptoms.     

Spinal deformity in young athletes

Young athletes may have a spinal deformity incidentally or potentially related to their sport. These athletes should be encouraged to continue sports participation in many instances. Brace wear is commonly used for kyphotic and scoliosis deformities. Many sports can be played in the brace. Even with sports that cannot practically be played in the brace, most bracing protocols have enough time out of brace during the day for the athlete to continue participation. However, good physical therapy for flexibility and strengthening of the spine should be continued. Even sports that potentially aggravate the deformity may be continued in these circumstances.     

Head and neck injuries in young taekwondo athletes.

BACKGROUND: To investigate the location, type, situation and mechanism of head and neck injuries in young taekwondo athletes. METHODS: Experimental design: Prospective. Setting: National and international taekwondo tournaments. Participants: 3,341 boys and 917 girls, aged 6 to 16 years. Measures: Injury rates per 1,000 athlete-exposures (A-E) for total number of head and neck injuries, location, type, situation, and mechanism of injury. RESULTS: There was a significant difference between young male and female taekwondo athletes in total head and neck injury rate (p < 0.001) with the boys (21.42/1,000 A-E) recording a higher rate than the girls (16.91/1,000 A-E). The head was the most often injured body part (6.10/1,000 A-E and 4.55/1,000 A-E for boys and girls, respectively). The contusion was the most often occurring injury type for both boys (8.41/1,000 A-E) and girls (7.80/1,000 A-E). The cerebral concussion ranked second in both boys (5.11/1,000 A-E) and girls (4.55/1,000 A-E). The unblocked attack was the major injury situation for both boys (19.78/1,000 A-E) and girls (14.96/1,000 A-E). As a consequence, the major injury mechanism was receiving a blow (20.93/1,000 A-E and 16.25/1,000 A-E for boys and girls, respectively). Only the boys (0.66/1,000 A-E) incurred the most serious head and neck injuries that resulted in > or = 21 days away from participation. CONCLUSIONS: The national and international taekwondo governing bodies should review their current injury prevention measures. Given the potentially debilitating nature of these injuries, implications for any diagnostic capabilities on site should be carefully reviewed.     

Radiologic abnormalities of the thoraco-lumbar spine in athletes

A radiologic study of the thoraco-lumbar spine was performed in 143 (117 male and 26 female) athletes (wrestlers, gymnasts, soccer players and tennis players), aged 14 to 25 years and 30 male non-athletes, aged 19 to 25 years. Film interpretation was made after mixing the films from all groups and without knowledge of the individual's identity. Various types of radiologic abnormalities occurred in both athletes and non-athletes but were more common among athletes, especially male gymnasts and wrestlers. Abnormalities of the vertebral ring apophysis occurred exclusively in athletes. Combinations of different types of abnormalities were most common in male gymnasts and wrestlers.     

Knee function after anterior cruciate ligament injury in elite collegiate athletes

BACKGROUND: Anterior cruciate ligament injuries are common in athletes, but there are few studies of long-term outcomes. HYPOTHESIS: Long-term knee function of anterior cruciate ligament-injured athletes is inferior to that of their uninjured teammates. STUDY DESIGN: Retrospective cohort study. METHODS: Thirty-three Division I-A athletes who had sustained an anterior cruciate ligament injury during their college career completed a series of questionnaires that assessed knee function and quality of life 2 to 14 years after injury. Their responses were compared with those of a matched cohort of their uninjured teammates. RESULTS: There were no differences in the mean Tegner scores, modified Lysholm scores, or in the scores of the SF-36 between groups. Sixteen anterior cruciate ligament-injured athletes scored A or B in the subjective portion of the International Knee Documentation Committee score and 17 scored C or D, whereas 24 control subjects scored A or B and 9 scored C or D, a statistically significant difference between groups. Five injured and 14 control athletes had participated at a professional or national team level after college. CONCLUSIONS: Quality of life of elite collegiate athletes who sustained an anterior cruciate ligament injury was not significantly different from that of their uninjured teammates, but knee function differed between groups.     

Low back pain in young athletes. A practical approach.

