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

Introduction. The aim of this study was to evaluate the health quality of life and return to sports activities following pelvic ring injuries. Patients and Methods. Between January 2006–2007 patients treated in our institution with pelvic fractures were eligible to participate. Inclusion criteria were adult patients. Exclusion criteria were children and pathological fractures. Data recorded included demographics, injury mechanism, fracture pattern, Injury severity score (ISS), associated injuries, method of fixation, complications and functional outcome. Health related quality of life was assessed using the (EuroQol) and return to sports activities was evaluated using a return to sports questionnaire. The minimum follow up was 24 months (24–39). Results. Out of 60 patients, 53 (29 male) met the inclusion criteria. The mean age was 43 years (21–63), mean ISS was 25.1 (9–58). There was a significant decrease in quality of life (p<0.0001). The decrease was significant in all 5 EQ5D domains with mobility, usual activities and pain to be most significantly affected, p<0.0001. There was also a significant decrease in sporting activities (p>0.0001), (42 patients reported a decrease; 6 patients performed the same degree of activities and 5 reported an increase (they had the lowest mean ISS of 18 points)). Regression analysis showed lower extremity injury to be a significant risk factor for decreased sporting and physical activity, p> 0.049. Conclusion. Pelvic fracture causes a significant decrease in quality of life and return to sports activities. The presence of a lower limb fracture is a significant risk factor for a reduced sporting activity

Introduction and purpose: One of the sequelae that patients with recurrent shoulder dislocation must face is a significant limitation of their capacities for daily living and sports activities. The purpose of treatment is the recovery of stability in order that patients can return to their activities with the as little loss of mobility and strength as possible. The aim of our study was to analyze the evolution of physical activity and correlate final stability with postoperative sports activity. Materials and methods: We carried out a retrospective study on a sample of 30 patients diagnosed with recurrent shoulder dislocation who underwent surgery between January 2001 and May 2005. After a minimum 2 years’ follow-up, mobility and strength in the operated shoulder was assessed, comparing it to the contralateral limb; the stability and possible recurrence in the affected limb were also evaluated. Furthermore, at that time, data was collected on the sports activities of the patients. Results: After more than 2 years’ follow-up a statistically significant decrease in the number of patients who performed high-risk sports was observed. Furthermore, in those patients who continued to practice high-risk sports after surgery, greater stability was seen in comparison with those patients who did not (p> 0.05). Conclusions: Patients that undergo surgery for recurrent shoulder dislocation decrease their sports activities in comparison with their preoperative activities and the results of surgery are independent of postoperative sports activity

Introduction:. One reason that young and active patients choose hip resurfacing arthroplasty (HRA) rather than stemmed total hip arthroplasty (THA) is that they wish to return to high impact sports after their operation. Few studies have addressed the outcome in hip arthroplasty patients who choose to participate in high impact sports post-operatively. We therefore wanted to determine if the durability of HRA in highly active patients was decreased. Methods:. From 5/2001 to 5/2011, a single surgeon performed 2434 HRA cases in 2013 patients. The study group consists of all patients that had a UCLA Activity score of 9 or 10 at any point after surgery in our prospective database. There were 936 (38%) cases in 776 patients who reported participating in high impact sports at some point after surgery. This group was compared to the entire database. The mean age of the study group was 50 ± 8 years, which was significantly younger than the entire group (P = 0.0007). 82% of the study group was male compared to 73% in the entire group (P < 0.0001). 85% of the primary diagnoses were osteoarthritis in the study group compared to 78% in the entire group (P < 0.0001), followed by dysplasia (8%) and osteonecrosis (4%). Results:. For the study group, the average follow-up length was 4 ± 2 years. 389 (42%) cases had at least 5 years follow-up. 10 (1%) revisions were identified: five (0.5%) due to femoral component loosening; two (0.2%) due to adverse wear; two (0.2%) for acetabular component loosening; one (0.1%) for acetabular fracture. There was no difference in the failure rate due to any specific complication type. The Kaplan-Meier survivorship rate was 99.5% at 5 years and 95.8% at 10 years, which compared to 96.9% at 5 years and 91.6 at 10 years for the entire group. 61 cases had the acetabular inclination angles >50°; 2 of which were revised for adverse wear related failures. Metal ion test results were available for 52% cases in the study group. Metal ion levels were ≥7 μg/L in 18 (1.9%) cases and ≥10 μg/L in 11 (1.2%). Excluding the failed cases, the average Harris hip scores were 99 ± 3 for the study group which was significantly better than the entire group (P < 0.0001). Discussion:. When compared to the entire database, hip resurfacing patients that participate in high impact sports after surgery have a significantly higher HHS; they have a similar 10-year survivorship of 95.8%; they have a similar low adverse wear failure rate of 0.2%. We therefore conclude that a patient's activity level has little effect on the 10 year outcome of HRA and that restrictions are therefore not necessary after hip resurfacing

