Neuromuscular exercises prevent severe knee injury in adolescent team handball players

Purpose

Team handball is associated with a high risk of severe knee injury that needs to be reduced, particularly at the youth level. The purpose of this study was to show how an injury-prevention programme effectively reduces severe knee injury in adolescent team handball players.

Methods

Of 23 adolescent handball teams of both sexes, 13 were randomly allocated into the intervention group (168 players) and 10 into the control group (111 players). Players of the intervention group regularly participated in an injury-prevention programme for one season. Handball exposure and sustained injuries were documented for both groups on a monthly basis. The primary outcome parameter of the injury-prevention programme was the incidence of severe knee injury.

Results

Of the 279 included players, 68 (24%) sustained 82 injuries yielding an overall incidence of 1.85 injuries per 1000 h handball exposure (intervention group: 50 injuries/incidence: 1.90/1000 h; control group: 32 injuries/incidence: 1.78/1000 h). Knee injury was the second most frequent injury in adolescent team handball. The primary outcome parameter, severe knee injury occurred significantly more often in the control group [mean age (SD) 15.1 (1.0), injury incidence 0.33/1000 h] than in the intervention group [mean age (SD) 14.9 (0.9), injury incidence 0.04/1000 h]. The odds ratio was 0.11 (95% CI 0.01–0.90), p?=?0.019. Other injuries to the lower extremities showed no significant difference between the two groups.

Conclusions

Frequent neuromuscular exercises prevent severe knee injury in adolescent team handball players and should thus be included in the practical routine as well as in the education of team coaches.

     

Increased injury rates after the restructure of Germany’s national second league of team handball

Purpose

Scientific injury data in men’s professional team handball injuries are rare and even less scientific information exists on injury prevention. In 2011, Germany’s national second team handball league was restructured by merging the existing two regional leagues into one league. This study evaluates the injury patterns in professional team handball and compares the injury rates between the first and second league before and after the restructure.

Methods

All players of Germany’s national first and second men’s team handball leagues have mandatory trauma insurance with the same insurance company. This retrospective cohort study analysed the injury data of three consecutive seasons 2010–2013 using standardized injury definitions.

Results

1194 professional team handball players were included in this study. The majority of severe injuries affected the lower extremities, shoulders, and hands. The average injury incidence significantly differed between the first (4.9 injuries per 1000 h) and the second league (3.9 per 1000 h, p?<?0.01). The injury incidence in the restructured second league had increased from 3.7 to 4.1 per 1000 h (p?<?0.01) and prevalence from 67.1 to 79.3% (p?<?0.001), thus almost to the same levels of the first league. The second league showed more time-loss injuries at all severity levels.

Conclusion

This study yielded a high injury incidence after the restructure of the national second team handball league and presents details on prevalence, incidence, and patterns of injury in professional men’s team handball. This study is an important basis for developing injury prevention strategies that should focus on the shoulders, hands, and lower extremities and on reducing the number of matches and travel burden.

Level of evidence

III.

     

Beach handball is safer than indoor team handball: injury rates during the 2017 European Beach Handball Championships

Purpose

Beach handball is a relatively new type of sports, which was derived from team handball. Medical issues such as frequency and severity of injury are yet unknown. The purpose of this study was to investigate the injury pattern and injury rates of this new type of sports.

Methods

This study investigated the injury incidence of 30 national teams (10 senior and 20 u-17 teams, 16 men’s and 14 women’s teams) participating in the 2017 European Beach Handball Championships. Reports on injuries sustained during the senior and u-17 youth tournaments were provided by the medical staff of each team. Injury incidence was differentiated between age and sex, and between the five field positions (goalkeeper, wing, central defender, pivot, and specialist).