Lumbar spine pain accounts for 5 to 8% of athletic injuries. Although back pain is not the most common injury, it is one of the most challenging for the sports physician to diagnose and treat. Factors predisposing the young athlete to back injury include the growth spurt, abrupt increases in training intensity or frequency, improper technique, unsuitable sports equipment, and leg-length inequality. Poor strength of the back extensor and abdominal musculature, and inflexibility of the lumbar spine, hamstrings and hip flexor muscles may contribute to chronic low back pain. Excessive lifting and twisting may produce sprains and strains, the most common cause of low back pain in adolescents. Blows to the spine may create contusions or fractures. Fractures in adolescents from severe trauma include compression fracture, comminuted fracture, fracture of the growth plate at the vertebral end plate, lumbar transverse process fracture, and a fracture of the spinous process. Athletes who participate in sports involving repeated and forceful hyperextension of the spine may suffer from lumbar facet syndrome, spondylolysis, or spondylolisthesis. The large sacroiliac joint is also prone to irritation. The signs and symptoms of disc herniation in adolescents may be more subtle than in adults. Disorders simulating athletic injury include tumours and inflammatory connective tissue disease. Often, however, a specific diagnosis cannot be made in the young athlete with a low back injury due to the lack of pain localisation and the anatomic complexity of the lumbar spine. A thorough history and physical examination are usually more productive in determining a diagnosis and guiding treatment than imaging techniques. Diagnostic tests may be considered, though, for the adolescent athlete whose back pain is severe, was caused by acute trauma, or fails to improve with conservative therapy after several weeks. Radiographs, bone scanning, computed tomography, and magnetic resonance imaging may help identify, or exclude serious pathology. Fortunately, the majority of cases of low back pain in adolescents respond to conservative therapy. Immediate treatment of an acute injury, such as a sprain or strain, includes cryotherapy, electrogalvanic stimulation, anti-inflammatory medications and gentle exercises. Prolonged bed rest should be avoided since atrophy may occur rapidly. Strong analgesics are also usually contraindicated, except for sleep, since they mask pain and may allow overvigorous activity. Early strengthening exercises include the Williams flexion exercises and/or McKenzie extension exercises. Both exercise motions may often be prescribed. Athletes with an acute disc herniation, however, should only perform extension exercises initially. Athletes with spondylolysis, spondylolisthesis and facet joint irritation should initially be limited to flexion exercises.(ABSTRACT TRUNCATED AT 400 WORDS)     

Physiological considerations in training young athletes

Healthy children evidence smaller values of cardiorespiratory function than adults, but these are in proportion to the smaller body size. At birth, the distribution of muscle fibres and the activity of enzymes in muscle are different from in adults, but these differences disappear at about age 6. On the other hand, muscle fibre thickness increases from birth to about 18 years of age and this is concurrent with increases in muscular strength. The increase in maximal oxygen consumption (VO2max) that accompanies growth and maturation in the human has been attributed in the main to appreciating muscle mass. During exercise, heart rate and cardiac output increase in the child as in the adult, but the heart rate in the child is greater and the stroke volume smaller. Furthermore, the arteriovenous difference in oxygen is greater in the exercising child than in the adult. Children also evidence a diminished blood pressure response to exercise. It seems that control of ventilation at exercise is the same in children as in adults, but exercise ventilation has been reported to be less efficient in the child. The young are less capable of regulating core temperature at exercise than adults and are more readily dehydrated. Very limited data suggest that muscle energy substrate storage and utilisation in children are such that they are less capable of anaerobic metabolism than adults. Generally, children respond to aerobic training as do adults, but such training in the first decade of life has been reported to have negligible effects. Blood lipid levels in children seem to be favourably influenced by persistent endurance activity. Ventilatory efficiency of children at exercise is augmented by aerobic training. Maximal values of ventilation and breathing frequency are increased in children and youth by endurance training. Conflicting data exist regarding the influence of training upon the child's vital capacity. Pulmonary diffusion capacity in well trained children has been seen to be greater than in untrained youngsters and many workers have reported increased VO2max as an outcome of endurance training. Limited data indicate that the nature of training may alter muscle fibre distribution in youthful athletes, and that muscle fibre hypertrophy can be induced in the young by means of strength and power training.(ABSTRACT TRUNCATED AT 400 WORDS)