Introduction. End-stage ankle osteoarthritis is a debilitating condition that results in functional limitations and a poor quality of life. Ankle arthrodesis (AAD) and total ankle replacement (TAR) are the major surgical treatment options for ankle arthritis. The purpose of the present study was to compare preoperative and postoperative participation in sports and recreational activities, assesses levels of habitual physical activity, functional outcome and satisfaction of patients who underwent eighter AAD or TAR. Methods. 41 patients (mean age: 60.1y) underwent eighter AAD (21) or TAR (20) by a single surgeon. At an average follow-up of 30 (AAD) and 39 (TAR) months respectively activity levels were determined with use of the University of California at Los Angeles (UCLA) activity scale. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, patients's satisfaction and pre- and postoperative participation in sports were assessed as well. Results. In the AAD group 90% and in the TAR group 76% were active in sports preoperatively. Postoperatively in both groups 76% were active in sports (AAD p=0.08). The UCLA score was 7.0 (± 1.9) in the AAD group and 6.8 (± 1.8) in the TAR group (p=0.78). The AOFAS score reached 75.6 (± 14) in the AAD group and 75.6 (± 16) in the TAR group (p=0.97). Conclusion. Our study revealed no significant difference between the groups concerning activity levels, participation in sports activities, UCLA and AOFAS score. After AAD the number of patients participating in sports decreased. However, this change was not statistically significant

Drug Free Sport New Zealand (DFSNZ) aims to maintain New Zealand Sport as a drug free environment and thereby enhance our proud and successful sporting culture. New Zealand is bound into the World Anti-Doping Code and must therefore adhere to World Anti-Doping rules. Detection of doping violations is one of the functions of DFSNZ. An aim of DFSNZ is to eliminate the risk of athletes failing a sports anti-doping test as a result of using legitimately prescribed medication as treatment without a Therapeutic Use Exemption (TUE). This can create major problems for the athlete who may then have to appear before the Sports Tribunal. Some substances on the prohibited list are used by Orthopaedic Surgeons as part of regular management. “National level” athletes require a TUE to be completed prior to use of these medications or immediately following use in emergency situations. Examples are:. Narcotics and Intravenous Corticosteroids perioperatively. Probenecid to enhance antibiotic concentrations in treating infections. Other athletes who are not in this category but may be tested do not require a TUE immediately but still have to be able to provide evidence that the medication was used for therapeutic use if they were subsequently to fail a test. It is the athlete’s responsibility to notify the surgeon and obtain the appropriate documentation. Athletes in the Testing Pools will carry a card with reference to MIMS Resources, the DFSNZ website and Hot-line. From time to time athletes stressed by the situation of their injury may forget to notify the surgeon, prior to surgery, of anti-doping requirements. Surgeon (and anaesthetist) awareness and support for the programme will enhance the overall care of the patient and limit subsequent demands on both the patient and medical staff. The aim of this presentation is to enlighten NZOA members regarding the correct procedures to follow should a prohibited substance be required when treating an athlete who is subject to drug testing in sport