Results

During the tournaments, 87 injuries were recorded yielding an overall injury incidence of 286.1 per 1000 match hours. Time-loss due to injury was 49.3 per 1000 match hours. Senior players had a higher overall injury incidence with 395.3 injuries than u-17 players with 205.7 injuries per 1000 h match hours (p?<?0.01). Comparison of the injury incidence between the two sexes showed 330.23 injuries per 1000 h handball exposure for male players and 234.9 injuries for female players (n.s.). The most frequent injury type was sprains (21 injuries, 24.1%) followed by contusions (19 injuries, 21.8%) and skin abrasions with (15 injuries, 17.2%). Central defenders and specialists had the highest injury incidence. Thighs, ankles, as well as foot and toes (altogether 12 injuries, all 13.8%) were the three most frequently injured anatomic sites.

Conclusions

Beach handball seems to have a lower incidence of time-loss injuries than that reported for indoor team handball. This study is an important basis for developing injury prevention strategies in this sports that should focus on thighs, ankles, feet and toes. Further research into this new type of sports is essential to identify risk factors and to develop adequate injury prevention measures.

Level of evidence

II.

     

Rotational glenohumeral adaptations are associated with shoulder pathology in professional male handball players

Purpose

Glenohumeral range of motion adaptations may affect throwing athletes and contribute to shoulder injury. The purpose of this study was to evaluate shoulder rotation deficits among elite professional handball players and its correlation to the presence of shoulder pain and morphological changes.

Methods

Eighty-seven elite professional handball players and 41 healthy non-athlete volunteers participated in the study. Evaluations included measurement of range of internal and external rotation, total arch of motion, identification of shoulder pain and ultrasound scan for diagnosis of rotator cuff tears and internal impingement.

Results

Glenohumeral rotational deficits (>20–25°) were found among 11 players group (13%). The throwing shoulders in the players group showed a decrease in internal rotation and an increase in external rotation with significantly larger ranges among players compared to the non-athlete group. Internal rotation deficit >20° was associated with higher incidence of shoulder pain among players. Both internal rotation deficits (>25°) and total arch of motion deficit (>20°) co-existed with higher incidence of internal impingement. Shoulder pain was common (36/97–41%) and was associated with decreased external rotation and total arch of motion. Internal impingement (found in 13/87–15%) correlated with decreased rotation ranges and a greater deficit in total arch of motion, whereas higher gain in external rotation correlated with a partial rotator cuff tear (found in 12/87–14%).

Conclusions

Shoulder pathologies and problems commonly affected the group of handball players. Greater glenohumeral rotational deficits in throwing shoulders of handball players correlate with shoulder pain and internal impingement, while increased external rotation with partial rotator cuff tears. Such deficits affect 13% of the athlete population. Major clinical relevance of the study is to monitor handball players’ shoulders both clinically and by proper imaging. Evaluation of range of rotation seems to identify shoulders at risk of the pathology.

Level of evidence

Cross-Sectional study with control group, Level II.

     

Return to sports after arthroscopic capsulolabral repair using knotless suture anchors for anterior shoulder instability in soccer players: minimum 5-year follow-up study

Purpose

To report the return to sports and recurrence rates in competitive soccer players after arthroscopic capsulolabral repair using knotless suture anchors at a minimum of 5 years of follow-up.

Methods

All competitive soccer players with anterior glenohumeral instability treated by arthroscopic capsulolabral repair using knotless suture anchors between 2002 and 2009 were retrospectively identified through the medical records. Inclusion criteria were: no previous surgical treatment of the involved shoulder, absence of glenoid or tuberosity fractures, absence of large Hill–Sachs or glenoid bone defect, minimum follow-up of 5 years, instability during soccer practice or games, and failure of non-surgical treatment. The charts of included players were reviewed, and a phone call was performed in a cross-sectional manner to obtain information on: current soccer, return to soccer, recurrence of instability, shoulder function (Rowe score), and disability [Quick-Disability of the Arm, Shoulder, and Hand (DASH) score and Quick-DASH Sports/Performing Arts Module].

Results

Fifty-seven young male soccer players were finally included with a median (range) follow-up of 8 (5–10) years. Forty-nine (86 %) of the soccer players were able to return to soccer and 36 of them (73 %) at the same pre-injury level. There were 6 (10.5 %) re-dislocations in the 57 players, all of them of traumatic origin produced during soccer and other unrelated activities. The main reasons to not return to soccer were: knee injuries (two players), changes in personal life (two players), and job-related (three players). None of the players quit playing soccer because of their shoulder instability injury. The median (range) Rowe score, Quick-DASH score, and Quick-DASH sports score were 80 (25–100), 2.3 (0–12.5), and 0 (0–18.8), respectively.

