Operative treatment in non-emergency sports injuries: a sports medicine clinic experience.

PURPOSE: To elucidate referrals from sports medicine clinic (SMC) to orthopedics, consensus rates among physicians and surgeons on surgical need in these patients, and reasoning of the patients who refused to have surgery despite the recommendations by both groups in non-emergency sports injury patients. METHODS: We conducted a retrospective cohort analysis by using the administrative and referral records of a sports medicine clinic for the 15 months between October 2017 and January 2019. Gender, age, diagnosis, and type of sport were compared between two groups (patients referred to orthopedics vs patients treated in SMC). Agreement between orthopedics and SMC on surgical need in those patients who were referred to orthopedics was evaluated. We additionally screened the hospital archive for surgery reports of patients recommended surgery, and, if a patient did not have a surgery record, we investigated the reasons by telephone interview and categorized these reasons. RESULTS: Surgical evaluation needed for 4.7% (n = 155) of the patients. Patients referred to orthopedics were younger (median: 22.0 years), mostly male (n = 119, 76.8%), and involved in contact sports (n = 108, 69.7%) (p < 0.001 for all) compared to patients treated conservatively. Majority of the consultations were made owing to certain diagnoses such as cruciate/collateral ligament sprain (n = 70, 45.2%), meniscal tear (n = 21, 13.5%), and cartilage injuries (n = 15, 9.7%). Most of the patients diagnosed with Achilles tendon rupture (n = 2, 100%) and patellar instability (n = 13, 81.3%) were referred to surgery. Orthopedics agreed with the sports medicine physicians' opinions in most cases (n = 110, 71.0%). Thirty-four patients (30.9%) recommended surgery by the surgeon postponed/refused the treatment for various reasons or had surgery in another hospital. CONCLUSION: Most non-emergency sports injuries can be treated conservatively. Young and male patients participating in contact sports are more likely to need surgical treatment. Non-surgeon musculoskeletal health-care providers may consider referring patients to orthopedics considering the data demonstrated in this study. Nevertheless, patient's motivation to undergo an operation should be considered before referring to orthopedics.

The effects of home confinement on physical activity level and mental status in professional football players during COVID-19 outbreak.

OBJECTIVES: The coronavirus outbreak caused significant changes in football around the world, such as the suspension of leagues and home isolation of players, etc. The main purpose of the present study was to assess the psychological impacts of lockdown and similar restrictions on professional football players during the coronavirus pandemic. MATERIALS AND METHODS: The players from 36 professional football teams (n = 977) among Turkish Super League and First League teams were invited to complete a questionnaire including the Center for Epidemiologic Studies Depression Scale (CES-D), Impact of Event Scale-Revised Scores (IES-R) and short form of International Physical Activity Questionnaire (IPAQ). RESULTS: The online survey was completed by 237 players (24.3%). The mean number of self-quarantine day of participants was 26.9 ± 6.2 days. The median CES-D Scale and IES-R scores were 6.0 (min:0, max:42) and 23.0 (min:0, max:59), respectively. IPAQ scores of the players showed that four-fifths of the players still maintain high physical activity levels. There were negative, very weak and significant correlations between CES-D score and being married (r = -0.146, p = 0.024), as well as between CES-D score and IPAQ-Walking (r = -0.189, p = 0.004). A significant positive very weak correlation was observed between CES-D score and self-quarantine days (r = 0.148, p = 0.024). IPAQ-Walking was an independent predictor of CES-D. CONCLUSION: These findings support that maintaining regular physical activity and routinely exercising in a safe home environment is one of the most important strategies to ensure healthy mental state.

Evaluation of stoppage time due to field injuries in professional football games: do players really need medical help so often?

This study aimed to identify the incidence of stoppage time due to field injuries in professional football (soccer) games and to evaluate if the players involved really need medical care and whether team physicians deal with fake injuries. A total of 893 injury time-outs occurred leading to 956 treatments during 266 matches included in the study. The mean stoppage time was 88.7 ± 34.4 seconds. Less than one fifth of the injuries (17.4%) resulted in an impossibility to complete the game. The overall time-loss injury incidence which led players to miss the next game was 9.1/1000 match-hours (n = 80, 8.4% of all injuries). The players on teams in the lead at the time of the incident had significantly higher injury time-out incidence than players on teams who were losing (p < 0.05). Increasing the knowledge of team physicians, coaches, referees, and rule-makers about the medical needs of players during the game will help to identify the behaviour pattern of players.

