The December 2022 Sports Roundup. 360. looks at: Anterior cruciate ligament (ACL) repair with dynamic intraligamentary stabilization or anterior ACL at five years?; Femoroacetabular impingement in mild osteoarthritis: is hip arthroscopy the answer?; Steroids in Achilles tendinopathy: A randomized trial

There is a disparity in sport-related injuries between sexes, with females sustaining non-contact musculoskeletal injuries at a higher rate. Anterior cruciate ligament ruptures are between two and eight times more common than in males, and females also have a higher incidence of ankle sprains, patellofemoral pain, and bone stress injuries. The sequelae of such injuries can be devastating to an athlete, resulting in time out of sport, surgery, and the early onset of osteoarthritis. It is important to identify the causes of this disparity and introduce prevention programmes to reduce the incidence of these injuries. A natural difference reflects the effect of reproductive hormones in females, which have receptors in certain musculoskeletal tissues. Relaxin increases ligamentous laxity. Oestrogen decreases the synthesis of collagen and progesterone does the opposite. Insufficient diet and intensive training can lead to menstrual irregularities, which are common in female athletes and result in injury, whereas oral contraception may have a protective effect against certain injuries. It is important for coaches, physiotherapists, nutritionists, doctors, and athletes to be aware of these issues and to implement preventive measures. This annotation explores the relationship between the menstrual cycle and orthopaedic sports injuries in pre-menopausal females, and proposes recommendations to mitigate the risk of sustaining these injuries. Cite this article: Bone Joint J 2023;105-B(7):723–728

Sporting injuries around the ankle vary from simple sprains that will resolve spontaneously within a few days to severe injuries which may never fully recover and may threaten the career of a professional athlete. Some of these injuries can be easily overlooked altogether or misdiagnosed with potentially devastating effects on future performance. In this review article, we cover some of the common and important sporting injuries involving the ankle including updates on their management and outcomes.

Cite this article: Bone Joint J 2016;98-B:874–83.

Primary malignant bone and soft tissue tumours often occur in the lower extremities of active individuals including children, teenagers and young adults. Survivors routinely face long-term physical disability. Participation in sports is particularly important for active young people but the impact of sarcoma treatment is not widely recognised and clinicians may be unable to provide objective advice about returning to sports. We aimed to identify and summarise the current evidence for involvement in sports following treatment of lower limb primary malignant bone and soft tissue tumours. A comprehensive search strategy was used to identify relevant studies combining the main concepts of interest: (1) Bone/Soft Tissue Tumour, (2) Lower Limb, (3) Surgical Interventions and (4) Sports. Studies were selected according to eligibility criteria with the consensus of three authors. Customised data extraction and quality assessment tools were used. 22 studies were selected, published between 1985 – 2020, and comprising 1005 patients. Fifteen studies with data on return to sports including 705 participants of which 412 (58.4%) returned to some form of sport at a mean follow-up period of 7.6 years. Four studies directly compared limb sparing and amputation; none of these were able to identify a difference in sports participation or ability. Return to sports is important for patients treated for musculoskeletal tumours, however, there is insufficient published research to provide good information and support for patients. Future prospective studies are needed to collect better pre and post-treatment data at multiple time intervals and validated clinical and patient sports participation outcomes such as type of sports participation, level and frequency and a validated sports specific outcome score, such as UCLA assessment. In particular, more comparison between limb sparing and amputation would be welcome

The October 2023 Sports Roundup. 360. looks at: Extensor mechanism disruption in the treatment of dislocated and multiligament knee injuries; Treatment of knee osteoarthritis with injection of stem cells; Corticosteroid injection plus exercise or exercise alone as adjuvants for patients with plantar fasciitis?; Generalized joint hypermobility and a second ACL injury?; The VISA-A ((sedentary) questionnaire for Achilles tendinopathy?

Abstract. Introduction. The outcome of revision anterior cruciate ligament reconstruction (ACL-R) is guarded, particularly their return to sports activities. It is important to know the factors affecting the functional outcomes following a revision ACL-R. Methods. We analysed results from 39 patients, who underwent a revision ACL reconstruction by a single surgeon and was followed up over a year. Some of them were treated in 2-stage revision while the rest were single-stage revision, depending upon their size of bone tunnel or osteolysis as assessed by pre-operative CT scan. Result. We analysed data from 39 patients with a mean age of 31 (17–52) and an average follow-up of 3.6 years (2–5 years). The average KOOS quality of life score was 58.94 (±23.02) and the mean Lysholm score was 89.48 (±10.1). Medial meniscal tear was significantly correlated with Lysholm score (p<0.005), but not with KOOS-QOL. Tear in lateral meniscus was not related significantly. Patients having Grade II or above cartilage damage showed inferior outcomes in terms of Lysholm score and poor return to sports, and it was statistically significant (p<0.02). There was no significant differences in outcomes between single stage revision and 2-stage revision (p=0.336). 15 patients (42.5%) returned to their pre-injury sports activities after revision surgery with the mean return to sports score of 58.65 (±16.1). Conclusions. The long-term functional outcome after revision ACL reconstruction is satisfactory, but not the return to sports. Expectations on outcome should be carefully managed particularly those having concomitant medial meniscal injury or cartilage damage

