Epidemiology of Non-Contact Muscle Injuries in the Italian Male Elite Under-19 Football (Soccer) Championship.

BACKGROUND: While extensive research exists on muscle injuries among adult football players, a notable gap persists in studies concerning younger footballers. The aim of the current study is to provide epidemiological data on the characteristics of time-loss muscle injuries in young football players participating in the Italian Under-19 male elite Championship ("Primavera 1"). RESULTS: Conducted as a multicentre, prospective, observational cohort study, this research gathered injury data from the 2022-23 season across 14 of the 18 Clubs in the first Italian Under-19 championship. The cohort comprised 391 players with a mean age (± standard deviation) of 18.0 ± 0.4 years. A total of 479 injuries were reported, resulting in 14,231 days of activity lost. Of these, muscle injuries were 209 (44%), accounting for 4,519 (32%) days lost. Overall muscle injuries incidence was 1.82/1000 hours, with a mean injury burden of 39.4 days lost/1000 hours. Almost all muscle injuries (206 out of 209: 98.5%) occurred in hamstrings, quadriceps, adductors, calf and iliopsoas. Hamstrings injuries were the most burdensome (18.8 days lost/1000 hours) accounting for nearly half of all days lost due to muscle injuries. Incidence and burden of adductors injuries (0.25 injuries and 4.1 days lost/1000 hours, respectively) were found to be comparable to calf injuries (0.24 injuries and 4.7 days lost/1000 hours, respectively). Iliopsoas injuries accounted for a noteworthy portion of the total, with an injury incidence of 0.16/1000 hours and a burden of 3.3 days lost/1000 hours. Injuries with myo-tendinous or myo-aponeurotic involvement demonstrated delayed return-to-football compared to those without such involvement (35.6 vs. 18.5 days, p < 0.0001). CONCLUSIONS: The study highlighted a peculiar distribution of non-contact muscle injuries among elite young football players. While hamstring injuries were confirmed as the most burdensome, incidence and burden of adductors and calf injuries were found to be similar. A significant incidence and burden of iliopsoas injuries were observed. These findings suggest potential implementations for targeted injury prevention strategies in the Italian male elite Under-19 football Championship.

Kinematics of 90° change of direction in young football players: Insights for ACL injury prevention from the CUTtheACL study on 6008 trials.

PURPOSE: To investigate the 90° change of direction (COD) task in an extensive cohort of competitive healthy football players within the CUTtheACL study and to provide normative values and differences between males and females for full-body kinematics based on two-dimensional (2D) video analysis and scoring system. METHODS: One-thousand-and-two competitive football (soccer) players (age 16.3 ± 2.8 years, 264 females) were prospectively enroled. Each player performed three preplanned 90° COD tasks per limb. The 2D evaluation was performed through objective measures (collected through three high-speed cameras) of frontal and sagittal plane joint kinematics at the cut initial foot contact (IC) and maximum knee flexion angle. A previously published scoring system was adopted to measure the movement quality of the COD task. The scoring system included five criteria (limb stability [LS], pelvis stability [PS], trunk stability [TS], shock absorption [SA], movement strategy [MS]) ranked from 0/2 (nonadequate) to 2/2 (adequate) with a maximum score of 10/10. Normative data were provided for all the variables; statistical differences between male and female players were investigated (p < 0.05). RESULTS: A total of 6008 valid attempts were included. Frontal plane knee projection angle (FPKPA) at initial contact was 24.4 ± 9.8° (95th percentile: FPKPA > 40°). The total score was ≤4/10 in 71.2% of the trials, the lowest subscores were LS and PS. Female players showed different movement patterns with lower hip and trunk flexion both at IC and maximum knee flexion angle (p < 0.01, ES = 0.41-0.64). Female players also showed worse scores than males in SA, MS and total score (p < 0.01). CONCLUSION: Female players seem more prone to stiffer lower limb strategy and greater pelvis-trunk frontal plane instability than males. Clinicians could adopt normative data and sex-specific differences in players' movement techniques to improve ACL injury risk mitigation protocols. LEVEL OF EVIDENCE: Level IV.

Top-class women's soccer performance: peak demands and distribution of the match activities relative to maximal intensities during official matches.