Conclusions

Competitive soccer players undergoing arthroscopic capsulolabral repair with knotless suture anchors for shoulder instability without significant bone loss demonstrate excellent return to play at mid-to-long-term follow-up, with a 10.5 % chances of re-dislocating.

Level of evidence

IV.

     

Incidence of elbow injuries in adolescent baseball players: screening by a low field magnetic resonance imaging system specialized for small joints

Purpose

The aim of this preliminary study was to examine the capability of screening for elbow injuries induced by baseball using a low field small joint MRI system.

Materials and methods

Sixty-two players in the 4th–6th elementary school grades, with ages ranging from 9 to 12 years, participated in this study. Screening for elbow injuries was performed using a low-magnetic-field (0.2-T) magnetic resonance imaging (MRI) system designed for examinations of small joints of the extremities. Gradient-echo coronal, sagittal, and short-tau inversion recovery (STIR) coronal images of the dominant arm used for pitching were obtained to identify medial collateral ligament (MCL) injuries with or without avulsion fracture and osteochondritis dissecans.

Results

All 62 examinations were performed successfully, with 26 players (41.9 %) showing positive findings, all being confined to the MCL. No child showed bone damage. All criteria in the MRI evaluation of injuries showed high agreement rates and kappa values between two radiologists.

Conclusion

Screening for early detection of elbow injuries in junior Japanese baseball players can be successfully performed using a low-field MRI system specialized for small joints. The percentage of MCL injury without avulsion fracture was unexpectedly high (41.9 %).

     

Dietary habits in elite soccer players

Purpose

Physical training involves a balance among dietary intake, energy used and increasing physical activity. The keys to improve performance are diet and nutritional assessments. Accordingly, the purpose of this study is to assess dietary habits in a team of soccer players.

Methods

This study includes 28 elite soccer players (aged 27.88 ± 4.55 years, height 1.84 ± 0.06 m). Dietary habits, bio impedance analysis and skinfold thickness were examined throughout the soccer season of 2014–2015.

Results

Body composition was found to be in the normal range. A significant decrease in fat-free mass occurred in the end-season (T2, 72.8 ± 5.2; T3, 71.7 ± 5.6; p ≤ 0.001). These results show dietary habits which are not in accordance with the recommended international guidelines.

Conclusions

Results suggest that development of a nutrition programme would be helpful to maintain health and to improve performance.

     

Female adolescent elite handball players are more susceptible to shoulder problems than their male counterparts

Purpose

Shoulder problems are frequent among senior elite handball players. The objective of this study was to assess the prevalence of shoulder problems among adolescent elite handball players and to investigate potential differences in gender, school grade, playing position and playing level.

Methods

During the 2014 and 2015 pre-season periods, 471 players (age 15–18 years, 54% female) completed a comprehensive baseline questionnaire regarding history of any shoulder pain and shoulder problems experienced during the past season. The players were monitored weekly for one competition season (September–April) regarding shoulder problems and the amount of match and training. Generalised linear models with a binomial link function were used to calculate a prevalence ratio (PR) with 95% confidence interval (CI) to compare the subgroups of players.

Results

In total, 110 players (23%) reported having substantial shoulder problems (defined as moderate/severe reduction in training volume, or moderate/severe reduction in performance, or complete inability to participate) at some point during the follow-up season, of which almost half reported complete inability to participate. Of those players reporting substantial problems, 43% (95% CI 39–48) did so for at least 3 consecutive weeks during the season. The prevalence was significantly higher in female players (PR 1.46, 95% 1.04–2.06) and in backcourt players (PR 1.58, 95% CI 1.08–2.32), but no differences were found for school grade (PR 1.21 95% CI 0.88–1.67) or playing level (PR 1.09 95% CI 0.76–1.56).