Traditionally, sports Injuries have been sub-optimally managed through Emergency Departments (ED) in the public health system due to a lack of adequate referral processes. Fractures are ruled out through plain radiographs followed by a reactive process involving patient initiated further follow up and investigation. Consequently, significant soft tissue and chondral injuries can go undiagnosed during periods in which early intervention can significantly affect natural progression. The purpose of this quality improvement project was to assess the efficacy of an innovative Sports Injury Pathway introduced to detect and treat significant soft tissue injuries. A Sports Injury Pathway was introduced at Fiona Stanley Hospital (WA, Australia) in April 2019 as a collaboration between the ED, Physiotherapy and Orthopaedic Departments. ED practitioners were advised to have a low threshold for referral, especially in the presence of a history of a twisting knee injury, shoulder dislocation or any suggestion of a hip tendon injury. All referrals were triaged by the Perth Sports Surgery Fellow with early follow-up in our Sports Trauma Clinics with additional investigations if required. A detailed database of all referrals was maintained, and relevant data was extracted for analysis over the first 3 years of this pathway. 570 patients were included in the final analysis. 54% of injuries occurred while playing sport, with AFL injuries constituting the most common contact-sports injury (13%). Advanced Scope Physiotherapists were the largest source of referrals (60%). A total of 460 MRI scans were eventually ordered comprising 81% of total referrals. Regarding Knee MRIs, 86% identified a significant structural injury with ACL injuries being the most common (33%) followed by isolated meniscal tears (16%) and multi-ligament knee injuries (11%). 95% of Shoulder MRI scans showed significant pathology. 39% of patients required surgical management, and of these 50% were performed within 3 months from injury. The Fiona Stanley Hospital Sports Injury Pathway has demonstrated its clear value in successfully diagnosing and treating an important cohort of patients who present to our Emergency Department. This low threshold/streamlined referral pathway has found that the vast majority of these patients suffer significant structural injuries that may have been otherwise missed, while providing referring practitioners and patients access to prompt imaging and high-quality Orthopaedic sports trauma services. We recommend the implementation of a similar Sports Injury Pathway at all secondary and tertiary Orthopaedic Centres

Background. Return to sports after anterior cruciate ligament reconstruction (ACLR) is multifactorial and rotational stability is one of the main concerns. Anterolateral ligament reconstruction (ALLR) has been recommended to enhance rotational stability. Purpose. To assess the effect of ALLR on return to sports. Study Design. Retrospective comparative cohort study;. Level of evidence: III. Methods. A total of 68 patients who underwent ACLR after acute ACL injury between 2015 and 2018 with a follow-up of at least 24 months were enrolled in the study. Patients with isolated ACLR (group ALL(-), n=41) were compared to patients with ACLR+ALLR (group ALL(+), n=27) in regard to subjective knee assessment via Tegner activity scale, Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, Knee Documentation Committee (IKDC) form and Lysholm score. All tests were performed before the surgery, at 6 months and 24 months postoperatively. Results. Mean follow-up was 29.7±2.9 months for group ALL(-) and 31.6±3.0 for ALL(+) (p=0.587). Tegner, ACL-RSI and IKDC scores at last follow-up were significantly better in ALL(+) compared to ALL(-). There were no significant differences in isokinetic extensor strength and single-leg hop test results between the groups. 40 (97.6%) patients in ALL(-) and 27 (100%) in ALL(+) had a grade 2 or 3 pivot shift (p=0.812) preoperatively. Postoperatively, 28 (68.3%) patients in ALL(-) and 25 (92.6%) patients in ALL(+) had a negative pivot shift (p<0.001). 2 (5.9%) patients in ALL(-) and 1 (3.7%) patient in ALL(+) needed ACLR revision due to traumatic re-injury (p=0.165). There was no significant difference in the rate of return to any sports activity (87.8% in ALL(-) vs 88.9% in ALL(+); p=0.532), but ALL(+) showed a higher rate of return to the same level of sports activity (55.6%) than group ALL(-) (31.7%) (p=0.012). Conclusion. ACLR combined with ALLR provided a significantly higher rate of return to the same level sports activity than ACLR alone, probably due to enhanced rotational stability

