A comparative study of the effectiveness of an osteopathic primary care sports medicine led intervention on performance in men's collegiate lacrosse players.

CONTEXT: Comprehensive sports medicine care goes beyond the treatment of injuries resulting from athletic activities. Ultimately, it is a competence that includes knowledge in physical therapy, training, nutrition, coaching, motivation, competition, mentoring, psychology, and spirituality that allows the physician and patient to collaborate on promoting the patient's health goals. The current literature demonstrates a lack of knowledge in the Osteopathic Primary Care Sports Medicine Model's effectiveness in performance. OBJECTIVES: To determine whether a comprehensive osteopathic primary care sports medicine approach can improve performance and health outcomes in collegiate athletes. METHODS: A randomized controlled trial commenced just prior to the start of the lacrosse season and concluded at the end of the season. All the New York Institute of Technology (NYIT) collegiate lacrosse players were educated first in a 1-day seminar of the core competencies, and all participants had access to ask questions on their own volition. Then they were randomized into two groups, either the experimental group receiving the direct osteopathic primary care sports medicine intervention (n=18) or the control group not having active intervention (n=19). Also, the overall team winning percentage for that season was computed and compared to that for the previous years and the following year. Participants were assessed before and after the intervention with the Patient Health Questionnaire (PHQ-9), the 36-Item Short Form Survey (SF-36), custom Osteopathic Primary Care Sports Medicine questionnaire, and body fat composition, and their changes were compared between the experimental group and the control group. Collected data were analyzed using the repeated-measures analysis of variance. RESULTS: Thirty-seven participants were enrolled in the study. After 14 participants were excluded due to being lost to follow-up, 23 athlete records were analyzed. The winning percentage of the team was highest during the year of the study period time than in the 3 previous years and the following year. The test group did not have any statistically significant change in the PHQ-9, SF-36, custom Osteopathic Primary Care Sports Medicine questionnaire, as well as in body fat composition. CONCLUSIONS: When used during a collegiate lacrosse season, this Osteopathic Primary Care Sports Medicine intervention did not significantly improve health outcomes. This preliminary study, despite its limitations in compliance and study population size, did demonstrate improvement in overall team performance when comparing the intervention sport season to other seasons but was not statistically significantly. Therefore, further studies are warranted to improve the understanding in this approach to athlete health outcomes and performance.

Characterization of the structure-function relationship at the ligament-to-bone interface.

Soft tissues such as ligaments and tendons integrate with bone through a fibrocartilaginous interface divided into noncalcified and calcified regions. This junction between distinct tissue types is frequently injured and not reestablished after surgical repair. Its regeneration is also limited by a lack of understanding of the structure-function relationship inherent at this complex interface. Therefore, focusing on the insertion site between the anterior cruciate ligament (ACL) and bone, the objectives of this study are: (i) to determine interface compressive mechanical properties, (ii) to characterize interface mineral presence and distribution, and (iii) to evaluate insertion site-dependent changes in mechanical properties and matrix mineral content. Interface mechanical properties were determined by coupling microcompression with optimized digital image correlation analysis, whereas mineral presence and distribution were characterized by energy dispersive x-ray analysis and backscattered scanning electron microscopy. Both region- and insertion-dependent changes in mechanical properties were found, with the calcified interface region exhibiting significantly greater compressive mechanical properties than the noncalcified region. Mineral presence was only detectable within the calcified interface and bone regions, and its distribution corresponds to region-dependent mechanical inhomogeneity. Additionally, the compressive mechanical properties of the tibial insertion were greater than those of the femoral. The interface structure-function relationship elucidated in this study provides critical insight for interface regeneration and the formation of complex tissue systems.

Characterization of the mechanical properties and mineral distribution of the anterior cruciate ligament-to-bone insertion site.

The anterior cruciate ligament (ACL) connects the femur to the tibia through direct insertion sites and functions as the primary restraint to anterior tibial translation. The ACL-to-bone insertion sites exhibit a complex structure consisting of four zones of varied cellular and matrix components, consisting of ligament, non-mineralized fibrocartilage, mineralized fibrocartilage and bone, which allow for the effective load transfer from ligament to bone, thereby minimizing stress concentrations and preventing failure. The mineral content and distribution within the fibrocartilage region may be an important structural component of the insertion site which may influence the mechanical properties. The goals of this study are to characterize the compressive mechanical properties of the fibrocartilage region of the ACL-to-bone insertion site and evaluate how the mineral distribution at the interface relates to these compressive properties. In order to determine the compressive mechanical properties we have utilized a novel microscopic mechanical testing method combined with digital image correlation and employed energy dispersive X-ray analysis (EDAX) in order to evaluate the mineral content and distribution across the femoral and tibial insertion sites. The results reveal that a regional mineral gradient is observed across the fibrocartilage which corresponds to depth-dependent variations in compressive mechanical properties. This depth- dependent mechanical inhomogeneity strongly correlates to the increase in mineral content of the mineralized fibrocartilage (MFC) region compared to the non-mineralized fibrocartilage (NFC). Additionally, the tibial NFC and MFC mechanical properties are greater than those of the femoral NFC and MFC which corresponds to a greater mineral content in the NFC and MFC regions of the tibial insertion. The findings of this study suggest that a structure-function relationship exists at the ACL-to-bone interface.