The prevalence of Achilles and patellar tendon injuries in Australian football players beyond a time‐loss definition

Little is known about the prevalence and associated of morbidity of tendon problems. With only severe cases of tendon problems missing games, players that have their training and performance impacted are not captured by traditional injury surveillance. The aim of this study was to report the prevalence of Achilles and patellar tendon problems in elite male Australian football players using the Oslo Sports Trauma Research Centre (OSTRC ) overuse questionnaire, compared to a time‐loss definition. Male athletes from 12 professional Australian football teams were invited to complete a monthly questionnaire over a 9‐month period in the 2016 pre‐ and competitive season. The OSTRC overuse injury questionnaire was used to measure the prevalence and severity of Achilles and patellar tendon symptoms and was compared to traditional match‐loss statistics. A total of 441 participants were included. Of all participants, 21.5% (95% CI : 17.9‐25.6) and 25.2% (95% CI 21.3‐29.4) reported Achilles or patellar tendon problems during the season, respectively. Based on the traditional match‐loss definition, a combined 4.1% of participants missed games due to either Achilles or patellar tendon injury. A greater average monthly prevalence was observed during the pre‐season compared to the competitive season. Achilles and patellar tendon problems are prevalent in elite male Australian football players. These injuries are not adequately captured using a traditional match‐loss definition. Prevention of these injuries may be best targeted during the off‐ and pre‐season due to higher prevalence of symptoms during the pre‐season compared to during the competitive season.     

Low prevalence of patellar tendon abnormality and low incidence of patellar tendinopathy in female collegiate volleyball players

ABSTRACT

The prevalence of patellar tendinopathy has been reported to be as high as 50% in elite male volleyball (VB) players; however, the rate of injury in female collegiate VB athletes is unknown. The purpose of this study was to 1) identify the prevalence of ultrasonographic evidence of patellar tendon abnormality at the start of the preseason in female collegiate VB players; 2) report the incidence of tendinopathy during the season; and 3) determine if the preseason presence of tendon abnormality is associated with onset of disease. One hundred and six female collegiate VB players had both patellar tendons imaged. Incidence of patellar tendinopathy was tracked during the course of the 4-month season. Twenty-two athletes presented with ultrasonographic evidence of patellar tendon abnormality in at least one knee at the start of the preseason. The incidence of time-loss patellar tendinopathy was 0.26 (95% CI: 0.04, 0.85) per 1000 athletic exposures. This study was unable to determine if preseason presence of tendon abnormality was associated with a greater risk of tendinopathy due to power. The prevalence of tendon abnormality in the preseason and the incidence of patellar tendinopathy in female collegiate VB players are lower than that observed in other populations.     

Etiology and pathophysiology of tendon ruptures in sports

Of all spontaneous tendon ruptures, complete Achilles tendon tears are most closely associated with sports activities (1–3). Schönbauer (3) reported that 75% of all ruptures of the Achilles tendon are related to sports. In Plecko & Passl (2) the number was 60%. In our material of 430 cases, the number of sports-related Achilles ruptures was very similar (62%), while only 2% of ruptures of other tendons were sports-related (P<0.001) (1). Also, the majority of Achilles reruptures occurred in sports. The ruptures occurred most often in soccer (34%), track and field (16%) and basketball (14%). The distribution of Achilles ruptures according to different sports varies considerably from country to country, according to the national sport traditions. For example, in northern and middle Europe, soccer, tennis, track and field, indoor ball games, downhill skiing, and gymnastics are the most common; and in North America, football, basketball, baseball, tennis and downhill skiing dominate the statistics (1, 2, 4). In sports, some Achilles ruptures are not spontaneous or degeneration-induced but may occur as a consequence of the remarkably high forces that are involved in the performance (2). Ruptures in the high jump or triple jump are good examples. In such cases, failure in the neuromuscular protective mechanisms due to fatigue or disturbed co-ordination can frequently be found. The spontaneous complete rupture of the supraspinatus tendon of the rotator cuff does not occur very frequently in sports. Those sports that include high-energy throwing movements, such as American and Finnish baseball, American football, rugby and discus and javelin throwing, may, however, produce this injury. Partial tears and inflammations of the rotator cuff complex are much more frequent in throwing sports. The complete rupture of the proximal long head of the biceps brachii tendon is rare among competitive and recreational athletes. In our material, under 2% of these ruptures were associated with sports activities (5). The rupture (avulsion) of the distal tendon of the biceps muscle is rare. In sports, gymnastics, body building and weight lifting have been said to be able to produce this injury (6). In general, complete ruptures of the quadriceps tendon and the patellar tendon occur most often in older individuals. In our study, the mean age of these patients was 65 years (5). However, these injuries do also occur in younger age groups, especially in athletes. In athletes, the rupture most frequently occurs in high-power sports events, such as high jump, basketball and weight lifting, at the age of 15-30 years. A chronic patellar apicitis (jumper's knee) may predispose rupture of the tendon (7). As is the case with the rotator cuff complex, overuse inflammation and partial tears of the quadriceps and patellar tendons are one of the most characteristic athletic injuries. Complete spontaneous ruptures of other tendons in sports are rare, although the literature does provide case studies from almost every tendon the human body possesses (8–18).     

