Incidence of staff injury and illness at the Tokyo 2020 and Beijing 2022 Olympic and Paralympic Games.

Objective: To report epidemiological data regarding injury and illness among the Team USA staff during the Tokyo 2020 Summer Olympic and Paralympic Games and Beijing 2022 Winter Olympic and Paralympic Games. Methods: A retrospective review of all Team USA staff (total staff, N=1703 (62.5% female); total staff days (SD)=34 489) medical encounters during the Tokyo 2020 Games and Beijing 2022 Games was conducted. Details related to injury and illness were evaluated. Incidence with 95% CI per 1000 staff days were calculated. Results: A total of 32 illnesses (incidence [95% CI] 0.9 [0.6, 1.2]) and 23 injuries (incidence 0.7 [0.4, 0.9]) were sustained by the Team USA delegation staff members during the Tokyo 2020 Games and Beijing 2022 Games. Female staff reported more illnesses (illnesses proportion (IP) 2.9%; incidence 1.4 [0.8, 2.0]), while male staff incurred more injuries (IP 1.8%; incidence 0.9 [0.5, 1.3]). When stratified by physiological system, dermatological and infectious were the most common systems involved with illness (IP 0.5%; incidence 0.2 [0.1, 0.4]). Injuries to the upper limb were most common (IP 0.3%; incidence 0.3 [0.1, 0.5]). Conclusion: Injury and illness rates among the Team USA staff during the Tokyo 2020 Games and Beijing 2022 Games were low, but notable. Knowledge of injury and illness risks contributes to staffing decisions and prevention strategies for staff supporting athletes during competition.

Team USA injury and illness incidence at the 2022 Beijing Winter Olympic and Paralympic Games.

OBJECTIVE: The purpose of this study was to determine the injury and illness incidence from Team USA athletes from the 2022 Beijing Winter Olympic and Paralympic Games and assess any sex-based differences or differences between Olympic and Paralympic athletes. METHODS: Team USA Olympic (n=231, 48.5% female) and Team USA Paralympic (n=63, 22.2% female) athletes had medical encounters documented during the Games. Injuries and illnesses were defined according to the 2020 International Olympic Committee Consensus Statement and reviewed for accuracy by a physician. Incidence rates were calculated per 1000 athlete-days and further analysed by sex, sport, anatomical location, type of illness, injury event and injury mechanism, with incident rate ratios (IRRs) used for group comparisons. RESULTS: There were no differences in illness (Olympic illness, IRR=0.99 (95% CI 0.48 to 2.07), p=0.998; Paralympic illness, IRR=1.43 (95% CI 0.41 to 4.97), p=0.572) or injury rates (Olympic injury, IRR=0.63 (95% CI 0.39 to 1.03), p=0.062; Paralympic injury, IRR=1.01 (95% CI 0.43 to 2.35), p=0.988) between male and female (reference group) athletes. However, Olympic athletes had significantly lower illness (IRR=0.41 (95% CI 0.22 to 0.76), p=0.003) and injury (IRR=0.56 (95% CI 0.37 to 0.87), p=0.009) risks compared with Paralympic athletes. CONCLUSION: No significant sex-related differences in injury or illness were detected in Team USA Olympic or Paralympic participating in the 2022 Beijing Winter Games. However, Paralympic athletes exhibited higher rates of injury and illness compared with their Olympic counterparts. This study highlights delegation-specific epidemiological data which may facilitate more focused approaches for injury and illness prevention.

Etiology and Prevention of Common Injuries in Golf.

ABSTRACT: Golf is a popular sport played by individuals of varying age and skillsets. The golf swing is unique and complex, creating potential for various musculoskeletal injuries in both amateur and professional golfers. Understanding the basic biomechanics of the golf swing and its relation to injury etiology can assist the health care provider in recognizing and preventing musculoskeletal injuries secondary to golf. Most injuries occur in the upper limb and the lumbar spine. This review describes musculoskeletal pathologies seen in golfers with respect to anatomic area and golf swing biomechanics, while summarizing effective prevention strategies and swing modifications to address these potential injuries.

Platelet-Rich Plasma Injection for Thumb Carpometacarpal Joint Osteoarthritis.

Objective: To assess the effects of platelet-rich plasma (PRP) injection among patients with thumb carpometacarpal (CMC) joint osteoarthritis (OA). Design: Retrospective chart review with follow-up questionnaires/surveys. Post-procedure, patients were sent standardized, automatically-generated follow-up questionnaires, and contacted for a survey regarding patient-reported outcomes. Setting: Single institution (tertiary care hospital) outpatient clinic from 2015 to 2020. Participants: Nineteen adult patients (9 women; average age 65.0 [±6.3 years]) who received a PRP injection for OA of 1 or both thumb CMCs (N=19). Interventions: Platelet-rich plasma injection. Main Outcome Measures: Outcome measures included symptom improvement (subjective, visual analog scale), duration of benefit, subsequent procedures, satisfaction, and side effects/adverse events. Cellular composition of whole blood and PRP injectate (platelets, erythrocytes, leukocytes, neutrophils, lymphocytes, and monocytes) were analyzed. Results: Subjects reported moderate or excellent symptom improvement in 68.8% of injected joints and were moderately or very satisfied with 68.8% of the procedures. Mean patient-reported duration of benefit was 15.6 months (±19.5) months (mean duration of follow-up: 32.4 [±18.1] months). There were no major complications attributed to the procedures, but 1 patient was diagnosed with presumed unrelated lymphoma 2 weeks post-procedure. PRP mean platelet concentration was 1787.77 (±687.14) × 109/L, resulting in a mean platelet concentration factor of 8.80 (±4.19) times baseline and mean platelet dose of 1881 × 106. Other PRP cell concentration factors were erythrocytes, 0.02; neutrophils, 0.14; lymphocytes, 3.76; and monocytes, 3.29. Conclusions: PRP injection appears to be a safe and potentially effective treatment option for pain related to first CMC OA. Further study is needed to optimize treatment protocols and better understand which patients are most likely to benefit.

