| 1. |
- Ackermann, PW, et al.
(författare)
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Tendinopathy in sport
- 2012
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Ingår i: Sports health. - : SAGE Publications. - 1941-0921. ; 4:3, s. 193-201
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Tidskriftsartikel (refereegranskat)abstract
- Context: Tendinopathy is increasing in prevalence and accounts for a substantial part of all sports injuries and occupational disorders. Despite the magnitude of the disorder, high-quality scientific data on etiology and available treatments have been limited. Evidence Acquisition: The authors conducted a MEDLINE search on tendinopathy, or “tendonitis” or “tendinosis” or “epicondylitis” or “jumpers knee” from 1980 to 2011. The emphasis was placed on updates on epidemiology, etiology, and recent patient-oriented Level 1 literature. Results: Repetitive exposure in combination with recently discovered intrinsic factors, such as genetic variants of matrix proteins, and metabolic disorders is a risk factor for the development of tendinopathy. Recent findings demonstrate that tendinosis is characterized by a fibrotic, failed healing response associated with pathological vessel and sensory nerve ingrowth. This aberrant sensory nerve sprouting may partly explain increased pain signaling and partly, by release of neuronal mediators, contribute to the fibrotic alterations observed in tendinopathy. The initial nonoperative treatment should involve eccentric exercise, which should be the cornerstone (basis) of treatment of tendinopathy. Eccentric training combined with extracorporeal shockwave treatment has in some reports shown higher success rates compared to any therapies alone. Injection therapies (cortisone, sclerosing agents, blood products including platelet-rich plasma) may have short-term effects but have no proven long-term treatment effects or meta-analyses to support them. For epicondylitis, cortisone injections have demonstrated poorer long-time results than conservative physiotherapy. Today surgery is less indicated because of successful conservative therapies. New minioperative procedures that, via the endoscope, remove pathologic tissue or abnormal neoinnervation demonstrate promising results but need confirmation by Level 1 studies. Conclusions: Novel targeted therapies are emerging, but multicenter trials are needed to confirm the results of exercise and mini-invasive treatments.
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| 2. |
- Fagher, Kristina, et al.
(författare)
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Test-Retest Reliability of Isokinetic Knee Strength Measurements in Children Aged 8 to 10 Years.
- 2016
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Ingår i: Sports Health. - : SAGE Publications. - 1941-0921.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Isokinetic dynamometry is a useful tool to objectively assess muscle strength of children and adults in athletic and rehabilitative settings. This study examined test-retest reliability of isokinetic knee strength measurements in children aged 8 to 10 years and defined limits for the minimum difference (MD) in strength that indicates a clinically important change. HYPOTHESIS: Isokinetic knee strength measurements (using the Biodex System 4) in children will provide reliable results. STUDY DESIGN: Descriptive laboratory study. METHODS: In 22 healthy children, 5 maximal concentric (CON) knee extensor (KE) and knee flexor (KF) contractions at 2 angular velocities (60 deg/s and 180 deg/s) and 5 maximal eccentric (ECC) KE/KF contractions at 60 deg/s were assessed 7 days apart. The intraclass correlation coefficient (ICC2.1) was used to examine relative reliability, and the MD was calculated on the basis of standard error of measurement. RESULTS: ICCs for CON KE/KF peak torque measurements were fair to excellent (range, 0.49-0.81). The MD% values for CON KE and KF ranged from 31% to 37% at 60 deg/s and from 34% to 39% at 180 deg/s. ICCs in the ECC mode were good (range, 0.60-0.70), but associated MD% values were high (>50%). There was no systematic error for CON KE/KF and ECC KE strength measurements at 60 deg/s, but systematic error was found for all other measurements. CONCLUSION: The dynamometer provides a reliable analysis of isokinetic CON knee strength measurements at 60 deg/s in children aged 8 to 10 years. Measurements at 180 deg/s and in the ECC mode were not reliable, indicating a need for more familiarization prior to testing. CLINICAL RELEVANCE: The MD values may help clinicians to determine whether a change in knee strength is due to error or intervention.
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| 3. |
- Grassi, A., et al.
