Lower Body Weightlifting Injuries Treated in United States Emergency Departments from 2012-2021.

Weightlifting has become an increasingly popular form of exercise that has been shown to have many health benefits but can be dangerous if performed improperly. The objective of this study was to describe the epidemiology of lower body weightlifting injuries in the United States. The National Electronic Injury Surveillance System database was queried from January 1, 2012 to December 31, 2021 for lower body injuries related to using weightlifting equipment. Demographics, diagnosis, disposition, and mechanism of injury (MOI) were analyzed. There were 7,773 lower extremity weightlifting injuries identified from 2012-2021, giving a national estimate of 311,842 injuries. The most common MOI was dropped weight (n = 1785, 22.96%). Deadlifts were the most cited exercise that led to lower extremity injury (n = 503, 6.47%). Males were more likely than females to be injured (76% males vs. 24% females; p < 0.001), especially by compound movements with free weights including squats (79.63% males vs 19.96% females, p<0.03) and deadlifts (83.89% males vs. 16.10% females, p<0.001). Nearly all injuries were treated as outpatient but those admitted to the hospital were significantly older than those treated as outpatients (38.0 years vs. 31.2 years, p<0.05). Weightlifting carries a high risk of injury due to the intensity and technique required for the different movements involved.

Quadratus lumborum block provides improved immediate postoperative analgesia and decreased opioid use compared with a multimodal pain regimen following hip arthroscopy.

The purpose of our study was to evaluate the effect on immediate patient outcomes following hip arthroscopy with use of a preoperative, single shot quadratus lumborum (QL) block. We retrospectively reviewed patients who underwent hip arthroscopy following a preoperative QL block. These patients were matched by age and gender to patients who had not received a block. Visual analogue scale (VAS) pain scores immediately postoperatively and at the time of discharge were recorded. Hourly and overall opioid intake in the postanesthesia care unit (PACU) was also recorded. Continuous data was analysed with paired t-test, with significance being defined as P < 0.05. Complications in the immediate postoperative period were recorded, as was time from admission to PACU to discharge. Fifty-six patients were included. Twenty-eight patients underwent QL block and 28 did not undergo a block. QL block patients required significantly less hydromorphone (P = 0.010) and oxycodone (P = 0.001) during their time in the PACU, and significantly fewer morphine equivalents overall and per hour in the PACU (P < 0.001). Despite receiving less opioid analgesia, QL block patients had significantly less pain immediately postoperatively (P = 0.026) and at the time of discharge (P = 0.015). The mean time to PACU discharge was 155 ± 49 min, and there was no difference in time to discharge between groups (P = 0.295). One patient in the QL block group experienced persistent flank numbness. Hip arthroscopy patients who received a preoperative QL block had less pain and a lower opioid requirement in PACU than those who did not receive a block. Level of Evidence: Level III (Retrospective matched cohort study).

Significant Chondrocyte Viability Is Present in Acetabular Chondral Flaps Associated With Femoroacetabular Impingement.

