Prospective study of injury in volleyball players: 6 year results.

BACKGROUND: The volleyball game has a high complexity and thus entails a lot of strain to the players. Due to this high and different training and competition strain comprehensive and individual training plans should be developed with competing training objectives in order to prevent injuries. OBJECTIVE: The aim of the study was to analyse prospectively over six seasons the acute and overuse injuries of a German male professional volleyball team. METHODS: The study included 34 male national league players from season the 2007/08 to 2012/13. All players received a sport medicine examination and a functional diagnosis before each season. Based on the results the players received an individual training plan. RESULTS: The players suffered 186 injuries. The prevalence of acute injuries was 1.94 per player and overuse injuries 0.64 per player. The incidence of acute injuries was 3.3/1000 h volleyball and overuse injuries 1.08/1000 h volleyball. The largest number of injuries was found in the spine. The players had most likely minor injuries. The players had significantly fewer injuries in their second season (1.92) than in their first season (3.25; p= 0.004). CONCLUSION: It could be concluded that volleyball is a sport with a relative low prevalence of injuries compared to other team sports. The prevalence of injury is 2.58 per player. Due to an injury a player dropped out 16.91 days per season. An individual training program seems to reduce the incidence of injury.

Muscle strength of the lumbar spine in different sports.

BACKGROUND: The ability to stabilize the body center (core stability) against dynamic movements of the extremities and capability to absorb repetitive loading forces in the trunk play a crucial role in any professional sport specific performance. OBJECTIVE: The aim our cross sectional level of evidence 3 study was to determine, if athletes of different sport disciplines showed specific trunk strength profiles and if these were different from a control group. METHODS: 20 ironman triathletes, 18 amateur volleyball and 18 amateur soccer players were tested for their individual isometric strength of the lumbar spine in three planes of motion using a standartized test device. RESULTS: The test profile revealed similar strength parameters for extension and lateral flexion to the left in each of the 3 study groups tested. The lateral flexion to the right was significantly stronger than in the control group (soccer > volleyball > triathlon). In all 3 groups, weaknesses were found in the abdominal musculature, showing highly significant differences in flexion and bilateral rotation compared to the control group (p=0.001). CONCLUSIONS: Our study shows that sports specific training for triathlon, as well as the team sports soccer and volleyball, does not lead to balanced trunk musculature and core stability. In consequence predisposing injury and muscle dysbalane can trigger pain syndromes.

[Stress reactions in bones of the foot in sport: diagnosis, assessment and therapy]. / Knöcherne Stressreaktionen des Fusses im Sport: Diagnose, Beurteilung und Therapie.

Stress reactions and stress fractures are defined as structural damage to bone caused by repetitive stress or stereotypical loading. The balance between loading and unloading of bone is disrupted in stress reactions and stress fractures through the sport-specific demands and by the exogenous or endogenous risk factors present. In sports orthopedics the localization of stress reactions and stress fractures are subdivided into high risk fractures and low risk fractures. Conventional diagnostic radiology can initially be inconclusive. With symptoms persisting over 2 weeks further diagnostics using magnetic resonance imaging (MRI) should be performed. In the area of the foot stress reactions and stress fractures can often occur bilaterally or multifocally and most commonly affect the second metatarsals followed by the third metatarsals. Fractures of the fifth metatarsal, second metatarsal base, medial malleolus as well as navicular and sesamoid fractures are high risk fractures requiring special clinical and radiological monitoring. Basically, conservative treatment using the 2-phase model is the treatment of choice. In delayed union or severe pain surgical treatment is indicated.

[Clinical and gait analytical investigation of valgus knee bracing in therapy for medial degenerative joint disease of the knee]. / Klinische und ganganalytische Untersuchung einer valgisierenden Kniegelenkentlastungsorthese in der Therapie der medialen Gonarthrose.

