Clinical Journal of Sport Medicine最新文献

Abstract: Lactation is a metabolically & physiologically complex process. Even more complex are the potential feedback mechanisms involved in regulating hyperlactation. As elite athletes are increasingly choosing to have children and return to high level competition, it is important to explore the potential intersection of exercise and lactation physiology. To our knowledge, there are no case reports documenting hyperlactation in an elite female endurance athlete and possible relationship with sport performance. We present 1 case that suggests hyperlactation negatively influences performance, necessitating further research to explore this potential relationship.

Objective: To compare the clinical outcome of patients electing to undergo the Cross Bracing Protocol (CBP) for ACL rupture with those choosing surgical stabilization.

Design: Observational prospective cohort study with 2-year follow-up.

Setting: Private subspecialist sports orthopedics and sports medicine practice.

Patients: The 80 patients who both entered and completed the study were skeletally mature 16 to 40 years old, presenting with an acute noncontact isolated ACL rupture, taking part in pivoting sports and intent on returning to that activity. ACL rupture was diagnosed on both clinical assessment and MRI. Patients were fit for general anesthetic and free of significant medical conditions.

Interventions: Group A (40 patients) underwent surgical stabilization, and group B (40 patients) followed the CBP. The groups were similar regarding the following independent variables: age, body mass index, gender, dominance of the injured knee, and posterior tibial slope ( P > 0.05).

Main outcome measures: Recurrent instability, incidence of meniscal tears, and the following patient-reported outcome measures (PROMs); Tegner Activity Scores; Knee Injury Osteoarthritis Outcome Score subscales of sport/recreation and knee-related quality of life; subjective International Knee Documentation Committee score; and Lysholm Knee Score.

Results: Group B had significantly higher risk of recurrent instability (70% vs 2.5%, P < 0.001), medial meniscal tear (62% vs 2.5%, P < 0.001), and inferior performance on all PROMs ( P < 0.001).

Conclusions: The CBP is associated with an unacceptably high rate of recurrent instability when used to treat ACL ruptures in patients taking part in pivoting sports.

Objective: To investigate the relationship between injury factors, nonsteroidal anti-inflammatory medication (NSAID) use, and concussion outcomes.

Design: Prospective cohort.

Participants: Adolescents (N = 118) ≤14 days of concussion seen at a sports medicine center between November 2020 and May 2025.

Independent variable: Participants who reported ibuprofen and/or naproxen use were assigned to the "NSAID use" group, all others were assigned to the "No NSAID use" group.

Main outcome measures: Symptom severity, medical history, and medication use information were collected. The development of persisting symptoms after concussion (symptoms > 28 days, [PSaC]) was monitored via time to symptom resolution.

Results: We enrolled 118 participants with concussion (15.4 ± 1.7 years, 54% female, 8.4 ± 3.1 days postinjury): 29 (25%) reported taking NSAIDs (n = 24 ibuprofen, n = 3 naproxen, n = 2 ibuprofen/naproxen) before their evaluation. Those who reported NSAID use were evaluated sooner (7.4 ± 2.8 vs 8.7 ± 3.2 days postinjury; P = 0.05), weighed less (57.2 ± 11.0 vs 63.5 ± 17.0 kg; P = 0.06), and had more severe symptoms (59.9 ± 32.6 vs 39.3 ± 22.2; P < 0.001). More participants who reported NSAID use sustained a sport-related concussion (93% vs 73%; P = 0.02), and fewer participants who reported NSAID use started physical activity before evaluation (17% vs 39%; P = 0.03). Severe symptoms were associated with NSAID use (OR = 1.03; 95% confidence interval [CI], 1.01-1.05). Non-sport-related injuries (OR = 0.27; 95% CI, 0.08-0.91) and higher symptom severity (OR = 1.02; 95% CI = 1.00, 1.04) were associated with greater odds of PSaC, but NSAID use was not (OR = 0.62; 95% CI, 0.19-1.97).

Conclusions: In adolescents, NSAID use was associated with more severe symptoms but not PSaC. To optimize clinical guidance, future research should further evaluate the role of NSAIDs in concussion recovery.

Objective: To describe a novel, minimally invasive, ultrasound-guided technique for excision of ununited ossicles in patients with chronic Osgood-Schlatter disease (OSD) and Sinding-Larsen-Johansson syndrome (SLJS) who failed conservative management.

Design: Retrospective case series.

Setting: Ambulatory surgical center.

Patients: Five skeletally mature patients (ages 16-44 years), including competitive athletes and adults with chronic anterior knee pain due to OSD (n = 3) or SLJS (n = 2), all of whom remained symptomatic despite standard conservative treatments.

Main independent variable: Ultrasound-guided resection of intratendinous ossicles using a TX-bone device under local anesthesia, followed by a structured rehabilitation protocol.

Main outcome measures: Pain relief, ability to return to sport or prior activity, and functional recovery at 2 to 12 weeks postprocedure.

Results: All 5 patients successfully underwent ultrasound-guided ossicle excision without perioperative complications. Each reported meaningful pain reduction and returned to unrestricted activities within 2 to 12 weeks. Follow-up ranged from 6 to 14 months, with sustained symptom relief and return to prior sport participation. Outcomes compared favorably with open and arthroscopic techniques described in the literature.