BACKGROUND: Patients presenting with cam deformity of the femoral head and neck sustain repeated trauma to the articular cartilage of the superior acetabulum, with chondral delamination injuries found during hip arthroscopy. Two previous studies reveal conflicting chondrocyte viability data in these traumatic cartilage injuries. The full-thickness nature of flaps may suggest that chondrocytes residing in the cartilage flap matrix in the joint environment would remain viable despite shear trauma. Hypothesis/Purpose: The purpose of this study is to determine the in vivo tissue viability of acetabular chondral flaps in patients with femoroacetabular impingement (FAI) when samples are analyzed immediately after biopsy. We hypothesize that the majority of the tissue in acetabular chondral flaps is viable in the joint microenvironment. STUDY DESIGN: Descriptive laboratory study. METHODS: Partially detached cartilage flaps from 10 patients undergoing arthroscopic hip surgery for FAI were biopsied in a minimally traumatic manner before chondroplasty and microfracture. Samples were placed in cold Hank's Balanced Salt Solution without phenol red solution and immediately transported on ice to our laboratory. The edge of the samples was trimmed and further cut into 3 separate, 1-mm-thick sections. Sections were stained using a live/dead staining kit. Images were obtained with confocal microscopy, and the percentage of live cells was quantified. RESULTS: Patients averaged 36 ± 11 years (range, 18-48 years), and 2 patients were female. The mean body mass index was 28.9 ± 5.6 kg/m2. The total proportion of live cells from all sections analyzed was 85.8%. The proportion of live cells per patient was 87% ± 10%. CONCLUSION: We determined that acetabular chondral flaps are approximately 87% live cells when analyzed immediately after biopsy, with 6 of 10 patients having greater than 90% live cells. These data point to the importance of laboratory techniques in making viability judgments in biologic systems. CLINICAL RELEVANCE: Full-thickness cartilage loss is a difficult problem for all active people but particularly in the young population in whom joint preservation is key. We describe the viability of chondrocytes present in full-thickness acetabular-based chondral flaps encountered during hip arthroscopy. Identification of greater than 85% chondrocyte viability supports a foundation for evaluation and creation of novel clinical innovations for repair and replacement techniques using the flap as donor tissue, as alternatives to chondroplasty and microfracture.

Update on Anterior Cruciate Ligament Rupture and Care in the Female Athlete.

As female athlete sports participation has continued to increase, the rate of anterior cruciate ligament (ACL) rupture in female athletes has also increased. Individualized, patient-specific treatment is crucial to achieving optimal outcomes; ACL reconstruction must accurately restore native ACL anatomy and address any concomitant injury to secondary stabilizers. Rehabilitation programs should target hip, core, and trunk neuromuscular control; allow adequate time for graft ligamentization; and address the psychosocial needs of the athlete.

Morphologic Risk Factors in Predicting Symptomatic Structural Failure of Arthroscopic Rotator Cuff Repairs: Tear Size, Location, and Atrophy Matter.

PURPOSE: To evaluate whether morphologic characteristics of rotator cuff tear have prognostic value in determining symptomatic structural failure of arthroscopic rotator cuff repair independent of age or gender. METHODS: Arthroscopic rotator cuff repair cases performed by five fellowship-trained surgeons at our institution from 2006 to 2013 were retrospectively reviewed. Data extraction included demographics, comorbidities, repair technique, clinical examination, and radiographic findings. Failure in symptomatic patients was defined as structural defect on postoperative magnetic resonance imaging or pseudoparalysis on examination. Failures were age and gender matched with successful repairs in a 1:2 ratio. RESULTS: A total of 30 failures and 60 controls were identified. Supraspinatus atrophy (P = .03) and tear size (18.3 mm failures v 13.9 mm controls; P = .02) were significant risk factors for failure, as was the presence of an infraspinatus tear greater than 10 mm (62% v 17%, P < .01). Single-row repair (P = .06) and simple suture configuration (P = .17) were more common but similar between groups. Diabetes mellitus and active tobacco use were not significantly associated with increased failure risk but psychiatric medication use was more frequent in the failure group. CONCLUSIONS: This study confirms previous suspicions that tear size and fatty infiltration are associated with failure of arthroscopic rotator cuff repair but independent of age or gender in symptomatic patients. There is also a quantitative cutoff on magnetic resonance imaging for the size of infraspinatus involvement that can be used clinically as a predicting factor. Although reported in the literature, smoking and diabetes were not associated with failure. LEVEL OF EVIDENCE: Level III, retrospective case control.

Chronic exercise preserves brain function in masters athletes when compared to sedentary counterparts.