Volume and T2 relaxation time measurements of quadriceps femoris and hamstring muscles are reliable and reproducible

Background/aim: Volume and T2 relaxation time measurements of the skeletal muscle provide quantitative information. We aimed to evaluate the interobserver reliability and the intraobserver reproducibility of measurements of volumes and T2 relaxation times of the quadriceps femoris and the hamstring muscles. Materials and methods: A cross-sectional reliability study was conducted on ten recreational athletes. The images of the quadriceps and the hamstring muscles of both limbs were obtained using a 3.0 Tesla magnetic resonance imaging (MRI) scanner. Two sports medicine specialists measured muscle volumes from a total of 2560 images and T2 relaxation times from a total of 40 images, and repeated this once more. The intraobserver and interobserver compliance were assessed by the intraclass correlation coefficient (ICC) and Cronbach's alpha (α). Results: Volume and T2 relaxation time of quadriceps femoris and hamstring muscle measurements with MRI had good to excellent reliability (Muscle volume; intraobserver ICCs: between 0.97 and 0.99, α: between 0.98 and 0.99 and interobserver ICCs: between 0.96 and 0.99, α: 0.99. T2 relaxation time; intraobserver ICCs: between 0.74 and 0.96, α: between 0.85 and 0.98 and interobserver ICCs: between 0.75 and 0.90, α: between 0.85 and 0.95). Conclusion: Volume and T2 relaxation time measurements of the quadriceps femoris and the hamstring muscles are reliable and reproducible.

Pain during walking and ascending stairs before hyaluronic acid injection was common in patients with knee osteoarthritis: a qualitative study

Background/aim: Knee osteoarthritis (OA) is a common pathology characterized by degeneration of the articular cartilage. The aim of the research was to ask patients how they decided to make the injection, what treatments they received, their complaints prior to and after the injection and how they feel at the moment, and whether they are currently exercising or not. Thus, to demonstrate the patients' outcomes with their own expression. Materials and methods: A total of 92 knee OA patients completed semistructured interviews, which included six open-ended questions. Results: A total of 92 patients (66 female, 26 male) aged between 36 and 95 years (mean 65.511.14) were included. Before the injection, the majority of the OA patients had pain complaints when walking (72.8%) and stair climbing (70.7%). One to four years after intraarticular injection, 45.2% of patients felt a decrease in their complaints. The majority of patients did not consider diet and exercise as a treatment option. In addition, almost all patients declared that they decided on hyaluronic acid injection treatment with the physician's recommendation. Conclusion: Pain during walking and stair climbing before hyaluronic acid injection was common in knee OA patients. Overall the patients felt a decrease in the symptoms after injection. Patients did not consider diet and exercise as a treatment option despite the recommendation by a physician.

Mean femoral cartilage thickness is higher in athletes as compared with sedentary individuals.

PURPOSE: It is unclear how high-intensity physical activity (HIPA) affects the knee joint, specifically the femoral cartilage (FC). Therefore, the aims of this study were to evaluate FC thickness via ultrasound among elite athletes involved in different types of HIPA, and to determine whether there is a correlation between serum cartilage oligomeric matrix protein (sCOMP) and rectus femoris (RF) thickness. METHOD: A total of 132 male individuals participated in this study and were assigned to two groups, the sedentary (n = 43, 23.9 ± 3.7) and athlete groups (n = 89, 22.7 ± 4.6), which did not significantly differ in age. The athletes were elite and performed HIPA during sports such as volleyball (n = 20), soccer (n = 21), basketball (n = 28), and weightlifting (n = 20). RF thickness and three (mid-point) measurements were obtained for each knee. The mean FC thickness for each knee was defined as the sum of the medial, lateral condyles, and intercondylar areas. Blood samples for sCOMP analyses were also obtained. RESULTS: All the measurements of the FC of both knees were significantly higher in the athletes than in the sedentary individuals (p < 0.001 and p = 0.001). The mean right and left FC values were also higher in the athletes (p < 0.001). Multiple linear regression analysis showed that participation in sporting activities was a significant predictor associated with the right and left mean FC thickness (p < 0.001 for both). No significant differences in the sCOMP levels were found between the two groups. CONCLUSION: It was found that the mean FC was higher among athletes than among sedentary individuals. As a result, it is suggested that sports' participation is an independent factor associated with the right and left mean FC thickness. LEVEL OF EVIDENCE: III.

