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1.
BMC Musculoskelet Disord ; 25(1): 739, 2024 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-39285398

RESUMO

BACKGROUND: The desire to return to sports (RTS) and return to performance at preinjury level (RTSP) is a common motivator for athletes undergoing anterior cruciate ligament (ACL) reconstructive surgery. However, for non-elite athletes little is known about the patient and surgical variables influencing RTS/RTSP. Purpose was to determine which patient or surgical variables had an effect on RTS/RTSP in non-elite athletes. We also analyzed whether patients that RTS and RTSP have more confidence in the knee and less difficulty pivoting. METHODS: A single-centre retrospective cohort study. All patients who had undergone primary hamstring ACL reconstruction within a 5-year period were included. Patients were asked about their pre- and postoperative sports participation using the Tegner Activity Score (TAS) as well as about their RTS/RTSP. Confidence in the knee and difficulty with pivoting were asked about. To determine the potential adverse effect of patient variables at the time of surgery (sex, age, height, weight, TAS preop) and surgical variables (graft diameter, surgical technique, concomitant injury) influencing RTS/RTSP, univariate and multivariate logistic regression analysis were used. RESULTS: 370 ACL reconstructions were included. Average follow-up was 4.6 years (SD 1.4). RTS rate was 65% and RTSP 43%. Median preinjury TAS was 7 (Q1:6, Q3:8)), postoperative 6 (Q1:4, Q3:7). Multivariate analysis showed that women were more likely to RTS (OR 2.40, 1.16-4.97). A lower preinjury TAS (OR 0.80, 0.67-0.95) resulted in higher RTSP levels. None of the surgical variables had a significant influence on RTS or RTSP. Patients who returned to sports or to preinjury-level performance displayed significantly more confidence in the operated knee and less difficulty pivoting than non-returning patients. CONCLUSION: Our study shows that 65% of non-elite athletes with an ACL reconstruction returned to sports, 43% at preinjury level. Women were over twice more likely to RTS than men. Preinjury TAS significantly influences RTSP, with a lower preinjury TAS leading to a higher percentage of RTSP. Patients returning to both scored better in their self-reported confidence in the knee and difficulty pivoting than non-returning patients. LEVEL OF EVIDENCE: Retrospective cohort III.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Volta ao Esporte , Humanos , Estudos Retrospectivos , Feminino , Volta ao Esporte/estatística & dados numéricos , Adulto , Masculino , Adulto Jovem , Lesões do Ligamento Cruzado Anterior/cirurgia , Traumatismos em Atletas/cirurgia , Adolescente , Atletas , Recuperação de Função Fisiológica , Seguimentos , Estudos de Coortes , Fatores Sexuais , Resultado do Tratamento
2.
Acta Ortop Mex ; 38(4): 234-238, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-39222947

RESUMO

INTRODUCTION: a common concern in presurgical medical appointment of total knee replacement medical appointment is return to exercise. The purpose of this study was to analyze functional results and return to sport in patients under 60 years of age after this surgery. MATERIAL AND METHODS: we retrospectively analyzed 41 total knee replacements in 36 athletic patients (average age: 53 years [46-60]). Average follow-up of two years (6 months-5 years). Diagnoses: 37 osteoarthritis, three sequelae of Rheumatoid Arthritis, 1 extra-articular deformity. Functional and radiographic outcomes assessed using modified Knee Society and High Activity Arthroplasty Scores. RESULTS: average improvement from 31.95 to 91.61 in KSS and average from 7.95 to 13.73 in HAAS. Return to sport in 3.5 months average (range 2-6 months). Three patients did not return to sport. CONCLUSIONS: we consider that delaying surgery in these patients will cause progression in their osteoarthritis pathology and cessation of their sports activities. This makes the surgical technique difficult in addition to reducing the patient's physical performance. Analyzing the survival rate of implants in young patients, more than 80% is reported in a 25-year follow-up.


