Long-term neuromuscular training and ankle joint position sense

Preventive effect of proprioceptive training is proven by decreasing injury incidence, but its proprioceptive mechanism is not. Major hypothesis: the training has a positive long-term effect on ankle joint position sense in athletes of a high-risk sport (handball). Ten elite-level female handball-players represented the intervention group (training-group), 10 healthy athletes of other sports formed the control-group. Proprioceptive training was incorporated into the regular training regimen of the training-group. Ankle joint position sense function was measured with the “slope-box” test, first described by Robbins et al. Testing was performed one day before the intervention and 20 months later. Mean absolute estimate errors were processed for statistical analysis. Proprioceptive sensory function improved regarding all four directions with a high significance (p<0.0001; avg. mean estimate error improvement: 1.77°). This was also highly significant (p≤0.0002) in each single directions, with avg. mean estimate error improvement between 1.59° (posterior) and 2.03° (anterior). Mean absolute estimate errors at follow-up (2.24°±0.88°) were significantly lower than in uninjured controls (3.29°±1.15°) (p<0.0001). Long-term neuromuscular training has improved ankle joint position sense function in the investigated athletes. This joint position sense improvement can be one of the explanations for injury rate reduction effect of neuromuscular training

Isolated Femoral Shaft Fracture in Wakeboarding and Review of the Literature

Introduction. Wakeboarding is an extreme sport that has shown increasing popularity in recent years, with an estimated 2.9 million participants in 2017. Due to this trend, injuries related to this sport are likely to become more common. Isolated femoral shaft are rare; however, they occur much more frequently in youth as a result of high velocity events, such as dashboard-related injuries. Few studies have addressed injuries related to wakeboarding, and of those that have, most have reported on muscle injuries, ligament ruptures, and sprains. Due to the dearth in literature, we want to present two cases of isolated noncontact femoral shaft fractures that resulted from wakeboarding. Case Presentation. Two 28-year-old, otherwise healthy, wakeboarders—patient A, male, and patient B, female—presented to our Department of Orthopaedics and Sports Medicine with isolated femoral shaft fractures. Both were admitted due to wakeboard-related noncontact injuries, where patient A fell while performing a sit-down start during cable wakeboarding and patient B after attempting a wake-jump. Both patients were being pulled by motorboats at roughly 40 km/h. After clinical examination and radiography, left spiral (AO classification: 32-A1.2) (patient A) and right-sided bending, wedge (AO classification 32-B2.2) (patient B) isolated femoral shaft fractures were diagnosed. No concomitant injuries were reported. For treatment, long reamed locked nails were applied, while the patients were under spinal anaesthesia. Physiotherapy was prescribed postoperatively. Patient A returned to wakeboarding 155 days after the surgery, and patient B returned after approximately half a year. Conclusion. This case series shows that even in noncontact sports such as wakeboarding, high-energy forces applied to the femur can cause isolated femoral shaft fractures. Despite multiple reports in various sports of stress fractures of the femur, there are few publications of direct trauma

Long-term (10-25 years) outcomes of knee osteochondral autologous transplantation in soccer players

Objective: Osteochondral lesions in the knee can occur in a high percentage of soccer players. Untreated, symptomatic osteochondral lesions can lead to reduced athletic performance, early career-ending, and the premature onset of knee osteoarthritis. One of the treatment options is osteochondral autologous transplantation with the mosaicplasty technique. The study aims to investigate the long-term outcomes of the procedure in the athletic population. Design: In a single-center retrospective study, the long-term outcomes of knee mosaicplasty pro- cedures in soccer players between 1992 and 2011 were investigated. Using International Knee Documentation Committee and Bandi score to evaluate the knee function, Tegner score to mea- sure activity, and MOCART 2.0 score to describe cartilage surface. Players’ skill level was divided into professional, competitive, and recreational groups. Results: Fifty-five out of 73 soccer players were included; 25 had MRI at the last follow-up control. The average follow-up time was 17,54 years (10,32-24,91). The mean International Knee Docu- mentation Committee score was 68.52 ± 16.01 (33-87), MOCART was 70.8 ± 18.12 (25-95), and 80% of the patient had a good Bandi score. The mean size of the defects was 2,08 cm 2 ± 1,19 (1-5 cm 2 ) and overall return to sport time was 7,78 ± 2,96 (4-12) months. Conclusion: The knee mosaicplasty procedure has a good long-term result, with no significant decrease in functional scores compared to other studies even after 20 years from the surgery. Therefore, osteochondral autologous transplantation is a reasonable option for soccer players with small to medium-sized osteochondral lesions in the knee

sj-pdf-1-ojs-10.1177_23259671241239665 – Supplemental material for Nonoperative Treatment as an Option for Isolated Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis

Supplemental material, sj-pdf-1-ojs-10.1177_23259671241239665 for Nonoperative Treatment as an Option for Isolated Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis by Robert de Jonge, Miklós Máté, Norbert Kovács, Marcell Imrei, Károly Pap, Gergely Agócs, Szilárd Váncsa, Péter Hegyi and Gergely Pánics in Orthopaedic Journal of Sports Medicine</p

sj-pdf-2-ojs-10.1177_23259671241239665 – Supplemental material for Nonoperative Treatment as an Option for Isolated Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis

Supplemental material, sj-pdf-2-ojs-10.1177_23259671241239665 for Nonoperative Treatment as an Option for Isolated Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis by Robert de Jonge, Miklós Máté, Norbert Kovács, Marcell Imrei, Károly Pap, Gergely Agócs, Szilárd Váncsa, Péter Hegyi and Gergely Pánics in Orthopaedic Journal of Sports Medicine</p

Calcaneal bone bruise after surgery for insertional Achilles tendinopathy

Abstract Objectives: Excision of the posterosuperior corner of the calcaneus (EPCC) is routinely undertaken in athletes after failure of conservative management of insertional Achilles tendinopathy. Some patients can experience sharp calcaneal pain during postoperative rehabilitation, a sign of a calcaneal bone bruise (CBB). Design: Case series, level of evidence IV. Setting: University teaching hospital. Patients: This study reports 8 patients who developed postoperative CBB after having started impact training too early. Intervention: Patients in whom a diagnosis of CBB had been formulated were followed to return-to-play and resolution of bone edema by MRI. Main Outcome Measures: Detection of CBB after EPCC. Results: After routine EPCC for insertional Achilles tendinopathy, 8 patients presented with sharp pain for a mean 7.1 weeks (median 6 weeks, range 5‐11 weeks) before clinical suspicion of CBB. At that stage, MRI showed clear evidence of a bone bruise, with a diagnosis of CBB formulated at an average of 10.8 postoperative weeks (range 6‐16 weeks). Calcaneal bone bruise resolved with modified symptom-free loading. Patients returned to play at average on 5.6 months (range 2‐9 months) after the diagnosis of postoperative CBB. Conclusions: We describe 8 athletes who developed painful CBB following routine EPCC for insertional Achilles tendinopathy after having increased their level of activities too soon after the index procedure. In these patients, the diagnosis of postoperative CBB can be formulated by MRI and more cautious rehabilitation implemented