Since total disc replacement (TDR) has broadened the spectrum of surgical treatment of degenerative spine diseases many comparison studies, particularly with interbody fusions (IF), have been done. Even though comparable results concerning functionality, radiologic results and subjective rating of life-quality have been presented, very few data about athletic activity before and after spine surgery exists. Material and Methods: Between 1/2002 and 10/2006 181 patients had interbody fusions and 57 had a total disc replacement. Of 86 IF-patients and 25 patients with TDR we have complete data, which was collected in pre- and postoperative clinic and radiologic routine control with standardised questionnaires containing evaluation of level (frequency) and sort of sport. Patients are matched according to demographic data and preoperative activity beside the most important match of operation method. Results: Patients with Total disc replacement show a later resumption of sports (19 weeks) than fusion patients (14 weeks), but more TDR patients (60%) achieve their preoperative level of sport than IF-patients (36%) do. Vice versa to the Fusion group in the TDR group more patients start a new sport after surgery than to stop one. Percentage of patients doing sports post- compared to preoperative is higher in both groups. Less patients having a TDR complain about technical limitations during practicing sports than fusion patients. Discussion: Despite later resumption of athletic activity TDR seems to be the better surgical treatment of degenerative disc diseases in active patients and athletes due to overall higher sports levels. If long term results can keep up with short time follow ups has to be questioned

Background: There is abundant literature on the treatment of Achilles tendon rupture; however data on sports and recreational activities after this injury is scarce. Patients and Methods: 71 patients were assessed in a prospective cross-sectional study after an average of 3 years after Achilles tendon rupture. 44 patients were treated non-operatively, using a functional algorithm, and 23 patients were treated operatively. Outcome parameters were the AOFAS-Score and the SF-36 Score. The strength of plantar-flexion was measured using the Isomed 2000 system, the structural integrity of the tendon was assessed sonografically. Results: Patients treated operatively had a higher complication rate than patients treated non-operatively (p=0.05). Re-rupture rate was identically in both groups. No difference was noted between the two groups for the AOFAS score (92 vs. 90). Moreover the SF-36 score did not show any significant difference between the groups. However, if compared to the age-adjusted normative population significant lower scores were achieved. A significant reduction in practicing sports was detected, as well as a reduction of plantar flexion of the affected foot (p=0.04). Conclusion: Except for complication rate no significant difference could be detected between the groups. Thus operative treatment in the recreational athletes should only be considered, if no adaptation of the ends of the tendon is diagnosed during the initial or repeated ultrasound. Regardless of the therapeutic intervention chosen an Achilles tendon rupture leads to marked changes in sports- and recreational activities

Introduction: Many knee outcomes measures have recently been developed and validated. However, most of these are lengthy and too cumbersome to use in a busy sports medicine practice. The purpose of this study was to develop a one-page outcomes form that documents function, activity and patient satisfaction for collection of knee outcomes data in a format that can be analyzed easily so that a surgeon may better assess the outcomes of the therapeutic regimens used. Methods: Validated knee questionnaires were evaluated for their length and ease of scoring. Scores were evaluated for test-retest reliability, floor and ceiling effects, criterion validity, construct validity, and responsiveness to change. In addition, the psychometric properties of a single-item patient satisfaction instrument with outcomes score were studied. Results: The Lysholm score and Tegner activity scale are short in length and provide a validated outcomes measurement tool for several sports medicine procedures. In addition to being validated for ACL, meniscus, and chondral defects, we tested their psychometric properties in patients seeking treatment for osteoarthritis of the knee. The Tegner scale and overall Lysholm score showed acceptable test-retest (ICC = 0.87 and 0.79, respectively) reliability, floor and ceiling effects, criterion validity, construct validity, and responsiveness to change. The standard error of the Lysholm was 6.7 and the minimum detectable change at 95% confidence level (MDC95) was 16. For the Tegner score, the standard error was 0.60 and the MDC95 was 1.2. For the one-item patient satisfaction scale, there was an acceptable floor (4.3%) but a high ceiling (39.4%) effect. There was acceptable criterion validity with significant (p< 0.05) correlations between the satisfaction with surgical outcomes and the validated Group Health of America Consumer Satisfaction Survey. There was acceptable construct validity with all hypotheses demonstrating significance (p< 0.05). Acceptable responsiveness to change was found. Conclusions: The Lysholm score, the Tegner activity scale, and a one-item patient satisfaction with outcomes scale provide a valid one-page knee outcomes measurement form. This simple form allows the collection of knee outcomes data in a busy sports medicine practice to help surgeons better assess the clinical outcomes in their patients