INTRODUCCIÓN: una inquietud frecuente en consultas prequirúrgicas de reemplazo total de rodilla es el regreso al ejercicio. El propósito de este estudio fue analizar resultados funcionales y retorno al deporte en pacientes menores de 60 años posterior a esta cirugía. MATERIAL Y MÉTODOS: analizamos retrospectivamente 41 reemplazos totales de rodilla en 36 pacientes deportistas (edad promedio: 53 años [46-60]). Seguimiento promedio de dos años (6 meses-5 años). Diagnósticos: 37 gonartrosis, tres secuelas de artritis reumatoidea, una deformidad extraarticular. Resultados funcionales y radiográficos evaluados mediante Knee Society modificado y High Activity Arthroplasty Score. RESULTADOS: mejoría promedio de 31.95 a 91.61 en KSS y promedio de 7.95 a 13.73 en HAAS. Retorno al deporte en 3.5 meses promedio (rango: 2-6 meses). Tres pacientes no retornaron al deporte. CONCLUSIONES: consideramos que el retraso de la cirugía en estos pacientes producirá progresión en su patología artrósica y cese de sus actividades deportivas. Esto dificulta la técnica quirúrgica además de disminuir el rendimiento físico del paciente. Analizando la tasa de supervivencia de implantes en pacientes jóvenes, se reporta más de 80% en seguimientos de 25 años.


Assuntos
Artroplastia do Joelho , Volta ao Esporte , Humanos , Estudos Retrospectivos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/estatística & dados numéricos , Pessoa de Meia-Idade , Masculino , Feminino , Volta ao Esporte/estatística & dados numéricos , Seguimentos , Fatores de Tempo , Osteoartrite do Joelho/cirurgia , Resultado do Tratamento , Recuperação de Função Fisiológica , Fatores Etários
3.
Arch Orthop Trauma Surg ; 144(8): 3379-3391, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39153101

RESUMO

INTRODUCTION: Paratenon preserving techniques to facilitate acute Achilles tendon rupture repair (AATR) functions by maintaining vascularity and biology for optimal healing response. Therefore, the purpose is to evaluate the outcomes following paratenon preserving repair of the midsubstance AATR. The hypothesis was that paratenon-preserving techniques demonstrate high return to play rates and low complication rates for the repair of the midsubstance AATR. MATERIALS AND METHODS: A systematic review of the PubMed, Embase, and the Cochrane Library databases was performed by two authors using specific search terms and eligibility criteria. The assessment of the evidence was two-fold: level and quality of evidence. A meta-analysis of proportions for the various complication rates was performed using the restricted maximum likelihood method following the Freeman-Tukey double-arcsine transformation. Fixed effects models were employed if I2 < 25% (low heterogeneity), and random effects models were employed if I2 ≥ 25% (moderate to high heterogeneity). RESULTS: The pooled return to play rate was 90.3%. The pooled rerupture rate as reported was 0.9% (best-case scenario 0.8% and worst-case scenario 6.8%). No meaningful subgroup analysis for rerupture rates could be performed based on the meta-regression. The pooled complication rate other than reruptures was 4.8%. The pooled infection rates were 0.3%, DVT rates were 1.6%, and sural nerve injury rates were 0.3%. CONCLUSIONS: Paratenon preserving techniques that are minimally invasive in nature demonstrated safe and favorable outcomes with high return to play rates and low complication rates for the repair of the midsubstance AATR.


Assuntos
Tendão do Calcâneo , Traumatismos dos Tendões , Tendão do Calcâneo/cirurgia , Tendão do Calcâneo/lesões , Humanos , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Recidiva , Volta ao Esporte/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Ortopédicos/métodos
4.
Eur J Orthop Surg Traumatol ; 34(6): 3289-3295, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39138668

RESUMO

PURPOSE: The aim of this study was to compare the functional outcomes, recurrence rate, range of motion (ROM) and return to sports activities between arthroscopic Bankart repair (ABR) versus arthroscopic Bankart/SLAP repair (ABR/S) in limited contact-athletes with a type V SLAP lesion in the scenario of recurrent anterior shoulder instability (RASI). Our hypothesis was that there is no difference between the two treatments. METHODS: Two groups of 45 limited-contact athletes with type V SLAP lesion were created. Group 1 underwent an arthroscopic Bankart repair, while group 2 had an arthroscopic Bankart/SLAP repair. The minimum follow-up period was 2 years. The WOSI and ASES scores were used to assess primary functional outcomes. Recurrence rate, ROM and return to sport were also evaluated. RESULTS: Significant differences were reported in the WOSI and ASES scores pre- and post-operatively in each group. There were no significant differences between the two groups (P = 0.78 and 0.43). We reported 4 recurrences (8.8 %) in group 1 and 5 (11.1 %) in group 2, with no difference between them (P = 0.62). There were no significant differences between the range of motion of each of the groups as well as between them. More than 90% of the athletes in both groups returned to their previous sporting activities. CONCLUSIONS: Limited-contact athletes with RASI who have a type V SLAP lesion as their primary diagnosis can be treated using either ABR or ABR/S with equal efficacy. Both treatment alternatives preserve athlete's function, stability, ROM and return to sport.


