Epidemiology of Hamstring Tears in National Collegiate Athletic Association Athletes: Findings From the National Collegiate Athletic Association Injury Surveillance Program Between 2014/2015 and 2018/2019.

OBJECTIVE: To describe the epidemiology of hamstring tears in National Collegiate Athletic Association (NCAA) sports. DESIGN: Descriptive epidemiology study. Athletic trainers from NCAA schools reported injuries to the NCAA Injury Surveillance Program. SETTING: A convenience sample of NCAA hamstring tear injuries during the 2014/2015 through 2018/2019 academic years. PATIENTS OR PARTICIPANTS: NCAA student-athletes. INDEPENDENT VARIABLES: Sport, sex, event type, season segment, injury history, and activity at the time of injury. MAIN OUTCOME MEASURES: Injury counts, rates, and proportions were used. RESULTS: Two thousand ninety-six hamstring tears from 8 474 400 athlete-exposures (AEs) were reported (2.47 per 10 000 AEs). Rates were highest in Men's Soccer (5.97 per 10 000 AEs) and Women's Soccer (3.13 per 10 000 AEs), among all Men's and Women's sports, respectively. Competition-related rates in Men's and Women's sports were highest in 2015 to 2016 then followed a decreasing pattern across the remainder of the study period. Among sex-comparable sports, rates were higher in men's (compared with women's) Baseball/Softball, Soccer, and Track and Field. The prevalence of recurrent injuries was comparable among men's (14.8%) and women's (11.5%) sports. Time loss hamstring tears were more prevalent in Men's sports than Women's sports [injury proportion ratio = 1.33; 95% confidence interval, (1.21, 1.47)]. CONCLUSIONS: Overall, hamstring tear rates were higher across all Men's sports compared with Women's sports. Rates across event type were comparable in several sports; and so, adjustments to practice are needed considering that practice environments are more modifiable than competitions. Indeed, improving hamstring tear prevention programs to reduce the burden of this injury in NCAA athletes remains critical.

The psychological effects of sports disruptions in NCAA Division I and II athletes during the COVID-19 pandemic: a mixed methods analysis.

BACKGROUND: Improving mental health outcomes in college athletics requires better understanding of how student-athletes respond to stress-inducing events. METHODS: Using a cross-sectional design, this study aimed to assess student-athletes' mental health status during the COVID-19 pandemic. Eligible participants (N.=489) included Division I and II student-athletes at least 18 years of age with plans to compete in the 2020-2021 sport season. Participants completed an online battery of psychological health surveys. RESULTS: Survey results suggested high psychological strain (APSQ: 20.58±8.08), mild symptoms of anxiety (GAD-7: 7.66±5.51) and depression (PHQ-9: 7.51±5.65), and burnout (ABQ: 2.37±0.96). CONCLUSIONS: A subset of student-athletes reported symptoms of psychological strain, depression, and anxiety warranting follow-up clinical evaluation and/or treatment according to scoring guidelines. Findings encourage psychological screening, particularly during sport-disrupting events, to better support athletes' mental health during high-stress conditions.

The psychological effects of event cancellation in Olympic-level swimmers: preliminary findings and mental health screening recommendations.

