Sleep Architecture in Response to a Late Evening Competition in Team-Sport Athletes.

PURPOSE: The aim of this study was to assess the effect of a late evening competition on sleep characteristics and perceived recovery in team-sport players using a validated self-applicable and portable polysomnographic device. METHODS: Sixteen team-sport players (age: 25.4 [1.4] y; body mass index: 23.6 [0.5] kg/m2) completed the study. Objective and subjective sleep data were collected for 4 consecutive nights: 2 nights before (PRE2 and PRE1) and the 2 nights after an evening match (POST1), performed between 6:00 PM and 9:00 PM. Total quality of recovery values were also collected in the morning. RESULTS: A significantly delayed bedtime (P < .0001; ηp2=.68, large) was observed in the first night after the competition (2 h 29 min [1 h 15 min]) compared both to PRE2 (+88 min; P < .0001), PRE1 (+98 min; P < .0001), and POST1 (+100 min; P < .0001), and similar results were observed for wake-up time (P = .033; ηp2=.39, large): Players woke up significantly later in evening match (9 h 20 min [1 h 55 min]) compared with PRE2 (+85 min; P = .050) and POST1 (+85 min; P = .049). Conversely, total sleep time; sleep efficiency; sleep onset latency; wake after sleep onset; cortical arousals; N1, N2, N3, and REM (rapid eye movement) percentages; total quality of recovery values; and scores of subjective sleep quality did not vary among the 4 study nights. CONCLUSIONS: Team-sport players had delayed bedtime and wake-up time following an evening competition; however, sleep quality, duration, and subjective scores of recovery were not affected by the evening match. The delayed wake-up time seems to protect athletes' sleep efficiency/duration against the evening-match-induced delayed bedtime.

Predictors of postoperative hospital length of stay after total knee arthroplasty.

INTRODUCTION: To collect and analyse clinical and functional variables of patients undergoing rehabilitation after total knee arthroplasty (TKA), in order to identify which amongst them could influence the post-operative length of hospital stay (LOS). METHODS: We conducted a retrospective analysis of prospectively collected data of 1,082 consecutive patients (746 females and 336 males) who underwent primary TKA and rehabilitation in our Orthopedic Institute between January 2013 and July 2017. Clinical and anthropometric data were analysed using a multivariate linear regression model. RESULTS: The average LOS was 5.08 ± 2.52 days in the Department of Orthopedic Surgery, and 12.67 ± 5.54 days in the Rehabilitation Unit. Age, female sex and the presence of comorbidities were predictive of a longer stay. The presence of caregiver assistance at home was associated with shorter LOS. There was no evidence of a statistically significant positive association between BMI and LOS. CONCLUSION: An in-depth and early knowledge of these factors may enable the whole multidisciplinary team to plan a patient-tailored rehabilitation path and a better allocation of resources to maximize patients' functional recovery, while reducing LOS and the overall cost of the procedure.

Case Report: Rehabilitation After Platelet-Rich Growth Factors' Intra-Articular Injections for Knee Osteoarthritis: Two Case Reports of a Home-Based Protocol.

Knee osteoarthritis (KOA) is a chronic progressive disease that can cause pain, functional impairment, and ultimately disability. A novel and promising therapeutic approach to KOA is the so-called regenerative medicine, a set of procedures designed to harness tissue regenerative capacity and optimize functional recovery. Increasing evidence points out that platelet-rich plasma (PRP) intra-articular injections can decrease pain and improve functional abilities in KOA patients. In the present case reports, we analyze two patients who were treated with PRP injections coupled with a posttreatment home-based rehabilitation program. The two patients were selected to represent two different populations: patient 1 was an 85-year-old with severe impairment of functional abilities, while patient 2 was a younger (59 years old) and more active patient. The protocol consisted in a series of exercise to be performed at home, during the five days following PRP injection for two consecutive weeks (10 days in total). The exercises were designed to reduce the inflammation after the injection, enhance the proprioceptive control of the treated lower limb, and strengthen hip and knee flexors and extensors, mainly by isometric work. Results were evaluated at two time points: before and 2 months after the first PRP injection. The outcomes considered were as follows: visual analog scale for pain, EuroQol 5 dimensions questionnaire, Tegner Activity Scale for functioning, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Both patients did not report any side effects from the treatment. Improvement in patient 1 was drastic at the two months follow-up as far as pain and functional abilities are concerned. Patient 2's improvement was less evident, probably due to the higher starting point in both pain and functionality. Overall, the developed program seemed safe and was tolerated by the patients analyzed in the study, who performed it with good compliance.

