The objective of this study was to determine the effects of body mass index (BMI), as a modifiable risk factor, on meniscal, chondral, and ligamentous injuries, as well as on bone marrow edema ...accompanying anterior cruciate ligament (ACL) rupture. This retrospective observational study analyzed 84 male patients who underwent primary ACL reconstruction from 2015 to 2018. Magnetic resonance imaging was performed within 6 weeks of injury. Bone bruise, tendon, ligament, meniscal, and muscle injuries were evaluated. The surgery was performed within 3 months after the injury. Detailed arthroscopic findings (chondral, meniscal, and ligamentous injuries) were documented intraoperatively. The weight and height were used to quantify BMI (weight in kg/height in m
). Of the 84 male patients, 58 had associated articular injuries. The median age of the study population was 24 years (minimum: 17 years, maximum: 43 years) years. The mean BMI, height, and weight were 27.12 ± 0.78 kg/m
, 1.73 ± 0.01 m, and 81.17 ± 21.52 kg, respectively. The relationship between higher BMI and associated articular injuries (95% confidence interval CI) was statistically significant (
< 0.001). There was a statistically significant relationship between weight and associated articular injuries (
= 0.003). Height and age were not predictive factors. Higher BMI and weight were significant risk factors for associated articular injuries in the presence of ACL tear. Height was not found to be a predictive factor. Higher BMI was associated with increased risk of medial and/or lateral meniscus tears and bone bruising.
We performed a systematic review and meta-analysis of epidemiological data of injuries in professional male football.
Forty-four studies have reported the incidence of injuries in football. Two ...reviewers independently extracted data and assessed trial quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement and Newcastle Ottawa Scale. Studies were combined in a pooled analysis using a Poisson random effects regression model.
The overall incidence of injuries in professional male football players was 8.1 injuries/1000 hours of exposure. Match injury incidence (36 injuries/1000 hours of exposure) was almost 10 times higher than training injury incidence rate (3.7 injuries/1000 hours of exposure). Lower extremity injuries had the highest incidence rates (6.8 injuries/1000 hours of exposure). The most common types of injuries were muscle/tendon (4.6 injuries/1000 hours of exposure), which were frequently associated with traumatic incidents. Minor injuries (1-3 days of time loss) were the most common. The incidence rate of injuries in the top 5 European professional leagues was not different to that of the professional leagues in other countries (6.8 vs 7.6 injuries/1000 hours of exposure, respectively).
Professional male football players have a substantial risk of sustaining injuries, especially during matches.
•Meta-analysis includes 55 studies of the effects of bicycle helmets on injuries.•Bicycle helmets reduce head injury by 48% and serious head injury by 60%.•Bicycle helmets reduce face injury by 23% ...and do not increase cervical spine injury.•Bicycle helmet effects are larger in single bicycle crashes than in collisions.
A meta-analysis has been conducted of the effects of bicycle helmets on serious head injury and other injuries among crash involved cyclists. 179 effect estimates from 55 studies from 1989–2017 are included in the meta-analysis. The use of bicycle helmets was found to reduce head injury by 48%, serious head injury by 60%, traumatic brain injury by 53%, face injury by 23%, and the total number of killed or seriously injured cyclists by 34%. Bicycle helmets were not found to have any statistically significant effect on cervical spine injury. There is no indication that the results from bicycle helmet studies are affected by a lack of control for confounding variables, time trend bias or publication bias. The results do not indicate that bicycle helmet effects are different between adult cyclists and children. Bicycle helmet effects may be somewhat larger when bicycle helmet wearing is mandatory than otherwise; however, helmet wearing rates were not found to be related to bicycle helmet effectiveness. It is also likely that bicycle helmets have larger effects among drunk cyclists than among sober cyclists, and larger effects in single bicycle crashes than in collisions with motor vehicles. In summary, the results suggest that wearing a helmet while cycling is highly recommendable, especially in situations with an increased risk of single bicycle crashes, such as on slippery or icy roads.
