Prevention of Non-Contact Anterior Cruciate Ligament Injuries among Youth Female Athletes: An Umbrella Review.

Anterior cruciate ligament (ACL) injuries account for a large percentage of knee injuries, disproportionately affecting female athletes. To help health professionals stay current, we performed an umbrella review to evaluate the effectiveness of ACL injury prevention programs in reducing non-contact ACL injury rates, determine the effective components within interventions, and provide clinical recommendations. Twelve databases (Medline, Embase, Cochrane Database of Systematic Reviews, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, PEDro, Web of Science Core Collection, Epistemonikos, TRIP, BC Guidelines and Protocols, CPG Infobase, ProQuest Dissertations and Theses Global) were searched in May 2021 to identify relevant systematic reviews and meta-analyses. Four databases were searched again in September 2021 to identify recent primary literature. Non-contact ACL injury data were extracted to calculate incidence rate ratios (IRRs) and these were combined using an inverse variance random-effects model. A qualitative assessment of included reviews was performed. The methodological quality of the studies was assessed using a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) or Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). Sixteen reviews and two primary studies met the inclusion criteria. Across 11 primary studies, prevention programs were effective in reducing non-contact ACL injuries by 64% (IRR = 0.36 (95% CI: 0.18-0.70)). A multi-faceted exercise program, beginning in the pre-season and containing at least three exercise types, may be beneficial in reducing ACL injury risk.

Epidemiology of all-complaint injuries in youth basketball.

This study evaluated the incidence and characteristics of all-complaint injuries, including acute and overuse injuries, in female and male youth basketball players. A total of 518 players (16 ± 1.4 years; 38.6% females), from 63 teams, participated in this prospective cohort study. Players were observed through one competitive high school or club basketball season to record exposure and all-complaint injuries, defined as any complaint resulting from participating in basketball-related activities, including but irrespective of the need for medical attention or time loss. Injury incidence rates and rate ratios were derived from Poisson's regression with 99.4% CI (Bonferroni's correction for multiple comparisons). The overall injury incidence rate was 14.4 (99.4% CI: 12.2-17.0) injuries/1000 h; 13.8 (99.4% CI: 11.2-16.8) in females and 14.8 (99.4% CI: 11.7-18.8) in males. While the incidence of injury was similar across injury classifications for female and male players, a potential lower overuse knee injury rate was noted for females vs males [IRR = 0.61 (99.4% CI: 0.34-1.07)]. The most commonly injured body location was the ankle (45%) in females and the knee (51%) in males. Overuse (vs acute) injuries were about 2x more common in the knee while acute (vs overuse) injuries were about 3x more common in the ankle, overall, and for female and male players. Based on an all-complaint injury definition, injury rates in competitive female and male youth basketball players are much higher than previously reported. This study provides an evidence base to inform more tailored interventions to reduce injuries in youth basketball.

Internal and External Workload in Youth Basketball Players Who Are Symptomatic and Asymptomatic for Patellar Tendinopathy.

OBJECTIVE: To examine the differences in external and internal workload in players with and without patellar tendinopathy. DESIGN: Nested case-control study. METHODS: Workload was monitored in 152 players (aged 13-18 years) for a 1-week period, including all practices, games, and conditioning sessions. Players were prescreened into patellar tendinopathy cases and controls without patellar tendinopathy, using the previously validated Oslo Sports Trauma Research Center-patellar tendinopathy questionnaire. Simple linear regression analysis, with adjustment for clustering by team and Bonferroni correction, was used to examine mean differences in measures of external workload (cumulative jump counts and sessions completed) and internal workload (session rating of perceived exertion in arbitrary units) between cases and controls. RESULTS: A total of 144 players (19 cases, 125 controls) met the inclusion criteria for final analysis. No significant differences were found between players with patellar tendinopathy and those without patellar tendinopathy in the 3 outcomes: jump count (mean difference, 45 jumps; 98.3% confidence interval [CI]: -41, 130; P = .177), basketball sessions completed (mean difference, 0.9; 98.3% CI: -0.3, 2.2; P = .067), and session rating of perceived exertion (mean difference, 346 arbitrary units; 98.3% CI: -459, 1151; P = .260). CONCLUSION: In the current study, a significant difference in workload was not detected between youth basketball players with patellar tendinopathy and players without patellar tendinopathy. Efforts toward identifying players at early stages of patellar tendinopathy and applying relevant interventions are warranted. J Orthop Sports Phys Ther 2020;50(7):402-408. Epub 6 Sep 2019. doi:10.2519/jospt.2020.9094.