Conclusions

The prevalence of substantial shoulder problems in adolescent elite handball players is high, especially among females, and this warrants further studies on risk factors for shoulder injury and the development of prevention strategies in handball players already before the age of 15. These findings also highlight the importance of introducing a clinical monitoring programme on a routine basis and improving the medical support, taking gender-related aspects into consideration, at handball-profiled secondary schools.

Level of evidence

II.

     

Ultrasound assessment of the posterior circumflex humeral artery in elite volleyball players: Aneurysm prevalence,anatomy, branching pattern and vessel characteristics

Objectives

To determine the prevalence of posterior circumflex humeral artery (PCHA) aneurysms and vessel characteristics of the PCHA and deep brachial artery (DBA) in elite volleyball players.

Methods

Two-hundred and eighty players underwent standardized ultrasound assessment of the dominant arm by a vascular technologist. Assessment included determination of PCHA aneurysms (defined as segmental vessel dilatation ≥150 %), PCHA and DBA anatomy, branching pattern, vessel course and diameter.

Results

The PCHA and DBA were identified in 100 % and 93 % (260/280) of cases, respectively. The prevalence of PCHA aneurysms was 4.6 % (13/280). All aneurysms were detected in proximal PCHA originating from the axillary artery (AA). The PCHA originated from the AA in 81 % of cases (228/280), and showed a curved course dorsally towards the humeral head in 93 % (211/228). The DBA originated from the AA in 73 % of cases (190/260), and showed a straight course parallel to the AA in 93 % (177/190).

Conclusions

PCHA aneurysm prevalence in elite volleyball players is high and associated with a specific branching type: a PCHA that originates from the axillary artery. Radiologists should have a high index of suspicion for this vascular overuse injury. For the first time vessel characteristics and reference values are described to facilitate ultrasound assessment.

Key Points

? Prevalence of PCHA aneurysms is 4.6 % among elite volleyball players. ? All aneurysms are in proximal PCHA that originates directly from AA. ? Vessel characteristics and reference values are described to facilitate US assessment. ? Mean PCHA and DBA diameters can be used as reference values. ? Radiologists need a high index of suspicion for this vascular overuse injury.

     

A test battery to investigate back pain in female soccer players

Introduction

Back pain (BP) is a concern in youth and adult soccer players. Medical staff should be aware of possible consequences on health status and physical performance of players and, therefore, should screen and/or test for BP.

Objective

The purpose of the study was to assess female soccer players with and without BP in a range of tests.

Methods

18 female youth football players (eight with and ten without BP) from a Bavarian Soccer Club were assessed with a test battery consisting of patients’ history, physical examination, questionnaire, Y Balance Test (YBT), Swiss Olympic Test (SOT) and maximum isometric strength of the trunk muscles.

Results

Participants without any BP showed non-significant better performance in the SOT and the YBT. In the dynamic lateral isometric muscle strength test, patients without BP had a statistically significant (p < 0.05) better result than the other cohort.

Conclusion

Our results show that there is a tendency of the cohort without BP for better outcome. Further testing may be needed to evaluate if our test battery is eligible to investigate BP in female soccer players.

     

Injuries of the obturator muscles in professional soccer players

Purpose

Obturator externus and internus muscular tears are uncommon injuries. Only a few case reports exist, mainly in high-level athletes. Our aim is to describe a series of obturator externus and internus muscular tears in professional soccer players.

Methods

Injury data from four teams from the First Division of the Spanish Soccer League were collected over a total of four seasons. Any soccer player who sustained an injury to either the obturator externus or internus identified on magnetic resonance (MRI) was included. All injured players were treated non-operatively with a goal of returning to play as fast as possible.

Results

Sixteen players sustained injuries to the obturator externus and internus during matches or training sessions. The main complaint was anterior hip pain with a physical examination showing pain during internal rotation or external rotation of the flexed hip. The MRI documented 12 muscular tears of the obturator externus, and 4 muscular tears of the obturator internus. All injuries were treated conservatively based on physical therapy, analgesic medications, and underwent a symptoms-based rehabilitation protocol. Mean return to play was 11.5 ?±? 8.8 days.