Return to play and performance after anterior cruciate ligament reconstruction in the National Basketball Association: surgeon case series and literature review

Objectives: To investigate return to play (RTP) and functional performance after anterior cruciate ligament reconstruction (ACLR) in National Basketball Association (NBA) players and to perform a systematic review of the literature to understand RTP after ACLR in professional basketball.

Methods: NBA players undergoing ACLR between 2008 and 2014 by two surgeons were identified. RTP and performance were assessed based on a review of publically available statistics. A systematic review of the literature was performed using the MEDLINE database. Inclusion criteria were: English language, ACL surgery outcome, professional basketball and RTP outcome. We reviewed studies for RTP rates and RTP performance.

Results: Our study included 12 professional basketball players with NBA level experience. Eleven of the 12 players returned to their prior level of play. Eight of the 9 (88.9%) players actively playing in the NBA returned to play in the NBA at a mean 9.8 months. Among players returning to NBA play, during RTP season 1, mean per game statistics decreased for the following: minutes, points, rebounds, assists, steals, blocks, turnovers and personal fouls – none of these changes reached statistical significance. Player efficiency ratings significantly declined from pre-injury (12.5) to the first RTP season (7.6) (p = 0.05). By RTP season 2, player performance metrics approximated pre-injury levels and were not significantly different. Six studies met inclusion criteria; reported RTP rates ranged from 78–86%. Identified studies similarly found a decline in functional performance after RTP.

Conclusion: There is a high rate (89%) of return to NBA play for NBA players undergoing ACLR. After RTP, however, there is a quantitative decline in initial season 1 RTP statistics with a significant decrease in player efficiency rating. By RTP season 2, performance metrics demonstrated an improvement compared to RTP season 1 but did not reach pre-injury functional performance, though performance metrics are not significantly different between pre-injury and RTP season 2.     

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.     

The healthy worker effect in professional football

We investigated the "healthy athlete effect" (HAE) in American professional football. Ages of death of professional football players who debuted prior to 1940 were obtained and differences between those ages and age-adjusted life expectancies were examined to determine if longevity increased with career length, controlling for birth year, body mass index (BMI), position, and type. Professional football players (N=1,512) lived an average of 6.1 (+/- 11.9 SD) years longer than age-matched controls from the general public. Career length significantly and incrementally increased longevity of players from an average of 5.5 years for players playing one season to 6.7 years for players playing 4 or more seasons. Both birth year and BMI had a statistically significant association with longevity, but position type did not. These data provide strong support for the healthy worker effect (HWE) in professional football.     

Significance of ultrasonographically detected asymptomatic tendinosis in the patellar and achilles tendons of elite soccer players: a longitudinal study

BACKGROUND: Chronic tendinosis of the Achilles or patellar tendons, or both, is one of the most frequent and severe conditions that affects athletes in sports such as soccer. It can often end an athlete's sports activity. HYPOTHESIS: Ultrasonography of asymptomatic tendons can be used to predict which athletes will develop tendon symptoms. STUDY DESIGN: Longitudinal study. METHODS: Using ultrasonography of the ankle and knee, we examined 54 elite soccer players in the top Danish soccer league before and after a single season (in January and December). RESULTS: At the start of the season, ultrasonography had revealed abnormalities in 29% of those examined. Eighteen percent (18 of 98 tendons) were observed to have abnormal sonographic findings in the patellar tendon at the initial examination in January. These athletes were found to have a 17% risk of developing symptomatic jumper's knee during the 12-month season. Eleven percent (11 of 96 tendons) were observed to have abnormal sonographic findings in the Achilles tendon at the initial examination; it was calculated that they had a 45% risk of developing symptoms of Achilles tendinosis. Only one of the players with normal tendons in January actually developed symptoms by the end of the season. CONCLUSIONS: For the first time it is now possible to identify risk factors for the development of serious tendon disorders in asymptomatic athletes. Future studies may be directed at developing preventive treatment to reduce the risk of chronic, therapy-resistant symptoms of tendinosis and ruptures.     