Assuntos
Artroscopia , Instabilidade Articular , Amplitude de Movimento Articular , Recidiva , Volta ao Esporte , Humanos , Artroscopia/métodos , Masculino , Volta ao Esporte/estatística & dados numéricos , Estudos Prospectivos , Instabilidade Articular/cirurgia , Instabilidade Articular/fisiopatologia , Feminino , Adulto , Adulto Jovem , Lesões do Ombro/cirurgia , Articulação do Ombro/cirurgia , Articulação do Ombro/fisiopatologia , Traumatismos em Atletas/cirurgia , Traumatismos em Atletas/fisiopatologia , Resultado do Tratamento , Adolescente , Luxação do Ombro/cirurgia , Luxação do Ombro/fisiopatologia , Lesões de Bankart/cirurgia , Recuperação de Função Fisiológica
5.
Eur J Orthop Surg Traumatol ; 34(6): 3259-3264, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39138667

RESUMO

BACKGROUND: The all-inside technique is now the most established treatment for meniscal repair, this usually involves a suture-based repair utilising interrupted sutures. A similar technique using continuous sutures can also be used; however there are no studies in the literature appraising this technique. This study aims to review outcomes for patients undergoing meniscal repair using a continuous suture all-inside technique. METHODS: We reviewed patients undergoing meniscal repair using a continuous suture all-inside technique over a 5 year period. We recorded demographic details, injury type, surgical procedure, incidence of reoperation, functional outcomes (Tegner-Lysholm and International Knee Documentation Committee (IKDC) score) return to sport and failure of repair. RESULTS: Data were collected for 37 patients. Mean age was 25.8 years, 81%, were male, median time to theatre was 169 days, mean follow-up time was 2.9 years. Concurrent ACL ruptures were present in 57%, all underwent ACL reconstruction in the same sitting. The mean Tegner-Lysholm score was 89. Mean IKDC score was 90.2. 78% were able to return to sport. Overall failure rate was 10.81%. Increasing age was associated with a decreased IKDC score (p = 0.02). Tegner-Lysholm score was significantly greater in patients with concurrent ACL injuries (p = 0.03) and patients with lateral meniscal tears (p = 0.04). CONCLUSION: In the first study to review outcomes following continuous all-inside suture-based meniscal repair we demonstrate excellent clinical outcomes with IKDC, Tegner-Lysholm, return to play and failure rates comparable to other commonly used techniques. We conclude that this is an acceptable and cost-effective technique.


Assuntos
Reoperação , Volta ao Esporte , Técnicas de Sutura , Lesões do Menisco Tibial , Humanos , Masculino , Adulto , Feminino , Volta ao Esporte/estatística & dados numéricos , Lesões do Menisco Tibial/cirurgia , Reoperação/estatística & dados numéricos , Adulto Jovem , Falha de Tratamento , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Reconstrução do Ligamento Cruzado Anterior/métodos , Reconstrução do Ligamento Cruzado Anterior/estatística & dados numéricos , Adolescente , Pessoa de Meia-Idade , Lesões do Ligamento Cruzado Anterior/cirurgia , Recuperação de Função Fisiológica , Artroscopia/métodos , Artroscopia/estatística & dados numéricos , Fatores Etários
6.
Medicina (Kaunas) ; 60(8)2024 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-39202510