(författare)
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Return to Sport Activity After Meniscal Allograft Transplantation: At What Level and at What Cost? A Systematic Review and Meta-analysis
- 2019
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Ingår i: Sports Health-a Multidisciplinary Approach. - : SAGE Publications. - 1941-7381 .- 1941-0921. ; 11:2, s. 123-133
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Tidskriftsartikel (refereegranskat)abstract
- Context: Meniscal injuries are common among both sport-and non-sport-related injuries, with over 1.7 million meniscal surgeries performed worldwide every year. As meniscal surgeries become more common, so does meniscal allograft transplantation (MAT). However, little is known about the outcomes of MAT in active patients who desire to go back to preinjury activities. Objective: The purpose of this systematic review and meta-analysis was to evaluate return to sport, clinical outcome, and complications after MAT in sport-active patients. Data Sources: A systematic search of MEDLINE, EMBASE, and CINAHL electronic databases was performed on February 25, 2018. Study Selection: Studies of level 1 through 4 evidence looking at MAT in physically active patients with reported return to activity outcomes and at least 2-year follow-up were included. Data Extraction: Details of sport-related outcomes and reoperations were extracted and pooled in a meta-analysis. Results: Nine studies were included in this systematic review. A majority (77%) of athletes and physically active patients were able to return to sport after MAT; two-thirds were able to perform at preinjury levels. Graft-related reoperations were reported in 13% of patients, while the joint replacement rate with partial or total knee prosthesis was 1.2%. Conclusion: Physical activity after MAT appears possible, especially for low-impact sports. However, because of the limited number of studies, their low quality, and the short-term follow-up, the participation recommendation for high-impact and strenuous activities should be considered with caution until high-quality evidence of long-term safety becomes available.
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| 4. |
- Johansson, Fredrik, et al.
(författare)
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Association between spikes in external training load and shoulder injuries in competitive adolescent tennis players : The SMASH cohort study
- 2022
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Ingår i: Sports Health. - : SAGE Publications. - 1941-0921. ; , s. 103-110
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Few studies have examined the association between the acute:chronic workload ratio (ACWR) and complaints/injuries in young tennis players. Primary aims of this study were to investigate if accumulated external workload "spikes" in ACWR of tennis training, match play, and fitness training, and to see if high or low workload/age ratio were associated with the rate of shoulder complaints/injuries in competitive adolescent tennis players. Additional aims were to report the incidence of complaints/injuries stratified by sex and level of play and to describe shoulder injury characteristics.HYPOTHESIS: Rapid increases in external workload are associated with the incidence of shoulder complaints and injuries.STUDY DESIGN: A cohort study.LEVEL OF EVIDENCE: Level 3.METHODS: At baseline, 301 adolescent competitive tennis players, 13 to 19 years, were screened and followed weekly for 52 weeks with questionnaires, in the years 2018 to 2019. Information about time-varying accumulated external workload spikes (uncoupled ACWR >1.3), and workload/age ratio, in 252 uninjured players were used in Cox regression analyses with the outcomes shoulder complaints (≥20) and injuries (≥40) (Oslo Sports Trauma Research Center Overuse Injury Questionnaire).RESULTS: For each additional workload spike in tennis training/match play, the hazard rate ratio (HRR) was 1.26 (95% CI, 1.13-1.40) for a shoulder complaint and 1.26 (95% CI, 1.15-1.39) for a shoulder injury. The HRR for fitness training was 1.11 (95% CI, 1.02-1.20) for a shoulder complaint and 1.18 (95% CI, 1.09-1.27) for a shoulder injury. Workload/age ratio was not associated with the rate of shoulder complaints or injuries.CONCLUSION: Accumulated external workload spikes of tennis training, match play, and/or fitness training are associated with a higher rate of shoulder complaints and shoulder injuries in competitive adolescent tennis players.CLINICAL RELEVANCE: Consistency in training load on a weekly basis is most likely more beneficial for adolescent tennis players regarding shoulder complaints/injuries than a training schedule comprising rapid increases (ie, spikes) in workload.
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| 5. |
- Johansson, Fredrik, et al.
