Effectiveness of a judo-specific injury prevention programme: a randomised controlled trial in recreational judo athletes.

OBJECTIVES: To evaluate the effectiveness of a trainer-supervised judo-specific injury prevention warm-up programme on overall injury prevalence. METHODS: We conducted a two-arm, cluster randomised controlled trial; the Injury Prevention and Performance Optimization Netherlands (IPPON) study. Judo athletes aged≥12 years were randomised by judo school to IPPON intervention or control group who performed their usual warm-up. Primary outcome was overall injury prevalence (%) over the follow-up period (16-26 weeks) measured fortnightly with the Oslo Sports and Trauma Research Centre Questionnaire. A modified intention-to-treat analysis was performed due to COVID-19, with estimates for the primary outcome obtained using generalised linear mixed models. Secondary outcomes included: prevalence of severe injuries, overall incidence, time-loss injuries, exposure, adherence and experiences of trainers and athletes. RESULTS: 269 judo athletes (IPPON: 117, Control: 152) were included. Mean injury prevalence over 16-26 weeks was 23% (95% CI 20% to 26%) in the IPPON and 28% (95% CI 25% to 30%) in the control group. We observed no significant difference of all reported injuries (OR 0.72 in favour of the IPPON group; 95% CI 0.37 to 1.39). Secondary outcomes also demonstrated no significant differences between groups. Specifically, no significant difference of severe injuries was reported (OR 0.80 in favour of the IPPON group; 95% CI 0.36 to 1.78). All trainers and 70% of athletes perceived the IPPON intervention as successful. CONCLUSION: The IPPON intervention did not significantly reduce the overall and severe injury prevalence. Despite this, we suggest the IPPON intervention be considered as an useful alternative to regular judo warm-up, given the high adherence and the positive clinical experiences of trainers and athletes. TRIAL REGISTRATION NUMBER: NTR7698.

Epidemiology of Injuries during Judo Tournaments.

Objective: To determine the injury incidence proportion, distribution of injuries by anatomical location; injury type; injury severity, time loss; mechanism and situations of injuries; and the relative risk of injuries by gender, age, and weight categories during judo tournaments. Study Design. It is a systematic review. Data Sources. A systematic review of the literature was conducted via searches in PubMed, EMBASE, Web of Science, CINAHL, SPORTDiscus, Google Scholar, and PEDro. Eligibility Criteria. All original studies on the incidence of injuries during judo tournaments were included. Results: Twenty-five studies were included out of the 1979 studies. Using the modified AXIS tool score for quality assessment, seven were rated as having good quality, nine were rated as having fair quality, and four were rated as having poor quality. The injury incidence proportion during tournaments ranged from 2.5% to 72.5% for injuries requiring medical evaluation and 1.1% to 4.1% for injuries causing time loss (i.e., inability to continue game participation). The most commonly reported injury location was the head, followed by the hand, knee, elbow, and shoulder. The most frequent types of injury were sprains, followed by contusions, skin lacerations, strains, and fractures. In judo tournaments, injuries were more often sustained during standing fights (tachi-waza) than in ground fights (ne-waza). Conclusion: The tournament injury incidence proportion ranged from 2.5% to 72.5% for injuries requiring medical attention and 1.1% to 4.1% for injuries causing time loss. The head was the most frequently injured body part, and sprain was the most frequent injury type. However, current reports on injuries during judo tournaments are heterogeneous and inconsistent, limiting our understanding of in-match injury risks. Future studies should utilize the guidelines of the International Olympic Committee consensus meeting statement on the methodological approach to injury reporting. We recommend a judo-specific extension of this statement to fit the unique features of judo sports practice.

Long-term results of the uncemented resurfacing shoulder hemiarthroplasty (Global Conservative Anatomic Prosthesis).

BACKGROUND: Treatment with uncemented resurfacing shoulder hemiarthroplasty has proved to be viable for patients with end-stage osteoarthritis at short- and mid-term follow-up. This study was essential to determine whether those outcomes will endure. This study presents the long-term results of the Global Conservative Anatomic Prosthesis (CAP) uncemented resurfacing shoulder hemiarthroplasty (DePuy Synthes, Warsaw, IN, USA). METHODS: All patients with a diagnosis of glenohumeral osteoarthritis and an intact and clinically sufficient rotator cuff who underwent uncemented resurfacing shoulder hemiarthroplasty between 2007 and 2009 were included. The data of all patients who completed the 10-year follow-up assessments were used for analysis. The visual analog scale pain score, Dutch version of the Simple Shoulder Test score, Constant score, Short Form 12 scores, and physical examination findings were evaluated preoperatively and postoperatively on an annual basis. All complications and revisions were documented. Radiographs were evaluated for loosening, luxation or subluxation, migration, and glenoid erosion. RESULTS: Of 48 shoulders, 23 (48%, 18 women and 5 men) were available for the 10-year follow-up assessments and their data were used for analysis. The main reasons for dropout were revision (27%) and death (10%). The mean follow-up period of the remaining patients was 10.9 years (range, 9-13 years). The visual analog scale pain score (from 6.5 ± 2.1 to 0.7 ± 1.6, P < .001), Simple Shoulder Test (Dutch version) score (from 22% ± 22% to 79% ± 22%, P < .001), Constant score (from 40 ± 29 to 70 ± 8, P < .001), and Short Form 12 physical score (from 36 ± 7 to 41 ± 12, P = .001) improved significantly compared with preoperative scores. Revision surgery was performed in 13 of the initial 48 shoulders (27%). Most revisions were seen within 7 years postoperatively. CONCLUSION: Two revisions have been performed in the mid-term to long term because of increased functional outcome scores and the absence of signs of loosening. Nevertheless, the high overall revision rate of 27% between short- and long-term follow-up reflects the need to limit the use of uncemented resurfacing shoulder hemiarthroplasty for the treatment of glenohumeral osteoarthritis.