OBJECTIVE: Exercise is beneficial for both the body and the mind, and it has been associated with protective neurocognitive effects, such as increased levels of brain-derived neurotrophic factor and neurogenesis. These effects are linked to the attenuation of age-related mental decline and the preservation of mental capacities in older, physically active adults. This study evaluated whether masters athletes, a highly active population, have better cognitive function compared to age-matched non-athletes based on the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) tool. METHODS: Masters athletes and sedentary controls were recruited and screened for eligibility. All subjects were excluded if they had preexisting neurological diseases, psychiatric disorders, substance abuse disorders, learning disorders, and/or a history of traumatic brain injury, and in addition, control subjects were excluded if they performed >1 h/week of aerobic exercise. All participants completed a health and activity survey which includes the SF-12 and the ImPACT neurocognitive test which measures verbal and visual memory as well as reaction time. Differences between masters athletes and the control population were determined by ImPACT score composites. RESULTS: 51 pairs of athletes and non-athletes were analyzed. Athletes had significantly higher verbal memory scores (85.9 ± 7.7 vs 79.9 ± 13.9, p = 0.01) and faster reaction times (0.71 ± 0.12 vs 0.76 ± 0.15 s, p = 0.04) on the ImPACT test. Athletes also scored significantly higher on the physical components summary score of the SF-12 (55.0 ± 3.3 vs 51.8 ± 6.7, p = 0.004). CONCLUSION: Masters athletes performed better on verbal memory and reaction time test, as well as on physical function as evaluated by the SF-12, compared to non-athlete controls. Chronic physical activity may preserve neurocognitive processes and increase physical health, which are protective factors for the negative effects of the aging process.

A review of femoroacetabular impingement and hip arthroscopy in the athlete.

Femoroacetabular impingement (FAI) is increasingly recognized as a pathological condition of the hip in athletes. Although it is not always symptomatic, the bone structure leading to FAI and its associated pathology can result in significant pain and performance decline in athletes. Recognition of athletes with symptomatic FAI is of the utmost importance, as prompt treatment is necessary in order to maintain desired sports activity levels and preserve joint function. This review explores the recent evidence on the evaluation, recognition, and treatment of femoroacetabular impingement, and discusses conservative management, postoperative rehabilitation, and treatment in the pediatric and master athlete populations.

The role of mobility as a protective factor of cognitive functioning in aging adults: a review.

CONTEXT: Over 33 chronic disease states and health disorders, including obesity and type 2 diabetes, are grouped into what is known as sedentary death syndrome. All these conditions are positively affected by 30 minutes of brisk exercise daily. In addition, only 30% of aging is based on genetics, with 70% on lifestyle. Therefore, a large majority of aging is controlled by individual health behaviors. Exercise is a powerful tool for healthy aging of the body and the mind. Courses of short- and long-term exercise provide benefits to musculoskeletal and cardiovascular health and can prevent age-related brain structural and functional losses. This review examines the evidence in support of mobility as an inexpensive and effective protective factor in maintaining brain health and preventing cognitive decline in aging adults. EVIDENCE ACQUISITION: A PubMed search was performed for articles in English from 1990 to 2012. Reference lists were also reviewed and relevant articles obtained. LEVEL OF EVIDENCE: Level 4. RESULTS: Evidence suggests that maintaining a high level of cardiopulmonary fitness and mobility exhibits protective effects on structural changes that occur with aging in areas of the brain associated with memory, attention, and task completion. Chronic exercise is also associated with preservation of overall cognitive functioning and prevention of dementia. CONCLUSION: In combination with other preventative measures, physical mobility can assist in preventing or slowing cognitive decline in aging adults.

Unicompartmental arthritis in the aging athlete: osteotomy and beyond.

The vitality of the aging athlete is largely dependent on continued mobility and pain-free motion. The early onset of osteoarthritis often has devastating consequences for these athletes and if left untreated, mobility declines and eventually prevents sporting activities all together. Recent advances in operative treatment for unicompartmental arthritis of the knee aim to delay the need for total joint arthroplasty by preserving or restoring the form and function of the knee to allow for continued sport participation. This review focuses on the recent literature of several surgical treatment options for unicompartmental disease including cartilage procedures, osteotomy, and unicompartmental arthroplasty.

Masterful care of the aging triathlete.

