Background:
There is no consensus on the optimal method of stabilization (arthroscopic or open) in collision athletes with anterior shoulder instability.
Purpose:
To examine the effect of ...“subcritical” bone loss and football-specific exposure on the rate of recurrent shoulder instability after arthroscopic stabilization in an intercollegiate American football population.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
Fifty intercollegiate football players underwent primary arthroscopic stabilization for anterior shoulder instability and returned to football for at least a single season. Preoperatively, 32 patients experienced recurrent subluxations, and 18 patients experienced a single or recurrent dislocation. Shoulders with glenoid bone loss >20%, an engaging Hill-Sachs lesion, an off-track lesion, and concomitant rotator cuff repair were excluded from the study. The primary outcome of interest was the ability to return to football without subsequent instability. Patients were followed for time to a subsequent instability event after return to play using days of exposure to football and total follow-up time after arthroscopic stabilization.
Results:
Fifty consecutive patients returned to American football for a mean 1.5 seasons (range, 1-3) after arthroscopic stabilization. Three of 50 (6%; 95% CI, 1.3%-16.5%) patients experienced recurrent instability. There were no subsequent instability events after a mean 3.2 years of military service. All shoulders with glenoid bone loss >13.5% (n = 3) that underwent arthroscopic stabilization experienced recurrent instability upon returning to sport, while none of the shoulders with <13.5% glenoid bone loss (n = 47) sustained a recurrent instability event during football (X2 = 15.80, P < .001). Shoulders with >13.5% glenoid bone loss had an incidence rate of 5.31 cases of recurrent instability per 1000 athlete-exposures of football. In 72,000 athlete-exposures to football with <13.5% glenoid bone loss, there was no recurrent instability. Significantly more anchors were used during the primary arthroscopic stabilization procedure in patients who experienced multiple preoperative instability events (P = .005), and lesions spanned significantly more extensive portions along the circumference of the glenoid (P = .001) compared with shoulders having a single preoperative instability event before surgical stabilization.
Conclusion:
Arthroscopic stabilization of anterior shoulder instability in American football players with <13.5% glenoid bone loss provides reliable outcomes and low recurrence rates.
Background Glenohumeral instability is a common injury sustained by young athletes. Surprisingly, little is known regarding the incidence
of glenohumeral instability in collegiate athletes or the ...relevant risk factors for injury. A better understanding of the
populations most at risk may be used to develop preventive strategies.
Hypothesis The incidence of glenohumeral instability in collegiate athletics is high, and it is affected by sex, sport, type of event,
and mechanism of injury.
Study Design Descriptive epidemiologic study.
Methods The National Collegiate Athletic Association injury database was queried for all glenohumeral instability events occurring
between the years 1989 and 2004. An analysis of the injuries was performed by sport, activity (competition versus practice),
sex, type of event (primary versus recurrent), mechanism of injury, and time loss from athletic performance. Incidence rates
and incidence rate ratios were calculated.
Results A total of 4080 glenohumeral instability events were documented for an incidence rate of 0.12 injuries per 1000 athlete exposures.
The sport with the greatest injury rate was menâs spring football, with 0.40 injuries per 1000 athlete exposures. Overall,
athletes sustained more glenohumeral instability events during games than practices (incidence rate ratio IRR, 3.50; 95%
confidence interval CI, 3.29â3.73). Male athletes sustained more injuries than did female athletes (IRR, 2.67; 95% CI, 2.43â2.93).
Female athletes were more likely to sustain an instability event as the result of contact with an object (IRR, 2.43; 95% CI,
2.08â2.84), whereas male athletes were more likely to sustain an event from player contact (IRR, 2.74; 95% CI, 2.31â3.25).
Time lost to sport (>10 days) occurred in 45% of glenohumeral instability events.
Conclusion Glenohumeral instability is a relatively common injury sustained by collegiate athletes. More injuries occurred during competition
and among male athletes.
Little is known of the incidence of shoulder instability, despite some evidence that it may be a common injury in young, athletic individuals. The goal of this study was to determine the incidence of ...shoulder dislocation in United States military personnel, as well as to identify the demographic risk factors for injury.