GOALS: The non-operative treatment of medial degenerative joint disease of the knee has proven to be difficult due to the underlying deformity and the pathological mechanical loading. Valgus knee bracing offers the possibility to directly address the mechanical deficit. The aim of this study was to analyse whether or not part-time valgus knee bracing in patients with medial osteoarthrits can effectively reduce knee pain and lead to reproducible changes in the gait analysis in comparison to an elastic knee bandage and an untreated control group. MATERIAL AND METHODS: In a prospective trial, 33 patients with symptomatic medial osteoarthritis of the knee joint with a minimum of grade 2 according to the radiographic classification of Kellegren & Lawrence were randomised into a treatment group with a valgus brace (n = 13; M4 OA®, Medi) and an elastic knee bandage (n = 10; Genumedi®, Medi). Both supportive devices were to be applied for 2-4 hours per day, especially during activity. The control group (n = 10) consisted of untreated individuals. The deviation of the leg axis and the degree of degenerative joint disease were evaluated radiographically at the onset of the study by a standing whole leg X-ray. The evaluation at the beginning of the study and after 16 weeks consisted of a clinical examination including various knee scores (Insall score, Lequesne score, HSS score, Tegner score, WOMAC, and VAS for pain). Additionally, at both times a 3-dimensional, instrumented gait analysis was carried out to document the joint angles of the affected knee in all planes. The obtained knee joint angles from all groups at both time points were compared to a control group of healthy persons without a history of knee pain by qualitative measurement. RESULTS: Radiographically, the medial deviation of the load axis from the knee joint centre (MAD) was 29 mm. In 27 patients we found a combination of femoral, intra-articular and tibial changes contributing to the varus alignment. The joint line conversion angle (JLCA) was pathological in all subjects. Clinically, in 4 of 5 subjective and objective scores (Insall score, Lequesne score, Tegner score, WOMAC, and VAS for pain) a statistically significant improvement of the symptoms, joint function and activity level thanks to the application of the corrective valgus knee brace was documented after 16 weeks. The knee bandage also led to an improvement, but only in 2 scores (Insall score, Tegner score). No changes were documented for the control group. The gait analysis of the orthosis group revealed an improvement in the extension and flexion angles (sagittal plane) and the knee rotation angles (horizontal plane) when compared to a control group. CONCLUSION: The correction obtained by this knee orthosis, which places a valgus stress on the medially osteoarthritic knee, is an effective addition to the conservative treatment protocols and is superior to the isolated use of an elastic knee bandage. Further research is warranted to evaluate the longevity of such treatment and to further improve the technique of gait analysis by the development of quantitative parameters.

[Muscle strength of the cervical and lumbar spine in triathletes]. / Das muskuläre Profil der Halswirbelsäule und der Lendenwirbelsäule bei Langstreckentriathleten.

AIM: The goal of this study was to analyse the muscle strength of the cervical and lumbar spine in ironman triathletes. The values were compared to the results obtained from a reference group. The test of the triathletes was carried out in an attempt to define a specific strength profile for these athletes. METHOD: In this study, 20 long-distance triathletes (∅ 37.3 ± 7.6 years of age, ∅ 1.80 ± 0.1 m, ∅ 73.7 ± 6.0 kg) were evaluated with regard to their individual and sport-specific strengths of the cervical spine in 2 planes and of the trunk strengths in all 3 planes of motion. The trunk strength profile of the triathletes revealed good average results in the trunk extensors and the lateral flexors of the left trunk. The reference group is the data base of the company Proxomed®, Alzenau. It is based on results of 1045 untrained, symptom-free subjects of different ages. RESULTS: Lumbar extension: The extension of the force values shows no significant difference from the reference group. Lumbar flexion: The flexion tests show highly significantly lower force values (5.025 ± 0.81 N/kg vs. 6.67 ± 0.6 N/kg) than the reference group. Flexion/extension: In the sagittal plane values for the triathletes demonstrate an imbalance in muscle strength ratios. The abdominal muscles turn in relation to the back extensor muscles too weakly to be very significant. Lumbar rotation: The force values of the athletes in both directions (right: 6.185 ± 1.46 N/kg, left: 7.1 ± 1.57 N/kg vs. 10.05 ± 0.34 N/kg) are highly significantly (p ≤ 0.001) lower than the reference values. Ratio of rotation left/right: The ratio of left/right rotation in the reference group is set at 1 and thus shows an equally strong force level between the two sides. Lumbar lateral flexion: The triathletes do not show any significant differences between the force values. Compared to the reference group there is no significant difference to the left side flexion. In the lateral bending the athletes have significantly better values than the reference group. Ratio of lateral left/right: In the reference group the ratio is set at 1. For triathletes, it shows an average value of 0.93. This difference is not significant. Cervical extension: The extension of the force values (1.96 ± 0.59 N/kg vs. 3.03 ± 0.24 N/kg) shows a highly significant difference from the reference group. Cervical flexion: In flexion (1.3 ± 0.42 N/kg vs. 2.17 ± 0.22 N/kg) triathletes have highly significantly lower strength values than the reference group. Flexion/extension: The triathletes did not differ significantly from the reference values (0.69 ± 0.23 and 0.72 ± 0.08). Lateral cervical spine: In comparison to the reference group (left: 1.67 ± 0.48 N/kg, right: 1.55 ± 0.46 N/kg vs. 2.36 ± 0.15 N/kg) in which there is left/right lateral flexion, there is a highly significant difference. Right lateral flexion is weaker than the left. Ratio of lateral left/right: The triathletes have a significant imbalance in the lateral flexion of the cervical spine compared to the reference group (1.07 ± 0.15 to 1). CONCLUSION: In conclusion, in the triathlon there is a specific stress that is obviously not an adequate stimulus for the muscles of the cervical spine in order to achieve a balanced musculature and the athletes should be advised to practice a preventive approach with regard to these areas.