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.     

Refracture of proximal fifth metatarsal (Jones) fracture after intramedullary screw fixation in athletes

This study details six instances of refracture of clinically and radiographically healed fractures of the base of the fifth metatarsal after intramedullary screw fixation. Four professional football players, one college basketball player, and one recreational athlete underwent intramedullary screw fixation of fifth metatarsal fractures. The athletes were released to full activities an average of 8.5 weeks (range, 5.5 to 12) after fixation, when healing was clinically and radiographically documented. Three football players developed refracture within 1 day of return to full activity. The other three athletes refractured at 2.5, 4, and 4.5 months after return to activity. Two football players underwent repeat fixation with larger screws and returned to play in the same season. The college basketball player underwent bone grafting and returned to play in subsequent seasons. The other three athletes underwent nonoperative management and healed uneventfully over 6 to 8 weeks. On the basis of this series, we recommend that 1) screw fixation using a large-diameter screw should be given careful consideration for patients with large body mass for whom early return to activity is important; 2) functional bracing, shoe modification, or an orthosis should be considered for return to play; 3) if refracture occurs, exchange to a larger screw may allow return to play in the same season; and 4) alternative imaging should be considered to help document complete healing.     

Self-reported jumpers’ knee is common in elite basketball athletes – But is it all patellar tendinopathy?

ObjectivesTo describe the prevalence and pain location of self-reported patellar tendinopathy and patellar tendon abnormality in a male elite basketball population.DesignCross-sectional.SettingPre-season tournament.ParticipantsSixty male athletes from the Australian National Basketball League.Main outcome measuresSelf-reported patellar tendinopathy (PT) using the Oslo Sports Trauma Research Centre Overuse Questionnaire (OSTRC). Pain location using pain mapping (dichotomised: focal/diffuse) and severity during the single leg decline squat. Ultrasound tissue characterisation scans of both patellar tendons.ResultsThirteen participants (22.7%) self-reported PT. Only 3 who reported PT had localised inferior pole pain. Thirty athletes reported pain during the decline squat, 15 described focal pain; 10 diffuse pain (5 missing data). Those with diffuse pain had greater years played [Md = 21 (13–24), n = 10 than focal pain (Md = 12 (7–26), n = 15), p = 0.042, r = 0.3]. Bilateral tendon abnormality was found in 45% of athletes and 15% had unilateral tendon abnormality.ConclusionElite male basketball athletes self-reporting PT had heterogeneity in pain location. When focal pain with loading was used as a primary definition of PT, ‘jumpers’ knee’ was not common in this cohort. This study found that abnormality of the patellar tendon was common and did not correlate with symptoms.     

Anthropometric and fitness profiles of elite players in two football codes

BACKGROUND: The aims were to describe anthropometric and performance characteristics of elite players in two football codes and explore the differences between them. METHODS: Data were compared by means of "t"-tests. Subjects: subjects were 19 professional soccer players and 33 inter-county Gaelic football players. Settings: measurements were made on members of a Premier League soccer team throughout their regular season, whilst the Gaelic footballers were members of the Mayo squad preparing for the 1999 All-Ireland championship. RESULTS: The variability in stature was significantly greater in the soccer players compared to the Gaelic footballers (p<0.01). Performances in the 10-m and 30-m sprints, and in vertical jump were superior in the soccer group compared to the Gaelic footballers (p<0.01). CONCLUSIONS: The intra-group variability on the anthropometric and performance measures of the soccer players is likely to be due to the specificity of positional roles. The combined groups could be described as lean and muscular with a reasonably high level of capacity in all areas of physical performance. Anaerobic characteristics of the professional soccer players were superior to those of Gaelic football players. It is concluded that anthropometric and performance assessment of elite footballers using mean values masks the heterogeneity evident within the football codes.     

Mechanical jumping power in athletes.

The Wingate cycle ergometer test is a widely used test of sustained muscular power. A limitation of the test is the lack of development and retrieval of stored elastic energy due to a lack of an eccentric phase. To measure mechanical power output of the entire stretch-shortening cycle, the test of Bosco et al (1983) was administered to 119 male athletes in 7 different activities during their pre-participation evaluations. The sports tested were indoor soccer, American football and ballet (professionals), outdoor soccer, basketball and wrestling (collegiate) and amateur bobsled. Results showed the overall average power output to be 20.37 W.kg-1 for the 60s reciprocal jumping test. Ballet dancers generated significantly less mechanical power than indoor soccer, basketball and bobsled athletes, while wrestlers generated significantly less power than indoor soccer and basketball athletes (all p less than 0.05). No other between-sport differences were seen. A subset of indoor soccer players (n = 10) were retested after 4 months of training. Power improved from 20.8 to 24.3 W.kg-1 (p less than 0.05). While between sport differences were limited, training differences in one subset of athletes were readily identified.     