(författare)
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External training load and the association with back pain in competitive adolescent tennis players : Results from the SMASH cohort study
- 2022
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Ingår i: Sports Health. - : SAGE Publications. - 1941-0921. ; 14:1, s. 111-118
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In young tennis players, high loads on the spine and high training volumes in relation to age are associated with a high lifetime prevalence of back pain. The primary aim of this study was to investigate if accumulated external workload "spikes" in the acute:chronic workload ratio (ACWR) of tennis training, match play, and fitness training, and if high or low workload/age ratio were associated with back pain events in competitive adolescent tennis players. Additional aims were to report the incidence of back pain stratified by sex and level of play and to describe the characteristics of players with back pain.HYPOTHESIS: Rapid increases in external workload are associated with the incidence of back pain.STUDY DESIGN: Cohort study of 198 competitive tennis players, 13 to 19 years, with a weekly follow-up for 52 consecutive weeks.LEVEL OF EVIDENCE: Level 3.METHODS: Accumulated external workload spikes (uncoupled ACWR >1.3), and the workload/age ratio, were time-varying exposures in Cox regression analyses with the outcome back pain (pain intensity ≥2/10 in the lower back and/or in the upper back/neck with a pain-related disability).RESULTS: For each additional workload spike in tennis training/match play, the hazard rate ratio (HRR) was 1.17 (95% CI, 1.06-1.28) for back pain. The corresponding HRR for fitness training was 1.13 (95% CI, 1.05-1.22). Training workload/age ratio was not related to back pain.CONCLUSION: Accumulated external workload spikes of tennis training, match play, and/or fitness training are associated with a higher rate of back pain events in competitive adolescent tennis players.CLINICAL RELEVANCE: Back pain is a troublesome clinical problem that may affect the performance of talented young tennis players. Structuring the training schedule to minimize rapid increases (ie, spikes) of training load on a weekly basis may enhance performance and reduce back pain in adolescent tennis players.
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| 6. |
- Markström, Jonas, 1985-, et al.
(författare)
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A minority of athletes pass symmetry criteria in a series of hop and strength tests irrespective of having an ACL reconstructed knee or being noninjured
- 2023
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Ingår i: Sports Health. - : Sage Publications. - 1941-7381 .- 1941-0921. ; 15:1, s. 45-51
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Tidskriftsartikel (refereegranskat)abstract
- Background: Between-leg symmetry in 1-leg hop and knee strength performances is considered important after anterior cruciate ligament reconstruction (ACLR) to facilitate a safer return to sport. While few athletes with ACLR demonstrate symmetry in test batteries, reference data for noninjured athletes are lacking, thus questioning how ACLR-specific poor symmetry is.Hypothesis: Athletes with ACLR (hamstring autograft) show lower symmetry and have a lower proportion of symmetric individuals than noninjured athletes for knee flexion strength but not for hop for distance, vertical hop, and knee extension strength.Study design: Cross-sectional.Level of Evidence: Level 3.Methods: A total of 47 athletes with ACLR (median 13.0 months post-ACLR) who had returned to their sport, and 46 noninjured athletes participated. Symmetry was calculated between the worse and better legs for each test and combinations of them using the limb symmetry index (LSIWORSE-BETTER, ranging from 0% to 100%). The 2 groups were compared for these values and the proportions of individuals classified as symmetric (LSIWORSE-BETTER ≥90%) using independent t-tests and Fisher’s exact tests, respectively.Results: Athletes with ACLR were less symmetric than noninjured athletes for knee flexion strength with a lower LSIWORSE-BETTER (83% vs 91%, P < 0.01) and a lower proportion of symmetric individuals (39% vs 63%, P = 0.04). No differences between groups were revealed for the hop tests, knee extension strength, or combinations of tests (P > 0.05). Only 17% of the athletes with ACLR and 24% of the noninjured athletes demonstrated symmetric performances for all 4 tests.Conclusion: Athletes with ACLR (hamstring autograft) showed poorer symmetry in knee flexion strength than noninjured athletes, although both groups had few individuals who passed the test battery’s symmetry criteria.Clinical relevance: Symmetry is uncommon among athletes irrespective of ACLR and should be considered regarding expected rehabilitation outcomes and return-to-sport decisions post-ACLR.