RESUMO

Background and Objectives: Although previous reports have shown that early anterior cruciate ligament (ACL) reconstruction is associated with an increased risk of stiffness, recommendations for delayed surgery are based on outdated literature. The advent of arthroscopic surgery and accelerated rehabilitation protocols warrants a reexamination of the optimal surgical timing. The purpose of this study was to investigate complications during early ACL reconstruction after injury in young athletes. Materials and Methods: A total of 87 patients (27 males and 60 females) were included in this study. Patients who underwent anatomic ACL reconstruction using hamstring autografts were evaluated. Patients under 25 years of age with a Tegner activity score greater than 6 were included and classified into three groups according to the time from injury to surgical treatment: one week from injury to surgery (early group), three to six weeks from injury to surgery (normal group), and three to six months from injury to surgery (delayed group). We evaluated the rates of various complications such as graft rupture, contralateral injury, the need for manipulation for loss of ROM, infection, and fracture around the knee up to 2 years postoperatively. In addition, we investigated postoperative muscle strength, Lysholm score, Tegner activity score, and period of the return to sport from injury. Results: Patients in the delayed group were younger than those in the other groups (p = 0.009). Patients in the early group had a lower range of motion than those in the other groups preoperationly. However, the 1-month postoperative range of motion was comparable between groups. Patients in the early group had greater postoperative Tegner activity scores than those in the other groups. The period of return to sport from injury in the delayed group was longer than in the other groups. There were no statistically significant differences in the postoperative complication rate, muscle strength, or Lysholm score. Conclusions: ACL reconstruction performed 1 week from injury to surgery in young athletic patients indicated the rate of complications were not significantly different among the groups. Early ACL reconstruction with no postoperative complications may be related to early return to sports and a high level of sports.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Volta ao Esporte , Humanos , Feminino , Masculino , Reconstrução do Ligamento Cruzado Anterior/métodos , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Estudos Retrospectivos , Adolescente , Volta ao Esporte/estatística & dados numéricos , Lesões do Ligamento Cruzado Anterior/cirurgia , Adulto Jovem , Atletas/estatística & dados numéricos , Adulto , Fatores de Tempo , Resultado do Tratamento , Traumatismos em Atletas/cirurgia , Complicações Pós-Operatórias
7.
Neurosurg Focus ; 57(1): E13, 2024 07.
Artigo em Inglês | MEDLINE | ID: mdl-38950438

RESUMO

OBJECTIVE: Baseball and softball pose unique risks for sport-related concussion (SRC). Although these are not collision sports, concussions in baseball and softball can nonetheless involve high-speed impacts. In a regional, single-institution cohort of baseball and softball athletes who sustained an SRC, the current study sought to 1) describe the mechanisms of injury that led to SRC, and 2) compare initial symptom burden and recovery metrics across mechanisms, including time to return to learn (RTL), time to symptom resolution, and time to return to play (RTP) by mechanism of injury. METHODS: A retrospective cohort study was performed of baseball and softball athletes 12 to 23 years old who sustained an SRC between November 2017 and April 2022. Mechanisms of injury were divided into two categories: 1) contact mechanism (i.e., what initiated contact with the injured player, such as head-to-ball), and 2) player mechanism (i.e., the action the injured player was performing at the time of injury, such as fielding). The recovery outcomes of time to RTL, symptom resolution, and RTP were compared between mechanisms using bivariate analysis and multivariable regression analysis, controlling for sex, age, time to present to concussion clinic, and initial total symptom score. RESULTS: The sample included 58 baseball and softball players (60.3% female, mean age 16.0 ± 1.9 years). Most SRCs (62.1%) occurred during competition. Head-to-ball (50.0%) was the most common contact mechanism, followed by head-to-head/body (31.0%) and head-to-wall/ground/equipment (17.2%). Fielding (63.8%) was the most common player mechanism, followed by drills (20.7%) and running (13.8%). SRCs sustained in practice had significantly longer RTL (median 10.0 [interquartile range (IQR) 3.3-16.3] vs 4.0 [IQR 2.0-8.0] days; U = 421.5, p = 0.031) and symptom resolution (37.0 [IQR 18.0-90.0] vs 14.0 [IQR 7.0-41.0] days; U = 406.5, p = 0.025) compared with SRCs sustained in competition. Multivariable regression analysis revealed that head-to-wall/ground/equipment contact mechanism was associated with longer RTL (ß = 0.30, 95% CI 0.07-0.54, p = 0.013). CONCLUSIONS: The current study found that SRCs in baseball and softball occurred more often in competition than in practice. Head-to-ball and fielding were the most common contact and player mechanisms, respectively. SRCs sustained in practice were associated with longer time to RTL and symptom resolution, and head-to-wall/ground/equipment was associated with longer RTL in multivariable regression analysis. These results provide empirical data to improve concussion safety in baseball/softball.


