A comparison of three methods for establishing an ACL reference length in vivo.

As anterior cruciate ligament (ACL) injuries are highly prevalent among active individuals, it is vital to better understand the loading conditions which lead to injury. One method for doing so is through measurement of dynamic, in vivo ACL strain. To measure strain, it is necessary to normalize elongation of the ACL to a 'reference length' which corresponds to the point at which the ligament transitions from being unloaded to carrying tension. The purpose of this study was to compare the length of the ACL in three different positions to evaluate their utility for establishing a reference (or zero-strain) length of the ACL. ACL reference length was determined using three different methods for each of ten healthy participants. Using magnetic resonance and biplanar radiographic imaging techniques, we measured the length of the ACL during supine resting, quiet standing, and anterior/posterior (AP) drawer testing. During the AP drawer testing, the slack-taut transition point was defined as the inflection point of the AP translation vs ACL elongation curve. There was good consistency between the three ACL length measurements (ICC=0.80). Differences in mean ACL length between the three methods were within 1 mm. While determining the precise zero-strain length of the ACL in vivo remains a challenge, the reference positions utilized in this study produce consistent measurements of ACL length. These findings are important because reliable measurements of in vivo ACL strain have the potential to serve as indicators of propensity for injury.

Electromyographic activity of shoulder muscles on two preventive exercise programmes for swimmer's shoulder: elastic band versus weight.

Strength programmes have shown good results in preventing swimmer's shoulder. However, there aren't studies based on electromyographic (EMG) analysis in these programmes. This study aims to compare an EMG activity of the middle trapezius (MT), lower trapezius (LT), infraspinatus (IS), serratus anterior (SA), and pectoralis major (PM) in two swimmer's shoulder preventive programmes - one performed with elastic band and the other with weights. Twenty competitive swimmers performed two strength programmes consisting of five exercises each, while the analysis of EMG activity in MT, LT, IS, SA, and PM for each exercise was recorded. The superficial EMG was used to collect data at a sampling frequency of 1000 hz. The Paired Sample T-test or the Wilcoxon test was applied to compare EMG activity between programmes. The internal rotation at 90º (p < 0.001) and external rotation at 90º (p ≤ 0.01) exercises produced high myoelectric shoulder muscle activity with an elastic band. Conversely, scapular punches (p < 0.001) exercise has high shoulder EMG activity when performed with weights. Performing the same preventive exercise programme with two different instruments produces great variability in the myoelectric activity of the shoulder muscles.

Is the Frequency of a Targeted Neuromuscular Training Program a Factor in Modifying Knee Joint Loading During Typical Netball Landing Tasks?

BACKGROUND: Unplanned sidestep cutting and forward single-leg jump-landing contribute to non-contact anterior cruciate ligament (ACL) injuries in netball. Neuromuscular training programs (NMTPs) have shown promising results in reducing injury risk in certain populations when compliance is high. Compliance is easier to achieve when NMTPs are effective yet require minimal time for completion. HYPOTHESIS: Once- and thrice-weekly intervention groups would be equally effective in reducing knee abduction and internal rotation moments during forward single-leg jump landing and unplanned sidestep cutting. STUDY DESIGN: Randomized controlled trial. LEVEL OF EVIDENCE: Level 3. METHODS: External peak knee abduction and peak knee internal rotation moments during unplanned sidestep cutting and forward single-leg jump-landing were assessed pre- and post-intervention for 17 elite-level female netballers assigned randomly to either a once-weekly or thrice-weekly group. Regular netball training continued throughout the intervention, which lasted 6 weeks (30 minutes/session). One-way analysis of covariance (α = 0.05) was utilized to compare post-intervention peak knee abduction and peak knee internal rotation moments between groups, controlling for pre-intervention knee moments during the forward single-leg jump-landing and unplanned sidestep cut. Paired t tests were used to examine within-group changes in knee moments pre- versus post-intervention. RESULTS: For unplanned sidestep cuts on the right leg, both groups differed significantly, with the once-weekly group displaying a decrease in peak knee internal rotation moments [F(1,14) = 5.23; P = 0.04] whereas the thrice-weekly group did not. No other significant group interactions were found. CONCLUSION: A condensed NMTP with targeted exercises, performed once-weekly as part of regular training, shows potential to reduce peak knee internal rotation moments that are injurious to the ACL during unplanned sidestep cutting in adult female netballers. CLINICAL RELEVANCE: A once-weekly targeted NMTP would pose minimal disruption to a high-performing athlete's training schedule and likely increase compliance to ensure the success of the NMTP.