We performed a query of the Defense Medical Epidemiology Database with the code from the International Classification of Diseases, Ninth Revision, for acute shoulder dislocation for the years 1998 through 2006. An overall injury incidence was calculated, in addition to multivariate analysis, to determine independent risk factors among the following demographic considerations: sex, race, branch of military service, rank, and age.
The overall incidence rate was 1.69 dislocations per 1000 person-years. Significant demographic risk factors were male sex, white race, service in the Army, junior enlisted rank, and an age of less than thirty years (p<0.0001).
The incidence of shoulder instability among U.S. military personnel (1.69 per 1000 person-years) is considerably higher than previous reports for the general U.S. population (0.08 per 1000 person-years). Male sex, white race, and an age of less than thirty years were significant independent risk factors for injury.
Background:
Acromioclavicular (AC) joint injuries, particularly sprains, are common in athletic populations and may result in significant time lost to injury. However, surprisingly, little is known ...of the epidemiology of this injury.
Purpose:
To define the incidence of AC joint injuries and to determine the risk factors for injury.
Study Design:
Descriptive epidemiological study.
Methods:
A longitudinal cohort study was performed to determine the incidence and characteristics of AC joint injury at the United States Military Academy between 2005 and 2009. All suspected AC joint injuries were reviewed by an independent orthopaedic surgeon using both chart reviews as well as assessments of radiological imaging studies. Injuries were graded according to the modified Rockwood classification system as well as dichotomized into low-grade (Rockwood types I and II) and high-grade (Rockwood types III, IV, V, and VI) injuries for analysis. Injury mechanisms, return-to-play timing, and athlete-exposures were documented and analyzed. χ2 and Poisson regression analyses were performed, with statistical significance set at P < .05.
Results:
During the study period, 162 new AC joint injuries and 17,606 person-years at risk were documented, for an overall incidence rate of 9.2 per 1000 person-years. The majority of the AC joint injuries were low-grade (145 sprains, 89%) injuries, with 17 high-grade injuries. Overall, male patients experienced a significantly higher incidence rate for AC joint injuries than female patients (incidence rate ratio IRR, 2.18; 95% confidence interval CI, 1.21-4.31). An AC joint injury occurred most commonly during athletics (91%). The incidence rate of AC joint injury was significantly higher in intercollegiate athletes than intramural athletics when using athlete-exposure as a measure of person-time at risk (IRR, 2.11; 95% CI, 1.31-3.56). Similarly, the incidence rate of AC injury was significantly higher among male intercollegiate athletes when compared to female athletes (IRR, 3.56; 95% CI, 1.74-8.49) when using athlete-exposure as the denominator. The intercollegiate sports of men’s rugby, wrestling, and hockey had the highest incidence rate of AC joint injury. Acromioclavicular injuries resulted in at least 1359 total days lost to injury and an average of 18.4 days lost per athlete. The average time lost to injury for low-grade sprains was 10.4 days compared with high-grade injuries at 63.7 days. Of the patients with high-grade injuries, 71% elected to undergo coracoclavicular/AC reconstructions. The rate of surgical intervention was 19 times higher for high-grade AC joint injuries than for low-grade injuries (IRR, 19.2; 95% CI, 7.64-48.23; P < .0001).
Conclusion:
Acromioclavicular separations are relatively common in young athletes. Most injuries occur during contact sports such as rugby, wrestling, and hockey. Male athletes are at greater risk than female athletes. Intercollegiate athletes are at greater risk than intramural athletes. The average time lost to sport due to AC joint injury was 18 days, with low-grade injuries averaging 10 days lost. High-grade injuries averaged 64 days lost to sport, and 71% elected to undergo surgical repair/reconstruction.
Epidemiology of Major League Baseball Injuries Posner, Matthew; Cameron, Kenneth L.; Wolf, Jennifer Moriatis ...
American journal of sports medicine,
08/2011, Letnik:
39, Številka:
8
Journal Article, Conference Proceeding
Recenzirano
Background
Little is known about the injury rates in Major League Baseball (MLB) players, as a formal injury surveillance system does not exist. The goal of this study was to characterize the ...epidemiology of MLB injuries over a 7-year period.
Hypothesis
Injuries in MLB would be common.
Study Design
Descriptive epidemiologic study.