BACKGROUND: Mental health screening of elite athletes is not routinely practiced following the cancellation of an athletic event. Though sporting event cancellation has negative career and training impacts on elite athletes, little is known about its psychological impact. To determine the extent to which sporting event cancellation might warrant psychological screening practices in elite athletics, this study evaluated elite-level swimmers' response to the cancellation of the 2020 Olympic Games through psychological assessment and qualitative interviewing. METHODS: A cross-sectional study design was implemented. Online psychological assessment included self-report scales to measure anxiety, burnout, psychological strain, and optimism/pessimism. Follow-up semistructured telehealth interviews were conducted to assess appraisals of and coping responses to the cancellation. RESULTS: Of the 14 participants assessed for mental health symptoms, 12 were available for interview procedures. Results (mean±SD) indicated "very high" psychological strain (22.71±4.83) and "mild" anxiety (6.29±4.87). All swimmers exhibited levels of psychological strain that warranted clinical evaluation per established cut-off scores. Thematic content analysis of interviews generated four themes: precancellation evaluations, primary appraisals, coping responses, and coping outcomes. Most swimmers exhibited maladaptive coping (75%); however, adaptative coping was as prevalent (92%), particularly through use of support networks. Most swimmers achieved positive coping outcomes (75%) and maintained strong 2021 Olympic-qualifying confidence (93%). In contrast, swimmers with poor coping outcomes (25%) employed more frequent maladaptive coping strategies and exhibited higher psychological distress. CONCLUSIONS: Findings urge sports medicine clinicians to implement psychological screening protocols in elite athletes following the cancellation of a major sporting event to attend to symptoms of psychological distress and to direct appropriate psychological intervention.

Technique for Reduction and Fixation of a Hoffa Fracture with Ipsilateral Patella Dislocation from Low-Energy Trauma, a Rare Injury: A Case Report.

CASE: A 25-year-old man sustained a right femur Hoffa fracture with an ipsilateral patella dislocation from a twisting injury to his right knee. He underwent open reduction and internal fixation of the right femur with medial patellofemoral ligament (MPFL) reconstruction with allograft. One year postoperatively, he had returned to full activity and painless range of motion. CONCLUSION: Hoffa fracture associated with ipsilateral patella dislocation is a rare injury in young men and warrants judicious clinician awareness. The literature regarding management of this injury combination is minimal, and this report aids in awareness while providing an effective method for treatment.

Ligamentous Lisfranc Injury: A Biomechanical Comparison of Dorsal Plate Fixation and Transarticular Screws.

OBJECTIVES: Optimal fixation technique after purely ligamentous Lisfranc injury remains controversial. This biomechanical study compares dorsal plate versus transarticular screw fixation by measuring dorsal and plantar joint diastasis. A unique protocol was developed, using reflective triad markers and positional cameras. METHODS: Eleven cadaveric matched pairs were assigned to either transarticular screw or dorsal plate fixation. Two reflective triad markers were placed into the medial cuneiform (C1) and second metatarsal base (MT2). Three cameras recorded the 3-dimensional location of triads to quantify C1-MT2 diastasis in the following states: intact Lisfranc ligament (INTACT), cut ligament (CUT), fixed (SCREW or PLATE) joint, and fixed joint after 10,000 loaded cycles. On completion, the plantar Lisfranc ligament insertions were identified, and plantar diastasis was determined using additional reflective triads. Statistical post hoc pairwise comparisons assessed differences in diastasis. RESULTS: C1-MT2 diastasis in the CUT state increased relative to INTACT (P < 0.001). SCREW fixation reduced C1-MT2 diastasis relative to CUT at dorsal (P < 0.007) and plantar (P = 0.015) locations after cycling. PLATE fixation significantly reduced dorsal diastasis relative to CUT (P < 0.001) but not for plantar diastasis (P > 0.99). PLATE plantar diastasis was numerically higher than INTACT but not significantly (P > 0.39). PLATE plantar diastasis tended to be greater than SCREW before cycling (P = 0.068) and after cycling (P = 0.080). CONCLUSIONS: Transection of the Lisfranc ligament complex yielded C1-MT2 diastasis. Both SCREW and PLATE fixation successfully reduced dorsal diastasis. However, upon load, the PLATE resulted in greater plantar diastasis, nearly statistically different relative to the SCREW. Cyclic loading at 343 N did not worsen diastasis.

Thoracic Spine Manipulation in Individuals With Subacromial Impingement Syndrome Does Not Immediately Alter Thoracic Spine Kinematics, Thoracic Excursion, or Scapular Kinematics: A Randomized Controlled Trial.