Clinical Utility of Qualitative Change of Direction Movement Assessment in ACL Injury Risk Evaluation.

Anterior cruciate ligament (ACL) injuries are complex and influenced by numerous internal and external risk factors that should be considered to effectively mitigate injury and facilitate informed return to sport decision-making. Among these risk factors, movement quality exhibited during sport-specific tasks has been identified as a significant predictor of injury occurrence. Particularly, change of direction (COD) movements, when performed with sub-optimal movement quality, such as knee valgus and lateral trunk flexion, are prominent mechanisms of ACL injury in multidirectional sports. Unfortunately, the formal and objective assessment of COD movement quality is underutilized in clinical and sports practice, with existing methods often confined to expensive, sophisticated laboratory settings impractical for everyday clinicians. The purpose of this clinical commentary is to demonstrate the necessity of integrating COD movement assessments to screen for potential ACL injury risk, particularly among higher-risk populations. The authors will review cost-effective and clinic-friendly objective tests used to qualitatively screen COD movements, such as the Cutting Movement Assessment Score and The Expanded Cutting Alignment Tool. Additionally, this commentary will discuss key considerations when assessing COD movement. Level of Evidence: 5.

Cross-Cultural Adaptation, Feasibility, Reliability, and Validity Tests of the Chinese Version of Ankle Ligament Reconstruction-Return to Sport After Injury Scale.

Background: The Ankle Ligament Reconstruction-Return to Sport After Injury (ALR-RSI) scale can be utilized for assessing patients who have previously sustained lateral ankle ligament injury before returning to sport. Given its original development for use in different languages, it is essential to translate and validate this scale for application to the Chinese population. Purposes: To translate and culturally adapt the ALR-RSI scale into a Chinese version and assess its reliability and validity. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: The procedure of translation and cross-cultural adaptation was performed following the recommended guidelines and the Chinese version of ALR-RSI (ALR-RSI-CHN) was conducted in patients with lateral ankle ligament surgery. Feasibility was assessed by floor/ceiling effects. Reliability was assessed by using Cronbach α as a measure to analyze internal consistency, while the intraclass correlation coefficient was utilized to examine test-retest reliability. Validity was assessed by using Spearman coefficients to analyze the correlations between ALR-RSI-CHN, the Karlsson scale, and the American Orthopaedic Foot and Ankle Society (AOFAS) scale. Results: A total of 66 participants were included. The ALR-RSI-CHN scale showed good feasibility with no floor/ceiling effects. The internal consistency of the scale was adequate with a Cronbach α of 0.93, and test-retest reliability was excellent with an interclass correlation coefficient of 0.97 (95% CI, 0.92-0.99). The ALR-RSI-CHN scale demonstrated moderate correlation with the Karlsson scale (r = 0.48 [range, 0.26-0.65]) and strong correlation with the AOFAS scale (r = 0.55 [range, 0.35-0.71]). A significant difference in ALR-RSI-CHN scores was observed between patients who returned to sports and those who did not, with respective scores of 53.60 (range, 44.50-62.69) and 42.25 (range, 35.51-49) (P = .04). Conclusion: The study demonstrated that the ALR-RSI-CHN scale had satisfactory psychometric properties, rendering it a feasible, reliable, and valid instrument for evaluating patients who have lateral ligament surgery in China.

Prevalence and associated factors of non-traumatic shoulder pain during spike and serve movements in male high school volleyball players: a cross-sectional study.