The aims of the current study were to determine the most demanding passages of match play (MDP) and the distribution of match activities relative to maximum intensities during official matches in top-class women soccer players. Twenty-eight women players competing in European championship and international UEFA competitions were monitored during 38 official matches (277 individual samples). Maximum relative (m · min-1) total distance (TD), high-speed running (HSRD), very high-speed running (VHSRD), sprint, acceleration and deceleration distances were calculated across different durations (1-5, 10, 15, 90 min) using a rolling average analysis. Maximum intensities (1-minpeak) were used as the reference value to determine the distribution of relative intensity across the whole-match demands (90-minavg). Time and distance higher than 90-minavg (> 90-minavg) were also calculated. MDP showed moderate to very large [effect size (ES): 0.63/5.20] differences between 1-minpeak vs all durations for each parameter. The relative (m · min-1) 1-minpeak was greater than 90-minavg of about +63% for TD, +358% for HSRD, +969% for VHSRD, +2785% for sprint, +1216% for acceleration, and +768% for deceleration. The total distance covered > 90-minavg was ~66.6% of the total distance covered during the 90-minavg for TD, ~84.8% for HSRD, ~97.4% for VHSRD, ~100% for sprint, ~99.1% for acceleration and ~98.2% for deceleration. The relative distance > 90-minavg was higher (P < 0.05) than the 90-minavg for each metric (ES: 2.22 to 7.58; very large). The present results may help coaches and sport scientists to replicate the peak demands during training routine in top-class women soccer players.

Effects of Chronic Supplementation of L-Arginine on Physical Fitness in Water Polo Players.

BACKGROUND: Ergogenic nutritional supplementation is sought by professional athletes for improving physical performance; nevertheless, scientific evidence to support the chronic use of L-Arginine among water polo players is missing. METHODS: Seventeen male professional water polo players were randomly assigned to assume 5 grams per day of L-Arginine (n = 9) or placebo (n = 8) for 4 weeks. The players' fitness level was assessed in the maximal speed swimming test. Ear lobe blood samples taken before and after the effort for serum lactate content were analyzed. A speed-to-lactate ratio was generated at the baseline and after 4 weeks of treatment. We also tested the effects of L-Arginine in vitro, measuring NO production, mitochondrial respiration, and gene expression in human fibroblasts. RESULTS: L-Arginine did not modify BMI, muscle strength, and maximal speed at 200 meters after 4 weeks. However, L-Arginine ameliorated oxidative metabolism to exercise as suggested by the statistically significant lower lactate-to-speed ratio, which was not observed in placebo-treated controls. In vitro, L-Arginine induced the expression of a key regulator of mitochondrial biogenesis (PGC1α) and genes encoding for complex I and increased the production of nitric oxide and the maximal oxygen consumption rate. CONCLUSIONS: Chronic L-Arginine is safe and effective in ameliorating the oxidative metabolism of professional water polo players, through a mechanism of enhanced mitochondrial function.

Clinical Outcomes and Return-to-Sports Participation of 50 Soccer Players After Anterior Cruciate Ligament Reconstruction Through a Sport-Specific Rehabilitation Protocol.

BACKGROUND: Rehabilitation of soccer players after anterior cruciate ligament reconstruction is usually performed without sport-specific guidelines, and the final phases are often left to the team coaches. The possibility of changing this approach has not yet been investigated. STUDY DESIGN: Case series. HYPOTHESIS: A specific rehabilitation protocol for soccer players, with direct control of the last on-field rehabilitation phases, may lead to complete functional recovery. METHODS: Fifty competitive soccer players who followed a sport-specific rehabilitation protocol for soccer were evaluated during the recovery period until their return to competition. The assessment of the functional outcomes was performed using the Knee Outcome Survey-Sports Activity Scale and isokinetic and aerobic fitness tests. RESULTS: The average start of on-field rehabilitation was 90 ± 26 days after surgery; the average time to return to the competitions was 185 ± 52 days. The improvement in the Knee Outcome Survey-Sports Activity Scale during on-field rehabilitation was significant (P < 0.01; from 79 ± 15% to 96 ± 7%). The isokinetic and aerobic fitness tests showed a significant improvement of muscle strength (knee extensors, +55%, P < 0.01; knee flexors, +86%, P < 0.01) and aerobic threshold (+23%, P < 0.01) from the beginning to the end of on-field rehabilitation. CONCLUSIONS: Adding on-field rehabilitation to the traditional protocols after anterior cruciate ligament reconstruction may safely lead to complete functional recovery in soccer players.

Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years' follow-up.