Effects of early virtual reality-based rehabilitation in patients with total knee arthroplasty: A randomized controlled trial.

BACKGROUND: Virtual reality (VR)-based rehabilitation is a promising approach for improving recovery in many conditions to optimize functional results, enhancing the clinical and social benefits of surgery. OBJECTIVE: To assess the efficacy of an early rehabilitation performed by the VR-based rehabilitation versus the traditional rehabilitation provided by physical therapists after primary total knee arthroplasty (TKA). METHODS: In this randomized controlled clinical trial, 85 subjects met the inclusion criteria and were randomized 3 to 4 days after TKA to an inpatient VR-based rehabilitation and a traditional rehabilitation. Participants in both groups received 60 minutes/day sessions until discharge (around 10 days after surgery). The primary outcome was the pain intensity. The secondary outcomes were: the disability knee, the health related quality of life, the global perceived effect, the functional independent measure, the drugs assumption, the isometric strength of quadriceps and hamstrings, the flexion range of motion, and the ability to perform proprioception exercises. Outcomes were assessed at baseline (3-4 days after TKA) and at discharge. RESULTS: VR-based or traditional rehabilitation, with 13% of dropout rate, shown no statistically significant pain reduction between groups (P = .2660) as well as in all other outcomes, whereas a statistically significant improvement was present in the global proprioception (P = .0020), in favor of the VR-based rehabilitation group. CONCLUSIONS: VR-based rehabilitation is not superior to traditional rehabilitation in terms of pain relief, drugs assumptions and other functional outcomes but seems to improve the global proprioception for patients received TKA. LEVEL OF EVIDENCE: Therapy, level 1b. CONSORT-compliant. TRIAL REGISTRATION: http://www.clinicaltrials.gov, ClinicalTrials.gov, NCT02413996.

Combined chronic anterior cruciate ligament and posterior cruciate ligament reconstruction: functional and clinical results.

PURPOSE: Multiligamentous injury to the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) is an uncommon but debilitating event. Patients with combined ligament injuries typically complain of painful, debilitating knee instability that restricts their sports and daily activities. The purpose of this retrospective study was to evaluate functional and clinical outcomes of patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot. METHODS: Medical records of 20 consecutive patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot were retrospectively reviewed. All patients had received either an allograft (group A) or a semitendinosus-gracilis graft for ACL repair and a bone-patellar tibial-bone graft for PCL repair (group B). Functional outcomes, after the initial follow-up period at 24-month FU, were assessed with concentric isokinetic knee extensor-flexor testing at 60 and 180°/s. The secondary aim was to compare long-term clinical recovery by the administration of the IKDC (International Knee Document Committee) Knee Ligament Evaluation Form, the Lysholm Knee Scoring Scale and the Cincinnati Knee Rating Scale. RESULTS: The mean per cent quadriceps strength deficit in the operated as compared to the healthy knee was 13.5 % in group A and 15 % in group B (angular velocity 60°/s) and 13.5 % in group A and 9.4 % in group B (angular velocity 180°/s). The mean per cent flexor strength deficit in the operated as compared to the healthy knee was 10.4 % in group A and 12.3 % in group B (angular velocity 60°/s) and 12.2 % in group A and 9 % in group B (angular velocity of 180°/s). The flexor-quadriceps ratio was 49.4 % in group A and 48.8 % in group B in the healthy knee and 53.2 % in group A and 53.8 % in group B in the operated knee (angular velocity 60°/s) and 63.9 % in group A and 60.7 % in group B in the healthy knee and 65 % in group A and 64.9 % in group B in the operated knee (angular velocity 180°/s). Lysholm outcome was 93.9 ± 3.9 in group A and 89.1 ± 7.6 in group B (n.s). Cincinnati score was 89.6 ± 7.3 in group A and 91.0 ± 6.9 in group B (p = 0.791). IKDC results were group A in six patients (60 %), group B in three patients (30 %) and group C in one patient (10 %) in the allograft group and group A in seven patients (70 %) and group B in three patients (30 %) for autologous group. CONCLUSIONS: The results of this study suggest that one-stage arthroscopic bicruciate ligament reconstruction can restore good knee joint function. Surgical treatment should be followed by a comprehensive rehabilitation programme with specific goals, objectives and strategies, including pain management and assessment of progress in recovery of joint function and perception of knee stability. LEVEL OF EVIDENCE: Retrospective case series, Level IV.