Systematic development of an injury prevention programme for judo athletes: the IPPON intervention.

OBJECTIVES: To systematically develop an injury prevention programme in judo and test its feasibility: Injury Prevention and Performance Optimization Netherlands (IPPON) intervention. METHODS: We used the five-step Knowledge Transfer Scheme (KTS) guidelines. In the first two steps, we described the injury problem in judo and showed possibilities to reduce the injury rates. In the third step, the Knowledge Transfer Group (KTG) translated this information into actions in judo practice. Expert meetings and practical sessions were held. In the fourth step, we developed the injury prevention programme and evaluated its feasibility in judo practice in a pilot study. As a final step, we will evaluate the injury prevention programme on its effectiveness to reduce injuries. RESULTS: In the first two steps, information collected indicated the need for reducing judo injuries due to high incidence rates. Injury prevention programmes have shown to be effective in reducing injuries in other sports. For judo, no injury prevention programme has yet been systematically developed. In the third step, the KTG reached consensus about the content: a trainer-based warm-up programme with dynamic exercises focusing on the shoulder, knee and ankle. In the fourth step, the intervention was developed. All exercises were approved in the pilot study. Based on the pilot study's results, the IPPON intervention was extended and has become suitable for the final step. CONCLUSION: We developed the IPPON intervention using the systematic guidance of the KTS. This trainer-based programme focuses on the prevention of shoulder, knee and ankle injuries in judo and consists of 36 exercises classified in three categories: (1) flexibility and agility, (2) balance and coordination and (3) strength and stability. The effectiveness and feasibility of the intervention on injury reduction among judo athletes will be conducted in a randomised controlled trial.

Clinical and Radiographic Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Graft and Femoral Cortical Button Fixation at Minimum 20-Year Follow-up.

BACKGROUND: The short-term outcomes of anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone or hamstring tendon (HT) graft are excellent with good clinical stability and patient-reported outcomes. Although some studies have reported the long-term outcomes of bone-patellar tendon-bone graft ACL reconstruction, few have reported the outcomes of HT graft ACL reconstruction. PURPOSE: To assess clinical and radiographic outcomes of HT graft ACL reconstruction with femoral cortical button fixation at a minimum 20-year follow-up. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A prospective study was performed in which all patients undergoing isolated transtibial primary ACL reconstruction between 1994 and 1996 with HT graft and femoral cortical button fixation were assessed clinically and radiographically. Follow-up was obtained in 48 of 94 patients (51%). Median (interquartile range) age at operation was 31 years (26-39 years); median follow-up was 21 years (20-22 years); 65% were male; and 48% had meniscal injury at surgery and underwent partial meniscectomy. Graft rupture, reoperation, and contralateral injury rates were assessed; clinical stability was measured using the KT-1000 arthrometer; patient-reported outcomes were assessed (International Knee Documentation Committee [IKDC], Lysholm, Forgotten Joint Score, Tegner activity, Knee injury and Osteoarthritis Outcome Score [KOOS], Anterior Cruciate Ligament Quality of Life [ACL-QOL], EuroQol 5-Dimension 5-Level [EQ-5D-5L]); and radiographic osteoarthritis (defined as Kellgren-Lawrence grade ≥2) was assessed for the ipsilateral and the contralateral knee. RESULTS: Graft rupture occurred in 4 patients (8%), contralateral injury in 4 patients (8%), and reoperation in 15 patients (31%), which consisted mainly of meniscal tears or hardware removal. In patients with an intact graft, excellent patient-reported outcome measures (PROMs) were noted, with a median Lysholm of 90 (78-100), subjective IKDC of 86 (72-95), and KOOS-Sports of 86 (58-100). There was low awareness of the operated knee (Forgotten Joint Score, 81 [60-96]) and good quality of life (ACL-QOL, 85 [75-94]; EQ-5D-5L, 0.87 [0.83-1.00]). Median side-to-side difference, as measured with the KT-1000 arthrometer, was 1 mm (-1 to 3 mm). Radiographic osteoarthritis was evident in 49% of ipsilateral and 10% of contralateral knees and was associated with meniscectomy at index surgery and decreased PROMs at follow-up. CONCLUSION: Long-term outcomes of transtibial HT graft ACL reconstruction with femoral cortical button fixation are generally good with a low failure rate, low awareness of the operated knee, and good clinical stability. Radiographic osteoarthritis was evident in approximately half of the patients at 20-year follow-up and was associated with meniscectomy at index surgery and decreased PROMs at follow-up.