The psychological effects of event cancellation in Olympic-level swimmers: preliminary findings and mental health screening recommendations.

BACKGROUND: Mental health screening of elite athletes is not routinely practiced following the cancellation of an athletic event. Though sporting event cancellation has negative career and training impacts on elite athletes, little is known about its psychological impact. To determine the extent to which sporting event cancellation might warrant psychological screening practices in elite athletics, this study evaluated elite-level swimmers' response to the cancellation of the 2020 Olympic Games through psychological assessment and qualitative interviewing. METHODS: A cross-sectional study design was implemented. Online psychological assessment included self-report scales to measure anxiety, burnout, psychological strain, and optimism/pessimism. Follow-up semistructured telehealth interviews were conducted to assess appraisals of and coping responses to the cancellation. RESULTS: Of the 14 participants assessed for mental health symptoms, 12 were available for interview procedures. Results (mean±SD) indicated "very high" psychological strain (22.71±4.83) and "mild" anxiety (6.29±4.87). All swimmers exhibited levels of psychological strain that warranted clinical evaluation per established cut-off scores. Thematic content analysis of interviews generated four themes: precancellation evaluations, primary appraisals, coping responses, and coping outcomes. Most swimmers exhibited maladaptive coping (75%); however, adaptative coping was as prevalent (92%), particularly through use of support networks. Most swimmers achieved positive coping outcomes (75%) and maintained strong 2021 Olympic-qualifying confidence (93%). In contrast, swimmers with poor coping outcomes (25%) employed more frequent maladaptive coping strategies and exhibited higher psychological distress. CONCLUSIONS: Findings urge sports medicine clinicians to implement psychological screening protocols in elite athletes following the cancellation of a major sporting event to attend to symptoms of psychological distress and to direct appropriate psychological intervention.

Ligamentous Lisfranc Injury: A Biomechanical Comparison of Dorsal Plate Fixation and Transarticular Screws.

OBJECTIVES: Optimal fixation technique after purely ligamentous Lisfranc injury remains controversial. This biomechanical study compares dorsal plate versus transarticular screw fixation by measuring dorsal and plantar joint diastasis. A unique protocol was developed, using reflective triad markers and positional cameras. METHODS: Eleven cadaveric matched pairs were assigned to either transarticular screw or dorsal plate fixation. Two reflective triad markers were placed into the medial cuneiform (C1) and second metatarsal base (MT2). Three cameras recorded the 3-dimensional location of triads to quantify C1-MT2 diastasis in the following states: intact Lisfranc ligament (INTACT), cut ligament (CUT), fixed (SCREW or PLATE) joint, and fixed joint after 10,000 loaded cycles. On completion, the plantar Lisfranc ligament insertions were identified, and plantar diastasis was determined using additional reflective triads. Statistical post hoc pairwise comparisons assessed differences in diastasis. RESULTS: C1-MT2 diastasis in the CUT state increased relative to INTACT (P < 0.001). SCREW fixation reduced C1-MT2 diastasis relative to CUT at dorsal (P < 0.007) and plantar (P = 0.015) locations after cycling. PLATE fixation significantly reduced dorsal diastasis relative to CUT (P < 0.001) but not for plantar diastasis (P > 0.99). PLATE plantar diastasis was numerically higher than INTACT but not significantly (P > 0.39). PLATE plantar diastasis tended to be greater than SCREW before cycling (P = 0.068) and after cycling (P = 0.080). CONCLUSIONS: Transection of the Lisfranc ligament complex yielded C1-MT2 diastasis. Both SCREW and PLATE fixation successfully reduced dorsal diastasis. However, upon load, the PLATE resulted in greater plantar diastasis, nearly statistically different relative to the SCREW. Cyclic loading at 343 N did not worsen diastasis.

Thoracic Spine Manipulation in Individuals With Subacromial Impingement Syndrome Does Not Immediately Alter Thoracic Spine Kinematics, Thoracic Excursion, or Scapular Kinematics: A Randomized Controlled Trial.

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To determine if thoracic spinal manipulative therapy (SMT) alters thoracic kinematics, thoracic excursion, and scapular kinematics compared to a sham SMT in individuals with subacromial impingement syndrome, and also to compare changes in patient-reported outcomes between treatment groups. BACKGROUND: Prior studies indicate that thoracic SMT can improve pain and disability in individuals with subacromial impingment syndrome. However, the mechanisms underlying these benefits are not well understood. METHODS: Participants with shoulder impingement symptoms (n = 52) were randomly assigned to receive a single session of thoracic SMT or sham SMT. Thoracic and scapular kinematics during active arm elevation and overall thoracic excursion were measured before and after the intervention. Patient-reported outcomes measured were pain (numeric pain-rating scale), function (Penn Shoulder Score), and global rating of change. RESULTS: Following the intervention, there were no significant differences in changes between groups for thoracic kinematics or excursion, scapular kinematics, and patient-reported outcomes (P>.05). Both groups showed an increase in scapular internal rotation during arm raising (mean, 0.9°; 95% confidence interval [CI]: 0.3°, 1.6°; P = .003) and lowering (0.8°; 95% CI: 0.0°, 1.5°; P = .041), as well as improved pain reported on the numeric pain-rating scale (1.2 points; 95% CI: 0.3, 1.8; P<.001) and function on the Penn Shoulder Score (9.1 points; 95% CI: 6.5, 11.7; P<.001). CONCLUSION: Thoracic spine extension and excursion did not change significantly following thoracic SMT. There were small but likely not clinically meaningful changes in scapular internal rotation in both groups. Patient-reported pain and function improved in both groups; however, there were no significant differences in the changes between the SMT and the sham SMT groups. Overall, patient-reported outcomes improved in both groups without meaningful changes to thoracic or scapular motion. LEVEL OF EVIDENCE: Therapy, level 1b-.

