Prevalence of knee instability in relation to sports activity

The objective was to estimate the prevalence of knee instability among active athletes and to investigate potential associations to type, amount and duration of sports participation. Based on a questionnaire, 339 athletes provided information about different features of occupation, sports activity and knee instability. The 12-month period prevalence of knee instability and constant or recurrent knee instability, and absence from sport and absence from work due to knee instability, was 22%, 14%, 5% and 1%, respectively. Knee instability as such, and constant or recurrent knee instability were found to be positively associated with female gender and different features of occupational work. In conclusion, knee instability is a commonly reported phenomenon among active athletes. It was found to be independent of the type and the amount of sports activity but highly dependent on female gender, type and amount of occupational work.     

Patello-femoral arthralgia in athletes attending a Sports Injury Clinic

Over a five year period, 137 athletes presented to a Sports Injury Clinic with patello-femoral arthralgia. This was 5.4% of the total injuries seen and a quarter of all knee problems treated. Running contributed to 32% of the athletes with patello-femoral pain. There was a 4:1 male:female ratio and nearly 70% were in the 16-25 year age range. A follow-up questionnaire was sent to 72 athletes seen in the last two years with a 78% response rate. Symptoms and treatment are discussed. After conservative therapy only 28.6% were entirely symptom free with a mean follow up of 13.1 months.     

Long-term prognosis for jumper's knee in male athletes. A prospective follow-up study

BACKGROUND: Little information is available on the long-term outcome of jumper's knee, a common problem among athletes. PURPOSE: Our aim was to determine the 15-year prognosis of jumper's knee. STUDY DESIGN: Prospective case control. METHODS: The prognosis for jumper's knee was studied using two groups: athletes with jumper's knee and nonsymptomatic control athletes. At baseline, all subjects participated in standardized clinical examinations and measurements, and 15 years later they were asked to respond to a questionnaire. RESULTS: Twenty athletes with jumper's knee and 16 athlete control subjects responded (response rate 74% and 84%, respectively). The jumper's knee group reported significantly more knee symptoms according to their Kujala score and more knee pain after repeated squatting. Fifty-three percent of the subjects in the jumper's knee group (9 of 17) reported that they had quit their sports career because of their knee problem, compared with 7% of the control athletes (1 of 14). Patellar height was associated with knee symptoms at follow-up. CONCLUSION: Jumper's knee causes mild but long-lasting symptoms after an athletic career.     

A cross sectional study of 100 athletes with jumper's knee managed conservatively and surgically. The Victorian Institute of Sport Tendon Study Group.

OBJECTIVES: Jumper's knee causes significant morbidity in athletes of all standards. However, there are few reference data on the clinical course of this condition in a large number of patients, and the aim of this study was to rectify this. METHODS: A retrospective study of the course of jumper's knee in 100 athletes who presented to a sports medicine clinic over a nine year period was carried out. Subjects completed a questionnaire designed to collect details of sport participation, symptoms, and time out of sport. Ultrasonographic results were recorded from the radiologists' reports. Histopathological results were obtained for patients who had surgery. RESULTS: Forty eight subjects recalled that symptoms of jumper's knee began before the age of 20 years. Symptoms prevented 33 from participating in sport for more than six months, and 18 of these were sidelined for more than 12 months. Forty nine of the subjects had two or more separate episodes of symptoms. Ultrasonography showed a characteristics hypoechoic region at the junction of the inferior pole of the patella and the deep surface of the patellar tendon. Histopathological examination showed separation and disruption of collagen fibres on polarisation light microscopy and an increase in mucoid ground substance consistent with damage of tendon collagen without inflammation. CONCLUSIONS: Jumper's knee has the potential to be a debilitating condition for a sports person. About 33% of athletes presenting to a sports medicine clinic with jumper's knee were unable to return to sport for more than six months.     