BACKGROUND: Patellofemoral lesions represent a very troublesome condition to treat for orthopaedic surgeons; however, second-generation autologous chondrocyte implantation (ACI) seems to offer an interesting treatment option with satisfactory results at short-term follow-up. HYPOTHESIS: Hyaluronan-based scaffold seeded with autologous chondrocytes is a viable treatment for the damaged articular surface of the patellofemoral joint. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Among a group of 38 patients treated for full-thickness patellofemoral chondral lesions with second-generation ACI, we investigated 34 who were available for final follow-up at 5 years. These 34 had chondral lesions with a mean size of 4.45 cm(2). Twenty-one lesions were located on the patella, 9 on the trochlea, and 4 patients had multiple lesions: 3 had patellar and trochlear lesions, and 1 had patellar and lateral femoral condyle lesions. Twenty-six lesions (76.47%) were classified as International Cartilage Repair Society (ICRS) grade IV A or B, 5 lesions (14.70%) were grade IIIC, and 3 (8.82%) were lesions secondary to osteochondritis dissecans (OCD). Results were evaluated using the International Knee Documentation Committee (IKDC) 2000 subjective and objective scores, EuroQol (EQ) visual analog scale (VAS), and Tegner scores at 2 and 5 years. Eight patients had second-look arthroscopy and biopsies. RESULTS: All the scores used demonstrated a statistically significant improvement (P < .0005) at 2 and 5 years' follow-up. Objective preoperative data improved from 8 of 34 (23.52%) normal or nearly normal knees to 32 of 34 (94.12%) at 2 years and 31 of 34 (91.17%) at 5 years after transplantation. Mean subjective scores improved from 46.09 points preoperatively to 77.06 points 2 years after implantation and 70.39 at 5 years. The Tegner score improved from 2.56 to 4.94 and 4.68, and the EQ VAS improved from 56.76 to 81.47 and 78.23 at 2 and 5 years' follow-up, respectively. A significant decline of IKDC subjective and Tegner scores was found in patients with multiple and patellar lesions from 2 to 5 years' follow-up. Second-look arthroscopies in 8 cases revealed the repaired surface to be nearly normal with biopsy samples characterized as hyaline-like in appearance. CONCLUSION: Hyaluronan-based scaffold seeded with autologous chondrocytes can be a viable treatment for patellofemoral chondral lesions.

Primary repair combined with bone marrow stimulation in acute anterior cruciate ligament lesions: results in a group of athletes.

BACKGROUND: The anterior cruciate ligament has been shown to have poor healing ability, and reconstruction is the standard treatment. HYPOTHESIS: Primary anterior cruciate ligament repair combined with bone marrow stimulation could restore stability and function in athletes with acute anterior cruciate ligament incomplete tears. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Among a group of 99 patients with clinically diagnosed anterior cruciate ligament acute lesions, 26 athletes with arthroscopically confirmed incomplete anterior cruciate ligament proximal tears were treated with primary repair combined with bone marrow stimulation of the anterior cruciate ligament femoral attachment site. Postoperatively, all patients underwent a specific rehabilitation program. All patients were prospectively evaluated; outcome measures were assessed using Marx, Noyes, Tegner, Single Assessment Numeric Evaluation, Lysholm, and International Knee Documentation Committee scores. Anterior tibial translation was measured using Rolimeter instrument under anesthesia and at final follow-up. RESULTS: All athletes were followed up for a mean 25.3 months (range, 17-38 months). Mean age was 26.6 years. Mean preinjury Tegner was 7.1 (SD, 1.1) and final Tegner 6.7 (SD, 1.4); mean preinjury Marx was 11.0 (SD, 3.4) and final Marx 9.6 (SD, 3.1); mean preinjury Noyes was 82.5 (SD, 5.8) and final Noyes 83.3 (SD, 7.2). These scores were not statistically different at P values of .020, .011, and .303, respectively. Final Single Assessment Numeric Evaluation rating was significantly lower than was preinjury Single Assessment Numeric Evaluation rating. This was mainly related to decreased self-confidence in high-risk sports and fear of new injury. Final Single Assessment Numeric Evaluation rating and Tegner scores were significantly higher than were their respective preoperative values. Mean Rolimeter side-to-side difference of anterior knee translation was significantly reduced from 3.5 mm (SD, 0.7) preoperatively to 1.3 mm (SD, 0.8) postoperatively. CONCLUSION: In this athletic population, anterior cruciate ligament primary repair in acute incomplete lesion combined with bone marrow stimulation effectively restored knee stability and function.

A feedback-controlled treadmill (treadmill-on-demand) and the spontaneous speed of walking and running in humans.

A novel apparatus, composed by a controllable treadmill, a computer, and an ultrasonic range finder, is here proposed to help investigation of many aspects of spontaneous locomotion. The acceleration or deceleration of the subject, detected by the sensor and processed by the computer, is used to accelerate or decelerate the treadmill in real time. The system has been used to assess, in eight subjects, the self-selected speed of walking and running, the maximum "reasonable" speed of walking, and the minimum reasonable speed of running at different gradients (from level up to +25%). This evidenced the speed range at which humans neither walk nor run, from 7.2 +/- 0.6 to 8.4 +/- 1.1 km/h for level locomotion, slightly narrowing at steeper slopes. These data confirm previous results, obtained indirectly from stride frequency recordings. The self-selected speed of walking decreases with increasing gradient (from 5.0 +/- 0.8 km/h at 0% to 3.0 +/- 0.9 km/h at +25%) and seems to be approximately 30% higher than the speed that minimizes the metabolic energy cost of walking, obtained from the literature, at all the investigated gradients. The advantages, limitations, and potential applications of the newly proposed methodology in physiology, biomechanics, and pathology of locomotion are discussed in this paper.