Strategies for treatment of childhood primary angiitis of the central nervous system.

Objective: Childhood primary angiitis of the CNS (cPACNS) is a devastating neurologic disease. No standardized treatment protocols exist, and evidence is limited to open-label cohort studies and case reports. The aim of this review is to summarize the literature and provide informed treatment recommendations. Methods: A scoping review of cPACNS literature from January 2000 to December 2018 was conducted using Ovid, MEDLINE, PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Vasculitis Foundation, European Vasculitis Society, CanVasc, Google Scholar, and Web of Science. Potentially relevant articles were selected for full-text review using the STROBE checklist if they met the following inclusion criteria: (1) reported treatment, (2) addressed pediatrics, (3) focused on the disease of interest, (4) included ≥5 patients, (5) original research, and (6) full-length articles. Reviews, expert opinions, editorials, case reports with <5 patients, articles lacking treatment information, or non-English articles were excluded. A standardized assessment tool measured study quality. Treatment and outcomes were summarized. Results: Of 2,597 articles screened, 7 studies were deemed high quality. No trials were available so no meta-analysis was possible. Overall, treatment strategies recommended are induction with acute antithrombotic therapy subsequently followed by high-dose oral prednisone taper over 3-12 months and long-term platelet therapy. In angiography-positive progressive-cPACNS and angiography-negative-cPACNS, we also recommend 6 months of IV cyclophosphamide therapy, with trimethoprim/sulfamethoxazole as part of induction, and maintenance therapy with mycophenolate mofetil/mycophenolic acid. Conclusion: No grade-A evidence exists; however, this review provides recommendations for treatment of cPACNS.

Higher Fat Mass Is Associated With a History of Knee Injury in Youth Sport.

Study Design Historical cohort study. Background History of a knee joint injury and increased fat mass are risk factors for joint disease. Objective The objective of this study was to examine differences in adiposity, physical activity, and cardiorespiratory fitness between youths with a 3- to 10-year history of sport-related intra-articular knee injury and uninjured controls. Methods One hundred young adults (aged 15-26 years; 55% female) with a sport-related intra-articular knee injury sustained 3 to 10 years previously and 100 controls matched for age, sex, and sport, who had no history of intra-articular knee injury, were recruited. Fat mass index (FMI) and abdominal fat (fat mass at the L1 to L4 vertebral levels) were derived using dual-energy X-ray absorptiometry. Physical activity and cardiorespiratory fitness were measured using the Godin Leisure-Time Exercise Questionnaire and the multistage 20-meter shuttle run test for aerobic fitness, respectively. Results Previously injured participants demonstrated higher FMI (within-pair difference, 1.05 kg/m2; 95% confidence interval [CI]: 0.53, 1.57) and abdominal fat (461 g; 95% CI: 228, 694) than uninjured controls. In multivariable linear regression analysis, previous injury was significantly associated with increased FMI. This increase was attenuated in those who participated in higher levels of physical activity or had higher estimated maximum volume of oxygen. Conclusion As a risk factor for osteoarthritis in an already susceptible group, excess adiposity is an undesirable trait in the potential pathway to joint disease. Increasing physical activity in this population may be a potential intervention to reduce adiposity thus impede disease initiation and/or progression. Level of Evidence Level 2b. J Orthop Sports Phys Ther 2017;47(2):80-87. doi:10.2519/jospt.2017.7101.