Do Plantar Pressure and Loading Patterns Vary with Joint Hypermobility in Young Females?

BACKGROUND: Joint hypermobility is a connective tissue disorder that increases joint range of motion. Plantar pressure and foot loading patterns may change with joint hypermobility. We aimed to analyze static plantar pressure in young females with and without joint hypermobility. METHODS: Joint laxity in 27 young females was assessed cross sectionally using the Beighton and Horan Joint Mobility Index. Participants were divided into the hypermobility (score, 4-9) and no hypermobility (score, 0-3) groups according to their scores. Static plantar pressure and forces were recorded using a pedobarographic mat system. RESULTS: Higher peak pressures (P = .01) and peak pressure gradients (P = .025) were observed in the nondominant foot in the hypermobility group. According to the comparison of dominant and nondominant feet in each group, the hypermobility group showed significantly higher peak pressures (P = .046), peak pressure gradients (P = .041), and total force values (P = .028) in the nondominant foot. CONCLUSIONS: The plantar pressure and loading patterns vary in young females with joint hypermobility. Evaluation of plantar loading as an injury prevention tool in individuals with joint hypermobility syndrome can be suggested.

Effects of hyperlipidemia on patellar tendon stiffness: A shear wave elastography study.

BACKGROUND: Recent studies presented that increased adiposity and hyperlipidemia may cause tendon pathology. The aim of this study was to evaluate the effect of hyperlipidemia on the patellar tendon stiffness by shear wave elastography. METHODS: A total of 51 participants (19 female, 32 male) were included. Participants were divided into two groups, according to their low-density lipoprotein levels, as the study group (hyperlipidemia, n = 24) and the control group (non-hyperlipidemia, n = 27). The patellar tendon and rectus femoris muscle shear wave velocities were measured by shear wave elastography. FINDINGS: Patellar tendon shear wave velocities was 5.02 (SD: 0.78) m/s in the control group and 5.98 (SD: 1.19) m/s in the hyperlipidemia group (ES = 0.95, P = .001). There was a positive moderate statistically significant correlation between patellar tendon shear wave velocity and low-density lipoprotein (r = 0.432, p < .002). In the multiple linear regression analysis, only low-density lipoprotein was found as a significant predictor of patellar tendon shear wave velocity (CI: 0.005-0.028, P = .007). INTERPRETATION: We evaluated the effects of hyperlipidemia and body mass index on patellar tendon mechanical properties with shear wave elastography. We found that the blood low-density lipoprotein level had an impact on patellar tendon stiffness independently of body mass index. Accordingly, it is important to evaluate individuals' low-density lipoprotein levels when examining risk factors for tendon pathology.

Evaluation of Muscle Injuries in Professional Football Players: Does Coach Replacement Affect the Injury Rate?

OBJECTIVES: To assess the incidence and characteristics of muscle injuries in professional football players and to assess if coach dismissal may be related with muscle injuries within 1-month period from the dismissal. DESIGN: Prospective cohort study during 3 consecutive seasons. SETTING: Turkish Super League football teams. PARTICIPANTS: One hundred eighteen male football players. MAIN OUTCOME MEASURES: Data on time-loss muscle injuries confirmed using magnetic resonance imaging were recorded, including type, body part, duration, and lay-off time, and training session and match exposure times. The muscle injury rate was evaluated at 2 weeks and 30 days after coach dismissal. RESULTS: In total, 124 muscle injuries were recorded, with injury incidences of 2.3 muscle injuries per 1000 hours of exposure overall, 1.2 in training sessions, and 13.6 in matches. Injury time loss ranged from 3 to 67 days (median, 13 days). Eighteen percent of the injuries (n = 23) were recurrent; no association was found between recurrence rate and the player's age or position (P = 0.15, P = 0.27, respectively). Recurrent injuries caused more severe injuries (26.1%, P = 0.02) and longer median lay-off time (P = 0.01). During the study, teams A and B replaced 7 and 3 coaches, respectively. The injury incidence increased to 5.3 per 1000 hours of exposure in the 2 weeks after the coach dismissal, and decreased to 4.5 within 1 month of coach dismissal. CONCLUSION: Given the link between coach dismissal and increased rates of muscle strain injuries, increased attentiveness to preventing muscle injuries during coaching transitions and to the impact of new training regimens is required by trainers and medical teams.