Introduction
It is well known that trampolines can be a particular source of danger, especially in children. We sought to examine the profile of those patients with trampoline injuries. We ...hypothesized there would be certain injury patterns predicative of trampoline injuries.
Methods
All patients submitted to Pennsylvania Trauma Outcome Study database from 2016 to 2018 were analyzed. Trampoline injury was determined by ICD-10 activity code. Injury patterns in the form of abbreviated injury scale body regions were examined. Patient demographics and clinical variables were compared between those with trampoline injury vs those without.
Results
There were 107 patients with a trampoline injury. All of these patients were discharged alive and had a blunt mechanism of injury. The most common injury type was injury to the extremities (n=90,84.1%) with 54(50.5%) upper extremity injuries and 36(33.6%) lower extremity injuries. Ten (9.35%) patients had injury to the spine and five (4.67%) had head injury. Those with trampoline injuries were significantly younger (13y vs. 48.6y) and more likely to be white or of Hispanic ethnicity. Almost half of the patients injured (49.5%) were under 10 years. Patients with trampoline injuries had significantly lower Injury Severity Scores and significantly higher shock index.
Discussion
The majority of patients with trampoline injuries had injury to an extremity. These results help better understand the demographic, physiologic, and anatomic patterns surrounding trampoline injuries. Current government standards recommend that no child under age six should use a full-sized trampoline; however, based of this study, we advise that this age be increased to ten.
Background:
The rate of secondary knee injuries after pediatric anterior cruciate ligament (ACL) injury is uncertain, and previous studies are limited because of poor methodology.
Purpose:
To ...evaluate the incidence of new meniscal injuries since the initial diagnostic magnetic resonance imaging (MRI) of young adults who sustained a pediatric ACL injury. In addition, to evaluate meniscal and cartilage injuries in the index knee and contralateral knee injuries on MRI at final follow-up (9.5 years). Furthermore, to assess leg length and alignment based on long-leg radiographs.
Study Design:
Case series; Level of evidence, 4.
Methods:
Study population at final follow-up included 47 young adults who sustained a pediatric ACL injury before age 13 years. They were followed prospectively since the time of injury for a mean 9.5 years at final follow-up. Imaging included diagnostic MRI of the index knee and 3.0-T MRI of both knees at 1-, 2-, and 9.5-year follow-up, in addition to long-leg radiographs at final follow-up. Forty-three patients underwent active rehabilitation without ACL reconstruction initially; 4 were treated with initial ACL reconstruction. At final follow-up, 27 (57%) had undergone ACL reconstruction.
Results:
Fourteen patients had meniscal tears in the index knee at final follow-up (prevalence, 30%). The majority of these were in the same location as previously repaired tears (n = 9). Between diagnostic MRI and final follow-up, 16 patients had sustained new meniscal tears to a healthy meniscus (incidence, 34%). At final follow-up, meniscal injuries recorded at baseline or during follow-up were no longer visible and appeared healed in 17 patients (20 tears). MRI at final follow-up showed cartilage injuries in the index knee of 13 patients (28%) and contralateral injuries in 8 patients (meniscus, n = 2; cartilage, n = 5; subchondral fracture, n = 1). Two patients had a leg-length difference >15 mm, and 3 had side-to-side difference in knee alignment >5°.
Conclusion:
The incidence of new meniscal tears after pediatric ACL injury was 34% during a mean follow-up period of 9.5 years. At final follow-up, 27 patients (57%) had normal menisci, and none had developed knee osteoarthritis. Primary active rehabilitation, close follow-up, and delayed surgery if needed may be a viable and safe treatment option for some pediatric ACL injuries.
Although sites and types of injury frequently occurring in fencers have been well described, the type of injury caused by the use of fencing movements is still unknown. This study aimed to provide ...basic data for injury prevention by understanding the sports injury status in fencers.
