Sports Medicine Research: In the Lab & In the Field (Sports Med Res)
Wednesday, April 16, 2014

Knees with an ACL Reconstruction Often Have Osteoarthritis Regardless of Graft Selection

Increased Risk of Osteoarthritis After Anterior Cruciate Ligament Reconstruction: A 14-Year Follow-up Study of a Randomized Controlled Trial

Barenius B, Ponzer S, Shalabi A, Bujak R, Norlen L, & Eriksson K.  Am J Sports Med.  2014 Published Online First March 18, 2014: doi: 10.1177/0363546514526139

Take Home Message:  Knees with a history of an anterior cruciate ligament injury are more likely to have osteoarthritis compared with a healthy contralateral knee but graft selection has no effect on long-term outcomes, such as osteoarthritis or knee functional outcomes.

An individual with a history of an acute knee injury, including anterior cruciate ligament (ACL) injury, is three to 6 six times more likely to have knee osteoarthritis (OA) than someone without a history of injury.  Unfortunately, we lack a consensus on whether ACL reconstruction timing and graft selection affects the risk for knee OA.  Therefore, the authors completed an extended follow up of a randomized clinical trial that compared quadrupled semitendinosus tendon and bone-patellar tendon-bone grafts.
Monday, April 14, 2014

Time and Cost of Diagnosis for Symptomatic Femoroacetabular Impingement

Time and Cost of Diagnosis for Symptomatic Femoroacetabular Impingement

Kahlenberg CA, Han B, Patel RM, Deshmane PP, Terry MA.  Orthopaedic Journal of Sports Medicine 2014 2(3):2325967114523916.

Take Home Message: Diagnosing labral tears with femoroacetabular impingement can be slow and expensive, it is important for health care professionals to quickly recognize and manage the symptoms.

Femoroacetabular impingement (FAI) and labral tears are the most common causes of non-arthritic hip pain in an active population.  Diagnosis of these conditions is often delayed as we try to rule out other diagnoses; but, this delay could be costly and expose a patient to prolonged periods of pain and increase their risk for long-term adverse health effects. If we had a better understanding of how patients were evaluated and treated for FAI and labral tears then this might help us identify strategies to improve patient care and reduce cost.  Therefore, these authors set out to determine the average time and money spent by an individual leading up to a diagnosis of a labral tear associated with FAI.
Friday, April 11, 2014

Can Biochemical Markers in the Blood Detect Concussions?

Blood biomarkers for brain injury in concussed professional ice hockey players

Shahim P., Tegner Y., Wilson DH., Randall J., Skillback T., Pazooki D., Kallberg B., Blennow K., Zetterberg H. JAMA Neurol. 2014; E1-E9.

Take Home Message: Biochemical markers in the blood, like T-tau, are elevated after a concussion and are associated with recovery time. These markers may eventually be developed into clinical tools to determine diagnosis and prognosis after concussions as well as to devise improved return-to-play decisions.

Most concussions heal within days to weeks, but up to 20% of patients have a prolonged recovery. The danger of developing chronic or progressive concussion symptoms may be linked to repeated concussions before the brain completely heals. Tools to detect and monitor the brain during the recovery process, such as biochemical markers (biomarkers) in the blood, could help us make objective decisions on whether returning an athlete to play is safe. As a first step in finding a potential biomarker, the authors compared preseason concentrations (47 players) of 3 biomarkers (total tau [T-tau], S-100b, neuron-specific enolase NSE]) to postconcussion concentrations (27 players) among professional Swedish ice hockey players.
Wednesday, April 9, 2014

Altered Lower Extremity Biomechanics Following an ACL Injury and Surgery May Increase the Risk of Reinjury

Anterior cruciate ligament injury alters preinjury lower extremity biomechanics in the injured and uninjured leg: the JUMP-ACL study.

Goerger BM, Marshall SW, Beutler AI, Blackburn JT, Wilckens JH, and Padua DA. Br J Sports Med. Epub Ahead of Print. 2014.

Take Home Message: Individuals who sustain an ACL injury develop altered lower extremity biomechanics compared with their biomechanics prior to the injury. These altered biomechanics are similar to movement patterns that may increase the risk of further ACL injury.