Stress fracture of the ulna in an elite ice dancer.

Stress fracture of the ulna is a rare overuse injury often arising from repetitive excessive forearm rotation. Here we report the first case of ulnar stress fracture in a female ice dancer. Diagnosis was made by history and physical examination, with the aid of imaging studies (plain x-ray, computed tomography, and magnetic resonance imaging), and biomechanical analysis of forearm pronation and supination. Following identification and modification of the causal technical element, the ice dancer was able to continue training and competing without cessation of activity. Treatment was with a 30-day course of capacitively coupled bone stimulation to promote fracture healing, confirmed on radiography and magnetic resonance imaging. Such injuries to ice dancers may be prevented at the planning stage of technical elements in the dance program if coaches place more attention on the potentially deleterious effects of difficult positions the lifted dancer must sustain to reward points on the technical elements score. Key pointsThe technical elements in ice dancing can overload joints and bones due to the positions held by the skaters.To project a competition program as much as possible safe regarding overuse injury prevention an accurate knowledge of physiological parameters of the ice dancer and of ISU rules is necessary.

Does soccer cleat design influence the rotational interaction with the playing surface?

Non-contact injuries in soccer players may be related to the interplay between cleat type and playing surface, and bladed shoes were often blamed for non-contact injuries with no research support. The aim of this study was to compare the rotational resistance (stiffness and peak sustainable torque) among three types of soccer cleats (metal studs, molded rubber studs, and bladed) in a controlled laboratory environment. The shoes were tested on both natural and artificial turfs under a compressive preload of 1000 N and with internal and external rotations. The three shoe models showed comparable performances with a good repeatability for each individual test on both playing surfaces. A less stiff behavior was observed for the natural turf. A tendency toward highest peak torque was observed in the studded model on natural surface. The bladed cleats provided peak torque and rotational stiffness comparable to the other models. Studded and bladed cleats did not significantly differ in their interaction with the playing surface. Therefore, soccer shoes with bladed cleats should not be banned in the context of presumed higher risk for non-contact injuries.

Reducing muscle injuries and reinjuries in one italian professional male soccer team.

BACKGROUND: The incidence rate of muscle injuries and re-injuries in professional elite soccer players actually is very high and may interfere with the fate of a championship. PURPOSE: To investigate the effect of a two-tiered injury prevention programme on first injury and re-injury incidence in top level male soccer players. Study design. CASE SERIES STUDY: Muscle injuries and re-injuries sustained by a group of 36 soccer player of an italian elite soccer team have been collected during 2010-2011 season. These data have been compared with those collected during the previous season in the same elite soccer team. RESULTS: A total of 64 injuries occurred, 36 (56%) of which during practice and 28 (44%) during matches. Muscle injuries accounted for 31.3% of the total (n=20), 70% (n=14) of which occurred during practice and 30% (n=6) during matches. Hamstring were the muscles most often injured (n=11) In all, 3 re-injuries occurred (15% of muscle injuries). No early re-injuries occurred. The incidence was 2.5 injuries/1000 hours and the burden was 37 days absence/1000 hours. CONCLUSIONS: Through the implementation of a group and personalized injury prevention program, we were able to reduce the total number of muscle injuries and days absent because of injury, in a team of elite soccer players, as compared to the previous season. Specifically, muscle injuries accounted for 31% of all injuries, as compared to 59% of all injuries sustained by the team during the previous season. The number of injuries/1000 hours of exposure was reduced by half (from 5.6 to 2.5) and the days absent/1000 hours fell from 106 to 37.

