The Heat is On - But Many States Are Leaving Us Out in the Cold

The Association between Mandated Preseason Heat Acclimatization Guidelines and Exertional Heat Illness during Preseason High School American Football Practices

Kerr ZY, Reigster-Mihalik JK, Pryor RR, Pierpoint LA, Scareno SE, Adams WM, Kucera KL, Casa DJ, & Marshall SW.  Environ Health Perspect. 2019; 127(4).  DOI: 10.1289/EHP4163  

https://www.ncbi.nlm.nih.gov/pubmed/30969138

Take Home Message: Mandating the use of the National Athletic Trainers’ Association Inter-Association Task Force (NATA-IATF) “acclimatization” guidelines in high school football is related to fewer athletes experiencing exercise-induced heat illness. 

The authors of the 2009 NATA-IATF “acclimatization” guidelines aimed to reduce exertional heat illnesses, which include heat stroke, heat syncope, heat exhaustion, and heat edema. Some state high school athletic associations have implemented these guidelines, yet the effectiveness of these guidelines is unknown.  Kerr and his colleagues assessed the relationship between state high school athletic associations adopting the NATA-IATF guidelines and the rate of exertional heat illnesses among high school students during preseason American football practices.

2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions

2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions

Schwarz EM, Parvizi J, Gehrke T, Aiyer A, Battenberg A, Brown SA, Callaghan JJ, Citak M, Egol K, Garrigues GE, Ghert M, Goswami K, Green A, Hammound S, Kates SL, McLaren AC, Mont MA, Namdari S, Obremskey WT, O'Toole R, Raikin S, Restrepo C, Ricciardi B, Saeed K, Sanchez-Sotelo J, Shohat N, Tan T, Thirukumaran CP, Winters B. J Orthop Res. 2019 May;37(5):997-1006. doi: 10.1002/jor.24293. Epub 2019 Apr 25.

Full Text is Freely Available

A research workgroup was assembled from the 2^nd International Consensus Meeting on Musculoskeletal Infection to “provide broad audience guidance on the controversies and major unmet needs in the field of” musculoskeletal infections. Major topics include…

• Developing a Functional Definition of “Acute” Versus “Chronic” Bone and Implant‐Related Infection
• Host Immunity, Immunotherapy and Immunoprophylaxis, and Cessation of Immunosuppressive Therapy
• The Use of Antibiotics for Musculoskeletal Infections
• Diagnosing Musculoskeletal Infections
• Modifiable Factors

View 192 other recent position statements, consensus statements, guidelines, and recommendations related to sports medicine.

Let’s Chat: 1 in 8 Patients Are Diagnosed with Osteoarthritis within 5 Years of an ACL Reconstruction

Post-traumatic osteoarthritis diagnosed within 5 years following ACL reconstruction

Bodkin SG, Werner BC, Slater LV, and Hart JM. Knee Surg Sports Traumatol Arthrosc. 2019. [Epub Ahead of Print].

https://link.springer.com/article/10.1007%2Fs00167-019-05461-y  

Take Home Message: Almost 1 in 8 patients seek medical care and are diagnosed with knee osteoarthritis within 5 years of an anterior cruciate ligament reconstruction.

Anterior cruciate ligament (ACL) rupture can lead to long-term changes in joint health and greatly affect an person’s short- and long-term quality of life. However, most studies have relied on sending surveys or inviting former patients back for an evaluation. Few studies have used large samples of healthcare data to identify people who are diagnosed with symptomatic knee osteoarthritis and seeking medical care. Therefore, Bodkin and colleagues completed an analysis of a national insurance-based, for-fee database of patient records to calculate the incidence of osteoarthritis following an ACL reconstruction and examine the risk factors related with osteoarthritis development.

An Evaluation of Patient-Reported Outcome Measure Usage in Secondary School ATs

The Use of Patient-Reported Outcome Measures: Secondary School Athletic Trainers' Perceptions, Practices, and Barriers.

Coulombe BJ, Games KE, Eberman LE; J Athl Train. 2019 Feb;54(2):142-151. doi:10.4085/1062-6050-86-17. Epub 2018 Aug 10.

