Return to Play After Soleus Muscle Injuries

BACKGROUND: Soleus muscle injuries are common in different sports disciplines. The time required for recovery is often difficult to predict, and reinjury is common. The length of recovery time might be influenced by different variables, such as the involved part of the muscle. HYPOTHESIS: Injuries in the central aponeurosis have a worse prognosis than injuries of the lateral or medial aponeurosis as well as myofascial injuries. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 61 high-level or professional athletes from several sports disciplines (soccer, tennis, track and field, basketball, triathlon, and field hockey) were reviewed prospectively to determine the recovery time for soleus muscle injuries. Clinical and magnetic resonance imaging evaluation was performed on 44 soleus muscle injuries. The association between the different characteristics of the 5 typical muscle sites, including the anterior and posterior myofascial and the lateral, central, and medial aponeurosis disruption, as well as the injury recovery time, were determined. Recovery time was correlated with age, sport, extent of edema, volume, cross-sectional area, and retraction extension or gap. RESULTS: Of the 44 patients with muscle injuries who were analyzed, there were 32 (72.7%) strains affecting the myotendinous junction (MT) and 12 (23.7%) strains of the myofascial junction. There were 13 injuries involving the myotendinous medial (MTM), 7 affecting the MT central (MTC), 12 the MT lateral (MTL), 8 the myofascial anterior (MFA), and 4 the myofascial posterior (MFP). The median recovery time (±SD) for all injuries was 29.1 ± 18.8 days. There were no statistically significant differences between the myotendinous and myofascial injuries regarding recovery time. The site with the worst prognosis was the MTC aponeurosis, with a mean recovery time of 44.3 ± 23.0 days. The site with the best prognosis was the MTL, with a mean recovery time of 19.2 ± 13.5 days (P < .05). There was a statistically significant correlation between recovery time and age (P < .001) and between recovery time and the extent of retraction (P < .05). CONCLUSION: Wide variation exists among the different types of soleus injuries and the corresponding recovery time for return to the same level of competitive sports. Injuries in the central aponeurosis have a significantly longer recovery time than do injuries in the lateral and medial aponeurosis and myofascial sites

Coronariografía no invasiva mediante tomografía computarizada con 16 detectores: estudio comparativo con la angiografía coronaria invasiva

Introducción y objetivos. La coronariografía no invasiva mediante tomografía computarizada con 16 detectores es una herramienta diagnóstica de reciente aparición cuya fiabilidad está por determinar. El objetivo del presente estudio es la comparación entre esta técnica y la coronariografía invasiva. Pacientes y método. Se estudió a 31 pacientes por ambas técnicas. El estudio no invasivo se realizó con un equipo Toshiba Aquilion 16. Se realizó una toma helicoidal del volumen cardíaco durante una apnea, inyectándose contraste en una vena periférica y reconstruyendo posteriormente las imágenes con cortes de 0,5 o 1 mm. Ambas coronariografías fueron evaluadas según un modelo anatómico predefinido de segmentación del árbol coronario. Se analizaron la presencia y la magnitud de las lesiones coronarias, considerando significativas las estenosis > 50%. Resultados. La coronariografía no invasiva permitió evaluar el 88,4% de los segmentos analizados por coronariografía convencional. Las causas de no evaluación de un segmento fueron: presencia extensa de calcio parietal coronario, apnea incorrecta, artefacto de movimiento y reducido calibre del segmento estudiado. La sensibilidad y la especificidad global de la coronariografía no invasiva para la detección de lesiones coronarias significativas fueron del 75 y del 91%, respectivamente. Los valores de sensibilidad y especificidad para los distintos segmentos coronarios considerados independientemente fueron: proximales, 89 y 93%; medios, 87 y 90%; distales, 50 y 90%, y ramas secundarias, 62 y 92%. Conclusiones. La coronariografía no invasiva mediante tomografía computarizada con 16 detectores muestra un elevado poder diagnóstico, en especial en las lesiones proximales y medias de los principales troncos coronarios

Usefulness of Cardiac Computed Tomography in Coronary Risk Prediction : A Five-Year Follow-Up of the SPICA Study (Secure Prevention with Imaging of the Coronary Arteries)

Accurate identification of individuals at high coronary risk would reduce acute coronary syndrome incidence and morbi-mortality. We analyzed the effect on coronary risk prediction of adding coronary artery calcification (CAC) and Segment Involvement Score (SIS) to cardiovascular risk factors. This was a prospective cohort study of asymptomatic patients recruited between 2013-2017. All participants underwent a coronary computed tomography angiography to determine CAC and SIS. The cohort was followed-up for a composite endpoint of myocardial infarction, coronary angiography and/or revascularization (median = five years). Discrimination and reclassification of the REGICOR function with CAC/SIS were examined with the Sommer's D index and with the Net reclassification index (NRI). Nine of the 251 individuals included had an event. Of the included participants, 94 had a CAC = 0 and 85 a SIS = 0, none of them had an event. The addition of SIS or of SIS and CAC to the REGICOR risk function significantly increased the discrimination capacity from 0.74 to 0.89. Reclassification improved significantly when SIS or both scores were included. CAC and SIS were associated with five-year coronary event incidence, independently of cardiovascular risk factors. Discrimination and reclassification of the REGICOR risk function were significantly improved by both indexes, but SIS overrode the effect of CAC

Time course and association of functional and biochemical markers in severe semitendinosus damage following intensive eccentric leg curls: differences between and within subjects

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