Asthma and allergy in young athletes in Siena Province. Preliminary results

AIM: The aim of the study was to assess the prevalence of asthma and related respiratory symptoms in a sample of the Siena pediatric population that engages in sport. METHODS: The subjects were 460 young athletes, age 7-14 years, enrolled in 23 sporting clubs in 10 municipalities of Siena Province. Subjects and their parents answered a questionnaire on life style and the children underwent basal spirometric tests at their respective training centers. RESULTS: A total of 352 questionnaires (76.6%) were returned; 80% of responders performed the spirometric test. The lifetime prevalences of asthma, allergic rhinitis and atopic dermatitis were found to be 17.33%, 22.16% and 11.08%, respectively. About 33.2% of subjects had also experienced symptoms compatible with exercise-induced bronchospasm (EIB) during sport and 4.2% of them had had to stop activity at least once. CONCLUSION: The results suggest that EIB is a major phenomenon in our province and that this disorder interferes with, or even limits, physical activity of young athletes.     

Anterior cruciate reconstruction in the chronically unstable knee using an expanded polytetrafluoroethylene (PTFE) prosthetic ligament

The purpose of this study is to review 30 patients with failed, multiply operated knees, or knees with gross instability which were reconstructed using the expanded polytetrafluoroethylene (PTFE) prosthetic ligament as a substitute for the ACL. The results were then compared with our experience with the proplast ligament used in a previous clinical series. This prospective review evaluated the patients preoperatively and at regular intervals during the postoperative period. The average followup was 24 months postoperation. Eighty-three percent of the patients had a satisfactory result, scoring greater than 140 points on a 200 point knee grading scale. Objectively, the anterior instability pattern was improved in 87% of the knees. Subjectively, pain of at least a mild degree persisted in 70% of the patients postoperatively. This pain seemed to correlate with articular cartilage changes documented intraoperatively. Major complications occurred in two patients. In conclusion, the PTFE prosthetic ligament was an improvement over the proplast ligament in the reconstruction of the multiply operated, unstable knee. The 83% satisfactory rate with the PTFE was promising compared to a 52% satisfactory rate using the proplast ligament. However, we encourage future long term studies of the PTFE prosthetic ligament in the reconstruction of the ACL in the chronically unstable knee.     

Content validity of the SOS-WRIST questionnaire for timely identification of wrist overuse in young athletes

Objectives: Young athletes do not always seek medical help for overuse wrist injuries, risking invalidating long-term consequences resulting from late diagnosis. This study aimed to develop a questionnaire to identify overuse wrist injuries in young athletes.

Methods: According to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria, items were collected from literature and 6 focus groups of sports physicians and of young athletes with (previous) overuse wrist injuries. An expert panel and 40 Delphi study participants performed item reduction. Young athletes evaluated comprehensiveness during interviews and English translation was performed according to linguistic validation guidelines.

Results: In total 323 items were generated and 110 were marked important by focus group participants. The resulting questionnaire consists of 18 multiple-choice questions about wrist pain during sports (e.g. pain during training, skipping training sessions/elements) and daily life activities (e.g. writing, turning a key), and other symptoms (e.g. reduced strength, swelling).

Conclusion: The SOS-WRIST questionnaire for identification of overuse wrist injuries in young athletes has good content validity. It can be used to promote awareness and timely treatment of overuse wrist injuries in young athletes.     

Arthroscopic treatment of posterolateral elbow impingement from lateral synovial plicae in throwing athletes and golfers