Arm position during extracorporeal shock wave therapy for calcifying tendinitis of the shoulder: a randomized study.

OBJECTIVE: To generate data on optimal shoulder position comparing two ultrasound-guided extracorporeal shock wave therapy techniques for the treatment of calcifying tendinitis of the shoulder. DESIGN: Random assignment to two groups of treatment with three months follow-up. SETTING: The data were collected in outpatients. SUBJECTS: Thirty-five subjects affected by calcifying tendinitis of the shoulder were examined. INTERVENTIONS: Each subject received three sessions of ultrasound-guided extracorporeal shock wave therapy (performed weekly). Neutral position technique was used in group A (n = 17, mean age 53 ± 9.2 years) and the hyperextended internal rotation technique was used in group B (n = 18, mean age 52.2 ± 10.8 years). MAIN OUTCOME MEASURES: The Constant and Murley method and radiographs were used to evaluate each subject before the treatment and at three months follow-up. RESULTS: There were no significant differences between changes in Constant total score and pain, activity of daily living and range of motion subscales of the two groups. Only the pain subscale showed a significant difference in favour of group B. Significant differences in the radiographic outcome were observed between the two groups: the percentage of total or subtotal resorption of the calcified deposits was 35.3% in group A (neutral position technique) versus 66.6% in group B (hyperextended internal rotation technique). The resorption of the calcific deposit positively influenced the clinical outcome. CONCLUSIONS: Positioning the shoulder in hyperextension and internal rotation during extracorporeal shock wave therapy seems to be a useful technique to achieve resorption of calcific deposits.

New therapeutic approaches for management of sport-induced muscle strains.

Muscle strains are one of the most common sports-induced injuries. Depending on the severity and location of the muscle strain, different treatment approaches can be taken. This review highlights recent trends in conservative, pharmacologic, and surgical approaches to the management of sports-induced muscle injuries as presented at a symposium held during the 93rd Annual Congress of the Italian Society of Orthopedics and Traumatology (SIOT) in Rome, Italy in November 2008. Conservative approaches now include growth factor therapy and administration of autologous platelet-rich plasma during the early postinjury period; however, its use is currently considered a doping violation under the World Anti-Doping Agency code, therefore restricting its use to nonelite sports people only. Topical anti-inflammatory therapy is a promising therapeutic strategy, since it allows local analgesic and anti-inflammatory effects while minimizing systemic adverse events. As the drug delivery system is critical to clinical effectiveness, the advent of a new delivery system for ketoprofen via a new-generation plaster with a marked increase in tissue penetration and a clinical efficacy comparable with that of oral administration, provides a viable option in the treatment of single sport lesions. Surgical treatment of muscle lesions is less common than conservative and topical therapies and indications are limited to more serious injuries. Presentations from SIOT 2008 show that advances in our understanding of the healing process and in conservative, pharmacologic, and surgical treatment approaches to the management of sports-induced muscle strains contribute to better clinical outcomes, faster healing, and a swifter return to normal training and activity levels.

Comparison of two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. A randomized controlled study.