[Muscular trunk stability in professional and amateur volleyball players]. / Volleyballspezifische Rumpfmuskelkraft bei professionellen und nicht professionellen Volleyballspielern.

AIM: The aim of this study was to analyse the efficiency of muscular activity in the trunk stabilisation of professional volleyball players compared to a group of amateur hobby players. The results were compared amongst the groups as well as with a reference group consisting of asymptomatic individuals. The question to be answered was whether or not professional volleyball players possess a characteristic strength profile in their trunk musculature and if differences exist with regard to the individuals' competitive playing level. METHOD: In this comparative study 12 professional volleyball players (German Bundesliga) and 18 non-professional volleyball players were analysed with regard to their isometric strength profile in all three planes. The reference group was provided by the Proxomed company, which had previously analysed healthy untrained individuals (n = 1045) of various age groups. RESULTS: A sports-specific profile for the musculature of volleyball players revealed a significant reduction in the flexion and rotation strength as well as a well-developed lateral flexion strength (highly significant when compared to the reference group). With reference to the level played, better strength values in flexion and lateral flexion were found among the professional athletes. CONCLUSIONS: Professional volleyball players present with a characteristic trunk musculature strength profile. A detailed analysis of the muscle strength of the spine as part of a sports medicine work-up could prove helpful in preventing injuries and overuse problems in professional and hobby volleyball players.

[Comparison of trunk muscle strength of soccer players with and without low back pain]. / Vergleich der Rumpfmuskelkraft von Fussballspielern mit und ohne Rückenschmerzen.

AIM OF THE STUDY: Low back pain in soccer players is one of the frequently appearing disorders caused by overuse. Myogenic dysbalances are under discussion as possible reason for this problem. In the present study the muscular strength profile of the trunk musculature of soccer players with and without low back pain was evaluated. The results of the asymptomatic players were compared to those of players with low back pain; furthermore, the collected data were compared to those of an asymptomatic reference group. The question posed was whether soccer players show a specific strength profile caused by the special, sports-specific requirements and whether this strength profile differs between players with and without low back pain. METHOD: In the present study the isometric maximal strength of 18 soccer players with and 18 soccer players without low back pain was measured in all 3 planes. The reference group was provided by the Proxomed company, which had previously analysed 1045 healthy untrained individuals of various age groups. RESULTS: The soccer players showed a sport-specific profile for the musculature, which was determined by a significant reduction of the flexion and rotation strength (flex: Ø 5.21 N/kg vs. Ø 6.49 N/kg; Ø 5.78 N/kg vs. Ø 6.66 N/kg respectively; rotation: left 7.09 N/kg, right 8.69 N/kg vs. left/right 10.1 N/kg; left 7.22 N/kg, right 8.24 N/kg vs. left/right 10.0 N/kg, respectively) as well as by an increased lateral flexion strength to the right-hand side in comparison to the reference group (lat. flex. right: 9.87 N/kg, respectively, 10.67 N/kg vs. 8.3 N/kg). A statistically significant correlation between the muscular activity in the trunk stability of soccer players with and without low back pain could not be shown. CONCLUSION: Obviously sports-specific training with additional specific training of the trunk muscles is not sufficient for the development of a balanced strength of trunk musculature. In the present study an influence of the performance of the trunk musculature on the incidence of low back pain could not be shown.

[Perioperative management in outpatient arthroscopy of the knee joint]. / Perioperatives Management in der ambulanten arthroskopischen Chirurgie des Kniegelenks.