BACKGROUND: Nontraumatic shoulder pain is a prevalent issue among male high school volleyball players, but its comprehensive assessment has been lacking in prior research, which often isolated specific aspects of shoulder function. This study aimed to identify contributing factors to shoulder pain in this population. HYPOTHESIS: The hypothesis posited that limited shoulder internal rotation (IR) range of motion (ROM), imbalance in rotator cuff muscle strength, intrinsic sensory disturbance, and joint stability are associated with shoulder pain in male high school volleyball players. Additionally, there was an anticipation that a substantial proportion of players would experience shoulder pain but refrain from reporting it to coaches. METHODS: Forty-nine male volleyball players aged 15-17 years were evaluated between February and June 2023. Questionnaires assessed the prevalence of shoulder pain during spiking and/or serving, as well as the frequency of reporting this pain to coaches. Various factors, including acromio-humeral distance, shoulder ROM, isometric strength, proprioception, joint stability (Upper Quarter Y-Balance Test), joint position sense, and upper extremity power (Seated Medicine Ball Throw Test; SMBT), were quantified. Logistic regression analyses was conducted to explore potential connections between these variables and shoulder pain. RESULTS: Shoulder pain was reported by 39% of participants, but it was rarely communicated to coaches (95%). Jump serves (odds ratio 1.84, p=0.02) and reduced shoulder IR ROM (odds ratio 0.94, p=0.03) were associated with shoulder pain. CONCLUSION: This study provides crucial insights into the prevalence, severity, and associated factors of shoulder pain among male high school volleyball players. The findings underscore the importance of improving athlete-coach communication to facilitate early intervention and preventive measures. Significant associations were observed between the use of jump serves, reduced shoulder internal rotation range of motion, and shoulder pain, highlighting the relevance of specific volleyball techniques in injury prevention. These findings offer valuable guidance to coaches and trainers in developing interventions aimed at mitigating the risk of shoulder pain and enhancing player performance.

A systematic review and network meta-analysis on the effectiveness of exercise-based interventions for reducing the injury incidence in youth team-sport players. Part 1: an analysis by classical training components.

OBJECTIVES: The primary purposes were (a) to estimate the pooled effects of injury prevention programs (IPPs) on reducing overall and some specific body regions (lower extremity, thigh, knee, and ankle) injury incidence rates (IIRs) and (b) to compare the effects of single- and multi-component IPPs on mitigating injury risk in youth team sport athletes. A secondary objective was to explore the individual effects of different components on these IIRs. MATERIALS AND METHODS: Searches were performed up to 15 January 2024 in PubMed, Web of Science, SPORTDiscus, and Cochrane Library. Eligible criteria were: exercise-based interventions evaluated against a control group, overall IIRs were reported, and youth (≤19 years old) team sport players. Two reviewers extracted data and assessed trial quality using the Consolidated Standards of Reporting Trials (CONSORT) statement, the Physiotherapy Evidence Database Scale (PEDro), and a risk of bias tool (Cochrane Back and Neck Group). Pooled effects were calculated by Frequentist random effects pairwise and network meta-analyses. RESULTS: Twenty-one studies were included. IPPs reduced overall, lower extremities, thigh, knee, and ankle IIRs by an average of approximately 35%. Most of the IPPs demonstrated statistically significant risk mitigation effects for overall and lower extremity injuries compared to control group. Interventions comprised exclusively of strength ([IRR = 0.3 [95%CI = 0.10-0.93]) and flexibility (IRR = 0.49 [95%CI = 0.36-0.68]), as well as those including stability exercises, were the most effective measures for reducing injuries in youth team sports. CONCLUSIONS: The implementation of current IPPs in training sessions for several weeks has shown to be an effective strategy for reducing the risk of injury in youth team sport athletes by one-third. Indirect evidence suggests that strength, flexibility, and stability might be exercise components with the highest risk mitigation effects; however, more research is crucial to confirm our estimates with direct evidence.

Injury prevention programs could reduce around one-third the incidence of injuries occurring in youth team sport athletes.Strength, flexibility, and stability seem to be key exercise-based components to be included in any training program aimed at minimizing the risk of injury in youth.Further research comparing head-to-head injury prevention programs in youth athletes is needed to make more founded conclusions on their true risk mitigation effects.

Innovative approaches beyond periprocedural hydration for preventing contrast-induced acute kidney injury.