Current endurance champions are turning in winning performances in their late 30s and 40s. These masters-age athletes present a special challenge to Sport Medicine practitioners who in previous decades have simply advised masters-aged athletes to stop competing to prevent or treat injury. The fact is, many of the physical changes commonly attributed to aging alone are actually due to the rages of sedentary aging. Recently a body of literature emerged which begins to define what we are capable of with chronic high-level exercise and guides masters-age athletes to train and rehab smarter to stay competitive. The factors influencing the relative declines in overall performance in the various sports include both physiological and lifestyle changes. The following review summarizes age and sex-related changes in triathlon performance, the biology of aging as it relates to endurance sport and factors that affect performance in the masters athletes.

Biological approaches to improve skeletal muscle healing after injury and disease.

Skeletal muscle injury and repair are complex processes, including well-coordinated steps of degeneration, inflammation, regeneration, and fibrosis. We have reviewed the recent literature including studies by our group that describe how to modulate the processes of skeletal muscle repair and regeneration. Antiinflammatory drugs that target cyclooxygenase-2 were found to hamper the skeletal muscle repair process. Muscle regeneration phase can be aided by growth factors, including insulin-like growth factor-1 and nerve growth factor, but these factors are typically short-lived, and thus more effective methods of delivery are needed. Skeletal muscle damage caused by traumatic injury or genetic diseases can benefit from cell therapy; however, the majority of transplanted muscle cells (myoblasts) are unable to survive the immune response and hypoxic conditions. Our group has isolated neonatal skeletal muscle derived stem cells (MDSCs) that appear to repair muscle tissue in a more effective manner than myoblasts, most likely due to their better resistance to oxidative stress. Enhancing antioxidant levels of MDSCs led to improved regenerative potential. It is becoming increasingly clear that stem cells tissue repair by direct differentiation and paracrine effects leading to neovascularization of injured site and chemoattraction of host cells. The factors invoked in paracrine action are still under investigation. Our group has found that angiotensin II receptor blocker (losartan) significantly reduces fibrotic tissue formation and improves repair of murine injured muscle. Based on these data, we have conducted a case study on two hamstring injury patients and found that losartan treatment was well tolerated and possibly improved recovery time. We believe this medication holds great promise to optimize muscle repair in humans.

Biologic approaches to enhance rotator cuff healing after injury.

BACKGROUND: Despite the advances in surgical procedures to repair the rotator cuff, there is a high incidence of failure. Biologic approaches, such as growth factor delivery and stem cell and gene therapy, are potential targets for optimization to improve the outcome of rotator cuff therapies and reduce rates of reinjury. This article outlines the current evidence for growth factor and stem cell therapy in tendon healing and the augmentation of rotator cuff repair. METHODS: Literature on the PubMed-National Center for Biotechnology Information database was searched using the keywords growth factor, factor, gene therapy, stem cell, mesenchymal, or bone marrow in combination with rotator cuff, supraspinatus, or infraspinatus. Articles that studied growth factors or stem cells alone in rotator cuff repair were selected. Only 3 records showed use of stem cells in rotator cuff repair; thus, we expanded our search to include selected studies on stem cells and Achilles or patellar tendon repairs. Bibliographies and proceedings of meetings were searched to include additional applicable studies. We also included hitherto unpublished data by our group on the use of stem cell transplantation for rotator cuff therapy. RESULTS: More than 70 articles are summarized, with focus on recent original research papers and significant reviews that summarized earlier records. CONCLUSIONS: Use of growth factors, stem cell therapy, and other tissue-engineering means serve to augment classical surgical rotator cuff repair procedures. The combination of stem cells and growth factors resulted in enhanced repair that emulated uninjured tissue, but the literature search reflected paucity of research in this field. Preclinical evidence from gene therapy and stem cell studies can be used as a start to move therapy from the experimental phase to clinical translation in patients.

Chronic exercise preserves lean muscle mass in masters athletes.