AIM: Nowadays, complex arthroscopic procedures of the knee joint, such as ACL reconstruction, are routinely carried out on an outpatient basis. The reduced time spent with the patient places high demands on the surgeon with regard to the management of such cases. The aim of this study was to evaluate the current standards of perioperative management following outpatient arthroscopic surgery of the knee in Germany. METHODS: A questionnaire consisting of 18 questions was sent to 215 members of the German Association of Outpatient Arthroscopy (BVASK e. V.), dealing with the following topics: antibiotic prophylaxis, DVT prophylaxis, use of a tourniquet and suction drain, physical therapy, physiotherapy, analgesia, anaesthesia and emergency management. More than 51% of the forms were returned and considered suitable for statistical analysis. RESULTS: A total of 62% of the surgeons reported the use of an antibiotic prophylaxis (i. v. single shot) in every arthroscopic case, while 19% administer antibiotics only occasionally, especially in ACL reconstruction. Postoperative antibiotic treatment was reserved for special situations, such as prior joint infection. Prophylaxis of DVT by means of low molecular weight heparin was carried out in 96% of the cases. 51% prescribed anticoagulant agents for 1 week, 39% for the duration of reduced weight bearing. Half of the surgeons used a tourniquet cuff, 22% exsanguinate the limb prior to cuff inflation. A suction drainage was applied by 36% of the surgeons regularly and by 45% occasionally. The drain is left for one day by 79% of the surgeons, while 11% reported a shortened use of only several hours. With regard to analgesia, 66% of all surgeons apply some kind of local anaesthetic into the knee joint post surgery. Systemic preoperative analgesics or anti-inflammatory agents are given regularly in 56 % of the cases. A total of 92% of the procedures are carried out under general anaesthesia. In 36% of the cases, some kind of additional regional peripheral anaesthesia is used. With regard to postoperative care, cryotherapy is considered standard (97%) and 64% of the surgeons recommend physiotherapy. Nearly all surgeons (97%) offer the patients the opportunity to reach them personally via mobile phone during the first night following arthroscopic surgery. CONCLUSIONS: DVT prophylaxis with LMWH, general anaesthesia, postoperative cryotherapy and personal availability by phone can be considered part of the standard perioperative management following outpatient knee arthroscopy in Germany. However, a wide variety of treatment options can be found regarding topics such as analgesia, antibiotic prophylaxis, tourniquet, knee drainage and physiotherapy.

[Influence of sex and side dominance on the results of quantitative, three-dimensional motion analysis of the upper extremities]. / Einfluss des Geschlechts und der Seitendominanz auf die Ergebnisse der quantitativen, dreidimensionalen Bewegungsanalyse der oberen Extremitäten.

AIM: Clinical assessment does not provide objective and quantitative evaluation of the shoulder function. Based on instrumental gait analysis a system for three-dimensional motion analysis of the upper extremities has been developed. The aim of this study is to evaluate the results of instrumental upper extremity motion analysis with respect to dependence on sex and side dominance. METHOD: 16 healthy subjects (8 male, 8 female, mean age 26 years) were included. Three-dimensional motion analysis was carried out with a video-based system and passive markers. All subjects performed two movement tasks representing activities of daily living (task A: reaching the neck, task B: removing a parking token). All joint angles of the upper extremity were recorded and graphically displayed. Additionally, a calculation of quantitative parameters was performed. RESULTS: Contrary to expectations the task "reaching the neck" was not combined with external shoulder rotation. Females performed most of the tasks quicker and with higher reproduction accuracy. Movement reproduction accuracy was rarely dependent on dominance. CONCLUSION: Three-dimensional upper extremity motion analysis of activities of daily living allows a precise and quantitative evaluation of movement patterns. The differences with respect to sex and side in a healthy group have to be respected in studies dealing with comparative shoulder function.

[Procalcitonin (PCT) as diagnostic tool for the monitoring of spondylodiscitis]. / Procalcitonin (PCT) als Verlaufsparameter der Spondylodiszitis.