Background. Surgical resection of middle facet tarsal coalition is a well documented treatment option in symptomatic individuals that do not respond to conservative treatment. The ability to return to full recreational activity post resection may have implications on foot biomechanics and possibly degenerative changes in the subtalar and adjacent joints. Hypothesis. Open resection of middle facet tarsal coalitions should improve subtalar joint motion and biomechanical function and facilitate return to sports. Aim. The aim of this study was to assess the outcomes of open resection of middle facet tarsal coalitions (MFTCs) with particular emphasis on return to sports. Methods. Retrospective review of clinical and radiographic records of paediatric and adolescent patients who had open resection of middle facet tarsal coalitions. The ankle and hind foot were evaluated according to the American Orthopaedic Foot and Ankle Society Ankle-Hind foot Scale (AOFAS). We also quantified the return-to-activity time after tarsal coalition surgery. Results. We identified thirteen patients (Mean age; 13.7years Range; 7–21 years) with eighteen middle facet tarsal coalitions operated over a seven year period. Ten patients (12 feet) who underwent resection had an average return to recreational activity time of approximately twelve weeks and reported better exercise tolerance post resection. Conclusion. Surgical excision of middle facet tarsal coalitions has a favourable outcome with respect to return to sports

This project determines the numbers of UK service personnel with sports related injuries requiring physiotherapy or admission to Bastion Role 3 facility. We identified the trend of the injuries and how they were sustained during. The outcomes were recorded to determine the cost to the mission. Data was collected from April to September 2013. Results included 123 (29% of the deployed contingent in BSN catchment) were unfit for role whilst receiving treatment and 27 personnel (6%) were unable to return to their role in theatre due to their injury. 19 personnel were evacuated to UK, 7 to RCDM and 12 DAH to RRU. The mean length of hospital stay was 2.5 days, the total number of overnight stays was 58. The cost of an overnight stay in a Role 3 hospital bed is £200 and the cost of an escorted Aeromed £8,020. Incidence of sports injuries of UK personnel during H18, requiring role 1 or role 3 interventions was 6.3%. Individual PT accounted for 84% of injuries and 16% due to duty PT. 50% were lower limb injuries (UL – 25%, spine – 25%). Following treatment 94% patients remained in BSN in role, 4% Aeromed to UK. The potential cost was estimated at a minimum of £163,980

In this systematic review, our aim was to explore whether or not patients are able to return to athletic activity following lower limb joint replacement. We also investigated any evidence as to whether participation in athletic activity post-joint replacement increases complications and reduces implant survival. A PubMed, Embase and Sports Discus search was performed using the MeSH terms ‘Sport’, ‘Athletic’, ‘Athlete’, ‘Physical’, ‘Activity’, ‘Arthroplasty’, ‘Total Hip Replacement’, ‘Hip Resurfacing’, ‘Total Knee Replacement’, ‘Unicompartmental Knee Replacement’ and ‘Unicondylar Knee Replacement’. From this search, duplications were excluded, the remaining abstracts were reviewed and any unrelated to the search terms were excluded. The remaining abstracts had their full papers reviewed. Following joint replacement, participation in sporting activity is common principally determined by pre-operative patient activity levels, BMI and patient age. The type of joint replaced is of less significance. Total time spent performing activity does not change but tends to be at a lower intensity. There is little evidence in the literature of an association between high activity levels and early implant failure. Cite this article: Bone Joint J 2014;96-B:923–7