Contrast-induced acute kidney injury (CI-AKI) is a major concern in clinical practice, particularly among high-risk patients with preexisting renal and cardiovascular conditions. Although periprocedural hydration has long been the primary approach for CI-AKI prevention, recent advancements have led to the development of novel approaches such as RenalGuard and contrast removal systems. This editorial explores these emerging approaches and highlights their potential for enhancing CI-AKI prevention. By incorporating the latest evidence into clinical practice, health-care professionals can more effectively maintain renal function and improve outcomes for patients undergoing contrast-enhanced procedures.

Comprehensive analysis of traumatic rupture of the aorta in road traffic crashes: incorporating epidemiological insights and K-prototype clustering.

OBJECTIVES: The identification of crash characteristics associated with traumatic rupture of the aorta (TRA) can significantly enhance countermeasures against TRA. Conventional epidemiological approaches struggle to adequately handle the substantial variability of traffic crash data. Consequently, this study aims to integrate conventional epidemiological analysis with data-driven cluster analysis to more comprehensively analyze TRA-related crash characteristics. METHODS: A total of 350 unweighted TRA crashes were extracted from traffic crash databases including comprehensive crash details and injury descriptions. Initially, a selection was made of 11 continuous variables and 9 categorical variables, describing crash characteristics. After correlation analysis and principal component analysis were applied to the dataset, K-prototype clustering was finally conducted using 6retained categorical variables and 6 principal components derived from the continuous variables. RESULTS: This study found significant age and gender disparities among TRA victims, with 50% falling within the age range of 25-59 years and an overwhelming majority (62.2%) being males. Side impacts emerged as the primary cause of TRA-related crashes (37.2%), followed by collisions with off-road objects (28.6%) and head-on collisions (24.8%). Cluster analyses revealed 6 distinct clusters within the TRA-related crash dataset. These clusters were characterized by factors such as vehicle model year, curb weight, collision dynamics, and seatbelt usage, providing a deeper understanding of the heterogeneity in TRA incidents and their associated factors. CONCLUSIONS: Although limitations related to available data sources and factors such as accompanying injuries and vehicle weight warrant further comprehensive investigations in the future, this study contributes valuable insights into TRA analysis to enhance understanding and prevention strategies.

Intrinsic Risk Factors for Noncontact Anterior Cruciate Ligament Injury in Young Female Soccer Players: A Prospective Cohort Study.

BACKGROUND: Previous studies have attempted to determine prognostic factors for predicting the occurrence of noncontact anterior cruciate ligament (ACL) injuries. However, studies on risk factors for noncontact ACL injuries in Asian female soccer players are limited. PURPOSE: To identify intrinsic risk factors for noncontact ACL injuries among young female Asian soccer players. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: This study evaluated 145 female Japanese soccer players for potential risk factors for noncontact ACL injury during the preseason medical assessment. In total, 25 variables were examined-including anthropometric data, joint range of motion, muscle flexibility, muscle strength, and balance measurements. Participants were monitored throughout a single season for noncontact ACL injuries diagnosed by physicians. RESULTS: Noncontact ACL injuries occurred in 13 knees of 13 players (9%). Lower hamstring-to-quadriceps ratio (0.44 ± 0.07 vs 0.50 ± 0.10; P = .04), greater knee extension muscle strength (3.2 ± 0.5 vs 2.7 ± 0.5 N·m/kg; P < .01), and longer playing experience (10.8 ± 3 vs 8.1 ± 4.2 years; P = .02) were significantly associated with new-onset noncontact ACL injuries in young female soccer players. No statistically significant between-group differences were found for any other variables. CONCLUSION: New-onset noncontact ACL injury in young female soccer players was significantly associated with lower hamstring-to-quadriceps ratio, greater knee extension muscle strength, and longer soccer experience. These findings will help develop strategies for preventing noncontact ACL injuries among female soccer players.

Demographic and Injury Characteristics as Potential Risk Factors for Anterior Cruciate Ligament Injuries: A Multicentric Cross-Sectional Study.