A career in sport does not eliminate risk of cardiovascular disease: A systematic review and meta-analysis of the cardiovascular health of field-based athletes

ObjectivesTo determine the prevalence of cardiovascular disease (CVD) risk factors in current field-based athletes.DesignMeta-analysis.MethodsThis review was conducted and reported in accordance with PRISMA and pre-registered with PROSPERO. Articles were retrieved via online database search engines, with no date or language restriction. Studies investigating current field-based athletes (>18years) for CVD risk factors according to the European Society of Cardiology and American Heart Association were screened. Full texts were screened using Covidence and Cochrane criteria. Eligible articles were critically appraised using the AXIS tool. Individual study estimates were assessed by random-effect meta-analyses to examine the overall effect.ResultsThis study was ascribed a 1b evidence level, according to the Oxford Centre for Evidence-based Medicine. 41 studies were identified, including 5546 athletes from four sports; American football; soccer; rugby and baseball mean ages: 18–28. Despite participation in sport, increased body mass was associated with increased total cholesterol, low-density lipoprotein, triglycerides, hypertension, systolic blood pressure, and decreased high-density lipoprotein. Linemen had increased prevalence of hypertension compared to non-athletes. Conflicting findings on fasting glucose were prevalent. There were inconsistencies in screening and reporting of CVD risk factors. Sport specific anthropometric demands were associated with elevated prevalence of CVD risk factors, most notably: elevated body mass; dyslipidemia; elevated systolic blood pressure and; glucose.ConclusionsThere are elevated levels of risk for CVD in some athletes, primarily football players. Lifestyle behaviours associated with elite athleticism, particularly football linemen potentially expose players to greater metabolic and CVD risk, which is not completely offset by sport participation.     

Neuromuscular and functional responses in professional soccer players during pre-season: implications for injury prevention

Objective

The purpose of this investigation was to assess the muscular strength of the knee extensors and flexors muscles, agility and functionality between dominant leg (DL) vs. non-dominant leg (NDL) of professional soccer players during pre-season.

Methods

Twenty-two healthy male professional soccer players (25.1?±?3.8 years; 182.1?±?5.9 cm; 79.3?±?5.4 kg; body fat 14.6?±?3.8%) from a club of the Brazilian second-division soccer league participated in this study. All soccer players underwent three tests to assess strength, power, and physical performance with an interval of 48 h inter-sessions. During the first assessment session, isokinetic tests were performed in which athletes performed maximal isokinetic concentric and eccentric contractions, as well as maximal isometric contractions. In the second and third assessment sessions, single leg step down and agility tests were performed, respectively.

Results

Maximum voluntary isometric contraction (MVIC) results showed a significant difference (p?<?0.04) between DL compared to the NDL for absolute and relative values. But, the isokinetic variables of knee extensors at 60°/s (total work and power) were significantly higher (p?<?0.03) in NDL. Pearson’s correlation was found to be significant between MVIC and single leg step down (SLSD) test for DL (r?=?0.70, p?=?0.0001) and NDL (r?=?0.58; p?=?0.002).

Conclusion

The results confirm that DL shows greater isometric strength than NDL. However, NDL revealed an increase in the total work and power output in professional soccer players. Furthermore, the SLSD test is recommended because it proved to be a good method for evaluating muscle strength by a positive correlation with MVIC.

     

Return to play after treatment of shoulder labral tears in professional hockey players

Objectives: Shoulder labral injuries in professional hockey players are often treated surgically to minimize missed ice time. Previous studies have shown that post-operative outcomes in these players are favorable, although they have not specifically focused on athletic performance and time to return to sport. Our objective was to report time to return to play and post-operative on-ice performance metrics after shoulder labral repair in professional ice hockey players.

Methods: We performed a retrospective review of the clinical records of all professional hockey players (NHL) who underwent arthroscopic shoulder labral repair by one surgeon between January 2004 and December 2008. Operative data included labral injury type, number of anchors used, concomitant pathology, and complications. Player information included position, shooting hand, games played before and after surgery, date of return to play (RTP), time on ice (TOI) and shots on goal before and after surgery. Paired sample t-test and independent sample t-tests or their non-parametric equivalents were used to compare pre-and post-operative player performance variables using the SPSS statistical package.