Hip and groin injuries are common in athletes who take part in high level sports. Adductor muscle tendon injuries represent a small but important number of these injuries. Avulsion of the tendons attached to the symphysis pubis has previously been described: these can be managed both operatively and non-operatively. We describe an uncommon variant of this injury, namely complete avulsion of the adductor sleeve complex: this includes adductor longus, pectineus and rectus abdominis. We go on to describe a surgical technique which promotes a full return to the pre-injury level of sporting activity. Over a period of ten years, 15 high-level athletes with an MRI-confirmed acute adductor complex avulsion injury (six to 34 days old) underwent surgical repair. The operative procedure consisted of anatomical re-attachment of the avulsed tissues in each case and mesh reinforcement of the posterior inguinal wall in seven patients. All underwent a standardised rehabilitation programme, which was then individualised to be sport-specific. One patient developed a superficial wound infection, which was successfully treated with antibiotics. Of the 15 patients, four complained of transient local numbness which resolved in all cases. All patients (including seven elite athletes) returned to their previous level of participation in sport. Cite this article: Bone Joint J 2015;97-B:1488–92

Background. The aim of this study is to analysis the ability of these patients, treated with MOMHR, to resume sport activities by gait analysis and clinical evaluations. Metal on metal hip resurfacing (MOMHR) is indicated to treat symptomatic hip osteoarthritis in young active patients. These patients require a high level of function and desire to resume sport activities after surgery. Study Design & Methods. 30 consecutive male patients playing high impact sports with unilateral hip osteoarthritis and normal contralateral hip were included in the study, they were treated with MOMHR by the same surgeon. No patients were lost to follow. The mean age at operation was 39.1 years (range 31 to 46). Primary diagnosis was osteoarthritis. OHS, HHS, UCLA activity score were completed at pre-operative time, six months and one year after surgery. Functionally, gait analysis was performed in all patients 6 months and one year after surgery. A stereophotogrammetric system (Smart-DX, BTS, Milano, Italy, 10 cameras, 250Hz) and two platforms (9286BA Kistler Instrumente AG, Switzerland) were used. Cluster of 4 markers were attached on the skin of each bone segment, a number of anatomical landmarks were calibrated and segment anatomical frames defined, markers were positioned by the same operator. Walking, running and squat jump were analyzed and strength and range of movement of the hips and knees were calculated. Results. At follow-up times the survival rate for the whole cohort was 100%. The mean pre-op OHS was 28.1 points (range 15.0 to 38.0), at 6 months after surgery was 44.5 points (range 44 to 48), at one year after surgery was 47.9 points (range 45 to 48). The mean pre-op HHS was 54.7 points (range 33.1 to 73.4), at 6 months after surgery was 96.7 points (range 93.4 to 100), at one year after surgery was 99.7 points (range 95.7 to 100). The mean pre-op UCLA activity score was 2.7 (range 2 to 4), at 6 months after surgery was 7.4 (range 5 to 10), at one year after surgery was 8.6 (range 7 to 10). At 6 months after surgery, patients showed a reduction of the differences between the operated and the contralateral side during walking, running and squat jumping. (p<0.01). One year after the operation there were no differences. At 3 months after surgery the mean hip flexion extension range of motion was in the normal hips 41±1.7 and in the operated hips 37.3±2.1; at 6 months after surgery the mean hip flexion extension range of motion was in the normal hips 45.4±1.8 and in the operated hips 42.0±1.7; At 1 year after surgery the hip flexion extension range of motion was in the normal hips 42.9±1.7 and in the operated hips 45.5±1.4. (p=0.001). Conclusions. Our gait analysis study shows that the biomechanical function of the operated hip is completely recovered 1 year after MOMHR operation. As a consequence sport activities can be successfully resumed. MOMHR is a good choice for young and active patients affected by hip osteoarthritis requiring a high level of activity