A total of 584 South Korean fencers were included in the survey and were classified according to the injured site, cause of injury, and movement that causes injury. The collected data were analyzed using frequency analysis, χ
tests, and logistic regression analysis to identify differences in sex, event type, age, and career.
Female (P=0.001) and foil fencers (P=0.015) were more likely to experience injury than male and sabre and epee fencers. The incidence of injury was significantly higher according to age (P=0.001) and career (P=0.001). The ankle was the most frequently injured site (17.71%). Injuries most frequently occur during Fente movement (48.11%). Insufficient warm-up was the most common cause of injury (23.91%) in all groups.
These results suggest that a specific warm-up program and strengthening exercises of the ankle and knee ligaments should be established to prevent injuries for fencers. Particularly, female, foil, adult, and experienced fencers should be more careful in preventing injuries.
With an estimated 3.8 million sport- and recreation-related concussions occurring annually, targeted prevention and diagnostic methods are needed. Biomechanical analysis of head impacts may provide ...quantitative information that can inform both prevention and diagnostic strategies.
To assess available head-impact devices and their clinical utility.
We performed a systematic search of the electronic database PubMed for peer-reviewed publications, using the following phrases: accelerometer and concussion, head impact telemetry, head impacts and concussion and sensor, head impacts and sensor, impact sensor and concussion, linear acceleration and concussion, rotational acceleration and concussion, and xpatch concussion. In addition to the literature review, a Google search for head impact monitor and concussion monitor yielded 15 more devices.
Included studies were performed in vivo, used commercially available devices, and focused on sport-related concussion.
One author reviewed the title and abstract of each study for inclusion and exclusion criteria and then reviewed each full-text article to confirm inclusion criteria. Controversial articles were reviewed by all authors to reach consensus.
In total, 61 peer-reviewed articles involving 4 head-impact devices were included. Participants in boxing, football, ice hockey, soccer, or snow sports ranged in age from 6 to 24 years; 18% (n = 11) of the studies included female athletes. The Head Impact Telemetry System was the most widely used device (n = 53). Fourteen additional commercially available devices were presented.
Measurements collected by impact monitors provided real-time data to estimate player exposure but did not have the requisite sensitivity to concussion. Proper interpretation of previously reported head-impact kinematics across age, sport, and position may inform future research and enable staff clinicians working on the sidelines to monitor athletes. However, head-impact-monitoring systems have limited clinical utility due to error rates, designs, and low specificity in predicting concussive injury.
Subclavian and axillary artery injuries are uncommon. In addition to many open vascular repairs, endovascular techniques are used for definitive repair or vascular control of these anatomically ...challenging injuries. The aim of this study was to determine the relative roles of endovascular and open techniques in the management of subclavian and axillary artery injuries comparing hospital outcomes, and long-term limb viability.
A multicenter, retrospective review of patients with subclavian or axillary artery injuries from January 1, 2004, to December 31, 2014, was completed at 11 participating Western Trauma Association institutions. Statistical analysis included χ, t-tests, and Cochran-Armitage trend tests. A p value less than 0.05 was significant.
Two hundred twenty-three patients were included; mean age was 36 years, 84% were men. An increase in computed tomography angiography and decrease in conventional angiography was observed over time (p = 0.018). There were 120 subclavian and 119 axillary artery injuries. Procedure type was associated with injury grade (p < 0.001). Open operations were performed in 135 (61%) patients, including 93% of greater than 50% circumference lacerations and 83% of vessel transections. Endovascular repairs were performed in 38 (17%) patients; most frequently for pseudoaneurysms. Fourteen (6%) patients underwent a hybrid procedure. Use of endovascular versus open procedures did not increase over the duration of the study (p = 0.248). In-hospital mortality rate was 10%. Graft or stent thrombosis occurred in 7% and graft or stent infection occurred in 3% of patients. Mean follow-up was 1.6 ± 2.4 years (n = 150). Limb salvage was achieved in 216 (97%) patients.