AIM: The diagnosis of spondylodiscitis is often prolonged, but it is an important differential diagnosis of backache. The discrimination between a bacterial infection and an aseptic inflammation with laboratory examinations like ESG, CRP or leukocytes is not possible. The aim of the present study was to determine the value of procalcitonin (PCT) as a diagnostic tool and monitoring parameter for spondylodiscitis and for the discrimination between bacterial infection and aseptic inflammation of the spine. METHOD: A total of 17 patients with spondylodiscitis and 18 patients with disc herniation as control were included in this study and ESG, CRP, leukocytes, fibrinogen, PNM elastase und PCT were examined for 50 days. The median age was 65 (17-78) years and the ratio of males to females was 8 : 9 in patients with spondylodiscitis and 62 (32-87) years and 7 : 11 in patients with disc herniation. For microbiological examination, CT-guided punctures were performed in patients with spondylodiscitis. RESULTS: In 64 % of the 17 patients with spondylodiscitis a microbiological agent was detected, in 73 % of these cases staphylococcus aureus was isolated. The laboratory parameters indicating an infection were increased except for two cases in patients with spondylodiscitis, the mean value of CRP was 115 mg/dL. Influenced by the therapy these parameters decreased during the observation period. Except for one patient with an infection of a cardiac pacemaker, the PCT concentration was not elevated in both groups (< 0.5 ng/mL). In the group with disc herniation there were no elevated laboratory parameters during the entire observation period. CONCLUSION: PCT is not useful as diagnostic tool or monitoring parameter for spondylodiscitis. Furthermore, it is not useful for the discrimination between a bacterial infection and an aseptic inflammation of the spine.

[Clinical results after three years use of matrix-associated ACT for the treatment of osteochondral defects of the knee]. / Klinische Drei-Jahres-Ergebnisse der matrixgekoppelten ACT zur Behandlung osteochondraler Defekte am Kniegelenk.

AIM: The aim of this study was to examine the clinical results after the treatment of osteochondral defects of the knee with autologous bone grafting and matrix-supported autologous chondrocyte transplantation (ACT). METHOD: In this study 13 patients with osteochondral defects of the knee (12 femoral, 1 tibial) with OCD ICRS grade IV or ICRS grade IV B were included. The osteochondral defects were reconstructed simultaneously with autologous monocortical cancellous bone cylinders or chips from cancellous bone and matrix-supported autologous chondrocyte transplantation (CaReS). Data were analysed in accordance with the ICRS criteria and the Brittberg score. Patients were followed up to 36 months after the operation. RESULTS: The average age of the patients was 34.9 (16 - 47) years at the time of surgery. The size of the defect was 8.1 (3.8 - 13.5) cm(2). The subjective and objective IKDC scores, the Brittberg and the ICRS function score were statistically significantly improved during the observation time. In one patient the transplantation failed and another patient was not available for the follow-up at 36 months. The objective IKDC score and the ICRS function score increased from 0/13 (0 %) to 11/12 (91.7 %) in categories A and B, or I and II, respectively, after 3 years. At this point of time 83.4 % (10/12) of the patients voted the treatment as excellent or good. The subjective IKDC score improved from 38.4 (+/- 12.7) preoperatively to 66.1 (+/- 17.0) after 3 years. CONCLUSION: The treatment of osteochondral defects of the knee with autologous bone grafting and matrix-supported autologous chondrocyte transplantation shows promising results even for larger defects. But for a final decision about this therapy the present sample size was too small. There is a need for further long-term investigation with a larger number of patients.

[Treatment of patellofemoral cartilage defects utilizing a 3D collagen gel: two-year clinical results]. / Die Behandlung femoropatellarer Knorpelschäden mit einem dreidimensionalen Kollagengel: Klinische Ergebnisse im Zwei-Jahres-Verlauf.

AIM: Here we present first clinical results of the treatment of patellofemoral cartilage lesions with a 3D collagen gel (CaReS). METHODS: Isolated patellofemoral cartilage lesions in 14 patients (13 patellar, 1 trochlear) were treated by matrix-based ACT using a collagen gel seeded with autologous chondrocytes. In this study, only those patients were taken into account who complied with the inclusion criteria of the German working group "tissue regeneration and tissue substitutes". Data were analysed in accordance with the ICRS criteria and the Brittberg score. We present the 2-year postoperative clinical follow-up. RESULTS: After 2 years the ICRS-IKDC and Brittberg scores revealed a statistically significant improvement. The preoperative rating of the objectiveIKDC and functional ICRS score improved from 0/14 and 2/14 (14.3%) to 11/14 (78.6%) in the categories A/B and I/II, respectively. 11 Patients(78.6%) judged the clinical outcome as excellent or good. The subjective IKDC score improved from 32.4 +/- 8.4 prior to operation to 67.8 +/- 27.4 at the 2-years follow-up. CONCLUSION: The use of 3D matrix systems could represent a promising improvement of conventional ACT in the treatment of patellofemoral cartilage lesions, but the results have to be verified by long-term investigations.