Methods
The authors analyzed the MLB disabled list data from 2002 through 2008. Injuries were analyzed for differences between seasons, as well as during seasons on a monthly basis. The injuries were categorized by major anatomic zones and then further stratified based on injury type. Position-specific subanalyses for pitcher and position players were performed.
Results
From the 2002 season through the 2008 season, an average of 438.9 players per year were placed on the disabled list, for a rate of 3.61 per 1000 athlete-exposures. There was a significant 37% increase in injuries between 2005 and 2008. The highest injury rate during the season was during the month of April (5.73/1000 exposures) and the lowest in September (0.54/1000 exposures). No differences were noted in the injury rates between the National League and the American League (incidence rate ratio IRR = 1.06; 95% confidence interval CI = 0.98, 1.15). Pitchers experienced 34% higher incidence rates for injury compared with fielders during the study period (IRR = 1.34; 95% CI = 1.25, 1.44). Among all player injuries, upper extremity injuries accounted for 51.4% while lower extremity injuries accounted for 30.6%. Injuries to the spine and core musculature accounted for 11.7% while other injuries and illnesses were 6.3% of the total disabled list entries. There was a significant association between position played and anatomic region injured (P < .001), with pitchers experiencing a significantly greater proportion of injuries to the upper extremity (67.0%; 95% CI = 63.1%, 70.9%) compared with fielders (32.1%; 95% CI = 29.1%, 35.1%). Conversely, fielders experienced a significantly greater proportion of injuries to the lower extremity (47.5%; 95% CI = 43.8%, 51.1%) compared with pitchers (16.9%; 95% CI = 14.9%, 18.8%). The mean number of days on the disabled list was 56.6. Overall, a greater proportion of disability days were experienced by pitchers (62.4%; 95% CI = 62.0%, 62.8%; P < .001) compared with fielders (37.6%; 95% CI = 37.3%, 37.9%).
Conclusion
Injuries in MLB resulting in disabled list designation are common. Upper extremity injuries were predominant in pitchers, while lower extremity injuries are more common in position players. These data may be used in the development of a formal MLB injury database, as well as in the development and implementation of specific preseason training and in-season conditioning for injury prevention.
Glucose and glutamine are the two principal nutrients that cancer cells use to proliferate and survive. Many cancers show altered glucose metabolism, which constitutes the basis for in vivo positron ...emission tomography (PET) imaging with (18)F-fluorodeoxyglucose ((18)F-FDG). However, (18)F-FDG is ineffective in evaluating gliomas because of high background uptake in the brain. Glutamine metabolism is also altered in many cancers, and we demonstrate that PET imaging in vivo with the glutamine analog 4-(18)F-(2S,4R)-fluoroglutamine ((18)F-FGln) shows high uptake in gliomas but low background brain uptake, facilitating clear tumor delineation. Chemo/radiation therapy reduced (18)F-FGln tumor avidity, corresponding with decreased tumor burden. (18)F-FGln uptake was not observed in animals with a permeable blood-brain barrier or neuroinflammation. We translated these findings to human subjects, where (18)F-FGln showed high tumor/background ratios with minimal uptake in the surrounding brain in human glioma patients with progressive disease. These data suggest that (18)F-FGln is avidly taken up by gliomas, can be used to assess metabolic nutrient uptake in gliomas in vivo, and may serve as a valuable tool in the clinical management of gliomas.
Epidemiologic research on sports-related concussion (SRC) has focused on individual risk factors, with limited research on institutional risk factors and variability in concussion rates.
This study ...used data from 53,822 athletes-seasons collected at 30 United States sites (26 civilian institutions and 4 military service academies), from 2014/15 to 2018/19 academic years, by the Concussion Assessment, Research, and Education Consortium. School-level risk factors included competitive division (DI, DII, DIII), school type (military/civilian) and a Sport Risk Index (SRI; Low, Medium, High). For comparability between civilian institutions and military academies, only NCAA athletes and concussions in sports games and practices were included. Random intercepts log-binomial regression was used to estimate Risk Ratios (RRs) and model variability in SRC risk.