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To determine if thoracic spinal manipulative therapy (SMT) alters thoracic kinematics, thoracic excursion, and scapular kinematics compared to a sham SMT in individuals with subacromial impingement syndrome, and also to compare changes in patient-reported outcomes between treatment groups. BACKGROUND: Prior studies indicate that thoracic SMT can improve pain and disability in individuals with subacromial impingment syndrome. However, the mechanisms underlying these benefits are not well understood. METHODS: Participants with shoulder impingement symptoms (n = 52) were randomly assigned to receive a single session of thoracic SMT or sham SMT. Thoracic and scapular kinematics during active arm elevation and overall thoracic excursion were measured before and after the intervention. Patient-reported outcomes measured were pain (numeric pain-rating scale), function (Penn Shoulder Score), and global rating of change. RESULTS: Following the intervention, there were no significant differences in changes between groups for thoracic kinematics or excursion, scapular kinematics, and patient-reported outcomes (P>.05). Both groups showed an increase in scapular internal rotation during arm raising (mean, 0.9°; 95% confidence interval [CI]: 0.3°, 1.6°; P = .003) and lowering (0.8°; 95% CI: 0.0°, 1.5°; P = .041), as well as improved pain reported on the numeric pain-rating scale (1.2 points; 95% CI: 0.3, 1.8; P<.001) and function on the Penn Shoulder Score (9.1 points; 95% CI: 6.5, 11.7; P<.001). CONCLUSION: Thoracic spine extension and excursion did not change significantly following thoracic SMT. There were small but likely not clinically meaningful changes in scapular internal rotation in both groups. Patient-reported pain and function improved in both groups; however, there were no significant differences in the changes between the SMT and the sham SMT groups. Overall, patient-reported outcomes improved in both groups without meaningful changes to thoracic or scapular motion. LEVEL OF EVIDENCE: Therapy, level 1b-.

Immediate changes in pressure pain sensitivity after thoracic spinal manipulative therapy in patients with subacromial impingement syndrome: A randomized controlled study.

BACKGROUND: Thoracic SMT can improve symptoms in patients with subacromial impingement syndrome. However, at this time the mechanisms of SMT are not well established. It is possible that changes in pain sensitivity may occur following SMT. OBJECTIVES: To assess the immediate pain response in patients with shoulder pain following thoracic spinal manipulative therapy (SMT) using pressure pain threshold (PPT), and to assess the relationship of change in pain sensitivity to patient-rated outcomes of pain and function following treatment. DESIGN: Randomized Controlled Study. METHODS: Subjects with unilateral subacromial impingement syndrome (n = 45) were randomly assigned to receive treatment with thoracic SMT or sham thoracic SMT. PPT was measured at the painful shoulder (deltoid) and unaffected regions (contralateral deltoid and bilateral lower trapezius areas) immediately pre- and post-treatment. Patient-rated outcomes were pain (numeric pain rating scale - NPRS), function (Pennsylvania Shoulder Score - Penn), and global rating of change (GROC). RESULTS: There were no significant differences between groups in pre-to post-treatment changes in PPT (p ≥ 0.583) nor were there significant changes in PPT within either group (p ≥ 0.372) following treatment. NPRS, Penn and GROC improved across both groups (p < 0.001), but there were no differences between the groups (p ≥ 0.574). CONCLUSION: There were no differences in pressure pain sensitivity between participants receiving thoracic SMT versus sham thoracic SMT. Both groups had improved patient-rated pain and function within 24-48 h of treatment, but there was no difference in outcomes between the groups.

Anticipating problems unique to revision ACL surgery.

Anterior cruciate ligament (ACL) injuries are common in the athletic population. In fact, ACL reconstruction has become one of the most common orthopedic procedures. With the increasing number of primary ACL reconstructions being performed combined with the continued expectations of high-level athletes, revision ACL reconstruction is likely to become more frequent. Revision ACL reconstruction poses several diagnostic and technical challenges compared to primary reconstructions. The purpose of this article is to highlight problems that are unique to revision ACL reconstruction such as tunnel malposition, tunnel widening, preexisting hardware, and injuries to concomitant structures in the knee. Recognizing and avoiding these pitfalls are crucial to obtaining a successful result after revision ACL reconstruction.