Background: Anterior cruciate ligament (ACL) injuries are prevalent and can have debilitating consequences, with various factors potentially influencing their occurrence. This multicentric study aimed to comprehensively analyze the epidemiological characteristics of ACL injuries. We hypothesized that specific patient characteristics, such as age, sex, body mass index (BMI), and sports involvement, would be associated with distinct injury patterns and risk profiles. Methods: This cross-sectional study analyzed the medical records of 712 patients aged 15-60 diagnosed with ACL rupture. Data on demographics, injury mechanisms, associated injuries, graft type, and sports involvement were collected. Results: The majority of patients were male (93.1%), aged 15-30 years (80.2%), and overweight (66.7%). Autografts were the predominant graft choice (96.07%). Associated injuries were present in 79.5% of cases, with medial meniscus ruptures being the most common (37.36%). Sports-related (49.3%) and non-sports-related (50.7%) injuries were nearly equal, with non-contact injuries more prevalent (71.1%). In the sports-related subgroup, associated injuries emerged as a significant risk factor for ACL rupture (p = 0.014, OR = 1.596, 95% CI: 1.101-2.314), whereas non-contact mechanisms showed borderline significance (OR = 0.75, p = 0.09). Moreover, younger athletes were more susceptible to sports-related injuries (p = 0.024), with football being the primary sport involved. Conclusions: This study identified a high prevalence of concomitant injuries with ACL injury, which increased the risk of ACL injury, particularly in sports-related cases. Age-related differences in injury patterns highlight the need for age-appropriate preventive measures, especially for younger athletes participating in high-risk sports. This underscores the need for comprehensive injury assessment, targeted prevention strategies, and optimized clinical management approaches tailored to different populations' specific characteristics and risks.

Coaching the coaches: exploring the effectiveness of the 'Move Well Be strong' youth injury prevention programme for grassroot coaches and PE teachers.

INTRODUCTION: Coaches play a major role in developing movement in their performers, especially at grassroots levels. However, there are significant knowledge gaps amongst grassroots coaches and physical education (PE) teachers regarding movement competency and injury prevention programs. This study aimed to explore the effectiveness of knowledge gain, adoption and implementation following a youth injury prevention workshop for grassroots coaches and PE teachers. METHODS: 56 grassroots coaches and PE teachers completed a validated questionnaire exploring use, knowledge, attitude towards and confidence to deliver youth movement competency training before and after an online workshop. Bayesian Wilcoxon signed-rank tests were used to assess the knowledge, attitude, and confidence to deliver an injury prevention programme following the workshop. For all the Bayesian inference tests run, the Bayesian factor (BF10) was interpreted using the evidence categories ranging from extreme evidence (BF10 > 100) to anecdotical evidence (BF10 < 1). RESULTS: Post-workshop there was a 34% increase in respondents indicating that they had greater knowledge of injury prevention issues (55% pre-workshop vs 89% post-workshop) with statistically positive and moderate effects (BF10 > 100 [extreme evidence]). There was also a 25% increase in respondents indicating that they had a more sympathetic attitude towards injury prevention (67% sympathetic pre-workshop vs 93% sympathetic post-workshop) with statistically moderate effects (BF10 = 87.4 [very strong evidence]). A 19% increase in attendees' confidence to deliver an injury prevention programme was observed (69% high pre-workshop vs. 89% high post-workshop) with statistically moderate effects (BF10 = 85.9 [very strong evidence]). 100% of participants indicated an intent to adopt the injury prevention programme. CONCLUSIONS: An online workshop increased knowledge and confidence in grassroots coaches and PE teachers to deliver a youth injury prevention programme. Knowledge gained from training and upskilling created a positive attitude and confidence to deliver movement competency into coaching. Appropriate resources need to be developed and delivered in an accessible way to grassroots coaches and PE teachers via workshops and should be included in governing body coaching awards or as continuing professional development for youth coaches and PE teachers.

Retirements of professional tennis players in ATP and WTA tour events.

Professional tennis competition at the highest levels requires high physical, technical, tactical, and mental demands. Player retirement is a scenario that often occurs at the highest echelons of the game. The objective of this study was to descriptively determine which factors influence retirement of matches in tennis. Matches from the Women's Tennis Association (WTA) and Association of Tennis Professionals (ATP) tours played over 44 and 46 years were included in the study, respectively. The results showed an increasing trend in the incidence of retirements in both ATP and WTA events, especially in recent years. Factors associated with the match characteristics, such as the type of surface, the type of tournament, and the round of the draw, were shown to influence retirement. Variables associated with player characteristics, such as the age difference between players, did not show to influence retirement, whereas the ranking difference did. When comparing ATP and WTA matches, similar results were observed in which surfaces and tournaments had the highest or lowest incidence of retirements. On the other hand, as per the rounds, the results are not conclusive. The findings highlight the growing trend of match retirements in professional tennis and emphasize the relevant influence of match characteristics such as surface type, tournament type, and round of the draw. These insights can guide coaches, players, and tournament organizers in developing strategies to mitigate retirements and inform future research on enhancing player longevity and performance in tennis.

