Can Advanced Imaging Show Us the Pathophysiology Following a Concussion?

Linked MRI signatures of the brain's acute and persistent response to concussion in female varsity rugby players

Manning KY, Llera A, Dekaban GA, Bartha R, Barreira C, Brown A, Fischer L, Jevremovic T, Blackney K, Doherty TJ, Fraser DD, Holmes J, Beckmann CF, Menon RS. Neuroimage Clin.2018 Dec 3. pii: S2213-1582(18)30375-9.

Full Text Freely Available

Take Home Message: Athletes in rugby have altered white matter structural and functional connectivity after a concussion and in season. Some changes may persist up to 6 months post-injury.

Researchers use advanced imaging studies (e.g., diffusion tensor imaging, resting-state functional magnetic resonance imaging) to assess structural and functional changes following a concussion. This can help clinicians and researchers understand if there are long-term problems after a concussion and discover potential therapeutic interventions. Unfortunately, it is challenging to interpret the complex structural and functional brain changes that occur after a concussion. Therefore, the authors used advanced analyses to examine changes in brain structure (diffuse tensor imaging) and function (resting-stage functional magnetic resonance imaging) together in 52 healthy female varsity rugby players (~20 years of age) over a five-year period (71 in season data sets, 60 off-season data sets).

Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC)

Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC).

Pelliccia A, Solberg EE, Papadakis M, Adami PE, Biffi A, Caselli S, La Gerche A, Niebauer J, Pressler A,, Schmied CM, Serratosa L, Halle M, Van Buuren F, Borjesson M, Carrè F, Panhuyzen-Goedkoop NM, Heidbuchel H, Olivotto I, Corrado D, Sinagra G, Sharma S. Eur Heart J. 2018 Dec 14. doi: 10.1093/eurheartj/ehy730. [Epub ahead of print]

Full Text Not Freely Available

The Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC) has released a position statement on participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis. The contents cover an array of topics:

• Shared decision making process 
• Diagnosis of cardiomyopathy in athletes 
• Hypertophic cardiomyopathy 
• Dilated cardiomyopathy 
• Left ventricular non-compaction cardiomyopathy 
• Arrhythmogenic (right ventricular) cardiomyopathy 
• Athletes with isolated ECG abnormalities 
• Athletes with cardiomyopathy and implanted cardioverter defibrillator 
• Prescription for leisure-time physical activity in patients with cardiomyopathy 
• Myocarditis 
• Pericarditis 
• Classification of sport activities

Many sections discuss topics like electrocardiography, echocardiography, cardiovascular magnetic resonance imaging, exercise testing, and risk stratification.

View 183 other recent position statements, consensus statements, guidelines, and recommendations related to sports medicine.

Pediatric Cervical Spine Clearance: A Consensus Statement and Algorithm from the Pediatric Cervical Spine Clearance Working Group

Pediatric Cervical Spine Clearance: A Consensus Statement and Algorithm from the Pediatric Cervical Spine Clearance Working Group.

Herman MJ, Brown KO, Sponseller PD, Phillips JH, Petrucelli PM, Parikh DJ, Mody KS, Leonard JC, Moront M, Brockmeyer DL, Anderson RCE, Alder AC, Anderson JT, Bernstein RM, Booth TN, Braga BP, Cahill PJ, Joglar JM, Martus JE, Nesiama JO, Pahys JM, Rathjen KE, Riccio AI, Schulz JF, Stans AA, Shah MI, Warner WC Jr, Yaszay B. J Bone Joint Surg Am. 2019 Jan 2;101(1):e1. doi: 10.2106/JBJS.18.00217.

Full Text Freely Available

The Pediatric Cervical Spine Clearance Working Group, a subgroup of the Pediatric Cervical Spine Study Group, created a consensus statement for pediatric cervical spine clearance. They defined pediatric cervical spine clearance as “the process by which a child with a suspected CSI undergoes clinical evaluation (history and physical examination) and, in select cases, is evaluated by diagnostic imaging to determine that a CSI has not occurred.” The Work Group used the consensus statement to develop an algorithm to guide protocols for cervical spine clearance. This algorithm is presented as a Figure in the document.