BACKGROUND: Although elbow pain is common in throwing athletes and golfers, posterolateral impingement from a hypertrophic synovial plica is a rare but possibly underdiagnosed condition. PURPOSE: To evaluate the clinical results of arthroscopic treatment of symptomatic lateral elbow plicae in this athletic population. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twelve patients, 9 male and 3 female, whose mean age was 21.6 years (range, 17-33 years), were reviewed. There were 7 baseball pitchers, 2 softball players, and 3 golfers. All patients had diagnosed isolated lateral elbow plica; none had lateral epicondylitis, instability, osteochondritis dissecans, arthritis, loose bodies, or nerve conditions. The mean time from onset of symptoms to treatment was 9.25 months (range, 3-24.5 months). At a mean follow-up of 33.8 months (range, 24-65.5 months), patients were evaluated with a questionnaire and examination, based on the American Shoulder and Elbow Surgeons standardized elbow assessment and previously reported elbow outcome score. RESULTS: Posterolateral elbow pain was present in all patients. Fifty-eight percent (7 of 12 patients) complained of clicking or catching, whereas only 25% (3 of 12) experienced swelling or effusion. At elbow arthroscopy, a thickened synovial lateral plica was debrided in all cases. Ninety-two percent (11 of 12 patients) reported an excellent outcome with a mean elbow score of 92.5 points (maximum, 100 points). Return to competitive play averaged 4.8 months (range, 3-9.5 months). One patient with a fair outcome developed medial elbow instability that later required reconstructive surgery. CONCLUSION: Posterolateral elbow impingement from hypertrophic synovial plicae can cause significant pain and disability in throwing athletes and golfers. With careful diagnosis and exclusion of other elbow problems, treatment with arthroscopic debridement and focused rehabilitation is highly successful and allows these athletes to return to their previous level of play.     

Surgical treatment of ankle instability in athletes.

Eighteen athletes with symptoms of recurrent sprain and instability of the ankle during activity were treated by reconstructing the lateral ligament by the Evans technique. Before the operation 55 per cent had given up all athletic activities because of pain, swelling or instability, and 17 per cent had restricted their activities. The average age at operation was 24.6 years and the average follow-up period 3.1 years. Normal stability was achieved in 67 per cent and improved stability in 11 per cent, but only 33 per cent were still engaged in athletic activities without any complaints from the ankle. The results are similar to other methods of surgical repair.     

Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study

BACKGROUND: Female athletes are at significantly greater risk of anterior cruciate ligament (ACL) injury than male athletes in the same high-risk sports. Decreased trunk (core) neuromuscular control may compromise dynamic knee stability. HYPOTHESES: (1) Increased trunk displacement after sudden force release would be associated with increased knee injury risk; (2) coronal (lateral), not sagittal, plane displacement would be the strongest predictor of knee ligament injury; (3) logistic regression of factors related to core stability would accurately predict knee, ligament, and ACL injury risk; and (4) the predictive value of these models would differ between genders. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: In this study, 277 collegiate athletes (140 female and 137 male) were prospectively tested for trunk displacement after a sudden force release. Analysis of variance and multivariate logistic regression identified predictors of risk in athletes who sustained knee injury. RESULTS: Twenty-five athletes (11 female and 14 male) sustained knee injuries over a 3-year period. Trunk displacement was greater in athletes with knee, ligament, and ACL injuries than in uninjured athletes (P < .05). Lateral displacement was the strongest predictor of ligament injury (P = .009). A logistic regression model, consisting of trunk displacements, proprioception, and history of low back pain, predicted knee ligament injury with 91% sensitivity and 68% specificity (P = .001). This model predicted knee, ligament, and ACL injury risk in female athletes with 84%, 89%, and 91% accuracy, but only history of low back pain was a significant predictor of knee ligament injury risk in male athletes. CONCLUSIONS: Factors related to core stability predicted risk of athletic knee, ligament, and ACL injuries with high sensitivity and moderate specificity in female, but not male, athletes.     