Reliability of a Musculoskeletal Assessment for the Examination of Cervical Spine Pain and Injuries in Special Forces Combat Soldiers.

An assessment of protocol reliability is an essential step prior to human subject testing for injury prevention. The purpose of this study was to examine the inter-rater and intra-rater reliability of a portable cervical range of motion and isometric strength protocol designed for special forces combat soldiers who are at risk for cervical spine pain and injury due to exposure to head-supported mass. Eight individuals were tested three times to assess reliability, the standard error of the measurement (SEM), and the minimal detectable change across six range of motion measures and six strength measures of the cervical spine. One tester tested all participants twice for intra-rater reliability, and a second tester assessed the participants to examine inter-tester reliability. All reliability measures demonstrated good to excellent reliability (ICC = 0.70-0.96 (isometric strength); ICC = 0.85-0.94 (range of motion)). All SEM scores were 12% or lower for all reliability measures. The findings of this study demonstrate that the protocol developed for a longitudinal multi-site study is reliable and appropriate to implement for injury prevention in military personnel.

Effect of ESC (electronic stability control) on tree and pole impacts with focus on rear impacts.

Objective: The effect of ESC (Electronic Stability Control) was investigated for the rate of crash exposure, serious injury and fatality in pole and tree impacts. Field data was analyzed by crash type (front, side, rear and rollover) and model year (MY) before, during and after the implementation of ESC. Methods: The number of pole and tree impacts was determined for four groups of vehicle model years (MY): 1981-1989 MY and 1990-2002 MY before the introduction of ESC, 2003-2009 during the phase-in of ESC and 2010-2020 MY after essentially all vehicles were equipped with ESC. Collisions were grouped by front, side, rear and rollover. Three databases were analyzed: 1990-2020 FARS, 1990-2015 NASS-CDS and 2017-2020 CISS. Vehicle registration was obtained from IHS Markit to determine the rate of pole and tree impacts per 100,000 registered vehicles. The same vehicle selection criteria was used for vehicle registration and crash data. Results: Fatalities dropped 65.2 % (95 % CI, 63.0-67.4 %), z = 43.7, p < 0.001 into poles and 60.3 % (95 % CI, 59.0-61.5 %), z = 72.4, p < 0.001 into trees in vehicles equipped with ESC comparing 1990-2002 MY to 2010-2020 MY vehicles. Seriously injured occupants in crashes with poles dropped 75.9 % (95 % CI, 75.0-76.9 %), z = 116, p < 0.001 between 1990 and 2002 MY and 2010-2020 MY vehicles. There was a 65.2 % (95 % CI, 64.4-65.9 %), z = 141, p < 0.001 reduction in tree impacts. The crash exposure to pole impacts dropped 36.0 % (95 % CI, 35.8-36.3 %), z = 252, p < 0.001 from 80.77/100,000 registered vehicles in 1990-2002 MY vehicles to 51.69/100,000 in 2010-2020 MY vehicles. There was a 61.0 % (95 % CI, 60.8-61.2 %), z = 434, p < 0.001 reduction in tree impacts. For rear impacts, fatalities dropped 82.9 % (95 % CI, 71.3-94.4 %), z = 9.37, p < 0.001 into poles and 74.8 % (95 % CI, 67.8-81.9 %), z = 14.8, p < 0.001 into trees. Serious-injury in rear impacts with poles and trees were essentially eliminated in 2010-2020 MY vehicle crashes. There were significant drops in fatalities in side and frontals impacts and rollovers in vehicles equipped with ESC. Conclusion: ESC helps the driver maintain vehicle heading and significantly reduced the rate of serious injury and fatality in off-road impacts with poles and trees. The benefits of ESC may not be realized with impairments when the driver does not appropriately steer the vehicle.