A total of 2,503 SRCs were observed during the study period, including 829 competition SRCs (33%) and 1,674 practice SRCs (67%). Most variability in SRC risk was at the level of athlete or team (within-school), rather than at the school-level. Specifically, across the three SRC outcomes (all competition and practice combined, competition-only, and practice-only), within-school variability was 5 to 7 times greater than between-school variability. Three school-level risk factors (Division, School Type, and SRI) accounted for over one-third (36%) of between-school variability. SRI was the strongest school-level predictor of SRC risk (RR = 5.7; 95%CI: 4.2, 7.6 for High vs. Low). SRC risk was higher for Division I compared to Divisions II/III (RR = 1.6; 95%CI: 0.9, 2.9 for DI vs. DIII), and military academies had a moderately elevated risk of SRC (RR = 1.4; 95%CI: 0.7, 2.7).
A large portion of the apparent variability between schools was attributable to structural factors (sport risk and competitive level), suggesting that there were minimal systemic differences in concussion identification between schools. While most variability is within-school, understanding school-level determinants of concussion risk may still be important in providing the implementation science context for individual-level interventions.
Background:
While posterior glenohumeral instability is becoming increasingly common among young athletes, little is known of the risk factors for injury.
Purpose:
To determine the modifiable and ...nonmodifiable risk factors for posterior shoulder instability in a high-risk cohort.
Study Design:
Case-control study (prognosis); Level of evidence, 2.
Methods:
A prospective cohort study in which 714 young athletes were followed from June 2006 through May 2010 was conducted. Baseline testing included a subjective history of instability, instability testing by a sports medicine fellowship–trained orthopaedic surgeon, range of motion, strength measurement with a handheld dynamometer, and bilateral noncontrast magnetic resonance imaging of the shoulder. A musculoskeletal radiologist measured glenoid version, height, depth, rotator interval (RI) height, RI width, RI area, and RI index. Participants were followed to document all acute posterior shoulder instability events during the 4-year follow-up period. The time to the posterior shoulder instability event during the follow-up period was the primary outcome of interest. Univariate and multivariable Cox proportional hazards regression models were used to analyze the data.
Results:
Complete data on 714 participants were obtained. During the 4-year surveillance period, 46 shoulders sustained documented glenohumeral instability events, of which only 7 were posterior in direction. The baseline factors that were associated with subsequent posterior instability during follow-up were increased glenoid retroversion (P < .0001), increased external rotation strength in adduction (P = .029) and at 45° of abduction (P = .015), and increased internal rotation strength in adduction (P = .038).
Conclusion:
This is the largest known prospective study to follow healthy participants in the development of posterior shoulder instability. Posterior instability represents 10% of all instability events. The most significant risk factor was increased glenoid retroversion. While increased internal/external strength was also associated with subsequent instability, it is unclear whether these strength differences are causative or reactive to the difference in glenoid anatomy. This work confirms that increased glenoid retroversion is a significant prospective risk factor for posterior instability.
Background Two previous studies have examined the association between an increased posterior tibial slope and anterior cruciate ligament
(ACL) injuries as measured on plain radiographs. The study ...results were contradictory, with 1 reporting a statistical difference
and the other showing no association.
Purpose To determine if there is a difference in posterior tibial slope angle between patients with a history of noncontact ACL injury
and a control group with no history of ACL injury. A secondary objective was to examine differences in tibial slope angle
between male and female subjects within each group.
Study Design Case-control study; Level of evidence, 3.
Methods We identified all noncontact ACL injuries that were treated operatively at the United States Military Academy, West Point,
New York, from 2004 to 2007. We digitally measured the posterior tibial slope from plain film radiographs of 140 noncontact
ACL injuries, stratified them by sex, and compared them with a control cohort of 179 patients and radiographs.
Results Subjects in the noncontact ACL group had significantly greater slope angles (9.39° ± 2.58°) than did control subjects (8.50° ± 2.67°) ( P = .003). The trend toward greater tibial slope angles in the noncontact ACL group was also observed when each sex was examined
independently; however, the difference was only statistically significant for the female subjects between the injury and control
groups (9.8° ± 2.6° vs 8.20° ± 2.4°) ( P = .002).
Conclusion Despite the identification of an increased posterior tibial slope as a possible risk factor for women, more research that
combines the multifactorial nature of an ACL injury must be performed.
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