Assuntos
Traumatismos em Atletas , Beisebol , Concussão Encefálica , Recuperação de Função Fisiológica , Humanos , Concussão Encefálica/epidemiologia , Beisebol/lesões , Masculino , Feminino , Adolescente , Adulto Jovem , Estudos Retrospectivos , Recuperação de Função Fisiológica/fisiologia , Criança , Estudos de Coortes , Atletas , Volta ao Esporte/estatística & dados numéricos
8.
Spine J ; 24(10): 1817-1824, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-38871060

RESUMO

BACKGROUND CONTEXT: Returning to recreational sporting activities after adult spinal deformity (ASD) correction may significantly impact the patient's perceived quality of life. PURPOSE: This study sought to characterize participation in sporting activities before and after ASD surgery, and to identify factors associated with impaired return to sports. STUDY DESIGN: Cross-sectional survey and retrospective review of prospectively collected data. PATIENT SAMPLE: Patients who underwent posterior-only thoracolumbar ASD surgery between 2016 and 2021 with ≥1 year follow-up and ≥3 levels of fusion to the pelvis were included. OUTCOME MEASURES: Preoperative and postoperative participation in sports, timing of return to these activities, and reasons for limited sports participation postoperatively were assessed. METHODS: A survey was used to evaluate outcome measures. Differences in demographic, surgical, and perioperative variables between patients who reported improved, unchanged, or worsened activity tolerance were evaluated. RESULTS: Ninety-five patients were included (mean age: 64.3±10.1 years; BMI: 27.3±6.1 kg/m2; median levels fused: 7). The survey was completed at an average of 43.5±15.9 months after surgery. Sixty-eight (72%) patients participated in sports preoperatively. The most common sports were swimming (n=33, 34.7%), yoga (n=23, 24.2%), weightlifting (n=20, 21.1%), elliptical (n=19, 20.0%), and golf (n=11, 11.6%). Fifty-seven (83.8%) returned to at least one sport postoperatively, most commonly 6-12 months after surgery (45%). Elliptical had the highest rate of equal or improved participation (53%). Patients generally returned below their preoperative level to all other sports. Reasons for reduced sporting activities included physical limitation (51.4%), fear (20.0%), pain (17.1%), and surgeon advice (8.6%). There were no differences in the demographic, surgical, or perioperative characteristics between those who returned to sports at the same or better level compared with those who returned at a lower level. CONCLUSIONS: About 84% of patients successfully resumed sporting activities after undergoing fusion to the sacrum/pelvis for ASD. However, this return is typically at a lower level of participation than their preoperative participation, particularly in higher demand sports. Understanding trends in sporting activity may be valuable for counseling patients and setting expectations.


Assuntos
Volta ao Esporte , Fusão Vertebral , Humanos , Pessoa de Meia-Idade , Masculino , Feminino , Volta ao Esporte/estatística & dados numéricos , Idoso , Estudos Retrospectivos , Estudos Transversais , Pelve/cirurgia , Esportes/estatística & dados numéricos , Vértebras Lombares/cirurgia , Qualidade de Vida , Vértebras Torácicas/cirurgia
9.
Medicina (Kaunas) ; 60(6)2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38929538