OBJECTIVE: To describe and compare two extracorporeal shock wave therapy techniques for the treatment of painful subcalcaneal spur. DESIGN: Random assignment to two groups of treatment with two and eight months follow-up. SETTING: The data were collected in outpatients. SUBJECTS: Forty-five subjects with a history of at least six months of heel pain were studied. INTERVENTIONS: Each subject received a three-session ultrasound-guided extracorporeal shock wave therapy (performed weekly). Perpendicular technique was used in group A (n=22, mean age 59.3 +/- 12 years) and tangential technique was used in group B (n= 23, mean age 58.8 +/- 12.3 years). MAIN OUTCOME MEASURES: Mayo Clinical Scoring System was used to evaluate each subject before the treatment and at two and eight months follow-up. RESULTS: Mayo Clinical Scoring System pretreatment scores were homogeneous between the groups (group A 55.2 +/-18.7; group B 53.5 +/- 20; P>0.05). In both groups there was a significant (P<0.05) increase in the Mayo Clinical Scoring System score at two months (group A 83.9 +/- 13.7; group B 80 +/- 15,8) and eight months (group A 90 +/- 10.5; group B 90.2 +/-8.7) follow-up. No significant differences were obtained comparing the Mayo Clinical Scoring System scores of the two groups at two and eight months follow-up. CONCLUSIONS: There was no difference between the two techniques of using extracorporeal shock wave therapy. The tangential technique was found to be better tolerated as regards treatment-induced pain, allowing higher energy dosages to be used.

Comparison of two ultrasonographic localization techniques for the treatment of lateral epicondylitis with extracorporeal shock wave therapy: a randomized study.

OBJECTIVE: To describe and compare two ultrasonographic localization techniques for the treatment of lateral epicondylitis with extracorporeal shock wave therapy (ESWT). DESIGN: Forty-one subjects selected through clinical examination were randomly assigned to two groups of treatment. INTERVENTIONS: Each subject received a three-session ultrasound-guided ESWT (performed weekly). Lateral tangential focusing was used in group A, whereas back tangential focusing was used for group B. MAIN OUTCOME MEASURES: Total Elbow Scoring System (TESS) and a visual analogue scale (VAS) were used to evaluate each subject before the treatment and at six months follow-up. RESULTS: TESS and VAS pretreatment scores were homogeneous between the groups (p > 0.05). In both groups there was a significant (p < 0.05) increase in the TESS score and a decrease in the VAS score but there was no resolution of the pain. TESS and VAS follow-up scores were homogeneous between the two groups (p > 0.05). CONCLUSIONS: There was no difference between the two techniques of using ESWT.

Muscle strains in soccer: a five-year survey of an Italian major league team.

We analyzed muscle injuries collected from an Italian major-league soccer team during the period 1995-2000. We considered all the muscle accidents that had required a player to stand down for three or more days. Among the overall injuries, muscle accidents were the most frequent, representing 30% (103 cases), followed by contusions (28%), sprains (17%) and tendinopathies (9%). There was one recurrence involving the hamstring. Lack of training was one of the causes of such injuries; in fact the training/match ratio of those seasons (3.6 to 1) show that there was little time for training compared to the number of matches.

The influence of local steroid injections, body weight and the length of symptoms in the treatment of painful subcalcaneal spurs with extracorporeal shock wave therapy.

OBJECTIVE: To evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) for the treatment of painful subcalcaneal spurs and evaluate whether local steroid injections, body weight and the length of symptoms can affect the clinical results. DESIGN: Subjects were selected through clinical examination and heel radiograms according to diagnosis of painful subcalcaneal spurs. SUBJECTS: Sixty-four subjects were divided into two groups of treatment depending on their past history of previous local steroid injections. INTERVENTIONS: Each subject received a three-session ESWT (performed weekly). A rehabilitative programme was instituted, consisting of self-assisted plantar fascia and plantar flexors stretching exercises. MAIN OUTCOME MEASURES: The Mayo Clinical Scoring System (MCSS) was utilized to evaluate each subject before the treatment and at two- and ten-month follow-ups. In addition, standard radiograms were done both before the treatment and at the ten-month follow-up. RESULTS: Patients with no past treatment using steroids did not show any statistically significant improvement of the MCSS at the two-month follow-up. The statistical significance was obtained at the ten-month follow-up. Patients with past treatment using steroids did not show any statistically significant improvement of the MCSS at either follow-up. At the radiogram check, none of the subjects showed any modification of the heel spurs. CONCLUSIONS: According to the results of the present study ESWT should be considered as an effective treatment for painful subcalcaneal spurs. Previous local steroid injections may negatively affect the result of ESWT.