Immediate changes in pressure pain sensitivity after thoracic spinal manipulative therapy in patients with subacromial impingement syndrome: A randomized controlled study.

BACKGROUND: Thoracic SMT can improve symptoms in patients with subacromial impingement syndrome. However, at this time the mechanisms of SMT are not well established. It is possible that changes in pain sensitivity may occur following SMT. OBJECTIVES: To assess the immediate pain response in patients with shoulder pain following thoracic spinal manipulative therapy (SMT) using pressure pain threshold (PPT), and to assess the relationship of change in pain sensitivity to patient-rated outcomes of pain and function following treatment. DESIGN: Randomized Controlled Study. METHODS: Subjects with unilateral subacromial impingement syndrome (n = 45) were randomly assigned to receive treatment with thoracic SMT or sham thoracic SMT. PPT was measured at the painful shoulder (deltoid) and unaffected regions (contralateral deltoid and bilateral lower trapezius areas) immediately pre- and post-treatment. Patient-rated outcomes were pain (numeric pain rating scale - NPRS), function (Pennsylvania Shoulder Score - Penn), and global rating of change (GROC). RESULTS: There were no significant differences between groups in pre-to post-treatment changes in PPT (p ≥ 0.583) nor were there significant changes in PPT within either group (p ≥ 0.372) following treatment. NPRS, Penn and GROC improved across both groups (p < 0.001), but there were no differences between the groups (p ≥ 0.574). CONCLUSION: There were no differences in pressure pain sensitivity between participants receiving thoracic SMT versus sham thoracic SMT. Both groups had improved patient-rated pain and function within 24-48 h of treatment, but there was no difference in outcomes between the groups.

Anticipating problems unique to revision ACL surgery.

Anterior cruciate ligament (ACL) injuries are common in the athletic population. In fact, ACL reconstruction has become one of the most common orthopedic procedures. With the increasing number of primary ACL reconstructions being performed combined with the continued expectations of high-level athletes, revision ACL reconstruction is likely to become more frequent. Revision ACL reconstruction poses several diagnostic and technical challenges compared to primary reconstructions. The purpose of this article is to highlight problems that are unique to revision ACL reconstruction such as tunnel malposition, tunnel widening, preexisting hardware, and injuries to concomitant structures in the knee. Recognizing and avoiding these pitfalls are crucial to obtaining a successful result after revision ACL reconstruction.

Current concepts in ACL Injuries.

Anterior cruciate ligament (ACL) injuries are common in athletic and physically active populations, and can result in significant functional disability. Female athletes in particular have been found to be at a relatively high risk for noncontact ACL injuries. Many risk factors, both intrinsic and extrinsic, have been identified. Although some individuals may be treated nonoperatively with an aggressive rehabilitation program, athletes desiring to return to physical activities that require use of the ACL need surgical reconstruction. Surgical techniques remain controversial in regard to tunnel placement and optimal graft choices. Recent literature advocates a more oblique ACL reconstruction to more closely recreate normal knee kinematics and eliminate pathologic rotational laxity. A supervised and intensive rehabilitation program is necessary to achieve desired results. Anatomic and neuromuscular risk factors, often gender related, are the focus of most ACL injury prevention programs.

Anatomic revision ACL reconstruction.

Anterior cruciate ligament (ACL) injuries are common in the athletic population. In fact, ACL reconstruction has become one of the most common orthopedic procedures with over 100,000 being performed annually. As the number of primary ACL reconstructions continues to increase, so will the need for revision surgery. The causes of failure are numerous and multifactorial. However, understanding the exact cause of failure before undertaking a revision ACL surgery is paramount in providing the patient with a successful outcome. It is our belief that anatomic restoration of ACL anatomy in the revision setting is best accomplished using the double-bundle technique in the majority of cases. This is a technically demanding procedure that requires proper preoperative preparation. This article outlines our approach to these challenging situations.

Arthroscopic technique for the evaluation and treatment of posterior shoulder instability.

Posterior instability is becoming an increasingly recognized problem with today's contact athletes. Although not as common as anterior Bankart lesions, posterior capsulolabral pathology can lead to significant instability and pain. Open posterior repair is difficult and results in the literature have been inconsistent. However, there is recent evidence to support arthroscopic repair with capsular placation as a promising solution. Our technique for arthroscopic posterior capsulolabral repair will be reviewed with emphasis on the key aspects for a successful outcome.

Unsuspected non-Hodgkin's lymphoma discovered with routine histopathology after elective total hip arthroplasty.

The utility and cost-effectiveness of routine histologic examination of specimens from elective total joint procedures continues to be a source of debate. We describe a case of unsuspected non-Hodgkin's lymphoma discovered after routine histopathologic examination of a femoral head with osteoarthritis. The evidence both for and against routine tissue submission after elective arthroplasty cases is outlined in a review of the literature. By illustrating a neoplasm that would have been missed without routine pathologic examination, this case underscores a need for continued scrutiny of methods to effectively reduce medical costs while maintaining quality of care.