RESUMO

Background and Objectives: Lateral ankle injuries are commonly encountered injuries, and the open modified Broström operation (OMBO) is the primary treatment option. Recently, an arthroscopic modification of the Broström operation (AMBO) was developed; many studies have shown that there are no significant differences in clinical and radiological outcomes between the two surgical methods. However, no studies have been conducted comparing the two surgical methods in terms of return to play (RTP) time. This study assesses the time to RTP and the functional clinical outcomes. Materials and Methods: Sixty patients were enrolled from January 2012 to July 2014. They were segregated into two cohorts: the AMBO group comprised 30 patients, while the OMBO group comprised another 30 patients. Each participant underwent standardized treatment and rehabilitation regimens and RTP time was measured using seven questions that explored the times to return of painless walking, running, jumping, squatting, climbing stairs, and rising up on the heels and toes. We compared the time intervals from the onset of instability to the date of surgery. Clinical outcomes were evaluated before the surgery, 6 weeks after surgery, and 6 months after surgery. The assessments included the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the pain visual analog scale (VAS) score, subjective satisfaction with rehabilitation, and activity level. Results: In terms of RTP, AMBO was associated with a shorter interval to walking without pain (7.07 ± 2.96 weeks) relative to OMBO (11.03 ± 8.58 weeks). No disparities were observed in the time to return to play (RTP) between OMBO and AMBO. While there were no discrepancies in the 6-month postoperative AOFAS or VAS scores, the 6-week postoperative VAS score was notably lower in the AMBO group compared to the OMBO group. AMBO provided a faster RTP in terms of two of the seven questions in a group exhibiting high-level physical activity. The rate of subjective satisfaction with rehabilitation was higher for AMBO than for OMBO. Conclusions: Aside from walking, the duration to return to play and the clinical outcomes were similar between AMBO and OMBO treatments for lateral ankle instability. AMBO is a good treatment option and should be carefully considered for athletes with lateral ankle instability. AMBO demonstrated positive outcomes in a group with higher activity levels compared to others, particularly in terms of time to RTP, subjective satisfaction, and postoperative pain.


Assuntos
Artroscopia , Instabilidade Articular , Volta ao Esporte , Humanos , Masculino , Feminino , Adulto , Instabilidade Articular/cirurgia , Artroscopia/métodos , Volta ao Esporte/estatística & dados numéricos , Resultado do Tratamento , Traumatismos do Tornozelo/cirurgia , Fatores de Tempo , Articulação do Tornozelo/cirurgia , Adulto Jovem , Recuperação de Função Fisiológica
10.
Arch Orthop Trauma Surg ; 144(7): 3145-3151, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38869659

RESUMO

INTRODUCTION: Traumatic elbow dislocations are among the most common injuries in sport climbing. They occur most frequently in bouldering (a climbing discipline with strong upward trend often performed indoors) due to the typical low-height backward fall into crashpads. There is still no data about the functional outcome and return to sport of this typical bouldering injury. MATERIALS AND METHODS: All Patients with elbow dislocations due to a bouldering associated fall between 2011 and 2020 were identified retrospectively in our level I trauma centre. Trauma mechanisms, injury types and therapies were obtained. Follow-up was performed with an online questionnaire including sports-related effects, return to sport and the Elbow Self-Assessment Score (ESAS). RESULTS: 30 patients with elbow dislocations after bouldering accidents were identified. In 22 (73.3%) patients the injury was a simple dislocation. The questionnaire was completed by 20 patients. The leading mechanism was a low-height fall into crashpads. Surgical procedures were performed in every second patient. 18 patients (90%) reported return to bouldering after 4.7 ± 2.1 months. 12 patients (66.7%) regained their pre-injury level. Mid-/Long-term follow-up (mean 105 ± 37.5 months) showed excellent results in ESAS score (97.2 ± 3.9 points). Persistent limited range of motion or instability was reported by only 3 patients (15%). CONCLUSION: Most athletes are able to return to bouldering but only two thirds regain their pre-injury performance level in this demanding upper-extremity sport. The unique low-height trauma mechanism may create a false sense of security. Specific awareness and safety features should be placed for climbing athletes to reduce elbow injuries.


Assuntos
Lesões no Cotovelo , Luxações Articulares , Volta ao Esporte , Humanos , Estudos Retrospectivos , Masculino , Adulto , Luxações Articulares/cirurgia , Feminino , Volta ao Esporte/estatística & dados numéricos , Acidentes por Quedas/estatística & dados numéricos , Articulação do Cotovelo/cirurgia , Articulação do Cotovelo/fisiopatologia , Adulto Jovem , Traumatismos em Atletas/cirurgia , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Adolescente
11.
Am J Sports Med ; 52(7): 1692-1699, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38702964