Conclusion

Although uncommon, tears of the obturator externus and internus occur in professional soccer players. The MRI scan was essential to the location, classification, and evaluation of the injury size. The clinical relevance of our investigation is based on the relatively benign prognosis of these injuries.

Level of evidence

IV.

     

Specific futsal training program can improve the physical performance of futsal players

Purpose

This study investigated the effects of 12-week of specific futsal training on body composition, oxygen uptake (VO_2max), anaerobic capacity, and agility of male semi-professional futsal players.

Methods

Thirteen athletes were subjected to a 12-week program of specific training for futsal with the external load of sessions prescribed from rated perceived exertion. VO_2max, agility, anaerobic index, and body composition were assessed before and after the 12-week training program.

Results

The main findings were that the 12-week training period was able to significantly reduce the fat percentage of body composition (?7.5 %) and to improve the agility (3.9 %), aerobic capacity (>7 %), and anaerobic index (6–25 %).

Conclusions

Based on these results, it can be concluded that a 12-week program of specific training for futsal with the external load of sessions prescribed from rated perceived exertion can significantly improve the body composition, agility and aerobic and anaerobic capacity of semi-professional futsal players.

     

Long-Term Results from the MAJESTIC Trial of the Eluvia Paclitaxel-Eluting Stent for Femoropopliteal Treatment: 3-Year Follow-up

Purpose

To report the 3-year results of the MAJESTIC first-in-human study of the Eluvia Drug-Eluting Vascular Stent System for treating femoropopliteal artery lesions.

Methods

The prospective, single-arm, multicenter clinical trial enrolled 57 patients with symptomatic lower limb ischemia (Rutherford category 2, 3, or 4) and lesions in the superficial femoral artery or proximal popliteal artery. Mean lesion length was 70.8 ± 28.1 mm, and 46% of lesions were occluded. Efficacy measures at 2 years included primary patency, defined as duplex ultrasound peak systolic velocity ratio of ≤2.5 and the absence of target lesion revascularization (TLR) or bypass. Safety monitoring through 3 years included adverse events and TLR.

Results

Primary patency was estimated as 83.5% (Kaplan–Meier analysis) at 24 months, and 90.6% (48/53) of patients maintained an improvement in Rutherford class. At 36 months, the Kaplan–Meier estimate of freedom from TLR was 85.3%. No stent fractures were identified, and no major target limb amputations occurred.

Conclusion

MAJESTIC results demonstrated long-term treatment durability among patients whose femoropopliteal arteries were treated with the paclitaxel-eluting Eluvia stent.

Level of Evidence

Level 2b, cohort study

     

In vivo effects of radiofrequency ablation on long bones and the repair process in swine models

Purpose

To investigate in vivo effect of radiofrequency ablation (RFA) on swine long bones and the repair process.

Materials and methods

RFA was performed in six swine at the end and middle part of the tibia or femur. After RFA, radiological examinations were performed, and the swine were killed immediately and at different time points post-RFA for histopathological examination.

Results

All swine had successful RFA. The RFA-induced elliptical necrotic area ranged from 3.81–5.24 cm² (mean 4.08 ± 0.73 cm²) at the bone end but 5.60–8.98 cm² (mean 7.58 ± 1.41) at the middle part immediately after RFA until 10 days, with the necrosis area significantly smaller (P = 0.000) at the end than at the middle. RFA only damaged the cortical bone slightly (0.01 cm thick) with no damage to the soft tissues outside the compact bone at both the end and middle. Surrounding the elliptic pale zone of coagulative necrosis was a narrow brown band of hemorrhage and inflammatory exudate. From day 10 until week 12, tissue proliferation and repair became increasingly apparent, with proliferated granulation, fibrous tissue, and fresh and mature bone trabecula.

Conclusion

RFA can quickly and effectively destroy the cancellous bone tissue without affecting the cortical bone and activate bone remodeling.

     

Risk factors for acute knee injury in female youth football

Purpose

To prospectively evaluate risk factors for acute time-loss knee injury, in particular ACL injury, in female youth football players.