[First clinical experiences with a novel 3D-collagen gel (CaReS) for the treatment of focal cartilage defects in the knee]. / Erste klinische Erfahrungen mit einem neuartigen dreidimensionalen Kollagengel (CaReS) zur Behandlung fokaler Knorpeldefekte am Kniegelenk.

AIM: In this prospective study we present a novel technique of matrix-based chondrocyte transplantation for the treatment of focal cartilage defects. METHOD: 22 patients with chondral or osteochondral femoral defects were treated with 3D-collagen type-I gel seeded with autologous chondrocytes (CaReS). Overall handling of this novel method is described, and results after 2 years follow-up with regard to the ICRS-score are presented. RESULTS: 14 patients were treated because of a focal chondral lesion, in 8 cases subchondral bone had to be reestablished. The average defect size was 6 cm(2). In all cases cell-seeded matrix samples could be fixed with fibrin glue without any problems. The average surgery time was 69 min, length of the surgical approach was 8.2 cm. No surgery-specific problems had to be observed. A significant improvement in IKDC-score, functional score and overall rating after 3 or 6 months up to 2 years follow-up was detected. After 2 years post-OP 13 Patients were evaluated and matrix-based defect treatment by CaReS was rated good to excellent by 84.6 % of the patients. CONCLUSION: Defect treatment with cell-seeded 3D-collagen gel is easy to handle with a good clinical outcome after 2 years follow-up. Further investigations with higher patient number, longer follow-up time and histological and biomechanical sample analysis are needed in order to establish this method as an improvement of conventional ACT.

Upper trapezius muscle conduction velocity during fatigue in subjects with and without work-related muscular disorders: a non-invasive high spatial resolution approach.

The development of fatigue at the muscle fibre level can be assessed in terms of a decrease in conduction velocity (CV). The present study aimed to investigate if work-related muscular disorders in occupations characterised by static loads of long duration affect fatigue resistance in the painful muscle. A group of eight secretaries suffering from bilateral chronic muscle pain in the shoulder/neck region was compared to a group of healthy subjects. The upper trapezius muscle was studied under isometric contractions, holding the arm in the horizontal plane up to the endurance point. Changes in CV estimated at the motor unit level were investigated using a non-invasive high spatial resolution electromyographic (EMG) approach. In addition, the number of motor unit potentials per second (PPS), and the root mean square (RMS) of bipolar signals were assessed, and the results reported as the mean and standard error for each value. Subjects with work-related disorders showed less pronounced changes in CV with respect to healthy subjects. No differences between subjects with and without work-related disorders were encountered for the PPS and RMS. The present findings on CV indicate an increased fatigue-related recruitment of MUs in the painful muscle with respect to a healthy muscle. The fact that this recruitment is not reflected in the PPS and RMS estimates might be due to a fatigue-induced decrease in the firing rate and/or the de-recruitment of fatigued MUs. Furthermore, methodological limitations of the adopted method in the estimation of 'global' parameters such as the PPS and RMS have to be considered.

[The injury pattern following the introduction of the junior premier league in Germany compared to professional senior football (soccer)]. / Das Verletzungsmuster nach Einführung der A-Junioren-Fussball-Bundesliga in Deutschland im Vergleich zum Senioren-Profi-Fussball.

In 2003 the junior soccer premier league (U19) has been introduced in Germany to increase the competitive level in this group of age (16 - 18 years). It is the aim of this study to compare the injury pattern accompanying this new league of semi-professional junior soccer with a professional senior team. In a retrospective study all traumatic and overuse injuries, responsible for absence from practice or matches, which occurred in two seasons of one junior premier league team were recorded and analyzed. These data were compared to the injury pattern of a professional senior team based on a one-season survey. Overall, more traumatic than overuse injuries were seen. The lower extremity was predominantly affected by both. The ankle joint was the most injured joint. An injury rate of 2.89 per 1000 hours of soccer was calculated for the juniors and 2.35 for the seniors. Junior players missed 15.8 days and seniors 17.1 days of practice or match as result of an injury. Semi-professional junior and professional senior soccer share the same injury patterns with regard to injury rates and types of injuries. Therefore a professional medical care with special emphasis on prophylaxis is warranted in semi-professional junior soccer.