RESUMO

BACKGROUND: Thoracic outlet syndrome (TOS) remains a rare diagnosis but is being recognized as a cause of upper extremity dysfunction in professional baseball players. PURPOSE/HYPOTHESIS: The purpose was to determine performance and return-to-play (RTP) outcomes in professional baseball players after surgical treatment of TOS. The hypothesis was that there would be a high RTP rate in professional baseball players after TOS surgery with no statistical differences in performance between pitchers who had TOS surgery and matched controls. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: All professional baseball players who underwent surgical treatment of TOS between 2010 and 2017 were identified using the Major League Baseball Health and Injury Tracking System database. Demographic and performance data (before and after surgery) for each player were recorded. Performance variables were then compared between players who underwent TOS surgery and matched controls. The matching criteria were no history of previous surgeries on affected arm, age at time of surgery, throwing side, level of play (Major or Minor League Baseball), and years of experience playing professional baseball. RESULTS: Overall, 52 players underwent surgery for TOS, of whom 46 (88%) were pitchers. The type of TOS was neurogenic in 69% and venous in 29%. One player had arterial TOS. After TOS surgery, 79% of players returned to play at the same or higher level (RTSP) by 9.5 months and played ≥3 years after surgery. No differences were found in RTSP rate based on the type of TOS. No statistical difference was found in RTP rates between major and minor league players. Pitchers had a 76% RTSP, which was similar to the natural attrition for control pitchers (P = .874). After TOS surgery, pitchers saw a decline in several performance metrics, but these declines were not different from those of control pitchers, indicating that the decline in performance after TOS surgery was no faster than is seen in healthy professional pitchers as they age. CONCLUSION: The rate of RTSP after surgery for TOS in professional baseball players was 79%. There was no difference in RTP based on the type of TOS. Pitchers who underwent surgery for TOS had no significant differences in pitching performance metrics after surgery compared with matched controls.


Assuntos
Desempenho Atlético , Beisebol , Volta ao Esporte , Síndrome do Desfiladeiro Torácico , Humanos , Beisebol/lesões , Síndrome do Desfiladeiro Torácico/cirurgia , Volta ao Esporte/estatística & dados numéricos , Adulto , Masculino , Adulto Jovem , Estudos de Casos e Controles , Estudos Retrospectivos , Estudos de Coortes
12.
J ISAKOS ; 9(4): 557-561, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38616017

RESUMO

OBJECTIVES: Functional testing (FT), commonly used to evaluate dynamic knee function and provide objective information about how well a patient, has progressed in rehabilitation following an anterior cruciate ligament (ACL) reconstruction. The purpose of the study was to determine whether a functional test could be used as an assessment tool for return to activity following isolated meniscus repair. METHODS: The results of FT completed between 80 and 150 days post-operation (representing 4-months post-operative) in isolated meniscal repair patients were analysed for the involved limb, uninvolved limb, and limb symmetry index (LSI). Involved limb performance and LSI on FT were also recorded for a matched cohort of patients who underwent an isolated ACL reconstruction between 151 and 220 days post-operation (representing 6-months post-operative). The meniscus cohort was compared to the ACL cohort. RESULTS: The meniscus cohort (n â€‹= â€‹26) performed well (LSI of 88% or better) on all functional test exercises, including all hop tests. There were patients in the meniscus cohort who did not achieve 90% LSI on the FT at 4 months. There was no statistically significant difference in any of the tests between the meniscus and ACL (n â€‹= â€‹39) cohorts. CONCLUSION: A majority of isolated meniscal repair patients perform well on FT by 4 months post-operatively and similar to patients undergoing isolated ACL reconstruction at 6 months post-operatively. Not all patients performed well on FT at 4 months post-operatively; however so, there may be a role for FT in isolated meniscal repair patients, and those patients may need further physical therapy prior to a return to sports. LEVEL OF EVIDENCE: III; Retrospective cohort study. LEVEL OF EVIDENCE: IV.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Lesões do Menisco Tibial , Humanos , Masculino , Feminino , Reconstrução do Ligamento Cruzado Anterior/métodos , Adulto , Lesões do Menisco Tibial/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Recuperação de Função Fisiológica , Meniscos Tibiais/cirurgia , Modalidades de Fisioterapia , Adulto Jovem , Traumatismos do Joelho/cirurgia , Volta ao Esporte/estatística & dados numéricos , Adolescente , Estudos Retrospectivos , Resultado do Tratamento , Articulação do Joelho/cirurgia , Articulação do Joelho/fisiopatologia , Ligamento Cruzado Anterior/cirurgia , Estudos de Coortes
13.
BMJ Open ; 14(4): e079953, 2024 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-38684271