The management of subclavian and axillary artery injuries still requires a wide variety of open exposures and procedures, especially for the control of active hemorrhage from more than 50% vessel lacerations and transections. Endovascular repairs were used most often for pseudoaneurysms. Low early complication rates and limb salvage rates of 97% were observed after open and endovascular repairs.
Prognostic/epidemiologic, level IV.
Background:
Bone bruises are commonly seen on magnetic resonance imaging (MRI) in acute anterior cruciate ligament (ACL) injuries and can provide insight into the underlying mechanism of injury. ...There are limited reports that have compared the bone bruise patterns between contact and noncontact mechanisms of ACL injury.
Purpose:
To examine and compare the number and location of bone bruises in contact and noncontact ACL injuries.
Study Design:
Cross-sectional study; Level of evidence, 3.
Methods:
Three hundred twenty patients who underwent ACL reconstruction surgery between 2015 and 2021 were identified. Inclusion criteria were clear documentation of the mechanism of injury and MRI within 30 days of the injury on a 3-T scanner. Patients with concomitant fractures, injuries to the posterolateral corner or posterior cruciate ligament, and/or previous ipsilateral knee injury were excluded. Patients were stratified into 2 cohorts based on a contact or noncontact mechanism. Preoperative MRI scans were retrospectively reviewed by 2 musculoskeletal radiologists for bone bruises. The number and location of the bone bruises were recorded in the coronal and sagittal planes using fat-suppressed T2-weighted images and a standardized mapping technique. Lateral and medial meniscal tears were recorded from the operative notes, while medial collateral ligament (MCL) injuries were graded on MRI.
Results:
A total of 220 patients were included, with 142 (64.5%) noncontact injuries and 78 (35.5%) contact injuries. There was a significantly higher frequency of men in the contact cohort compared with the noncontact cohort (69.2% vs 54.2%, P = .030), while age and body mass index were comparable between the 2 cohorts. The bivariate analysis demonstrated a significantly higher rate of combined lateral tibiofemoral (lateral femoral condyle LFC + lateral tibial plateau LTP) bone bruises (82.1% vs 48.6%, P < .001) and a lower rate of combined medial tibiofemoral (medial femoral condyle MFC + medial tibial plateau MTP) bone bruises (39.7% vs 66.2%, P < .001) in knees with contact injuries. Similarly, noncontact injuries had a significantly higher rate of centrally located MFC bone bruises (80.3% vs 61.5%, P = .003) and posteriorly located MTP bruises (66.2% vs 52.6%, P = .047). When controlling for age and sex, the multivariate logistical regression model demonstrated that knees with contact injuries were more likely to have LTP bone bruises (OR, 4.721 95% CI, 1.147-19.433, P = .032) and less likely to have combined medial tibiofemoral (MFC + MTP) bone bruises (OR, 0.331 95% CI, 0.144-0.762, P = .009) compared with those with noncontact injuries.
Conclusion:
Significantly different bone bruise patterns were observed on MRI based on ACL injury mechanism, with contact and noncontact injuries demonstrating characteristic findings in the lateral tibiofemoral and medial tibiofemoral compartments, respectively.
To determine which work-related injuries are the most frequent and costly.
Secondary analysis of workers' compensation claims data.
Data were provided by a large, Maryland workers' compensation ...insurer from 1998 through 2008.
Not applicable.
None.
For 45 injury types, the number of claims and compensation amount was calculated for total compensation and for medical and indemnity compensation separately.
Back and knee injuries were the most frequently occurring single injury types, whereas heart attack and occupational disease were the most expensive in terms of mean compensation. When taking into account both the frequency and cost of injury (mean cost × number occurrences), back, knee, and shoulder injuries were the most expensive single injury types.
Successful prevention and management of back, knee, and shoulder injuries could lead to a substantial reduction in the burden associated with work-related injuries.
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