Mixed Martial Arts: Comparing the King-Devick and Sport Concussion Assessment Tool 5 in knockouts, technical knockouts and choke holds.

Objective: To compare validity indices of the King-Devick (KD) test and Sport Concussion Assessment Tool 5 (SCAT5) for traumatic events in MMA, and to determine if perfusion events (alterations in consciousness as the result of choke holds) cause similar changes in KD/SCAT5 scores. Design: A prospective cohort study in MMA fighters who completed KD and SCAT5 assessments before and after a match. Outcomes were categorized as non-event, traumatic event, or perfusion event. KD/SCAT5 changes were compared between all athletes. Participants: One hundred forty MMA athletes (7 women, 133 men), mean age=27.1 ± 4.9 years. Intervention: N/A. Main outcome measures: King-Devick (KD) test and Sport Concussion Assessment Tool 5 (SCAT5). Results: Among the 140 athletes, 19 sustained traumatic and 15 perfusion events. Testing provided sensitivities/specificities of 21.05%/93.39% (KD) and 77.78%/52.99% (SCAT5) in detecting a traumatic event. KD and SCAT5 Symptom Severity scores differed between athletes with and without traumatic events (P=.041 and .014). KD and SCAT5 Symptoms Score changes were observed between athletes with and without traumatic events (P=.023 and .042). Neither KD nor SCAT5 differed significantly between athletes with and without perfusion events. Conclusions: The KD test provides high specificity and the SCAT5 demonstrates reasonable sensitivity when detecting a traumatic event. Of the SCAT5, symptoms-related scores may most effectively identify a traumatic event. A traumatic event may cause KD/SCAT5 changes similar to a concussion, while perfusion events did not.

Prospective, Single-blind, Randomized Controlled Trial to Evaluate the Effectiveness of a Digital Exercise Therapy Application Compared With Conventional Physical Therapy for the Treatment of Nonoperative Knee Conditions.

OBJECTIVE: To evaluate the effectiveness and adherence of a home exercise therapy program using a digital exercise therapy application (DETA) compared with conventional physical therapy (PT). DESIGN: Parallel group, randomized controlled trial. SETTING: Two clinics in a tertiary care academic center. PARTICIPANTS: Participants (N=60) were enrolled within 1 week after a provider visit for knee pain. Inclusion criteria: age 18-75 years, knee pain diagnosis, and clinician-prescribed PT. INTERVENTIONS: Participants were randomized to complete either an 8-week intervention of conventional PT (enrolled n=29; complete n=26) or the DETA (enrolled n=31; completed n=24). MAIN OUTCOME MEASURES: Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Physical Function (PF) scores implemented via computer adaptive tests; number of exercise sessions completed per week (adherence). RESULTS: Compared with the PT group, the DETA group reported significant decreases in PROMIS-PI scores (-6.1±6.7 vs -1.5±6.6, P<.05, d=0.78) and increases in PROMIS-PF scores (6.0±6.6 vs -0.8±5.8, P<.01, d=0.89) after 8 weeks. No group differences in adherence were observed (P>.05). CONCLUSIONS: Use of this DETA resulted in greater pain and functional improvements compared with PT, with no differences in adherence. It is possible this application may be a viable alternative to conventional PT in certain cases. A larger sample from various geographic locations is needed to improve generalizability and for subgroup analysis. Further investigation is warranted to determine the factors responsible for the differences observed between the groups.

The Significance of a "Close" Margin in Extremity Sarcoma: A Systematic Review.

Background: An important measure of successful sarcoma treatment is the surgical tumor margin, yet defining and reporting the tumor margin has remained a source of controversy. Our study sought to determine whether there is a need to be more specific in classifying a margin by distinguishing a 'close' margin, or if simply calling a margin positive or negative is sufficient. Methods: We performed a comprehensive literature search in which all studies were reviewed independently by two separate reviewers. Studies eligible for inclusion and data analysis consisted of those that reported on at least ten patients with a primary sarcoma of the extremities who received limb-salvage or amputation surgery with a report of the final surgical margin as well as the histologic grade. Only studies that provided local recurrence outcomes with a minimum follow-up of two years were included. Results: Our literature search and article exclusion process resulted in 22 articles that contained 498 patients for data analyses. We found that the Enneking classification system distinguishes between intralesional, marginal, and wide/ radical margins, and that a close margin behaves closer to a positive margin than a negative margin. When all tumors were analyzed, a marginal margin gave a recurrence rate of 50.48% compared to an intralesional margin recurrence rate of 75.76% and a wide/ radical margin of 7.22%. A marginal margin set to a positive margin gave the highest sensitivity compared to comparing marginal margins to wide and intralesional margins alone. This was also observed when tumors were stratified into high-grade osteosarcomas treated with chemotherapy. In addition, we found that chemotherapy dramatically reduced local recurrence rates in osteosarcoma. Conclusions: Our literature search and data analysis showed that the Enneking classification system was able to give more information on local recurrence compared to a simple dichotomous system, and therefore may be considered a more successful predictor of treatment outcomes. As a result, this investigation may lead a suggestion of a practice-changing proposal of how surgical margins in sarcoma should be reported universally amongst multiple disciplines and institutions.Level of Evidence: II.