Full Text Freely Available

Take Home Message: Many secondary school athletic trainers viewed patient-reported outcomes as beneficial; however, skip using them because of time constraints (e.g., time to fill-out, score, or analyze).

A clinician can use patient-reported outcome (PRO) measures to assess how a patient perceives their symptoms, function, and rehabilitation progress. PROs are an essential way to inform how patient-centered care is provided after an injury. Unfortunately, clinicians, especially secondary school athletic trainers, may skip using PROs for many reasons. Understanding how and why a secondary school athletic trainer uses PROs may lead to strategies to promote the use of PROs. Hence, the authors used a web-based survey to evaluate the views that exist regarding the application, benefits, and problems associated with implementing PROs in the clinical practice of secondary school athletic trainers.

BEAR in Mind: There’s a New ACL Repair Technique on the Block

Bridge-Enhanced Anterior Cruciate Ligament Repair: Two-year results of a first-in-human study

Murray MM, Kalish LA, Fleming BC, Proffen BL, Ecklund K, Kramer DE, Yen YM, & Micheli LJ.  Ortho J Sports Med. 2019; 7(3).  DOI: 10.1177/2325967118824356  

https://journals.sagepub.com/doi/abs/10.1177/2325967118824356

Take Home Message: Bridge-enhanced anterior cruciate ligament repair is producing similar outcomes to hamstring autograft reconstruction up to 2 years post-surgery.

Anterior cruciate ligament (ACL) surgical reconstruction techniques are evolving to improve short- and long-term outcomes for patients after surgery.  A newer approach that is getting a lot of attention is the bridge-enhanced anterior cruciate ligament repair (BEAR). To perform a BEAR, a surgeon repairs the ACL with sutures and a scaffold to promote optimal alignment and healing.  Before large clinical trials can be performed with this new procedure it is critical to have initial results to ensure it is safe and potentially beneficial. Hence, the authors conducted an observational cohort study of 10 participants who received a BEAR and 10 who received a hamstring autograft ACL reconstruction to assess physical exam findings, patient-reported outcomes, and adverse events at one and two years after surgery.

The Use of PROMs Among Athletic Trainers Remains Low

Use of Patient-Reported Outcome Measures in Athletic Training: Common Measures, Selection Considerations, and Practical Barriers.

Lam KC, Harrington KM, Cameron KL, Valier ARS. J Athl Train. 2019 [Epub ahead of print]

Full Text is Freely Available

Take Home Message: The use of patient-reported outcome measures (PROMs) remains low among athletic trainers; however, athletic trainers who use PROMs commonly use injury- or joint-specific PROMs or single-item PROMs. Time to complete and score PROMs are important barriers to using PROMs.

The “Athletic Training Education Competencies” and the “Role Delineation/Practice Analysis” emphasizes the support for the implementation of patient-reported outcome measures (PROMs) into clinical practice to enhance patient care. However, athletic trainers appear reluctant to use them due to barriers such as time constraints. A better understanding of how athletic trainers perceive and use PROMs may help improve the adoption of PROMs into clinical practice. Therefore, the authors created a survey, which was distributed to ~18,000 athletic trainers to describe the commonly used PROMs, why those PROMS are selected, and barriers and reasons for not using PROMs.

Repair may be Just as Good as Reconstruction

Acute Anterior Cruciate Ligament Rupture: Repair or Reconstruction?

Hoogeslag RAG, Brouwer RW, Boer BC, de Vries AJ, and Huis in ‘t Veld H. Am J Sports Med. 2019. [Epub Ahead of Print].
https://journals.sagepub.com/doi/abs/10.1177/0363546519825878

Take Home Message: People who receive a dynamic augmented anterior cruciate ligament (ACL) repair have similar outcomes to those who receive an ACL reconstruction during the first 2 years after surgery

Many clinicians have discussed the pros and cons of a surgical reconstruction or conservative care for an anterior cruciate ligament (ACL) rupture. In recent years, there has also been a renewed interest in re-assessing suture repair of a ruptured ACL. Therefore, Hoogeslag and colleagues completed a randomized trial to examine patient-reported, clinical, and radiological outcomes among young adults receiving a dynamic augmented ACL repair or ACL reconstruction.