Sports Medicine Research: In the Lab & In the Field (Sports Med Res)
Wednesday, January 28, 2015

ACL Graft Type May Not Matter When Attempting to Improve Patient-Reported Outcome 2-Years Post-Surgery

A randomized clinical trial comparing patellar tendon, hamstring tendon, and double-bundle ACL reconstructions: Patient-reported outcomes at a minimal 2-year follow up.

Mohtadi N, Chan D, Barker R, Paolucci EO. Clin J Sports Med. [Epub Ahead of Print]. 2014

Take Home Message: Three anterior cruciate ligament (ACL) reconstruction techniques yield similar patient-reported and objective outcomes for up to 2 years after surgery. The one exception was joint laxity, which was better among patients who received a patellar tendon autograft instead of one of two hamstring techniques.

Anterior cruciate ligament (ACL) surgery is often performed with the aim of restoring joint biomechanics and allowing an athlete to return to participation with no limitations. Despite numerous surgical techniques it remains debated if one approach is superior to another. Therefore, Mohtadi and colleagues completed a prospective, double-blind randomized control trial to compare the patient-reported outcomes of 3 anatomically positioned autograft options 2 years after surgery.
Monday, January 26, 2015

Minding the Gap: Connecting Pre-season Screenings with Prospective Injury Data

Association of Y Balance Test Reach Asymmetry and Injury in Division I Athletes

Smith CA, Chimera NJ, Warren M. Med Sci Sport Exerc. 2015; 47(1): 136-141. http://journals.lww.com/acsm-msse/Abstract/2015/01000/Association_of_Y_Balance_Test_Reach_Asymmetry_and.18.aspx

Take Home Message: Anterior reach asymmetry larger than 4 cm on the Y Balance test was associated with increased risk of non-contact injury in a sample of collegiate athletes.

Clinicians need an efficient and accurate screening strategy that can be used across multiple sports and genders to identify athletes at risk for musculoskeletal injury. This could help identify individuals who need interventions to potentially prevent injuries. The Y balance test, a measure of dynamic balance during single leg stance, may be an ideal screening test. This study investigated the link between Y Balance Test results, collected during pre-participation physicals, and non-contact injuries over the course of a season. The researchers hypothesized that anterior asymmetrical reach would be related with increased risk of noncontact lower extremity injury. Additionally, they thought that a lower composite score would increase an athlete’s chance of a noncontact injury.
Wednesday, January 21, 2015

Hip Special Tests Add Little Diagnostic Value

Diagnostics accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis

Reiman MP, Goode AP, Cook CE, Holmich P, & Thorborg K. Br J Sports Med.2014, 0:1-12. E pub ahead of print December 16, 2014

Take Home Message: There are many clinical special tests geared towards diagnosing labral tears and femoroacetabular impingement.  Unfortunately, these tests are largely not helpful in confirming the presence of the pathology in population that is likely to have either.

Hip surgery is becoming a common strategy to correct femoroacetabular impingement and labral pathologies.  Diagnosing these conditions can be challenging and there is interest around developing cost-effective and accurate clinical tests for diagnosis of these hip pathologies.  The authors of this systematic review aimed to evaluate the diagnostic accuracy of hip physical examination tests.
Monday, January 19, 2015

Lystedt-Type Laws Are Effective in Assisting Concussion Management

Analyzing the Effect of State Legislation on Health Care Utilization for Children With Concussion

Gibson TB., Herring SA., Kutcher JS., Broglio SP. JAMA Pediatrics. Epub ahead of print.

Take Home Message: Legislation regulating pediatric concussion injury management seems to be effective. From 2009-20012 states with legislation had a 92% increase in concussion-related health care utilization while states without legislation had a 75% increase.

Washington enacted the first concussion injury legislation in 2009 (Lystedt Law) and by 2014 all states had a similar law. This is the first time that laws mandate medical attention for an injury but it is unclear how these laws affected injury reporting and health care utilization. Therefore, the authors sought to evaluate health care utilization rates for concussion from January 1, 2006 through June 30, 2012, in states with and without legislation.
Wednesday, January 14, 2015

Oral Contraceptive Use May Help Prevent ACL Injury

Is the use of oral contraceptive associated with operatively treated anterior cruciate ligament injury?: A case-control study from the Danish Knee Ligament Reconstruction Registry.

Rahr-Wagner L, Thillemann TM, Mehnert F, Pedersen AB, and Lind M. Am J Sports Med. 2014; 42:2897-2906.
           
Take Home Message: Women who take oral contraceptives are less likely to sustain an anterior cruciate ligament (ACL) injury than women who do not.

A woman is 2 to 9 times more likely to have an ACL injury than a man, especially in the athletic population. A better understanding of the factors that place women at a higher risk, would allow clinicians to implement more effective preventative measures against ACL injury. Previous literature has shown that collagen synthesis is inhibited when estrogen levels are increased; therefore, Rahr-Wagner and colleagues completed a case-control study to assess the impact of oral contraceptive use on the odds of sustaining an operatively treated ACL injury among women in a national registry.
Tuesday, January 13, 2015

Development of Clinical Recommendations for Progressive Return to Activity After Military Mild Traumatic Brain Injury: Guidance for Rehabilitation Providers.

Development of clinical recommendations for progressive return to activity after military mild traumatic brain injury: guidance for rehabilitation providers.

McCulloch KL1, Goldman LS, Lowe L, Radomski MV, Reynolds J, Shapiro CR, West TA. J Head Trauma Rehabil. 2015 Jan-Feb;30(1):56-67. doi: 10.1097/HTR.0000000000000104.

“The Office of the Army Surgeon General in collaboration with the Defense and Veterans Brain Injury Center…convened an expert working group to review the existing literature and propose clinical recommendations that standardize rehabilitation activity progression following” mild traumatic brain injury. Key sections of the results are integration of graded activity progression with other Department of Defense guidelines, symptom monitoring, activity descriptions, and timing of progression through stages.

Wednesday, January 7, 2015

Thessaly Test is not Necessarily Value Added for Meniscal Diagnosis Accuracy

Validity of the Thessaly test in evaluating meniscal tears compared with arthroscopy: a diagnostic accuracy study

Goossens P, Keijesers E, van Geenen RJ, Zijta A, van den Broek M, Verhagen AP, & Scholten-Peeters GG. J Orthop Sports Phys Ther.: 1-26. E pub ahead of print November 24, 2014

Take Home Message: The Thessaly test is comparable in accuracy to a modified McMurray test in a group of patients with a high prevalence of meniscal tears. 

The Thessaly test is a newer test that was designed to assist in the diagnosis of meniscal tears during clinical examination.  The Thessaly test is performed by asking a patient to stand with about 20 degrees of knee flexion and having them internally and externally rotate their body. Since the introduction of the test in 2005, a couple of studies have investigated it, but the accuracy of this test has yet to be established.  The authors of this study aimed to evaluate the diagnostic accuracy of the Thessaly test in comparison to arthroscopy (the gold standard) in 593 patients (average age = 49 years).