A history of concussions is associated with symptoms of common mental disorders in former male professional athletes across a range of sports

Objective: Recent reports suggest that exposure to repetitive concussions in sports is associated with an increased risk of symptoms of distress, anxiety and depression, sleep disturbance or substance abuse/dependence (typically referred as symptoms of common mental disorders[CMD]) and of later development of neurodegenerative disease, in particular chronic traumatic encephalopathy (CTE). The primary aim of this study was to explore the relationship between sports career-related concussions and the subsequent occurrence of symptoms of CMD among former male professional athletes retired from football (soccer), ice hockey and rugby (union). Methods: Cross-sectional analyses were performed on baseline electronic questionnaires from three prospective cohort studies among former male professional athletes retired from football (soccer), ice hockey and rugby (union). The number of confirmed concussions was examined through a single question, while symptoms of distress, anxiety and depression, sleep disturbance and adverse alcohol use were assessed using validated questionnaires. Results: From 1,957 former professional athletes contacted, a total of 576 (29%) completed the questionnaire. Of these, 23% had not incurred a concussion during their career, 34% had two or three, 18% four or five, and 11% six or more concussions. The number of sports career-related concussions was a predictor for all outcome measures (β = 0.072–0.109; P ≤ 0.040). Specifically, former professional athletes who reported a history of four or five concussions were approximately 1.5 times more likely to report symptoms of CMD, rising to a two- to five-fold increase in those reporting a history of six or more sports career-related concussions. Conclusions: These data demonstrate an association between exposure to sports concussion and subsequent risk of symptoms of CMD in former professional athletes across a range of contact sports. Further work to explore the association between sports concussion and symptoms of CMD is required; in the meanwhile, strategies for effective risk reduction and improved management appear indicated

Korrekturosteotomie bei lateraler Tibiakopfimpression und Valgusfehlstellung

Zusammenfassung : Operationsziel : Verbesserung der Gelenkkongruenz bei fehlverheilten Frakturen des lateralen Tibiaplateaus, Schmerzreduktion, Vorbeugung einer Arthrose. Indikationen : Valgusfehlstellung der proximalen Tibia und damit verbundene intraartikuläre Impression des Tibiaplateaus Kontraindikationen : Patienten in schlechtem Allgemeinzustand. Hochgradiges Defizit der Kniegelenkfunktion. Patientenalter > 65 Jahre. Chronische Infektion. Weichteilprobleme. Unfähigkeit des Patienten, die Extremität nach der Operation abrollend zu belasten. Operationstechnik : Tangentiale Osteotomie des mittlerer Fibuladrittels. Gerader lateraler oder parapatellarer Zugang zur lateralen proximalen Tibia. Laterale Arthrotomie des Kniegelenks. Proximale keilförmige öffnende ("open wedge‘ Osteotomie der Tibia. Intraartikuläre Korrektur der Impression des lateralen Tibiakondylus durch subchondrales Einstößeln von Spongiosa. Beurteilung der Achsenverhältnisse des Beins. Interposition kortikospongiöser Knochentransplantate zur Stützung der öffnenden Osteotomie. Bei Bedarf interne Fixation. Weiterbehandlung : Kontinuierliche passive Bewegung bis 90° Flexion ab dem 1. postoperativen Tag. Nach Anlage einer stabilisierenden Schiene dürfen die Patienten 8 Wochen abrollend mobilisieren. Nach radiologischer Knochenheilung schrittweiser Aufbau der Belastung. Ergebnisse : Zwischen 1977 und 1998 wurden 23 Patienten operiert. Zwei Fehlschläge waren zu verzeichnen, wovon einer in einer Arthrodese und der andere in einem totalen Gelenkersatz mündete. Nach durchschnittlich 14 Jahren (5-6 Jahre) wurden 21 Patienten nachuntersucht. Zwei Patienten litten unter einer signifikanten Verschlechterung der Arthrose, vier Patienten wiesen eine leicht progrediente Knorpeldegeneration auf, und bei 15 Patienten war das Ausmaß des Gelenkverschleißes unverändert. Durchschnittlich konnten der tibiofemorale Winkel um 8,6° (13-14,4°), die Tibiakopfimpression um 6 mm (4-9 mm) und der Bewegungsumfang um 12° (0-20°) verbessert werden. Pseudarthrosen fanden sich nich

