Three Main Mechanisms Characterize Medial Collateral Ligament Injuries in Professional Male Soccer-Blow to the Knee, Contact to the Leg or Foot, and Sliding: Video Analysis of 37 Consecutive Injuries.

OBJECTIVE: To describe the mechanisms, situational patterns, and biomechanics (kinematics) of medial collateral ligament (MCL) injuries in professional male soccer players. DESIGN: Case series. METHODS: Fifty-seven consecutive MCL injuries across 2 seasons of professional soccer matches were identified. We obtained and reviewed 37 of 57 (65%) injury videos to establish the injury mechanism, situational pattern, and knee flexion angle. We used detailed biomechanical analysis to assess the indirect and noncontact injuries. Injury layoff times, timing of injuries during the match, and location of the injuries on the pitch were also reported. RESULTS: Twenty-three (62%) injuries were direct contact, 9 (24%) were indirect contact, and 5 (14%) were noncontact. Three main sprain mechanisms were noted: (1) direct contact/blow to the knee (n = 16), (2) contact to the leg or foot (lever like) (n = 7), and (3) sliding (n = 9). Seventy-three percent of MCL injuries occurred during 2 main situations: (1) pressing/tackling (n = 14, 38%) and (2) being tackled (n = 13, 35%). For indirect and noncontact injuries, knee valgus loading (100% of cases), hip abduction (73% of cases), and external foot rotation (92% of cases) were prominent injury kinematics, often with lateral trunk tilt (median, 10°; 64% of cases) and rotation (64% of cases). Knee flexion angles were higher for indirect and noncontact injuries (median, 100°) than for direct-contact injuries (median, 22°; P<.01). CONCLUSION: Nearly two thirds of MCL injuries occurred after direct contact; 1 in every 4 MCL injuries occurred after indirect contact. Three sprain mechanisms characterized MCL injuries: (1) blow to the knee, (2) contact to the leg or foot (lever like), and (3) sliding. J Orthop Sports Phys Ther 2021;51(12):611-618. Epub 16 Nov 2021. doi:10.2519/jospt.2021.10529.

Recommendations for Hamstring Function Recovery After ACL Reconstruction.

It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). This requires in part more high-quality original research, but also an approach to translate existing research into practice to overcome the research to implementation barriers. This includes research on ACLR athletes, but also research on other pathologies, which with some modification can be valuable to the ACLR patient. One important consideration after ACLR is the recovery of hamstring muscle function, particularly when using ipsilateral hamstring autograft. Deficits in knee flexor function after ACLR are associated with increased risk of knee osteoarthritis, altered gait and sport-type movement quality, and elevated risk of re-injury upon return to sport. After ACLR and the early post-operative period, there are often considerable deficits in hamstring function which need to be overcome as part of the functional recovery process. To achieve this requires consideration of many factors including the types of strength to recover (e.g., maximal and explosive, multiplanar not just uniplanar), specific programming principles (e.g., periodised resistance programme) and exercise selection. There is a need to know how to train the hamstrings, but also apply this to the ACLR athlete. In this paper, the authors discuss the deficits in hamstring function after ACLR, the considerations on how to restore these deficits and align this information to the ACLR functional recovery process, providing recommendation on how to recover hamstring function after ACLR.

Gnathological postural treatment in a professional basketball player: a case report and an overview of the role of dental occlusion on performance.

AIMS: During competitions and training many professional athletes use to wear occlusal splints to improve their sports performance. However, notwithstanding some studies concluded that achieving a balanced cranial-occlusal system could bring to an improvement of sports performances, the results are still contrasting. Probably the gnathological postural treatment of athletes has greater influence on performance when the individual suffers of Temporomandibular Joint Disfunction (TMJ) or physio-postural pathologies owing to the consequent alteration of the "tonic-postural system". This clinical case details a gnathological postural approach to a professional basketball player suffering from muscular problems related to the stomatognathic apparatus and a low back pain unresolved with the only physiotherapy, which limited her performance. METHODS: Force platform and T-Scan III appliances were used in order to check the postural and occlusal condition of the athlete and as an aid to clinical parameters in achieving a correct splint balance. RESULTS: After the treatment involving inserting an occlusal splint and physiotherapy sessions, the patient no longer complained of low back pain problems and the symptoms associated with the stomatognathic apparatus improved considerably. In particular, after the tests carried out on an isokinetic machine, a force increase related to the quadriceps muscles was detected when the patient was wearing the occlusal splint. CONCLUSIONS: All athletes must however be analysed individually and carefully with clinical and instrumental analyses in order to consider the possible real effectiveness of an occlusal splint for improving postural structure and sports performance.

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.