Chondrolysis after partial lateral meniscectomy in athletes

Rapid chondrolysis after partial arthroscopic lateral meniscectomy has been seldom reported in literature. Considering the relatively high number of partial lateral meniscectomy performed, we cannot understand why this complication is so rare. The purpose of this paper is to report a series of athletes developing a chondrolysis associated with posterolateral corner laxity after a partial lateral meniscectomy and attempt to hypothesize the pathogenesis of this devastating complication. Five male professional soccer players of Italian championship with a mean age of 26.8 years underwent a partial lateral meniscectomy because of a traumatic lateral meniscus tear. Patients showed a slight varus knee and there were clinical signs compatible with a meniscal tear. No other pathological sign were found. An MRI scan confirmed these findings. After surgery patients were unable to resume sport activities because of swelling and knee pain during training sessions. At a mean time of 8 months (range 6-12 months) from surgery patients were re-examined and a new MRI scan was performed. Clinical examination revealed a slight swelling of the knee and signs of posterolateral corner laxity. MRI scan revealed intra-articular fluid and pathological findings of knee posterolateral corner associated with a thinning of the articular cartilage. Arthroscopy showed free cartilagineous debris floating into the knee and a high grade of cartilage damage on the lateral compartment. The evaluation of lateral compartment, ruled-out a new tear of the meniscal remnant and showed a positive drive-trough sign with knee in the Fig. 4 positioning. All patients had an open re-tensioning of the posterior meniscofemoral capsule, and in one case, an augmentation of the popliteal tendon using a free semi-tendinous graft was also done. This surgery gave a complete resolution of symptoms and patients resumed sports activities without any restriction after a period between 4 and 5 months. Based on this experience we hypothesize that partial lateral meniscectomy may have a role in causing a subtle rotatory instability that combined with high stress of sports activity can dramatically increase the susceptibility of joint to chondrolysis, Varus knee seems to be a possible predisposing factor. Open surgery addressing the insufficiency of lateral or posterolateral corner has been found to be effective in improving knee function and resolve patients symptoms at a short-term follow-up.     

Verletzungen und Überlastungsschäden im leistungsorientierten Kanusport

BackgroundInjuries in canoeing has been described only a little in general-accessible literature. They are focused on shoulder and arm injuries. In this article the most frequent injuries in competitive canoeing are worked out.Materials and MethodsIn a retrospective questionnaire analysis 360 canoeists were asked about their sport-related complaints and injuries within the last four years.ResultsFinally 104 elite-canoeing-athletes could be included. The allocation of the injuries and overuse symptoms was carried out by body region. Shoulder problems have been reported with a frequency of 26%. Pain in the lumbar spine and the knee joint was reported in 33% and 27% of the athletes. Dysesthesia in the legs (32%) and wrist-pain (29%) were also reported in about one third of the athletes.ConclusionsThe present paper shows that canoeing as obvious upperbody stressing sports can also lead to complaints like dysesthesia of the legs and pain in the lumbar spine, knee and wrist. These complaints occur almost as often as the expected shoulder complaints.Level of evidence: III     

Prevalence of asthma-like symptoms, asthma and its treatment in elite athletes

The objective was to determine the prevalence of asthma-like symptoms and asthma and the use of asthma medication in Danish elite athletes. A cross-sectional questionnaire survey of Danish elite athletes was conducted in 2006. All elite athletes ( N =418) financially supported by the national organization of elite athletes comprised the study group; 329 (79%) completed the questionnaire concerning their sport, asthma-like symptoms, asthma and use of asthma medication. Asthma-like symptoms at rest were reported by 41% of respondents; 55% reported asthma-like symptoms at rest or at exercise. Physician-diagnosed asthma was present in 16% and 14% had current asthma. Asthma medication was taken by 7% of the athletes, of whom 79% used inhaled corticosteroids and 21% used inhaled β₂-agonists only. Athletes participating in endurance sports had higher prevalences of current asthma (24%) and use of asthma medication (15%) than all other athletes ( P <0.01). Athletes participating in endurance sports have a higher prevalence of asthma and use of asthma medication. The frequency of asthma medication is lower than the prevalence of current asthma indicating that there is no overuse of asthma medication among Danish elite athletes.     