Results: Eleven NHL Players (13 shoulders) were included in the study. The average follow-up was 19.4 months (12.7–37 months, SD 7.4) and average age was 29 years (20–36, SD 5.1). Of the 13 shoulders, there were various types of labral tears including three Bankart tears, three superior (SLAP) tears, two posterior tears, three combined anterior/posterior tears, and two panlabral tears. All 11 players returned to play (RTP) after surgery at an average time of 4.3 months. There were no significant differences between time to RTP for players with dominant-sided injuries (4.2 months) and non-dominant injuries (4.6 months), p = 0.632. Five players had increased time-on-ice (TOI) and five players had decreased TOI after surgery, though this difference was not significant (p = 0.3804). On average, the shots on goal per game played (SOG/GP) decreased by 0.13 after surgery which was not significantly different (p = 0.149). There were no post-operative complications observed.

Conclusion: Professional ice hockey players can safely return to full competition at an average of 4.3 months after arthroscopic shoulder labral repair without significant decline in player performance.     

Quadriceps tendinosis and patellar tendinosis in professional beach volleyball players: sonographic findings in correlation with clinical symptoms

The purpose was to assess quadriceps and patellar tendinosis in professional beach volleyball players and to correlate ultrasound findings with clinical symptoms. During a grand-slam beach volleyball tournaments all 202 athletes (100 men and 102 women) were invited to participate at this study. Sixty-one athletes (38 male, mean age 29.6, 23 female, mean age 27.1) were included. The dominant leg was right in 51 (84%) and left in ten athletes (16%). Lysholm knee score and pain during the game was assessed using a visual analogue scale. Sonography of the quadriceps tendon and the patellar tendon was performed by a blinded sonographer. Sonographic findings were compared between both legs and correlated to clinical findings using a regression analysis. Quadriceps tendinosis was diagnosed in 13 (21%, dominant leg)/21 (34%, non-dominant leg), patellar tendinosis in 13(21%)/18(30%). Only sonographic findings at the quadriceps tendon were significantly associated with pain: thickness of the quadriceps tendon (mean diameter 6.9 mm/7.1 mm, significant for both legs P = 0.011/P = 0.030), abnormal echo texture (11/16; P = 0.001/P = 0.228), areas with positive power Doppler signals (mean number 0.3/0.4; P = 0.049/0.346), calcifications (mean number: 0.9/1.1; P = 0.021/0.864). A relationship between findings at patellar tendon was not found. Quadriceps tendinosis is as common as patellar tendinosis in professional beach volleyball players. Thickening and structure alteration of the quadriceps tendon is associated with anterior knee pain during beach volleyball.     

Case Report: Peptic Ulcer Disease in a Professional Athlete

Abstract

Peptic ulcer disease (PUD) is a common problem that affects 4 million people in the United States. Although its prevalence has not been studied in the athletic population, one would suspect PUD would affect athletes at a similar rate or higher based on the predispositions to certain risk factors of this disease. This case report addresses the particular predispositions for PUD in a professional football athlete.     

Jump-landing mechanics in patellar tendinopathy in elite youth basketballers

Patellar tendinopathy (PT) is a leading cause of morbidity in jump-landing athletes. Landing mechanics are identified as a factor associated with PT and/or patellar tendon abnormality. This study aimed to identify key jump-landing variables associated with PT. Thirty-six junior elite basketball players (men n = 18, women n = 18) were recruited from a Basketball Australia development camp. Three-dimensional (3D) kinematic and ground reaction force (GRF) data during a stop-jump task were collected as well as ultrasound scans of the patellar tendons and recall history of training load data. Mixed-model factorial analyses of variance were used to determine any significant between-group differences. Of the 23 participants included for statistical analyses, 11 had normal bilateral patellar tendons (controls) and eight reported PT (currently symptomatic); however, the four participants categorized as asymptomatic with patellar tendon abnormality on diagnostic imaging were excluded from statistical analyses due to their small sample size. Athletes with PT displayed a similar knee flexion angle at initial foot-ground contact (IC) and hip extension strategy during a stop-jump horizontal landing. Despite a similar kinematic technique, athletes with PT utilized a strategy of a longer stance duration phase from IC to peak force. This strategy did not lead to those athletes with PT decreasing their peak vertical GRF nor patellar tendon force during landing but enabled these athletes to land with a lower rate of loading (control 59.2 ± 39.3 vs. PT 29.4 ± 33.7 BW.s-1). Athletes with PT still reported significantly reduced training volume (control 4.9 ± 1.8 vs PT 1.8 ± 1.1 sessions/wk; total training time/wk control 2.4 ± 1.0 vs PT 1.4 ± 1.1 h/wk).