Aging is commonly associated with a loss of muscle mass and strength, resulting in falls, functional decline, and the subjective feeling of weakness. Exercise modulates the morbidities of muscle aging. Most studies, however, have examined muscle-loss changes in sedentary aging adults. This leaves the question of whether the changes that are commonly associated with muscle aging reflect the true physiology of muscle aging or whether they reflect disuse atrophy. This study evaluated whether high levels of chronic exercise prevents the loss of lean muscle mass and strength experienced in sedentary aging adults. A cross-section of 40 high-level recreational athletes ("masters athletes") who were aged 40 to 81 years and trained 4 to 5 times per week underwent tests of health/activity, body composition, quadriceps peak torque (PT), and magnetic resonance imaging of bilateral quadriceps. Mid-thigh muscle area, quadriceps area (QA), subcutaneous adipose tissue, and intramuscular adipose tissue were quantified in magnetic resonance imaging using medical image processing, analysis, and visualization software. One-way analysis of variance was used to examine age group differences. Relationships were evaluated using Spearman correlations. Mid-thigh muscle area (P = 0.31) and lean mass (P = 0.15) did not increase with age and were significantly related to retention of mid-thigh muscle area (P < 0.0001). This occurred despite an increase in total body fat percentage (P = 0.003) with age. Mid-thigh muscle area (P = 0.12), QA (P = 0.17), and quadriceps PT did not decline with age. Specific strength (strength per QA) did not decline significantly with age (P = 0.06). As muscle area increased, PT increased significantly (P = 0.008). There was not a significant relationship between intramuscular adipose tissue (P = 0.71) or lean mass (P = 0.4) and PT. This study contradicts the common observation that muscle mass and strength decline as a function of aging alone. Instead, these declines may signal the effect of chronic disuse rather than muscle aging. Evaluation of masters athletes removes disuse as a confounding variable in the study of lower-extremity function and loss of lean muscle mass. This maintenance of muscle mass and strength may decrease or eliminate the falls, functional decline, and loss of independence that are commonly seen in aging adults.

Activation of MKK3/6, SAPK, and ATF-2/c-jun in ACL fibroblasts grown in 3 dimension collagen gels in response to application of cyclic strain.

Signal transduction pathways involved in response to cyclic tensile strain and strain deprivation in anterior cruciate ligament (ACL) fibroblasts grown in 3D collagen gels were investigated. Application of cyclic tensile strain resulted in significant activation (phosphorylation) of MKK3/6, SAPK and their downstream target transcription factors, ATF-2 and c-jun, while strain deprivation resulted in a decrease in these kinases and transcription factors. These data suggest that ACL fibroblasts cultured in 3D collagen gels respond to the mechanical environment and provide a useful system for determination of the molecular mechanisms involved in the regulation of proliferation and matrix turnover by mechanical load.

Model-based tracking of the hip: implications for novel analyses of hip pathology.

This study investigated the efficacy of a combined high-speed, biplane radiography and model-based tracking technique to study hip joint kinematics and arthrokinematics. Comparing model-based tracking to the gold standard of radiostereometric analysis using implanted metal beads, joint translation was measured with a bias of 0.2 mm and a precision of 0.3 mm, whereas joint rotation was measured with a bias of 0.2° and a precision of 0.8°. A novel measure of hip arthrokinematics characterizing the region of closest contact in the anterosuperior acetabulum was measured with a bias of 0.9% and a precision of 2.5%. Model-based tracking of the hip thus provides the opportunity to noninvasively study hip pathologic conditions such as osteoarthritis and femoroacetabular impingement with great accuracy.

Stem cells for the treatment of skeletal muscle injury.

Skeletal muscle injuries are extremely common, accounting for up to 35%-55% of all sports injuries and quite possibly affecting all musculoskeletal traumas. These injuries result in the formation of fibrosis, which may lead to the development of painful contractures, increases patients' risk for repeat injuries, and limits their ability to return to a baseline or pre-injury level of function. The development of successful therapies for these injuries must consider the pathophysiology of these musculoskeletal conditions. We discuss the direct use of muscle-derived stem cells and some key cell population dynamics as well as the use of clinically applicable modalities that may enhance the local supply of stem cells to the zone of injury by promoting angiogenesis.

Participation in high-impact sports predicts bone mineral density in senior olympic athletes.