The association of concussion history and symptom presentation in combat sport athletes

ObjectiveThe purpose of this study was to describe the concussion-related symptoms reported among combat sport athletes with and without a history of concussion, and a history of neck injury.DesignCross-sectional survey.SettingData were collected using an online survey instrument.ParticipantsThree hundred and nine adult combat sport athletes.Main outcome measuresSelf-reported 12-month concussion history and neck injury history and a 22-item symptom checklist.ResultsA history of concussion was reported by 19.1% of athletes, a history of neck injury was reported by 23.0%, and 13.6% reported both injuries. Neck pain was the most frequently reported symptom. Athletes with a history of injury had significantly greater proportions of ‘high’ total symptoms and symptom severity scores compared with athletes with no history of injury. Athletes with a history of concussion had 2.35 times higher odds of reporting ‘high’ total symptoms and symptoms severity scores.ConclusionAthletes with a history of concussion or neck injury have greater odds of presenting with higher symptom scores. The presence of high total symptom scores and high symptom severity scores may indicate a need for further investigation into domains commonly associated with concussion.     

Long-term follow-up of bradycardia in elite athletes

The aim of the study was to examine the hypothesis that when former high-level athletes retired from competition, bradycardia would vanish. ECG changes and factors possibly related to the persistence of bradycardia were investigated. We performed a longitudinal follow-up study in 157 former elite athletes who had records of bradycardia < 50 bpm when they were active in high-level competition. All had retired from competitive sport for a minimum of five years prior to participation in the follow-up examination. Data on sport modality, hours of weekly training during competition periods, years participating in high-level competition, and years since retirement from competition were abstracted from medical records at two sports medicine centers. ECGs from this time were studied. At the post-retirement follow-up examination, participants underwent a clinical examination that included blood pressure and ECG recordings, and answered a structured questionnaire about their physical exercise since retirement from their sporting career. In the post-retirement period, a total of 65 % of participants had persistent bradycardia, 18 % with bradycardia < 50 bpm. Multivariate analysis showed that persistence of resting bradycardia was associated with regular exercise and number of years in high-level competition, but not with symptoms such as palpitations, dizziness or syncope, or major ECG alterations.     

Dutch translation of the Kujala Anterior Knee Pain Scale and validation in patients after knee arthroplasty

Purpose

To translate and validate the Kujala Anterior Knee Pain Scale (AKPS) in patients who have undergone total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA) and evaluate the internal consistency, construct validity and ceiling or floor effect.

Methods

After standard forward and backward translation was performed, 302 patients who have received a TKA or UKA filled out the AKPS together with Hospital for Special Surgery (HSS) patella score, visual analogue score (VAS) for pain, the Oxford 12-item questionnaire and the SF-36 at follow-up. The internal consistency was tested using Cronbach’s α coefficient. The construct validity was assessed using Spearman’s rank correlation (R) to test for correlations between the AKPS and VAS HSS, HSS patella score, VAS month, Oxford 12-item questionnaire and SF-36 subscales. Ceiling or floor effects are given in percentage of patients giving a maximum or minimum score.

Results

The internal reliability of the AKPS is acceptable with a Cronbach’s α of 0.81 in patients after TKA or UKA. A high correlation was found between the AKPS and the Oxford 12-item questionnaire (R = 0.81). Moderate correlations were found with the VAS month (R = 0.63), HSS patella score (R = 0.51) and SF-36 subscales physical functioning (R = 0.59), role-physical (R = 0.59), bodily pain (R = 0.57). Other correlations were poor, therefore indicating a good convergent and divergent validity. Ceiling effects were observed for the HSS patella score (31 %), VAS HSS (51 %), VAS pain (19 %), SF36-RP (46 %), SF36-RE (80 %) and SF36-BP (24 %). No ceiling or floor effect was found for the AKPS, Oxford 12-item and the other SF36 domains.

Conclusions

The AKPS appears to be reliable and valid in patients after knee arthroplasty, with no ceiling and floor effects, and can be used to assess anterior knee pain in patient who underwent joint replacement surgery.