A novel approach to enhance ACL injury prevention programs

Abstract Efficacy studies have demonstrated decreased anterior cruciate ligament (ACL) injury rates for athletes participating in injury prevention programs. Typically, ACL injury prevention programs entail a combination of plyometrics, strength training, agility and balance exercises. Unfortunately, improvements of movement patterns are not sustained over time. The reason may be related to the type of instructions given during training. Encouraging athletes to consciously control knee movements during exercises may not be optimal for the acquisition of complex motor skills as needed in complex sports environments. In the motor learning domain, these types of instructions are defined as an internal attentional focus. An internal focus, on one’s own movements results in a more conscious type of control that may hamper motor learning. It has been established in numerous studies that an external focus of attention facilitates motor learning more effectively due to the utilization of automatic motor control. Subsequently, the athlete has more recourses available to anticipate on situations on the field and take appropriate feed forward directed actions. The purpose of this manuscript was to present methods to optimize motor skill acquisition of athletes and elaborate on athletes’ behavior

Osteoarthritic changes in the knees of recently retired male professional footballers: a pilot study

Background: Knee osteoarthritis (OA) is common amongst retired male professional footballers. There is limited understanding with respect to the interplay between imaging findings, clinical presentation and patient-reported outcome measures (PROMs) in retired professional footballers with knee OA. Objectives: This pilot study aimed to evaluate the extent of radiological and clinical knee OA in a cohort of retired male professional footballers, and to explore the relationship between these findings and knee-related PROMs. Methods: Fifteen retired male professional footballers underwent knee radiographs and were surveyed on their history of clinical OA, severe knee injury and previous knee surgery. The Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) and the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) were used to assess health outcomes, such as level of function and pain. Results: Radiological knee OA was diagnosed in six out of 15 participants. Seven of the participants had a clinical diagnosis of knee OA. Evidence of clinical and radiological OA was present amongst four participants. Radiological knee OA and clinical OA was significantly associated with a history of severe knee injury and previous knee surgery. Low correlations (ρ<-0.40) were found between knee OA severity and knee-related PROMs. Moderate correlation (ρ=-0.65) was found between clinical knee OA and KOOS-SP. Conclusion: Clinical knee OA correlates with PROMs amongst retired professional footballers but radiological OA does not. Further studies are required to understand the relationship between imaging findings, clinical presentation and PROMs amongst retired professional footballers with knee OA.

“Web impingement” of the ankle: a case report

This case report presents two patients with persisting anterior ankle impingement pain after an ankle distortion. A web-like intra-articular fibrous band was discovered and resected. The patients presented were, after a 1-year follow-up, pain fre

No time to waste : necessary health support for retired professional rugby players

There has been increasing scrutiny of professional rugby following the concern that retired players might face several negative health conditions. Currently, support measures addressing the health of retired professional rugby players are not systematically implemented. This is unusual as professional rugby stakeholders have the duty of care to protect and promote the long-term health of retired players. Professional football has a health programme for retired players that is implemented globally. This programme formed the basis for the After Rugby Career Consultation (ARCC) which was developed to empower the sustainable health and quality of life of retired professional rugby players. The ARCC relies on information from three sources: (1) educational material, (2) medical examination, and (3) guidance, referral and/or monitoring. The South African rugby stakeholders have connected to pilot the ARCC as there is no time to waste: a step towards necessary health support for retired professional rugby players is needed.http://sajsm.org.za/index.php/sajsmhj2021Sports Medicin

Implantation of a Cushioning Injectable Implant Using Needle Arthroscopy in the Foot and Ankle and First Carpometacarpal Joint

Injectable implants constitute a newly developed treatment class in the battle against osteoarthritis. They consist of water-formulated supramolecular polymer, coming from a new class of resorbable biomedical materials, and are implanted in encapsulated joints in a liquid form, where they solidify to form a tough, elastic, and cushioning layer between the joint surfaces. To resort any effect, intra-articular delivery should be guaranteed, and the implant should be distributed throughout the entire joint space. Traditional implantation techniques do not seem to suffice for this new implant class, being either imprecise (traditional injection) or overly invasive (open procedures and traditional arthroscopic surgery). We describe a needle arthroscopic implantation technique to reap the benefits of both worlds, ensuring precise implant delivery while avoiding unnecessarily invasive procedures. This study depicts our needle arthroscopic technique for implantation of injectable implants in the ankle, first metatarsophalangeal joint, and first carpometacarpal joint.</p

Does Perception of Usefulness of Arthroscopic Simulators Differ with Levels of Experience?