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| 7. |
- Naili, Josefine E., et al.
(författare)
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A longitudinal case-control study of a female athlete preinjury and after ACL reconstruction : hop performance, knee muscle strength, and knee landing mechanics
- 2023
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Ingår i: Sports Health. - : Sage Publications. - 1941-7381 .- 1941-0921. ; 15:3, s. 357-360
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Tidskriftsartikel (refereegranskat)abstract
- Athletes with an anterior cruciate ligament (ACL) injury followed by ACL reconstruction (ACLR) often perform various testing to guide return to sport, but preinjury data are rarely available for comparison. This longitudinal case-control study reports absolute value and between-leg symmetry data on maximal performances for single-leg hop height and distance, muscle strength, and side hop landing mechanics of an 18-year-old female soccer athlete collected 5 months before sustaining an ACL injury and again at 10, 13, and 29 months post-ACLR. Her data were compared across test sessions and to cross-sectional data of 15 asymptomatic female athletes.
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| 8. |
- Netterström-Wedin, Fred H., et al.
(författare)
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Diagnostic Accuracy of Clinical Tests Assessing Ligamentous Injury of the Talocrural and Subtalar Joints : A Systematic Review With Meta-Analysis
- 2022
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Ingår i: Sports health: a multidisciplinary approach. - : Sage Publications. - 1941-7381 .- 1941-0921. ; 14:3, s. 336-347
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Tidskriftsartikel (refereegranskat)abstract
- Context: Ankle sprains are the most common acute musculoskeletal injury. Clinical tests represent the first opportunity to assess the sprain's severity, but no systematic review has compared these tests to contemporary reference standards.Objective: To determine the diagnostic accuracy of clinical tests assessing the talocrural and subtalar joint ligaments after ankle sprain.Data Sources: CINAHL, EMBASE, MEDLINE, hand-searching, and PubMed-related article searches (inception to November 18, 2020).Study Selection: Eligible diagnostic studies compared clinical examination (palpation, joint laxity) against imaging or surgery. Studies at a high risk of bias or with high concerns regarding applicability on Quality Assessment of Diagnostic Accuracy Studies-2 were excluded from the meta-analysis.Study Design: Systematic review and meta-analysis.Level of Evidence: Level 3a.Data Extraction: True-positive, false-negative, false-positive, and true-negative findings were extracted to calculate sensitivity, specificity, and likelihood ratios. If ordinal data were reported, these were extracted to calculate Cohen's kappa.Results: A total of 14 studies met the inclusion criteria (6302 observations; 9 clinical tests). No test had both sensitivity and specificity exceeding 90%. Palpation of the anterior talofibular ligament is highly sensitive (sensitivity 95%-100%; specificity 0%-32%; min-max; n = 6) but less so for the calcaneofibular ligament (sensitivity 49%-100%; specificity 26%-79%; min-max; n = 6). Pooled data from 6 studies (885 observations) found a low sensitivity (54%; 95% CI 35%-71%) but high specificity (87%; 95% CI 63%-96%) for the anterior drawer test.Conclusion: The anterior talofibular ligament is best assessed using a cluster of palpation (rule out), and anterior drawer testing (rule in). The talar tilt test can rule in injury to the calcaneofibular ligament, but a sensitive clinical test for the ligament is lacking. It is unclear if ligamentous injury grading can be done beyond the binary (injured vs uninjured), and clinical tests of the subtalar joint ligaments are not well researched. The generalizability of our findings is limited by insufficient reporting on blinding and poor study quality.
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| 9. |
- Slater, Diane, et al.