Conclusions: This case series is the first to describe an ultrasound-guided technique for excision of chronic, symptomatic OSD and SLJS ossicles. The approach demonstrated rapid recovery, excellent pain relief, and favorable functional outcomes. Further prospective studies with larger cohorts are warranted to validate efficacy and long-term safety.

Abstract: Narrowing of the ischiofemoral space leading to the entrapment of neurovascular structures is the pathologic basis of ischiofemoral impingement (IFI). In our clinical practice, we encountered a patient with secondary IFI because of an osteochondroma in the lesser trochanter region, presenting with typical posterior hip pain. Traditional surgical methods typically involve lesion resection through a posterolateral approach to the hip, with only a few patients reported using hip arthroscopy. We present a modified posterior hip arthroscopic technique for resecting an osteochondroma near the lesser trochanter. This technique allows for rapid access to the lesion site and provides clear visualization of the sciatic nerve under arthroscopy, facilitating safe and thorough lesion resection.Level of evidence V, Case Study.

Objective: After concussion, athletes have an increased risk of subsequent injuries upon return to play (RTP) compared with nonconcussed peers. Cervical spine, vestibular, and oculomotor deficits have been observed after concussion, but associations with subsequent injuries have not been established. Our objective was to investigate whether head repositioning accuracy (HRA) and vestibular/oculomotor symptoms were associated with postconcussion injuries.

Design: Prospective cohort.

Setting: Academic research laboratory.

Participants: Adolescent athletes ages 13 to 18 years after concussion.

Independent variables: HRA error, vestibular/oculomotor symptoms.

Main outcome measures: We evaluated athletes at RTP clearance and monitored injury incidence for 1 year through monthly surveys. At RTP, we assessed HRA (outcome: mean HRA error across 12 trials) and the visiovestibular examination (VVE; outcome: number of subtests that provoked symptoms) to assess vestibular/oculomotor symptoms. We used Cox proportional hazards regression models to assess hazard of subsequent injury, adjusting for RTP clearance time and prior concussion/musculoskeletal injury.

Results: Forty-five participants were included (age = 15.8 ± 1.3 years, 58% female). Nineteen athletes reported 24 injuries during the 1-year follow-up. After adjusting for RTP clearance and prior concussion/musculoskeletal injury, greater HRA error was associated with higher hazard of subsequent injury (hazard ratio [HR]: 1.46; 95% confidence interval [CI], 1.03-2.08; P = 0.03); VVE symptom provocation was not (HR: 0.87; 95% CI, 0.64-1.19; P = 0.39).

Conclusions: Worse HRA may be associated with higher hazard of postconcussion injury. HRA is a clinically feasible assessment that may identify some individuals with increased injury risk who may benefit from further evaluation/rehabilitation before RTP.

Objectives: This study examined whether playing soccer in high school was associated with higher rates of mental health problems in early to middle adulthood.

Design: Longitudinal cohort study.

Setting: The National Longitudinal Study of Adolescent to Adult Health ("Add Health") databases were analyzed.

Participants: There were 221 individuals (53.8% women) who participated in high school soccer (without participating in football) and 2388 (67.2% women) who denied participating in soccer or any contact sports during high school.

Interventions: N/A.

Main outcome measures: This study includes longitudinal data from individuals assessed at Wave I (n = 6503; median age = 15), Wave III (median age = 22), Wave IV (median age = 29), and Wave V (n = 4196; median age = 38). We compared those who played soccer with those who did not engage in contact sports on several mental health outcomes.

Results: When comparing those who played high school soccer with those who did not play contact sports, there were no differences in the proportion who had a lifetime diagnosis of depression, lifetime diagnosis of anxiety or panic disorders, suicidal ideation in the past year, psychological counseling in the past year, or current depressed mood at Waves III, IV, or V (all P -values > 0.05). In addition, we matched soccer players to control participants on biologic sex, race, and educational attainment to control for potential confounds; the results were similar and nonsignificant.

Conclusions: Individuals who played soccer in high school did not have an increased rate of mental health difficulties at multiple follow-up time points during early to mid-adulthood.

Objective: To investigate the prevalence of low back pain (LBP) and disk degeneration (DD) and the relationship of DD with LBP among elite cross-country skiers.

Design: A cross-sectional study of elite cross-country skiers.

Setting: Study participants were recruited during autumn 2022 among elite cross-country skiers and collegiate skiers who were selected to national teams' training groups.

Participants: The original study group consisted of 44 skiers (16 national team skiers and 28 sports academy skiers).

Interventions: The study protocol included a 1.5T lumbar spine MRI, a clinical examination, and an interview with questions about general health and training as well as selected patient-reported outcomes. The morphology of intervertebral disks from T12/L1 to L5/S1 on sagittal T2-weighted midline images was visually assessed using the Pfirrmann classification with a grade 3 or higher considered degenerated in this age group.

Main outcome measures: Cross-sectional occurrence of DD on MRI and self-reported LBP.

Results: Low back pain was reported by 33 (75%) skiers. Half of the skiers had at least 1 disk of ≥grade 3 in the Pfirrmann classification. At least 1 disk grade ≥3 in the Pfirrmann classification was found in 61% (20 of 33) of skiers with LBP and 18% (2 of 11) of skiers without LBP ( P = 0.034).

Conclusions: The most important findings in our study were the high prevalence of self-reported LBP and a statistically significant difference in the occurrence of at least 1 degenerated disk in the Pfirrmann classification between skiers who reported LBP compared with those who did not.