Methods

Risk factors were studied in 4556 players aged 12–17 years from a randomised controlled trial during the 2009 season. Covariates were both intrinsic (body mass index, age, relative age effect, onset of menarche, previous acute knee injury or ACL injury, current knee complaints, and familial disposition of ACL injury) and extrinsic (no. of training sessions/week, no. of matches/week, match exposure ratio, match play with other teams, and artificial turf exposure). Hazard ratios (HRs) and 95 % confidence intervals (CIs) were calculated from individual variable and multiple Cox regression analyses.

Results

Ninety-six acute knee injuries were recorded, 21 of them ACL injuries. Multiple Cox regression showed a fourfold higher ACL injury rate for players with familial disposition of ACL injury (HR 3.57; 95 % CI 1.48–8.62). Significant predictor variables for acute knee injury were age >14 years (HR 1.97; 95 % CI 1.30–2.97), knee complaints at the start of the season (HR 1.98; 95 % CI 1.30–3.02), and familial disposition of ACL injury (HR 1.96; 95 % CI 1.22–3.16). No differences in injury rates were seen when playing on artificial turf compared with natural grass.

Conclusion

Female youth football players with a familial disposition of ACL injury had an increased risk of ACL injury and acute knee injury. Older players and those with knee complaints at pre-season were more at risk of acute knee injury. Although the predictive values were low, these factors could be used in athlete screening to target preventive interventions.

Level of evidence

II.

     

Kinematic analysis of postural control in gymnasts vs. athletes practicing different sports

Purpose

The aim of this study was to examine the postural control difference between gymnasts and other athletes practicing different sports.

Methods

Twenty-eight elite-level male athletes (7 gymnasts, 7 volleyball players, 7 windsurfers, and 7 monofin swimmers) participated in this study. Two-dimensional kinematic analysis of mediolateral and anteroposterior sway velocity of the center of mass (COM) on single plane balance board in bipedal and unipedal conditions, and on hard and foam surfaces was performed using two cameras (Sony, DCR-PC108^E, 50 Hz). Data were digitized using the video-based data analysis system SkillSpector.

Results

Findings showed significant between groups differences regardless of the postural stance i.e., unipedal or bipedal (d = 1.76–6.82, p < 0.01). In this regards, windsurfers presented the best postural performance in terms of sway velocity of the COM followed by gymnasts, volleyball players, and monofin swimmers. Furthermore, regardless of the postural stance, significant differences between surfaces (d = 0.61–1.03, p < 0.05) were established. In this context, COM’s sway velocity was higher for hard compared with foam surfaces for all disciplines (d = 0.75–0.66, p < 0.05) except monofin swimmers who presented higher COM’s sway velocity in foam compared to hard surfaces. Further, in the anteroposterior stance, windsurfers and gymnasts showed significantly lower floor contacts number compared with the other groups (d = 1.76–2.39, p < 0.01). However, volleyball players and monofin swimmers showed comparable postural performance in the mediolateral plane.

Conclusions

The windsurfers presented the best postural control followed by gymnasts, volleyball players, and monofin swimmers irrespective of the surface’s nature (i.e., hard or foam) and postural stance (i.e., bipedal or unipedal). Therefore, it is recommended to incorporate windsurfing practice to promote postural control of gymnastic athletes.

     

Two-dimensional motion analysis of dynamic knee valgus identifies female high school athletes at risk of non-contact anterior cruciate ligament injury

Purpose

Female athletes are at greater risk of non-contact ACL injury. Three-dimensional kinematic analyses have shown that at-risk female athletes have a greater knee valgus angle during drop jumping. The purpose of this study was to evaluate the relationship between knee valgus angle and non-contact ACL injury in young female athletes using coronal-plane two-dimensional (2D) kinematic analyses of single-leg landing.