View 182 other recent position statements, consensus statements, guidelines, and recommendations related to sports medicine.

National Athletic Trainers' Association Position Statement: Immediate Management of Appendicular Joint Dislocations

National Athletic Trainers' Association Position Statement: Immediate Management of Appendicular Joint Dislocations.

Susan L. Rozzi, Jeffrey M. Anderson, Scott T. Doberstein, Joseph J. Godek, Langdon A. Hartsock, and Edward G. McFarland (2019). Journal of Athletic Training In-Press.

Full Text Freely Available

The National Athletic Trainers’ Association released a position statement “to provide certified athletic trainers (ATs) with recommendations and guidelines for the immediate management of patients with joint dislocations.” The document includes 27 recommendations related to legal considerations, technique and skill considerations, general patient management, and joint-specific recommendations. The recommendations are followed by an extensive literature review.

View 181 other recent position statements, consensus statements, guidelines, and recommendations related to sports medicine.

Risk of Redislocation After Primary Patellar Dislocation

Risk of Redislocation After Primary Patellar Dislocation: A Clinical Prediction Model Based on Magnetic Resonance Imaging Variables

Arendt EA, Askenberger M, Agel J, & Tompkins MA.  Am J Sport Med. 2018; 46(14):3385-3390. DOI:10.11177/0363546518803936

https://journals.sagepub.com/doi/abs/10.1177/0363546518803936

Take Home Message: A patient with a primary patellar dislocation who is skeletally immature and has a sulcus angle > 154 and patella alta is more likely to redislocate over the next 2 years.

People who suffer patellar dislocations often opt for conservative management of the injury. However, many people suffer subsequent redislocations, which increases risk for more damage and surgery.  It would be helpful if clinicians could predict who is at risk for redislocation to guide more effective management decisions.  Therefore, the authors used 2 cohorts to determine if there are factors that differentiate people who redislocate their patella after an initial dislocation versus those who do not redislocate. The authors also tested if this information could help predict the risk of redislocation.

PRP: Slow and Steady Can Win the Race

Platelet-Rich Plasma Has Better Long-Term Results Than Corticosteroids or Placebo for Chronic Plantar Fasciitis: Randomized Control Trial.

Shetty SH, Dhond A, Arora M, Deore S. J Foot Ankle Surg. 2018. [Epub ahead of print]

https://www.sciencedirect.com/science/article/pii/S1067251618302825

Take Home Message: Patients with plantar fasciitis that received platelet-rich plasma (PRP) injections had better long-term outcomes compared to a placebo or corticosteroid injection.

Plantar fasciitis is a common cause of heel pain. About 90% of cases resolve with conservative treatment within a few weeks. However, there is no consensus on best practices and very few investigators have conducted randomized control trials to assess the efficacy between different therapeutic options. Therefore, the authors conducted a randomized control trial to investigate the efficacy of platelet-rich plasma (PRP) injections compared to corticosteroid or placebo injections among people with chronic plantar fasciitis.

Watch Out for the Turf Monster!

Higher rates of lower extremity injury on synthetic turf compared with natural turf among National Football League athletes.

Mack CD, Hershman EB, Anderson RB, Coughlin MJ, McNitt AS, Sendor RR, and Kent RW. Am J Sports Med. 2018. [Epub Ahead of Print].

https://journals.sagepub.com/doi/abs/10.1177/0363546518808499

Take Home Message: Injury rates on synthetic turf surfaces are 16% higher than on natural playing surfaces among National Football League (NFL) athletes.

Synthetic turf surfaces are increasingly common at sporting venues. These surfaces may increase injury risk. However, it is hard to incorporate this concern into clinical practice because there are many factors that affect playing surface and risk of injury (e.g., care of the playing surface, reporting of injuries, selection bias). Therefore, Mack and colleagues completed a cohort study to assess the incidence of lower body injuries among NFL athletes on modern generation synthetic turf surfaces and natural grass.