Sports Medicine Research: In the Lab & In the Field (Sports Med Res)
Wednesday, July 27, 2016

We’ll Ask the Question Again? Surgery or Nonoperative Treatment?

Is anterior cruciate ligament reconstruction effective in preventing secondary meniscal tears and osteoarthritis?

Sanders TL, Kremers HM, Bryan AJ, Fruth KM, Larson DR, Pareek A, Levy BA, Stuart MJ, Dahm DL, Krych AJ. Am J Sports Med. 2016 Jul;44(7):1699-707.

Take Home Message: Patients who sustained an anterior cruciate ligament (ACL) rupture were more likely to develop secondary meniscal injury and arthritis when compared to a matched cohort. Specifically, those that were treated nonoperatively or with delayed surgery may be more likely to develop secondary meniscal injury, develop arthritis, and be in need of a total knee replacement when compared with those patients treated with early surgery.

After an anterior cruciate ligament (ACL) rupture, physically active patients often receive an ACL reconstruction if they wish to return to some level of activity. However, there is conflicting evidence about the long-term benefits of an ACL reconstruction. Therefore, Sanders and colleagues completed a retrospective study to 1) evaluate the protective benefits of ACL reconstruction (ACLR) with regards to meniscal tears and physician-diagnosed arthritis, 2) determine if there is an optimal time frame for undergoing treatment, and 3) identify predictive factors of long-term disability.
Wednesday, July 20, 2016

After ACL Surgery…Close Enough? NO WAY!

Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture

Kyritsis P, Bahr R, Landreau P, Miladi R, & Witvrouw E.  Br J Sp Med. Published Online First: May 23, 2016. doi: 10.1136/bjsports-2015-095908

Take Home Message: Patients should attain all objective criteria goals prior to returning to sport.  A professional athlete who fails to meet functional criteria for return-to-sport or who has a low hamstring:quadriceps ratio is at greater risk for an anterior cruciate ligament graft rupture.

Athletes and clinicians are often focused on how quickly can we return a patient to sport after an anterior cruciate ligament (ACL) rupture.  There is no “set” return-to-play parameters that need to be met, and oftentimes clinicians think an athlete is “close enough” or will regain the remaining deficits upon return to sport.  However, history of an ACL injury is one of the largest risk factors for sustaining another ACL injury. Hence, the authors conducted a prospective cohort study to evaluate whether certain return-to-play criteria (e.g., functional assessments) were associated with risk of an ACL graft rupture after return to sport.
Monday, July 18, 2016

The New Norm When Missing SCAT3 Concussion Baseline Scores

Reliability and Validity of the Sport Concussion Assessment Tool-3 (SCAT3) in High School and Collegiate Athletes

Chin EY., Nelson LD., Barr WB., McCrory P., McCrea MA. Am J Sport Med. 2016; ahead of print

Take Home Message: A clinician needs to recognize that sex, competitive level, and attention deficit/hyperactivity disorder or learning disorder may influence SCAT3 scores. A medical professional could use normative conversion tables if they lack baseline scores and may not need to worry about practice effects with the SCAT3, except when retesting an athlete within 7 days.

The SCAT3 is a free and easy to administer test for sideline clinical assessment of concussed athletes. However, there is little published on what factors influence SCAT3 scores or how to interpret the SCAT3 and each subcomponents (sign and symptom score, SAC, modified BESS). Therefore, the authors collected 2,018 baseline SCAT3 exam scores from 9 high schools and 4 colleges (from August 2012 to October 2014) to evaluate predictors of baseline performance, reliability, and strategies to interpret scores (e.g., identifying reliable chance index cutoffs).
Wednesday, July 13, 2016

Determinants of Early Structural Changes After Injury

Degenerative changes in the knee 2 years after anterior cruciate ligament rupture and related risk factors: a prospective observational follow-up study.

Van Meer BL, Oei EHG, Meuffels DE, van Arkel ERA, Verhaar JAN, Bierma-Zeinstra SMA, and Reijman M. Am J Sports Med. 2016. [Epub Ahead of Print].

Take Home Message: Among 143 people with an anterior cruciate ligament (ACL) rupture, 40% had worsening osteophytes or cartilage defects during the first 2 years after injury. Males and people with a meniscal tear, medial cartilage defect at baseline, or medial bone marrow lesion at 1-year follow-up may be at risk for these early structural changes.

Sports Med Res has summarized several studies reporting that an athlete is at increased risk for knee osteoarthritis after an anterior cruciate ligament (ACL) injury. Unfortunately, we still need a deeper understanding of the early structural changes to design effective screening tools and interventions. Therefore, van Meer and colleagues completed a prospective cohort study to identify which factors are related with early (2 years post-surgery) structural changes as assessed by magnetic resonance imaging (MRI).
Wednesday, July 6, 2016

Near Point Convergence Is Worsened with Intense Subconcussive Impacts

Association of Football Subconcussive Head Impacts With Ocular Near Point of Convergence

Kawata K, Rubin LH, Lee JH, Sim T, Takahagi M, Szwanki V, Bellamy A, Darvish K, Assari S, Henderer JD, Tierney R, Langford D. JAMA Ophthalmol. 2016; ahead of print

Take Home Message: Football players with significant subconcussive impacts had impaired near point convergence before and after full contact practices compared with baseline scores. Football players with less intense head impacts showed no changes over time. Near point convergence may be a useful clinical tool to implement in sports at risk for subconcussive impacts. 

Subconcussive head impacts occur more frequently than concussive blows and may cause long-term neurological deficits. However, there are no clinical tools to detect the neurological consequences of subconcussive head impacts within one sport season. Therefore, the authors assessed whether repetitive subconcussive head impacts during preseason collegiate football is associated with changes in near point convergence (a measure of the closest point someone can follow an object coming towards their face).
Friday, July 1, 2016

2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures

2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures

Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, McConnell J, Vicenzino B, Bazett-Jones DM, Esculier J, Morrissey D, Callaghan MJ. Br J Sports Med. 2016 Br J Sports Med doi:10.1136/bjsports-2016-096384. [Epub ahead of print]

The International Patellofemoral Pain Research Retreat in Manchester released a consensus statement regarding terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis, and patient-reported outcomes. Each topic represents a section in the statement. The authors provide 13 consensus-based statements. This document complements another consensus statement from this retreat that suggested recommended physical interventions.

Wednesday, June 29, 2016

Don’t Delay, Report Your Concussion Today

“Play through it”: Delayed reporting and removal from athletic activity after concussion predicts prolonged recovery

Asken BM, McCrea MA, Clugston JR, Snyder AR, Houck ZM, and Bauer RM. J Ahtl Training. 2016. 51(4): 329-335.
Full Text Freely Available

Take Home Message: Athletes who immediately stopped activity and reported symptoms of a concussion typically missed fewer days before returning to activity than athletes who delayed reporting such symptoms.

Despite increased awareness about concussions and their consequences, some athletes fail to report their concussive symptoms to a medical professional and continue to participate in sport. To date, no one has evaluated the consequences of continuing to play after a concussion on recovery time. Therefore, Asken and colleagues completed a retrospective study to examine the association between delayed reporting and removal from athletic activity on concussion recovery time.