Current concepts in ACL Injuries.

Anterior cruciate ligament (ACL) injuries are common in athletic and physically active populations, and can result in significant functional disability. Female athletes in particular have been found to be at a relatively high risk for noncontact ACL injuries. Many risk factors, both intrinsic and extrinsic, have been identified. Although some individuals may be treated nonoperatively with an aggressive rehabilitation program, athletes desiring to return to physical activities that require use of the ACL need surgical reconstruction. Surgical techniques remain controversial in regard to tunnel placement and optimal graft choices. Recent literature advocates a more oblique ACL reconstruction to more closely recreate normal knee kinematics and eliminate pathologic rotational laxity. A supervised and intensive rehabilitation program is necessary to achieve desired results. Anatomic and neuromuscular risk factors, often gender related, are the focus of most ACL injury prevention programs.

Anatomic revision ACL reconstruction.

Anterior cruciate ligament (ACL) injuries are common in the athletic population. In fact, ACL reconstruction has become one of the most common orthopedic procedures with over 100,000 being performed annually. As the number of primary ACL reconstructions continues to increase, so will the need for revision surgery. The causes of failure are numerous and multifactorial. However, understanding the exact cause of failure before undertaking a revision ACL surgery is paramount in providing the patient with a successful outcome. It is our belief that anatomic restoration of ACL anatomy in the revision setting is best accomplished using the double-bundle technique in the majority of cases. This is a technically demanding procedure that requires proper preoperative preparation. This article outlines our approach to these challenging situations.

Arthroscopic technique for the evaluation and treatment of posterior shoulder instability.

Posterior instability is becoming an increasingly recognized problem with today's contact athletes. Although not as common as anterior Bankart lesions, posterior capsulolabral pathology can lead to significant instability and pain. Open posterior repair is difficult and results in the literature have been inconsistent. However, there is recent evidence to support arthroscopic repair with capsular placation as a promising solution. Our technique for arthroscopic posterior capsulolabral repair will be reviewed with emphasis on the key aspects for a successful outcome.

Reverse end-to-side neurotization in a regenerating nerve.

Bypass grafting around a neuroma-in-continuity entails coapting a nerve graft above and below the injured segment using two sequential end-to-side repairs. The proximal repair is analogous to what has been classically described as an end-to-side repair; the axons from the intact nerve sprout into the end of a recipient nerve and travel distally. At the distal connection, however, axons in the graft must enter the side of the intact nerve and find their way to appropriate end organs. This process has not been well investigated. To examine this, a reverse end-to-side repair, suturing the distal end of the peroneal nerve to the side of a transected and repaired tibial nerve, was performed in 20 rats. A primary end-to-end repair of the tibial nerve was performed in 10 additional rats. Twelve weeks later, contraction forces of the gastrocnemius muscle were measured following proximal stimulation. Measurements were repeated following elimination of potential axonal pathways to identify which axons (peroneal or tibial) had achieved greater reinnervation. The results indicated that both groups of axons had achieved significant reinnervation. This study supports the idea that a reverse end-to-side repair can result in axonal invasion of an intact but regenerating nerve and achieve functional recovery.

Unsuspected non-Hodgkin's lymphoma discovered with routine histopathology after elective total hip arthroplasty.

The utility and cost-effectiveness of routine histologic examination of specimens from elective total joint procedures continues to be a source of debate. We describe a case of unsuspected non-Hodgkin's lymphoma discovered after routine histopathologic examination of a femoral head with osteoarthritis. The evidence both for and against routine tissue submission after elective arthroplasty cases is outlined in a review of the literature. By illustrating a neoplasm that would have been missed without routine pathologic examination, this case underscores a need for continued scrutiny of methods to effectively reduce medical costs while maintaining quality of care.