The value of MRI STIR signal intensity on return to play prognosis and reinjury risk estimation in athletes with acute hamstring injuries

ObjectivesPrevious studies have shown low to moderate evidence for a variety of magnetic resonance imaging (MRI) features as prognostic factors in athletes with hamstring injuries. Short-tau inversion recovery (STIR) signal intensity has not yet been investigated for assessing the prognosis of acute muscle injuries. Our aim was to explore the relationship between MRI STIR signal intensity and time to return to play (RTP) and to investigate the association between MRI STIR and reinjury risk in athletes with acute hamstring injuries.Study designCase-control study.MethodsWe used MRI STIR to measure intramuscular signal intensity in patients with clinically diagnosed hamstring injuries at two time points: at injury and RTP. At injury, we calculated the association of MRI STIR signal intensity with the time to RTP and reinjury risk. At RTP, the association of MRI STIR signal intensity and reinjury risk and the change in MRI STIR signal intensity over time on reinjury risk was evaluated.Results51 patients were included. We found increased MRI STIR signal intensity: (1) at time of injury not to be associated with time to RTP, (2) at time of injury to be associated with a slightly lower risk for reinjury: odds 0.986 (0.975–0.998, p = 0.02) and (3) at RTP not to be associated with reinjury risk. (4) We found no association between the change in MRI STIR signal intensity over time and reinjury risk.ConclusionIncreased MRI STIR signal intensity at injury has no value in time to RTP prognosis, but is associated with a reduced reinjury risk.     

负压封闭引流减少创面毒素再损伤的临床观察

目的 通过与未行负压封闭引流(VSD)的创伤患者进行比较,探讨VSD减少创面愈合时毒素对机体再损伤的作用.方法 回顾性分析2005年1月至2009年6月采用VSD治疗的32例患者(VSD组)和同期未行VSD治疗的37例患者(换药组)资料.两组性别比例、年龄、损伤部位、面积、合并伤及创伤时间等一般情况比较差异均无统计学意义(P＞0.05).比较两组患者治疗前和治疗后1周的体温、血常规、肝肾功能变化、创面治疗及愈合时间等,并对结果进行多因素线性回归分析.结果 治疗前两组患者体温、血常规及肝肾功能指标的比较差异均无统计学意义(P＞0.05).治疗后5～7 d,VSD组与换药组的体温高于正常时间分别为(3.3±1.3)、(6.4±1.9)d,白细胞分别为(8.8±2.3)、(12.4±1.9)g/L,中性粒细胞分别为(6.3±2.4)、(9.2±2.7)g/L谷丙转氨酶分别为(41.1±30.0)、(58.9±34.5)U/L,谷草转氨酶分别为(38.0±24.7)U/L、(54.5±28.0)U/L,血肌酐分别为(94.8±23.7)、(118.6±23.5)μmol/L,伤口清创至植皮时间分别为(12.9±5.7)、(23.8±6.8)d,治疗时间分别为(26.5±12.5)、(36.7±13.2)d,创面愈合时间分别为(33.8±13.5)、(41.4±13.2)d,两组数据比较差异均有统计学意义(P＜0.05).结合各指标多因素分析及两组数据治疗前比较结果,治疗方式的不同是引起差异的主要因素.结论 VSD能促进创面毒素排出,减少毒素的再吸收和对机体的再损伤,促进创面愈合,缩短疗程.

Abstract：

Objective To investigate the effect of vacuum sealing drainage (VSD) on wound healing by reducing re-injury to the tissue attributable to wound toxins. Methods A series of 32 patients with serious limb trauma were included in the present study who received VSD treatment in our department from January 2005 to June 2009. Another series of 37 patients of the same category were used as controls who received no VSD treatment but dressing instead at the same period. Exclusion criteria were liver and kidney diseases, diabetes mellitus, hypertension, serious organ disorders and major nerve and vascular injuries.There were no significant differences between the 2 groups in sex, age, site and size of injury, complications,time of trauma (P＞0.05). Body temperature and blood parameters (including results of hepatic and renal function tests) before and one week after the VSD treatment, wound management, and wound healing time were compared between the 2 groups, using multi-factor linear regression analysis. Results There were no significant differences between the 2 groups in body temperature and blood parameters ( P ＞ 0. 05 ) before treatment. But there were significant differences after treatment between the 2 groups in duration of high body temperature(3.3±1.3 days for the VSD group versus 6. 4 ± 1.9 days for the control group), white blood cells (8.8±2.3 g/L versus 12.4±1.9 g/L), neutrophil (6.3 ±2.4 g/L versus 9.2 ±2. 7 g/L), alanine aminotransferase (41.1±30.0 U/L versus 58.9 ±34. 5 U/L), aspartate aminotransferase (38.0±24.7 U/L versus 54.5±28.0 U/L), creatinine (94.8±23.7 μmol/L versus 118.6±23.5 μmol/L), wound debridement to skin grafting time (12.9±5.7 days versus 23.8±6.8 days), total treatment time (26.5 ± 12.5 days versus 36.7±13.2 days), wound healing time (33.8±13.5 days versus 41.4±13.2 days) ( P ＜0. 05 ＝. All the analyses showed the difference were attributable to VSD treatment. Conclusion VSD can facilitate wound healing and shorten therapeutic course by effectively removing wound toxins and thus reducing re-injury to the tissue.     

Anterior cruciate ligament injuries in elite and high school rugby players: a 11-year review

Objectives: Over a 11-year period, we investigated the incidence of anterior cruciate ligament (ACL) injuries and the clinical outcomes after ACL reconstruction with hamstring autografts in two homogenous cohorts of rugby players. Methods: Two teams, including those in elite (94 players) and high school (290 players) clubs, were followed. Results: Isolated ACL injuries occurred in 28 players (12 elite, 16 high school). The incidence during match play was 1.26 per 1000 player-hours (95% confidence interval [95% CI]: 0.48–2.05) among elite players and 0.97 per 1000 player-hours (95% CI: 0.30–1.64) among high school players. After ACL reconstruction, 26 players (12 elite, 14 high school) were successfully contacted for follow-up at a mean of 71.9 months. None (0%) of the elite and 4 (29%) of the high school players experienced graft ruptures. Seven (58%) elite and 10 (91%) high school players were fearful of reinjury; the mean time to overcome this fear was 6.1 ± 4.9 months among elite players and 17.5 ± 26.0 months among high school players. Conclusion: In conclusion, young rugby players experienced inferior outcomes after ACL reconstruction with hamstring autografts compared with their older counterparts.     

Récidive et reprise du sport après chirurgie pour rupture du tendon calcanéen : suture simple versus Tenolig

The main risk of calcaneal tendon rupture surgery is recurrence. We try to compare the percutaneous suture with Tenolig (T) and the simple suture with open surgery (S) in athletes by phone questionnaire. The response rate was 74 %. Responses were analyzed with a Cox model. Of the 48 patients who responded, 14 were excluded (3 orthopedic treatments and 11 surgical treatments by suture with reinforcement). The mean follow-up for the questionnaire was 928 days for the Tenolig group (n = 10) compared to 942 days for the single suture group (n = 24). The groups were comparable with no significant difference in term of age, sex and sport. There was no significant difference in rates or time in return to sport. Regarding recurrence, the number was 4 in 10 cases for T and 1 in 24 for S (with a significant difference of P = 0.0272). In our study, the risk of recurrence is statistically higher for T than for S in athletes, with no difference in the time taken to return to sport, which seems to correspond to the risk of the series in the literature for T, that is estimated at 10 to 20 % for the larger series of cases.