Background:
Generalized joint hypermobility (GJH) has been identified as a risk factor for injury in various athletic patient populations.
Purpose:
To evaluate GJH as a predisposing risk factor for ...injury in a population of National Collegiate Athletic Association (NCAA) Division I football players.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
The Beighton score was collected for 73 athletes during their preseason physical examinations in 2019. GJH was defined as a Beighton score ≥4. Athlete descriptive characteristics, including age, height, weight, and playing position, were recorded. The cohort was evaluated prospectively for 2 years, and the number of musculoskeletal issues, injuries, treatment episodes, days unavailable, and surgical procedures for each athlete during this period were recorded. These measures were compared between the GJH and no-GJH groups.
Results:
The mean Beighton score was 1.4 ± 1.5 for the 73 players; 7 players (9.6%) had a Beighton score indicating GJH. During the 2-year evaluation, there were 438 musculoskeletal issues, including 289 injuries. The mean number of treatment episodes per athlete was 77 ± 71 (range, 0-340), and the mean number of days unavailable was 67 ± 92 days (range, 0-432 days). There were 23 athletes who required 25 operations, the most common procedure being arthroscopic shoulder stabilization (n = 6). The number of injuries per athlete was not significantly different between the GJH and no-GJH groups (3.0 ± 2.1 vs 4.1 ± 3.0; P = .13), nor were there any between-group differences in the number of treatments received (74.6 ± 81.9 vs 77.2 ± 71.5; P = .47), days unavailable (79.6 ± 124.5 vs 65.3 ± 89.3; P = .61), or rates of surgery (43% vs 30%; P = .67).
Conclusion:
A preseason diagnosis of GJH did not place NCAA football players at a greater risk for injury during the 2-year study period. Based on the findings of this study, no specific preparticipation risk counseling or intervention is warranted for football players who are diagnosed with GJH as defined by the Beighton score.
ImportanceClinical practice guidelines (CPGs) relating to concussion management are published by various healthcare specialties, including but not limited to orthopaedic surgery, family medicine, ...neurology and athletic trainers. A systematic analysis can help identify high quality CPGs for clinical use by sports medicine physicians.ObjectiveThe purpose of this study is to systematically identify and appraise relevant CPGs related to sports-related concussion in adult patients.Evidence reviewPredetermined selection criteria were used by two reviewers who independently identified published CPGs before 1 November 2018. CPGs were excluded if they focused only on paediatric patients or their scope was greater than concussion in the setting of sports. The remaining guidelines were analysed by five independent reviewers with different levels of training using the Appraisal of Guidelines for Research and Evaluation II tool. Guidelines were deficient if they earned scores less than 50%. The Spearman correlation coefficient was used to assess interobserver agreement between the evaluators. Scores were compared by publishing institution and healthcare discipline using Kruskal-Wallis tests.FindingsSeven CPGs met the inclusion criteria. Guidelines came from neurologists, athletic therapists/trainers and interdisciplinary sports medicine bodies. Interobserver agreement was strong and mean scores between surgical trainees (124.5) and board-certified surgeons (125.9) were not statistically different. Guideline quality was variable but not deficient (>50%), except regarding ‘editorial independence’. No statistical difference was found between guidelines from different publishing institutions. Additionally, no statistical difference was found between guidelines published by different healthcare professionals.Conclusions and relevanceOverall, CPG quality was variable but not deficient, except for the domain of editorial independence. Bias due to poor editorial independence is a concern, particularly in CPGs published by non-physicians. Given the similarity in content and methodological quality, consideration should be given to condense evidence into a single CPG to be used by all healthcare professionals in the management of sports concussion.Level of evidence1, Systematic Review.
Creative design: An approach to preparing mixed monolayers of thiolated single‐stranded DNA (ssDNA) and oligo(ethylene glycol)s (OEG‐AT) in a broad range of compositions as well as ssDNA/OEG‐AT ...patterns of any required shape (see top figure) has been shown. A combination of this approach with surface‐initiated enzymatic polymerization allows complex 3D DNA nanostructures to be sculpted with high spatial precision (bottom).
Patellar and hamstring tendinopathy are common injuries among elite athletes. Platelet-rich plasma (PRP) has emerged as a promising new therapy for accelerating healing and shortening recovery in ...patients with these conditions. We present 15 cases of PRP injection used for either patellar or hamstring tendinopathy in varsity collegiate athletes at a single institution. All of the athletes in our case series with hamstring or patellar tendinopathy were fully able to return to sport. Three of the athletes with patellar tendinopathy were referred for surgery, while none of the athletes with hamstring strain underwent a subsequent surgical procedure.