Evaluating the impact of occupational noise exposure on workplace fatal and nonfatal injuries in the U.S. (2006-2020).

OBJECTIVES: This study assessed the relationship between occupational noise exposure and the incidence of workplace fatal injury (FI) and nonfatal injury (NFI) in the United States from 2006 to 2020. It also examined whether distinct occupational and industrial clusters based on noise exposure characteristics demonstrated varying risks for FI and NFI. METHODS: An ecological study design was utilized, employing data from the U.S. Bureau of Labor Statistics for FI and NFI and demographic data, the U.S. Census Bureau for occupation/industry classification code lists, and the U.S./Canada Occupational Noise Job Exposure Matrix for noise measurements. We examined four noise metrics as predictors of FI and NFI rates: mean Time-Weighted Average (TWA), maximum TWA, standard deviation of TWA, and percentage of work shifts exceeding 85 or 90 dBA for 619 occupation-years and 591 industry-years. K-means clustering was used to identify clusters of noise exposure characteristics. Mixed-effects negative binomial regression examined the relationship between the noise characteristics and FI/NFI rates separately for occupation and industry. RESULTS: Among occupations, we found significant associations between increased FI rates and higher mean TWA (IRR: 1.06, 95% CI: 1.01-1.12) and maximum TWA (IRR: 1.10, 95% CI: 1.07-1.14), as well as TWA exceedance (IRR: 1.04, 95% CI: 1.01-1.07). Increased rates of NFI were found to be significantly associated with maximum TWA (IRR: 1.06, 95% CI: 1.04-1.09) and TWA exceedance (IRR: 1.03, 95% CI: 1.01-1.05). In addition, occupations with both higher exposure variability (IRR with FI rate: 1.49, 95% CI: 1.23-1.80; IRR with NFI rate: 1.40, 95% CI: 1.14-1.73) and higher level of sustained exposure (IRR with FI rate: 1.27, 95% CI: 1.12-1.44; IRR with NFI rate: 1.21, 95% CI: 1.05-1.39) were associated with higher rates of FI and NFI compared to occupations with low noise exposure. Among industries, significant associations between increased NFI rates and higher mean TWA (IRR: 1.05, 95% CI: 1.02-1.08) and maximum TWA (IRR: 1.06, 95% CI: 1.04-1.08) were observed. Unlike the occupation-specific analysis, industries with higher exposure variability and higher sustained exposures did not display significantly higher FI/NFI rates compared to industries with low exposure. CONCLUSIONS: The results suggest that occupational noise exposure may be an independent risk factor for workplace FIs/NFIs, particularly for workplaces with highly variable noise exposures. The study highlights the importance of comprehensive occupational noise assessments.

The Effect of Blood Flow Restriction during Low-Load Resistance Training Unit on Knee Flexor Muscle Fatigue in Recreational Athletes: A Randomized Double-Blinded Placebo-Controlled Pilot Study.

Background/Objectives: Despite the growing popularity of training with a controlled form of vascular occlusion, known as blood flow restriction (BFR) training, in the rehabilitation of orthopedic patients and sports medicine, there remains ample space for understanding the basis of its mechanism. The pilot study assessed the effect of BFR during a low-load resistance training unit on knee flexor muscle fatigue, intending to decide whether a larger trial is needed and feasible. Methods: The study used a prospective, randomized, parallel, double-blind, placebo-controlled design. Fifteen male healthy recreational athletes were randomly assigned to three equal groups: BFR Group, Placebo Group, and Control Group. The primary outcome was the change in the surface electromyography-based (sEMG-based) muscle fatigue index, which was determined by comparing the results obtained before and after the intervention. The intervention was the application of BFR during low-load resistance training for knee flexors. The occurrence of any adverse events was documented. Results: In all groups, the sEMG-based fatigue index for semitendinosus and biceps femoris muscles decreased after low-load resistance training, with the largest decrease in the BFR group. Although not statistically significant, BFR showed moderate and large effect sizes for the fatigue index of semitendinosus and biceps femoris, respectively. No adverse events were noted. Conclusions: The pilot study suggested that BFR during a low-load resistance training unit might affect knee flexor muscle fatigue, supporting the development of a larger randomized clinical trial.