Methods

Two hundred ninety-one female high school athletes newly enrolled in basketball and handball clubs were assessed. Dynamic knee valgus was analysed during single-leg drop jumps using 2D coronal images at hallux–ground contact and at maximal knee valgus. All subjects were followed up for 3 years for ACL injury. Twenty-eight (9.6%) of 291 athletes had ACL rupture, including 27 non-contact ACL injuries. The injured group of 27 knees with non-contact ACL injury was compared with a control group of 27 randomly selected uninjured knees. The relationship between initial 2D movement analysis results and subsequent ACL injury was investigated.

Results

Dynamic knee valgus was significantly greater in the injured group compared to the control group at hallux–ground contact (2.1 ± 2.4 vs. 0.4 ± 2.2 cm, P = 0.006) and at maximal knee valgus (8.3 ± 4.3 vs. 5.1 ± 4.1 cm, P = 0.007).

Conclusion

The results of this study confirm that dynamic knee valgus is a potential risk factor for non-contact ACL injury in female high school athletes. Fully understanding the risk factors that increase dynamic knee valgus will help in designing more appropriate training and interventional strategies to prevent injuries in at-risk athletes.

Level of evidence

Prognostic studies, Level II.

     

Athletic performance and career longevity following anterior cruciate ligament reconstruction in the National Basketball Association

Purpose

To identify the impact of anterior cruciate ligament (ACL) reconstruction on performance and career longevity for National Basketball Association (NBA) players.

Methods

Seventy-nine players (80 knees) with acute ACL tears in the NBA between the 1984–2014 seasons, and 112 age, height, weight, and performance-matched controls were identified. Pre- and post-injury performance outcomes including seasons played, games played, games started, minutes per game, points per game, field goals, 3-point shots, rebounds, assists, steals, blocks, turnovers, personal fouls, usage percentage and player efficiency ratings were compared between cases and controls using independent samples t tests and Fisher’s exact tests.

Results

Sixty-eight of seventy-nine players (86.1 %) returned to play in the NBA following ACL reconstruction. Mean length of post-operative play was 1.84 years shorter than matched controls (P = 0.001). There was a significantly higher rate of attrition from professional basketball for players with a history of ACL reconstruction (P = 0.014). In the first full season following surgery, players started in 15.5 fewer games (P = 0.001), they played in 17.3 fewer games (P < 0.001), and had combined player efficiency ratings 2.35 points lower (P = 0.001) when compared to matched controls. Over the length of their careers, players competed in 22.2 fewer games per season (P = 0.009).

Conclusions

There is a high rate of return to sport in the NBA following ACL reconstruction, although playing time, games played, player efficiency ratings and career lengths are significantly impacted in the post-operative period. These data should be used to manage patients’ expectations regarding their abilities to return to elite levels of athletic performance.

     

Revisiting the indirect signs of a temporal bone fracture: air,air, everywhere

Background and purpose

The standard head CT protocol makes detection of a temporal bone fracture difficult. The purposes of our study are to revisit the finding of air in various locations around the temporal bone as an indirect sign of fracture and determine if findings could predict fracture pattern.

Materials and methods

We searched the radiology reports for the keyword “temporal bone fracture.” We recorded the presence of air in multiple locations around the temporal bone and pneumocephalus, opacification of the mastoid air cells or the middle ear cavity, and dominant fracture pattern. Statistical analyses were performed using statistical software.

Results

A total of 135 patients (mean age 40 ± 20.1 years, 101 male, 34 female, range 1–91) had 152 fractures. At least one indirect finding was present in 143 (94.1%) fractures. Air was present adjacent to the styloid process in 94 (61.8%), in the temporomandibular joint in 80 (52.6%), adjacent to the mastoid process in 57 (37.5%), and along the adjacent dural venous sinus in 33 (21.7%) fractures. Mastoid opacification was present in 139 (91.4%) fractures. Opacification of the middle ear cavity was present in 121 (79.6%) fractures. A complex fracture significantly and positively correlated with pneumocephalus.

Conclusion

In the setting of trauma, air around the temporal bone and opacification of the mastoid air cells or middle ear cavity should prompt consideration of a temporal bone fracture even if the fracture line is not visible. The presence of pneumocephalus predicts a higher chance of complex fracture pattern.