Abstract Purpose The aim of this study was to evaluate the relationship between the anterior center-edge angle (ACEA) and lateral center-edge angle (LCEA) and crossover ratio. Methods Consecutive ...patients presenting for evaluation of hip pain were reviewed. The following measurements were recorded and analyzed: Crossover ratio, LCEA, ACEA, and alpha-angle. Results 68 patients met inclusion criteria. The only statistically significant radiographic measurement when stratified by gender was alpha angle ( P < 0.001). There was moderate correlation between crossover ratio and ACEA and LCEA with coefficients of −0.48 and −0.48, respectively. Conclusion A correlation exists between crossover ratio and ACEA and LCEA.
To compare complications following arthroscopy and arthrotomy for treatment of septic knee arthritis.
Patients undergoing arthroscopy and arthrotomy for a diagnosis of septic knee arthritis were ...identified in National Surgical Quality Improvement Program and placed in a multivariate analysis to determine if type of surgery contributed to postoperative complications.
Knee arthrotomy was associated with an increased risk for increased operative time Parameter estimate 4.555 (95% CI:3.023–6.085); p < 0.0001, minor morbid events OR 2.064 (95% CI: 1.447–2.943); p < 0.0001, and any morbidity OR 2.285 (95% CI:1.527–3.419); p < 0.0001.
Knee arthrotomy was associated with a higher risk of complications.
There is limited literature investigating the reliability of magnetic resonance-based assessments of labral size. The goal of this study was to validate the reliability of magnetic resonance ...arthrography-based labral size measurements with intra-operative arthroscopic measurements.
Patients undergoing hip arthroscopy for femoroacetabular impingement and labral tears were prospectively enrolled. Preoperative magnetic resonance arthrograms were used to determine labral size at the anterior-superior portion (zone 2), mid-superior portion (zone 3), and posterior-superior portion (zone 4). Intra-operative labral widths were measured at the same anatomical zones of the acetabulum using an arthroscopic probe. Mean labral size was determined for each location and a Pearson correlation was used to determine the correlation between imaging-based measurements and intra-operative measurements.
117 patients were enrolled with 70% being female, an average age of 39.1 ± 13.3, and an average body mass index was 26.5 ± 5.4. The average labral sizes based on intraoperative measurements were 6.85 mm in zone 2, 7.45 mm in zone 3, and 7.29 mm in zone 4. The average labral sizes based on MRA were 6.95 mm in zone 2, 7.24 mm in zone 3, and 6.71 mm in zone 4. There was a poor correlation between MRA and intraoperative measurements in zones 2 and 3 (zone 2: R = 0.171, p = 0.065; zone 3: R = 0.335, p = 0.00022) and no correlation in zone 4 (R = −0.22, p = 0.82).
This study demonstrates a poor correlation in labral measurements between magnetic resonance arthrogram imaging and intraoperative measurements, suggesting that this imaging modality may be insufficient in providing accurate measurements of labral size.
To investigate opioid utilization after anterior cruciate ligament (ACL) reconstruction in the setting of a multimodal pain regimen and assess the feasibility of prescribing fewer opioids to achieve ...adequate postoperative pain control.
Patients undergoing ACL reconstruction in conjunction with a multimodal approach to pain control were randomized to receive either 30 or 60 tablets of hydrocodone (10 mg)–acetaminophen (325 mg). Patients were contacted at multiple time points up to 21 days after surgery to assess opioid utilization and medication side effects. We compared the mean number of tablets used between groups as the primary outcome. Preoperative variables associated with an increased risk of higher opioid pain medication requirements were also assessed.
The final analysis included 43 patients in the 30-tablet group and 42 in the 60-tablet group. There was no significant difference between groups in the number of tablets consumed (9.5 vs 12.2, P = .22), number of days opioids were required (4.5 vs 6.2, P = .14), 3-month opioid refill rates (12% vs 7%, P = .48), or postoperative pain control at any point up to 21 days after surgery. The 30-tablet group had a significantly smaller proportion of unused tablets compared with the 60-tablet group (69% of prescribed tablets 910 tablets vs 80% of prescribed tablets 2,027 tablets, P < .001). Opioids were required after surgery by 91% of patients (n = 77), and 81% could have had their pain medication requirements met with a prescription for 15 tablets. Risk factors for increased postoperative opioid use included a family history of substance abuse (β = 14.1; 95% confidence interval, 5.7-22.4; P = .0014) and increased pain score at 2 hours after surgery (β = 1.07; 95% confidence interval, 0.064-2.07; P = .037).
Orthopaedic surgeons may significantly reduce the number opioid tablets prescribed after ACL reconstruction without affecting postoperative pain control or refill rates.
Level I, randomized controlled trial.
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