BACKGROUND: Loss of bone mineral density (BMD) and resultant fractures increase with age in both sexes. Participation in resistance or high-impact sports is a known contributor to bone health in young athletes; however, little is known about the effect of participation in impact sports on bone density as people age. HYPOTHESIS: To test the hypothesis that high-impact sport participation will predict BMD in senior athletes, this study evaluated 560 athletes during the 2005 National Senior Games (the Senior Olympics). STUDY DESIGN: Cross-sectional methods. The athletes completed a detailed health history questionnaire and underwent calcaneal quantitative ultrasound to measure BMD. Athletes were classified as participating in high impact sports (basketball, road race [running], track and field, triathalon, and volleyball) or non-high-impact sports. Stepwise linear regression was used to determine the influence of high-impact sports on BMD. RESULTS: On average, participants were 65.9 years old (range, 50 to 93). There were 298 women (53.2%) and 289 men (51.6%) who participated in high-impact sports. Average body mass index was 25.6 ± 3.9. The quantitative ultrasound-generated T scores, a quantitative measure of BMD, averaged 0.4 ± 1.3 and -0.1 ± 1.4 for the high-impact and non-high-impact groups, respectively. After age, sex, obesity, and use of osteoporosis medication were controlled, participation in high-impact sports was a significant predictor of BMD (R(2) change 3.2%, P < .001). CONCLUSIONS: This study represents the largest sample of BMD data in senior athletes to date. Senior participation in high-impact sports positively influenced bone health, even in the oldest athletes. CLINICAL RELEVANCE: These data imply that high-impact exercise is a vital tool to maintain healthy BMD with active aging.

Age-related rates of decline in performance among elite senior athletes.

BACKGROUND: Age-related disability and lost independence currently plague one third of older Americans. Many causes of disability, lost muscle mass and bone mineral density, are modifiable with exercise. Most exemplary of successful aging are the Senior Olympians; this group of vital athletes exhibit persistently high levels of functional capacity. PURPOSE: This study describes demographic data, injury characteristics and the effect of aging on physical performance in senior athletes to identify key time points for intervention to address declining performance. STUDY DESIGN: Cross-sectional study; Level of evidence, 4. METHODS: Senior Olympians (>50 years) participating in the 2001 National Senior Olympic Games were surveyed for demographic and health characteristics. Age-related changes in physical performance were determined from mean winning performance times in track and field events. These were plotted against age and task for men and women. Analysis of variance and intergroup significance were analyzed using the Tukey procedure. Percentage performance change across events was compared. The 2001 National Senior Olympic Games results were compared with American track and field record holders. RESULTS: Senior athletes' performance declined (male and female) approximately 3.4% per year over 35 years of competition-slowly from age 50 to 75 years and dramatically after age 75 years. Men showed no difference in decline of sprint and endurance events, whereas the decline in the sprint was greater than in endurance for women, especially after the age of 75 years. CONCLUSION: Even the healthiest examples of musculoskeletal aging experience significant performance declines around age 75 years. This may be a key time point for preventive intervention.

Osteoporosis in men.

Osteoporosis is a significant threat to aging bone in men. Thirty percent of hip fractures occur in men; during initial hospitalization and the first year after fracture, the mortality rate is twice that of women. Nevertheless, osteoporosis in men is grossly underdiagnosed and undertreated. The most frequent factors associated with osteoporosis in men are age >75 years, low baseline body mass index (<24 kg/m(2)), weight loss >5% over 4 years, current smoking, and physical inactivity. Osteoporosis in men is either secondary to a primary disease or is idiopathic. It exhibits a bimodal age distribution, with peaks at age 50 years (secondary disease) and at age 70 years (idiopathic). Prevention and early detection currently are the best forms of management. Alone or in combination, calcium, vitamin D, bisphosphonates, and human parathyroid hormone are all effective management options. In the acute setting of fragility fracture, the orthopaedic surgeon is key in identifying patients at risk because the surgeon provides primary care and may initiate prophylactic measures to prevent future fractures.