The Relationship between Training Load and Injury Risk in Basketball: A Systematic Review.

The relationship between training load and injury risk in basketball is an important area in sports injury prevention and performance enhancement; however, there is limited conclusive evidence of their associations. The aim of this systematic review was to examine the evidence of the relationship between training load and injury risk in basketball, which is one of the most common sports worldwide. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted on the PubMed, SCOPUS, and Web of Science databases up until March 2024. The search aimed to identify studies that prospectively and/or retrospectively examined the relationship between training load and injury risk in basketball. Inclusion criteria were limited to studies published before February 2024. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale and Oxford Centre for Evidence-Based Medicine levels of evidence. A narrative synthesis of the findings was performed. A total of 14 articles met the inclusion criteria and were included in the review. Of these, 11 studies reported at least partially statistically significant results, providing evidence of a relationship between training load and injury risk. In conclusion, the findings of this review suggest a clear relationship between training load and injury risk in basketball.

Athlete Health Implications of Match Injuries in Portuguese Rugby Union.

OBJECTIVE: Our aim was to report time-loss match injuries in Portugal's "Divisão de Honra" (Portuguese first tier) in the 2022/2023 season, focusing on injury incidence, burden, anatomical region, and type, to assess their impact on athletes' health and availability to play. METHODS: A prospective cohort study was conducted monitoring injuries via an online form filled in by each team's medical department, categorizing player position, as well as injury type, location, and severity. Incidence and burden were calculated per 1000 player-match-hours. RESULTS: The overall injury incidence was 54.4 injuries per 1000 player-match-hours (95% CI 30.3-96.2). Forwards had higher injury incidence than backs. Lower limbs were the most affected locations-29 injuries/1000 h of exposure (95% CI 13.7-52.0). Sprain/ligaments injuries were the most common type of injury (14.4 injuries/1000 h (95% CI 3.7-30.0), followed by muscle injuries (8.1 injuries/1000 h 95% CI 4.9-11.5). DISCUSSION: Injury incidence was higher than what is reported in amateur competitions and lower than for professionals. Injury severity was similar to that in other studies. Our study suggests a lower injury burden than in other semi-professional and elite leagues. These findings highlight the need for targeted injury prevention strategies in the Portuguese Rugby Union to increase athletes' availability by decreasing injury incidence and/or burden. Further research with broader participation and training injury data is needed.

Fluorescence-guided laparoscopic inguinal hernia repair using indocyanine green angiography to prevent iatrogenic vascular injury: A case report and video.

INTRODUCTION: Laparoscopic inguinal hernia repair (LIHR) is one of the most common surgical procedures performed worldwide, associated with a roughly 10 % rate of complications, most commonly iatrogenic injury to blood vessels, sometimes necessitating conversion to open surgery. Fluorescence-guided laparoscopic surgery using indocyanine green fluorescence angiography (ICG-FA) facilitates the precise identification of numerous anatomical structures, especially vascular, reducing their risk of iatrogenic injury. We present the first published case and video demonstrating LIHR with ICG-FA to prevent intra-operative vascular injury. PRESENTATION OF CASE: A 46-year-old, otherwise-healthy male with a right inguinal hernia underwent fluorescence-guided LIHR using ICG-FA. Before peritoneal dissection, 2 ml ICG was administered intravenously, followed by 10 ml physiological solution. The surgical field was then illuminated using the Stryker fluorescence system. Once vascular structures were located, the sac was dissected. After reversing the peritoneum, but before placing the extraperitoneal mesh, another dose of ICG was administered intravenously to aid in safely securing the mesh. Both times after ICG injection, both the iliac artery and spermatic arteries were clearly visible throughout their course in the surgical field within 45 s. The hernia was repaired successfully with no complications. DISCUSSION: ICG-FA appears to facilitate inguinal hernia repair by enabling real-time visualization of anatomical structures, theoretically reducing the risk of complications, particularly vascular injuries. It is particularly helpful identifying the inguinal area's highly-vascular 'triangle of doom'. CONCLUSIONS: Further studies are warranted to evaluate short- and the long-term outcomes and cost-effectiveness of ICG-fluorescence angiography during laparoscopic inguinal hernia repair.