We retrospectively analysed the clinical results of 30 patients with injuries of the sternoclavicular joint at a minimum of 12 months’ follow-up. A closed reduction was attempted in 14 cases. It was successful in only five of ten dislocations, and failed in all four epiphyseal disruptions. A total of 25 patients underwent surgical reduction, in 18 cases in conjunction with a stabilisation procedure. At a mean follow-up of 60 months, four patients were lost to follow-up. The functional results in the remainder were satisfactory, and 18 patients were able to resume their usual sports activity at the same level. There was no statistically significant difference between epiphyseal disruption and sternoclavicular dislocation (p > 0.05), but the functional scores (Simple Shoulder Test, Disability of Arm, Shoulder, Hand, and Constant scores) were better when an associated stabilisation procedure had been performed rather than reduction alone (p = 0.05, p = 0.04 and p = 0.07, respectively). We recommend meticulous pre-operative clinical assessment with CT scans. In sternoclavicular dislocation managed within the first 48 hours and with no sign of mediastinal complication, a closed reduction can be attempted, although this was unsuccessful in half of our cases. A control CT scan is mandatory. In all other cases, and particularly if epiphyseal disruption is suspected, we recommend open reduction with a stabilisation procedure by costaclavicular cerclage or tenodesis. The use of a Kirschner wire should be avoided

Keywords. Shoulder; dislocation; instability; skeletal immaturity; arthroscopic Bankart repair; outcomes. Introduction. Non-operative management of traumatic shoulder instability in children has a recurrence rate of up to 100%. Short-term outcomes of surgery in adults results has a quoted recurrence rates of around 10%. The aim of this study was to examine the surgical outcomes of adolescent patients (aged 13 to 18 years) undergoing arthroscopic stabilisation for shoulder instability. Methods. All patients had a labral tear sustained whilst participating in contact sports (84% rugby). Atraumatic, primary joint hyperlaxity and dyskinetic causes were excluded. All patients had a primary arthroscopic stabilisation. Patients were reviewed in clinic or contacted by post with a standardised outcome proforma. Sixty one shoulders in 57 patients met the inclusion criteria and were included. Mean follow up was 22 months, mean age was 16.8 (range 13 to 18), and 98% were male. All were Stanmore type 1 pathology. 16% had a concomitant SLAP repair, and 16% had a posterior labral tear. Results. 31% (19) reported recurrent dislocation, and 11 patients required further surgery. This is significantly higher than published series for adults, despite the senior author being a tertiary specialist. Despite the high recurrence rate, the median improvement in shoulder function was 90% and the median VAS for pain was 0. The majority of patients (61%) had a full return to pre-injury sporting activities, while 23% returned to decreased sporting activity and 16% stopped. The mean post-operative Oxford instability score was 26.8 (SD 12.9 range 12 to 48). 90% of recurrent dislocations occurred whilst playing rugby, but other than this, we could not identify any significant risk factors for the 19 shoulders that had recurrent dislocations (gender, type of sport, hyper laxity, type of tear). Conclusions. This study demonstrates that adolescent patients have a high risk of recurrent dislocation following arthroscopic stabilisation. Patients should be appropriately counselled and alternative procedures such as the coracoid transfer should be considered. Level of evidence: IV

Aim: To quantify the effect of overhead sports on static scapular position. Method: Three cohorts of young adults were evaluated: Swimmers (n=35), Tennis players (n=32) and Controls (n=33). Scapular position was determined using the method described by DiVita. Details of overhead activities, hand dominance and history of shoulder injuries were obtained by questionnaire. All measurements were performed by a single observer. Results: DiVita’s normalised ratios in dominant shoulders were 1.57±0.09 for swimmers, 1.61±0.11 for tennis players and 1.57±0.12 for controls. For non-dominant shoulders, the ratios were 1.58±0.1.5, 1.59±0.13 and 1.63±0.13 respectively. There were no significant differences between groups. Within male subjects, there were no differences in scapular size between athletes and controls on either dominant or non-dominant sides. However, scapular distance was significantly greater in swimmers in both shoulders (dominant p=0.009, non-dominant p=0.028) and in the dominant shoulder in tennis players (p=0.037) when compared with controls. Female athletes showed no differences in scapular size when compared with controls but female swimmers had greater scapular sizes on their non-dominant sides when compared with controls (p=0.016). Conclusions: There were measurable anthropometric differences between athletes and controls that supported our hypothesis of greater scapular distances in both shoulders in swimmers and in the dominant shoulder in tennis players when compared with controls. However, these were not borne out using a normalised ratio. DiVita’s method of assessing static scapula position is readily applicable to clinical and sporting settings and proved reproducible with minimal equipment. It may be worthy of further investigation