Level of evidence

Diagnostic study, Level I.     

Distal patellar tendinosis: an unusual form of jumper’s knee

Jumper's knee is a common problem in athletes participating in sports that involve running and jumping. Typically activity related pain is felt at the proximal insertion of the patellar tendon. Symptoms and findings in the more distal parts of the patellar tendon are unusual. All of the patients in this retrospective study were active athletes suffering from distal patellar tendinosis. There were 19 men and four women. The mean age of the patients was 24 years (range 12-32). All of the patients were operated on after conservative treatment lasting for an average of 23 months had failed. After a mean postoperative follow-up of 42 months 21 of the knees were rated good meaning that the athlete had returned to the prior level of activity without any symptoms. In three knees the result was fair as the patients benefited from the operation but there were some remaining symptoms. No poor results were reported. All patients were able to return to their previous level of sports 8-12 weeks after surgery. Operative treatment seems to give good results in most cases after unsuccessful conservative treatment of the unusual distal patellar tendinosis in athletes.     

Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction

BACKGROUND: Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction have not been established. HYPOTHESIS: Relationships exist between objective and subjective assessments after anterior cruciate ligament reconstruction. STUDY DESIGN: Case series. METHODS: Patients (N = 202) undergoing anterior cruciate ligament reconstruction with 2-year minimum follow-up were studied. Objective variables of ligament stability at follow-up included instrumented laxity, Lachman examination, and pivot-shift examination. Subjective variables of symptoms at follow-up included pain, swelling, giving way, locking, crepitus, stiffness, and limping. Subjective function at follow-up included walking, squatting, stair climbing, running, cutting, jumping, twisting, activity limitation, sports level, activities of daily living level, work level, knee function, sports participation, Lysholm score, and satisfaction with outcome. RESULTS: Instrumented knee laxity and Lachman examination had no significant (P >.05) relationships with any subjective variables of symptoms and function. Pivot-shift examination had significant associations with satisfaction (P =.03), partial giving way (P =.01), full giving way (P =.01), difficulty cutting (P =.01), difficulty twisting (P =.01), activity limitation (P =.01), overall knee function (P =.03), sports participation (P =.02), and Lysholm score (P =.01). CONCLUSIONS: The pivot-shift examination may be a better measure of "functional instability" than instrumented knee laxity or Lachman examination after anterior cruciate ligament reconstruction.     

Swedish translation and validation of a web‐based questionnaire for registration of overuse problems

The main aim of this study was to translate the Oslo Sport Trauma Research Center (OSTRC) Overuse Injury Questionnaire into Swedish. The validity and applicability of the questionnaire for studying overuse injuries among Swedish handball, volleyball, tennis, and orienteering top athletes were also examined. The back‐translation method was used for translation. An expert committee further developed it for use in a study of injuries in handball, orienteering, tennis, and volleyball. A 10‐week pretest was then conducted on 43 athletes, average age 21 (18–31) from these sports, during which time the athletes completed the modified OSTRC questionnaire on a weekly basis. In the 10th week, four additional questions were added in order to examine the questionnaire's content validity. No major disagreement was found in the translation. The athletes perceived the web‐based questionnaire to be smooth and easy to complete, accurately capturing overuse injuries. However, suggestions were made to add questions relating to the hip for orienteerers and to the hand/fingers for handball players. The average prevalence of overuse injuries for all athletes, in any anatomical area was 22% (95% confidence interval 20–25). Construct validity appeared to be high, and we therefore suggest that the questionnaire may be used when studying overuse injuries in different sports.     

Bilateral bucket handle medial plica in an adolescent

A case of bilateral knee pain and compromised function in an adolescent tennis player caused by symptomatic fenestrated bucket handle medial plicae is presented. Arthroscopic resection relieved all symptoms. The patient returned to competitive tennis and was without complaint at 12 month (left knee) and 18 month (right knee) follow-up.