(författare)
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Biopsychosocial Factors Associated With Return to Preinjury Sport After ACL Injury Treated Without Reconstruction: NACOX Cohort Study 12-Month Follow-up
- 2023
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Ingår i: SPORTS HEALTH-A MULTIDISCIPLINARY APPROACH. - : SAGE PUBLICATIONS INC. - 1941-7381 .- 1941-0921. ; 15:2, s. 176-184
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Tidskriftsartikel (refereegranskat)abstract
- Background: The limited research on prognosis after nonsurgical management of anterior cruciate ligament (ACL) injury has focused on physical factors. We aimed to assess relationships between key patient-reported outcomes, in line with a biopsychosocial approach, and returning to preinjury sport at 12 months after ACL injury treated without reconstruction. Hypothesis: We hypothesized that biopsychosocial factors would be associated with returning to preinjury sport at 12 months after ACL injury. Study Design: Prospective single cohort study. Level of Evidence: Level 2. Methods: Patients who had an ACL injury and did not have reconstruction during the first year after injury were recruited from healthcare clinics in Sweden, and followed up at 3, 6, and 12 months after injury. Return to preinjury sport at 12 months was the primary outcome. Explanatory variables were psychological readiness to return to sport, knee-related quality of life, and self-reported knee function. Using generalized estimating equations, we evaluated the relationships between the explanatory variables and the primary outcome at each timepoint. Results: Data were analyzed for 88 participants with a median age of 27 years (15-40 years). Soccer was the most frequently reported preinjury sport (n = 22). Forty participants (46%) had returned to their preinjury sport at 12 months after ACL injury. The odds of returning to preinjury sport at 12 months increased with higher self-reported knee function at 6 months (odds ratio [OR], 1.1; 95% CI, 1.0-1.1), and the odds of being returned to the preinjury sport at 12 months doubled for every 1-point increase (1-10 scale) in psychological readiness to return to sport measured at 12 months (OR, 1.9; 95% CI, 1.2-3.2). Conclusion: Superior self-reported knee function at 6 months and greater psychological readiness to return to sport at 12 months were associated with returning to the preinjury sport 1 year after ACL injury treated without reconstruction.
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| 10. |
- Svantesson, Eleonor, et al.
(författare)
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Only 10% of Patients With a Concomitant MCL Injury Return to Their Preinjury Level of Sport 1 Year After ACL Reconstruction: A Matched Comparison With Isolated ACL Reconstruction.
- 2023
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Ingår i: Sports health. - : SAGE Publications. - 1941-0921.
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Tidskriftsartikel (refereegranskat)abstract
- There is a need for an increased understanding of the way a concomitant medial collateral ligament (MCL) injury may influence outcome after anterior cruciate ligament (ACL) reconstruction.Patients with a concomitant MCL injury would have inferior clinical outcomes compared with a matched cohort of patients undergoing ACL reconstruction without an MCL injury.Matched registry-based cohort study; case-control.Level 3.Data from the Swedish National Knee Ligament Registry and a local rehabilitation outcome registry were utilized. Patients who had undergone a primary ACL reconstruction with a concomitant nonsurgically treated MCL injury (ACL + MCL group) were matched with patients who had undergone an ACL reconstruction without an MCL injury (ACL group), in a 1:3 ratio. The primary outcome was return to knee-strenuous sport, defined as a Tegner activity scale ≥6, at the 1-year follow-up. In addition, return to preinjury level of sport, muscle function tests, and patient-reported outcomes (PROs) were compared between the groups.The ACL + MCL group comprised 30 patients, matched with 90 patients in the ACL group. At the 1-year follow-up, 14 patients (46.7%) in the ACL + MCL group had return to sport (RTS) compared with 44 patients (48.9%) in the ACL group (P = 0.37). A significantly lower proportion of patients in the ACL + MCL group had returned to their preinjury level of sport compared with the ACL group (10.0% compared with 25.6%, adjusted P = 0.01). No differences were found between the groups across a battery of strength and hop tests or in any of the assessed PROs. The ACL + MCL group reported a mean 1-year ACL-RSI after injury of 59.4 (SD 21.6), whereas the ACL group reported 57.9 (SD 19.4), P = 0.60.Patients with a concomitant nonsurgically treated MCL injury did not return to their preinjury level of sport to the same extent as patients without an MCL injury 1 year after ACL reconstruction. However, there was no difference between the groups in terms of return to knee strenuous activity, muscle function, or PROs.Patients with a concomitant nonsurgically treated MCL injury may reach outcomes similar to those of patients without an MCL injury 1 year after an ACL reconstruction. However, few patients return to their preinjury level of sport at 1 year.
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