Some commercial simulators are available for training basic arthroscopic skills. However, it is unclear if these simulators allow training for their intended purposes and whether the perception of usefulness relates to level of experience. We addressed the following questions: (1) Do commercial simulators have construct (times to perform tasks) and face validity (realism), and (2) is the perception of usefulness (educational value and user-friendliness) related to level of experience? We evaluated two commercially available virtual reality simulators (Simulators A and B) and recruited 11 and nine novices (no arthroscopies), four and four intermediates (one to 59 arthroscopies), and seven and nine experts (> 60 arthroscopies) to test the devices. To assess construct validity, we recorded the median time per experience group for each of five repetitions of one identical navigation task. To assess face validity, we used a questionnaire to judge up to three simulator characteristic tasks; the questionnaire asked about the realism, perception of educational value, and perception of user-friendliness. We observed partial construct validity for Simulators A and B and considered face validity satisfactory for both simulators for simulating the outer appearance and human joint, but barely satisfactory for the instruments. Simulators A and B had equal educational value according to the participants. User-friendliness was judged better for Simulator B although both were graded satisfactory. The perception of usefulness did not differ with level of experience. Our observations suggest training on either simulator is reasonable preparation for real-life arthroscopy, although there is room for improvement for both simulators. These simulators provide training in surgical skills without compromising patient safet

Evaluation of a medical after-care intervention among deselected elite male Academy football players : a pilot study

OBJECTIVE : This pilot study aimed to evaluate the perception and satisfaction of deselected male Academy professional footballers towards a medical after-care intervention. METHODS : A quasiexperimental study design, with deselected players (aged≥18 years) at a single Premier League Academy during the 2022/2023 season, were invited to participate. The intervention included individualised health recommendations, key medical information and signposting to key support resources. Participants’ perceptions and satisfaction were assessed through an electronic survey. Descriptive analyses (mean, SD, frequency and/or range) were performed for all variables. RESULTS : Twelve out of 15 eligible participants (80% response rate) provided informed consent and completed the survey (mean age: 19.5 years). All (100%) of the participants were satisfied with receiving the medical information. Ten out of 12 (83.3%) participants agreed that all Academy players should receive this medical intervention on deselection. Nine (75%) players felt more prepared for the next steps in their careers due to the medical information shared with them. CONCLUSION : Deselected male Academy footballers expressed high satisfaction with an individualised medical intervention which shared key health information and signposted them to important resources (eg, mental health). Future studies across multiple clubs should explore the broader impact of this intervention among deselected male and female Academy footballers. Football clubs should consider integrating a medical after-care process for deselected players as part of routine care.http://bmjopensem.bmj.comhj2024Sports MedicineSDG-03:Good heatlh and well-bein

Return to Sports and Physical Activity After Total and Unicondylar Knee Arthroplasty: A Systematic Review and Meta-Analysis

People today are living longer and want to remain active. While obesity is becoming an epidemic, the number of patients suffering from osteoarthritis (OA) is expected to grow exponentially in the coming decades. Patients with OA of the knee are progressively being restricted in their activities. Since a knee arthroplasty (KA) is a well accepted, cost-effective intervention to relieve pain, restore function and improve health-related quality of life, indications are expanding to younger and more active patients. However, evidence concerning return to sports (RTS) and physical activity (PA) after KA is sparse. Our aim was to systematically summarise the available literature concerning the extent to which patients can RTS and be physically active after total (TKA) and unicondylar knee arthroplasty (UKA), as well as the time it takes. PRISMA guidelines were followed and our study protocol was published online at PROSPERO under registration number CRD42014009370. Based on the keywords (and synonyms of) 'arthroplasty', 'sports' and 'recovery of function', the databases MEDLINE, Embase and SPORTDiscus up to January 5, 2015 were searched. Articles concerning TKA or UKA patients who recovered their sporting capacity, or intended to, were included and were rated by outcomes of our interest. Methodological quality was assessed using Quality in Prognosis Studies (QUIPS) and data extraction was performed using a standardised extraction form, both conducted by two independent investigators. Out of 1115 hits, 18 original studies were included. According to QUIPS, three studies had a low risk of bias. Overall RTS varied from 36 to 89% after TKA and from 75 to >100% after UKA. The meta-analysis revealed that participation in sports seems more likely after UKA than after TKA, with mean numbers of sports per patient postoperatively of 1.1-4.6 after UKA and 0.2-1.0 after TKA. PA level was higher after UKA than after TKA, but a trend towards lower-impact sports was shown after both TKA and UKA. Mean time to RTS after TKA and UKA was 13 and 12 weeks, respectively, concerning low-impact types of sports in more than 90 % of cases. Low- and higher-impact sports after both TKA and UKA are possible, but it is clear that more patients RTS (including higher-impact types of sports) after UKA than after TKA. However, the overall quality of included studies was limited, mainly because confounding factors were inadequately taken into account in most studie