[Risk of injury in and adolescent and junior competitive karate]. / Das Verletzungsrisiko im Jugend- und Juniorenwettkampfkarate.

Increasing professionalism in competitive karate has led to a specific injury pattern. The aim of our study was to investigate the injury pattern in junior competitive karate and to evaluate the prophylactic effect of fist padding. During the 4 (th) Junior World Championships of the World Karate Confederation (WKC) 2004 235 karate fights were observed and injury-related data were recorded. Fist padding was used in 183 fights, 52 fights were carried out without. In 22 % of all fights we saw an injury. Most of them were mild injuries of the head and face: 32 bruises of the face (13 with epistaxis), 7 facial lacerations and 3 concussions (mild brain injury). 14 fights were stopped due to an injury. Only in the category male 18 - 20 years a higher rate of injuries was seen without fist padding (shobu ippon) compared to shobu sanbon (with fist padding). The injury pattern of junior competitive karate is comparable to senior karate. Fist padding does not generally reduce the incidence or severity of injuries.

[Meniscus replacement: current aspects in the field of tissue engineering]. / Meniskusersatz: Aktuelle Aspekte auf dem Gebiet des Tissue engineering.

Tissue engineering offers new opportunities for meniscus repair and replacement. In this field different approaches are being studied to genererate a meniscus subsitute by a combination of a matrix scaffold, cells and specific stimuli. MENISCUS REPLACEMENT BY ACELLUAR MATRICES: For meniscus replacement the matrix material has to meet high biomechanical demands. Besides implant geometry, the material properties and a secure intraarticular attachment are important preconditions for implant function. A collagen scaffold has already been applied clinically for partial meniscus replacement. Scaffolds made of synthetic, bioabsorbable polymers and small intestine submucosa have been employed in animal studies. Following implantation, matrices are invaded by cells and undergo a process of remodeling. Formation of fibrocartilage repair tissue has been observerd. The biomechanical quality of implants and their effect on cartilage preservation have to be studied further. CELLULAR SEEDING OF MATRICES FOR MENSICUS REPLACEMENT: Advanced biological and biomechanical implant quality might be achieved by seeding matrices with cells in vitro. However, the ideal type of cell for this purpose has not yet been identified. Autologous mensicus cells, articular chondrocytes and mesenchymal stem cells represent possible cellular sources. Additional stimuli, such as cytokines and mechanical forces, and techniques of genetic engineering might further contribute to enhance the quality of engineered tissue.

[Competitive karate and the risk of HIV infection--review, risk analysis and risk minimizing strategies]. / Wettkampfkarate und die Gefahr einer HIV-Infektion--Ubersicht, Risikoanalyse und Strategien zur Risikominimierung.

Bleeding facial injuries are not uncommon in competitive karate. Nevertheless, the risk of an infection with HIV is extremely low. Guidelines about the prevention of HIV infections are presented. Especially in contact sports and martial arts the athletes, judges and staff have to recognize and employ these recommendations. Bleeding wounds of the hands due to contact with the opponents teeth can be minimized by fist padding.

[Bacterial osteitis. Special considerations in immunocompromised patients]. / Bakterielle Osteitis. Besonderheiten beim immunkompromittierten Patienten.

With increasing life expectancy and better medical competence, the number of older patients with multimorbidity is growing. Patients with a deficient immune system need more attention during diagnosis and treatment of osteomyelitis.

Transient osteoporosis of the navicular bone in a runner.

INTRODUCTION: Transient osteoporosis or the bone marrow oedema syndrome is described as a self-limiting disorder. Transient osteoporosis usually affects only one bone, predominantly the proximal femur. Involvement of the foot is rare and often overlooked. A disorder of the navicular bone of the foot can be found twice in the literature. MATERIALS AND METHODS: We report a case of transient osteoporosis of the navicular bone of the foot in a 20-year-old, female, top-level track athlete (400 m sprinter) treated with alendronate, and a review of the literature. RESULTS: The therapeutic options are limited, frequently consisting of non-specific, symptomatic therapy. Some authors report favourable results with core decompression, while others have reported good results with a conservative regime of symptomatic treatment and avoidance of weight-bearing until the clinical and radiological changes have resolved. In the described case, the patient had a favourable result after a short course of treatment with alendronate. She experienced almost immediate pain reduction and presented a complete resolution of the abnormal signal intensity on MRI. CONCLUSION: This rapid result makes the use of alendronate seem promising in athletes with transient osteoporosis, permitting an early return to high-level activities.