Abstract. Introduction. The study aims were to demonstrate rates, level, and time taken to RTP in elite sports after ACL reconstruction (ACL-R) and compare football and rugby. Methods. A retrospective review of a consecutive series of ACL-R between 2005 and 2019 was undertaken. Patients were included if they were elite athletes and were a minimum of 2 years post primary autograft ACL-R. The outcomes measured were return to play (RTP), (defined as participation in a professional match or in national/ international level amateur competition), time to RTP after surgery, and RTP level (Tegner score). Results. Three hundred and ninety four elite athletes with 420 ACL-Rs (235 in footballers, 125 in rugby players and 60 in other sports) were included. 95.7% of all athletes returned to competition at a mean of 10.3 months after ACL-R with 90.1% at the same / higher level. There was no difference in RTP rates between rugby and football. Rugby players RTP faster than footballers (9.6 vs 10.6 months, (p=0.027). Overall re-rupture rate within 2 years was 6.4% but not significantly different between football (8.1%) and rugby (7.2%). Footballers were more likely to rupture their ACL during jumping / landing manoeuvres and to receive a PT graft than rugby players. There were no significant differences between football and rugby regarding patient characteristics, intraoperative findings and re-operation rates. Conclusion. Over 95% of all elite athletes RTP after primary ACL-R with 90% able to play at the same level. Rugby players RTP significantly faster than footballers

Spinal cord injury is an inevitable but rare occurrence in sports. Identifying trends and working to minimise risk is an integral part of sports management. All patients suffering a spinal cord injury in Scotland will be transferred to the Queen Elizabeth National Spinal Injuries Unit (QENSIU). Our records give an accurate account of trends in spinal cord injury. This study details the number of spinal cord injuries caused by sports and leisure pursuits in Scotland since 1992. 1451 patients have suffered a spinal cord injury in Scotland from 1992-2008. 142 (9.8%) arose from injuries during sport. The average age at injury was 32, and patients were predominantly male (91%). The commonest cause was diving (40, 28%) followed by cycling (29, 20%) climbing and hillwalking (15, 11%) and rugby union (12, 8%). Smaller numbers were seen in horse-riding (11), aerial sports (6), motor sports (6), snow sports (5), and football (5). Overall, there was evidence of an increasing trend in the number and severity of injuries in rugby and cycling. The number of spinal injuries, caused by diving, rugby and cycling remains disproportionally high and the increasing trends identified merit further investigation

The purpose of this study is to prove whether Japanese patients undergoing primary total hip arthroplasty (THA) for the hip dysplasia were able to return to sport after surgery. A questionnaire survey was completed by 77 patients in 9 males and 68 females between 1 and 3 years after surgery. Mean age at surgery was 66.1 (range, 49 to 87). In the 3 years before surgery 40 (51.9%) patients were participating in sport. By 1 to 3 years after surgery 43 (55.8%) patients were participating in sport. A total of 33 (82.5%) had returned to their sporting activities by 1 to 3 years after surgery in groups who played sports before surgery and 7 (17.5%) were unable to do with the most common reason being “cannot move as much as I wanted”. On the other hand, a total of 10 (27%) had started playing sports after surgery. The sports activities after surgery were the most common being walking, radio calisthenics, and swimming as low-impact sports. A total of 27 (73%) did not play sports before or after surgery with the most common reason being “fear of damage to the hip joint”. In conclusion, when Japanese patients who have undergone THA for hip dysplasia choose to participate in sports, orthopedic surgeons should provide information with which to evaluate the risk of sports activity and recommend appropriate sports activity

Posttraumatic shoulder instability is a common problem in the field of sports medicine. Especially overhead athletes need intact stabilisers to meet the functional requirements. Open procedures often result in limitations of movement postoperatively. Arthroscopic techniques offer potential advantages such as better range of motion and shorter rehabilitation times. Between September 1996 and October 2000 159 arthroscopic shoulder stabilisations were performed with FASTak® anchors. The mean follow up was 24.9 months (12–50). Rowe score and a visual analogue scale were used to measure patient satisfaction. 72 patients (m=57, f=15)with a mean age of 27.6 years (17–65) were included and clinically examined. The Rowe score increased to 83.1 after primary stabilisation and 68.1 after revision procedures. The visual analogue score demonstrated overall patient satisfaction. 89.1% (n=64) of the patients could return to sports with 68,4% (n=49) being able to return to their previous sports activity level. Overhead athletes returned to sports in 89.4% of cases and 63.3% to their pre-injury level. In the non-overhead athletes 86% returned to sports with 60% to their pre-injury level. This study demonstrates that arthroscopic shoulder stabilisation with FASTak® anchors may be offered to the athlete regardless of the sports activity. It allows return to sports in a high percentage and does offer the potential advantages of a faster return to the previous activity level, better range of motion and less postoperative pain. Disadvantages of the technique is a long learning curve and should therefore only be performed by dedicated and experienced shoulder surgeons