Following anterior cruciate ligament (ACL) injury and reconstruction, patients often employ altered biomechanics, which may explain why they are 5 to 15 times more likely suffer a reinjury. Unfortunately, we don’t know if these altered movement patterns existed before the first ACL injury or if they developed after the injury. If we could identify the altered movement patterns that develop after an injury it may help clinicians optimize rehabilitation procedures and correct any biomechanical patterns that could increase the risk of reinjury. Therefore, Goerger and colleagues completed a prospective, repeated measures, case-cohort study to compare lower extremity biomechanics before ACL injury and following ACL reconstruction in both the injured and uninjured leg.
Monday, April 7, 2014

Causes and Incidence of Sudden Death Among College Athletes

Etiologies of Sudden Cardiac Death in National Collegiate Athletic Association Athletes.

Harmon KG, Drezner JA, Maleszewski JJ, Lopez-Anderson M, Owens D, Prutkin JM, Asif IM, Klossner D, Ackerman MJ. Circ Arrhythm Electrophysiol. 2014. doi:10.1161/CIRCEP.113.001376.

Incidence and Causes of Sudden Death in U.S. College Athletes.

Maron BJ, Haas TS, Murphy CJ, Ahluwalia A, Rutten-Ramos S. J Am Coll Cardiol. 2014. doi:10.1016/j.jacc.2014.01.041.

Take Home Message: Two recent studies found different causes of SCD, which makes it difficult to develop cost-effective screening strategies when it remains uncertain what problems we should be screening for in preparticipation physicals.

There is an active debate regarding how best to prevent sudden cardiac death (SCD) in athletes with one camp recommending history and physical exam alone (per the 2007 AHA guidelines) versus another camp recommending history, physical exam, and electrocardiograms (per the 2005 EuropeanSports Study Group  and 2004 IOC guidelines). The first step toward the development of an effective screening program is to determine the incidence and causes of SCD in athletic populations.  In the United States, an accurate incidence rate remains elusive and estimates range from 1 in 200,000 in US athletes to 1 in 3,100 among male Division 1 basketball players.  These two manuscripts sought to define the etiology of SCD.
Wednesday, April 2, 2014

Cam Deformities Develop During Growth

A Cam Deformity Is Gradually Acquired During Skeletal Maturation in Adolescent and Young Male Soccer Players: A Prospective Study With Minimum 2-Year Follow-up.

Agricola R, Heijboer MP, Ginai AZ, Roels P, Zadpoor AA, Verhaar JA, Weinans H, & Waarsing JH.  Am J Sports Med.  2014 Published Online First Feburary 28, 2014: doi: 10.1177/0363546514524364

Take Home Message:  Cam deformities develop over time in skeletally immature elite soccer athletes.

A cam deformity may increase a person’s risk for chondral or labral hip injuries, and ultimately hip osteoarthritis (OA).  Athletes in high-impact sports are more likely to have of cam deformities compared with nonathletes (see related posts below).  Cam deformities may develop in response to high-impact sports during growth but it remains unclear as to how these deformities progress among athletes during and after skeletal maturity.  Therefore, the authors of this study primarily assessed how a cam deformity develops among adolescents and if the formation of this deformity is primarily before skeletal maturity.
Monday, March 31, 2014

The Effectiveness of Computerized Neurocognitive Testing

Computerized neurocognitive testing within 1 week of sport-related concussion: Meta-analytic review and analysis of moderating factors

Kontos A., Braithwait R., Dakan S., Elbin RJ. Journal of the International Neuropsychological Society. 2014; 20:1-9.

Take Home Message: Computerized neurocognitive testing results suggest athletes suffer small impairments within one week of a concussion. Several factors may lead to more pronounced impairments: age, type of neurocognitive test, and test administrator.

Clinicians commonly use computer neurocognitive testing to assess concussion. The reliability and validity of these tests have come into question based on several reviews (e.g., Mayers & Redick, 2012); however, Schatz et al (2012) pointed out flaws in those reviews. It is imperative that we have an objective examination of computer neurocognitive tests to determine their ability to identify the subtle effects of concussion so that we can implement them and interpret them optimally.  Therefore, Kontos et al performed a meta-analysis of 37 studies to determine the effects of concussion as measured by computerized neurocognitive testing administered within the first week of injury as well as to examine results among subgroups (i.e., type of neurocognitive exam, sport, & age).