Purpose: To assess the results of ACL reconstructions carried out at our institution in a non-elite cohort of patients with regards to return to active sports post reconstruction. Materials & Methods: Seventy-five (71%) of 106 patients who underwent reconstruction of isolated ACL tears between June 2001 and August 2004 performed by the senior author completed a newly designed questionnaire (incorporating Cincinnati Sports Activity Scale [CSAS]) to help us fully assess their return to sports and to elucidate reasons if not returning to pre-injury level. 55 were completed at follow up, with objective clinical assessment and other subjective questionnaires [KOOS, IKDC and Lysholm] and 20 were done through telephone interview. Results: All 75 patients were involved in sports at CSAS Levels 1 & 2 prior to their injury and 39 (52%) had to drop to level 4 after injury. Following reconstruction 61 patients (81.3%) returned to CSAS 1 & 2 levels. 28 of 30 patients (93.3%) operated within 2 years from injury achieved pre-injury CSAS levels compared to 33 of 45 (73.3%) with a longer interval. The mean Lysholm, IKDC and KOOS Sports scores at 12 to 24 months follow up revealed a progressive trend and were 84.9, 76.3 and 73.6 respectively. One reason for not returning to pre–injury intensity of sports was that many (71.7%) expressed fears of instability though most (70%) had no instability on playing. 77.8% of non-returners who were more than 30 years age reasoned not wanting to risk re-injury compared to 36.8% in the under 30 group. More significantly, 44.4% of over 30s said they were planning to drop their sporting level anyway compared to 5.5% in the younger group. Conclusion: ACL reconstruction is best done as early as possible after injury for persons intending to return to competitive sports. The results are even better after early intervention in younger patients. Psychosocial issues play a significant role in return to active sports

Hop tests are used to determine return to sports after ACL reconstruction. They mostly measure distance and symmetry but do not assess kinematics and kinetics. Recently, biomechanical evaluations have been incorporated into these functional jump tests for the better assessment of return to sport. We assessed the sagittal plane range of motion (ROM) of the knee, the deviation axis of rotation (DAOR), and the vertical ground reaction force (vGRF) normalized to body weight in nine healthy participants during the single leg (SLH) and crossover hop tests (COHT). Participants' leg lengths were measured. Jumping distances were marked in the test area as being 4/5 of the leg length. Four sensors were placed on the thighs, the legs and the feet. These body parts were handled as a single rigid body. Eight 480 Hz cameras were used to capture the movements of these rigid bodies. vGRF at landing were measured using a force plate (Bertec, Inc, USA). The ROM of the knee joint and the DAOR were obtained from kinematic data. Participants' joint kinematics metrics were similar in within-subjects statistical tests for SLH and COHT. We therefore asked whether the repeated vGRF normalized to body weight will be similar in both legs during these jumps. Joint kinematics metrics however were different in between subjects indicating the existence of a personalized jumping strategy. These hop tests can be recorded at the beginning of the training season for each individual, which can establish a comparative evaluation database for prospective lower extremity injury recovery and return to sport after ACL injury

Background. Many scoring systems exist that assess ankle function, none of them are validated for use in a group of higher demand patients. This group of patients there have potential problems with ceiling effects, not being able to detect change or that a sports-subscale is not included. This study was to create a validated self-administered scoring system for ankle injuries in athletes by studying existing scoring systems and key-informant interviews. Methods. The Sports Athlete Foot and Ankle Score (SAFAS) was developed from interviews with athletes as well as expert-opinions. Initially 26 patients were interviewed before creating the scoring system, this was modified from the Foot and Ankle Outcome Score, this had been partially validated previously and the subjects regarded the content as relevant but incomplete. Secondly, SAFAS the content was validated in a group of 25 patients with a range of injuries and 14 athletes without ankle injury. It is a self-administered region specific sports foot and ankle score that containing four subscales assessing the levels of symptoms, pain, daily living and sports. Results. Spearman correlation coefficients between SAFAS and the Foot and Ankle Ability Measure (FAAM) are 0.88 for activities of daily living and 0.78 for sports. Content validity gave high satisfaction at 75%. There was good internal consistency of each subscale; symptoms 0.77, pain 0.92, daily living 0.92 and sports 0.88. SAFAS has shown to be able to differentiate between injured and non-injured athletes. Conclusion. SAFAS is a measurement a suitable tool to assess differences in ankle function and disability between injured and non-injured athletes. It is valid to be used as a score in those clinical conditions which affect the high levels of ankle and hind foot function