RESUMO

OBJECTIVES: To examine non-sport- and sport-related concussion severity, clinical care frequency and delayed reporting in relation to recovery duration among collegiate athletes. DESIGN: Retrospective cohort study. SETTING: Pac-12 varsity collegiate athletes. PARTICIPANTS: 461 collegiate male and female athletes PRIMARY AND SECONDARY OUTCOME MEASURES: The incidence of sport-related concussion (SRC) and non-sport-related concussion (NRC) were collected as well as times to recovery and return-to-play (RTP), symptom score and symptom severity and reported a loss of consciousness (LOC), retrograde amnesia (RGA) and post-traumatic amnesia (PTA) following concussion incidence. RESULTS: Among 461 concussions, 388 (84%) occurred within sport and 73 (16%) occurred outside of sport. NRC, on average, required 3.5 more days to become asymptomatic (HR: 0.73, 95%confidence interval: 0.56 to 0.96, p=0.02) and 7 more days to RTP (HR: 0.64, 95% confidence interval: 0.49 to 0.85, p<0.01) compared with SRC. NRC were associated with an increase of 1.83 (p=0.07) symptoms reported at the time of diagnosis, an increase of 6.95 (p=0.06) in symptom severity and a higher prevalence of reported LOC (22% NRC vs. 3% SRC, p<0.001), PTA (15% NRC vs. 5% SRC, p<0.01) and RGA (10% NRC vs. 4% SRC, p=0.06), compared with SRC. There was no significant difference in clinical care (p=0.28) or immediate reporting (p=0.35) between NRC and SRC. CONCLUSION: NRC were associated with greater severity and longer recovery duration when compared with SRC in a cohort of collegiate athletes.


Assuntos
Atletas , Traumatismos em Atletas , Concussão Encefálica , Humanos , Masculino , Estudos Retrospectivos , Concussão Encefálica/epidemiologia , Concussão Encefálica/complicações , Feminino , Traumatismos em Atletas/epidemiologia , Adulto Jovem , Atletas/estatística & dados numéricos , Volta ao Esporte/estatística & dados numéricos , Recuperação de Função Fisiológica , Adolescente , Fatores de Tempo , Incidência , Universidades
14.
Knee Surg Sports Traumatol Arthrosc ; 32(6): 1591-1598, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38643395

RESUMO

PURPOSE: Injuries exert a detrimental impact on the team performance in professional football. Shoulder dislocations are known for their severity and often cause substantial lay-off times. However, there is a notable gap in the general understanding regarding the frequency and convalescence of these events in professional football. Thus, the aims of this study were (1) to determine the incidence, (2) to evaluate return to competition (RTC) and redislocation events (RDEs) and (3) to identify relevant player-, match- and injury-related parameters. METHODS: All shoulder dislocations within the highest three German football leagues (1.-3. Bundesliga) during the seasons 2012/2013 until 2022/2023 were identified. Player-, injury- and match-related data were obtained by performing a media analysis. Data were analysed using descriptive statistics. p Value was set at 0.05. RESULTS: A total of 90 first-time shoulder dislocations in 89 players with a median age of 25 years (interquartile range [IQR]: 23-28) were available for analysis. The incidence was 9.1 per 1000 Bundesliga matches played and increased over time. Forty-four (49%) shoulder dislocations were treated conservatively and 46 (51%) operatively. Median RTC was 24 days (IQR: 12-43) following conservative and 103 days (IQR: 85-135) following surgical treatment (p < 0.001). Twenty-two (24%) players suffered a redislocation, of whom 13 (59%) underwent initial conservative and nine (41%) initial surgical treatment (not significant [n.s.]). RDE following conservative treatment was after a median of 4 months (IQR: 2-22) and 7 months (IQR: 3-23) following surgical treatment (n.s.). CONCLUSION: The incidence of shoulder dislocation within professional football is increasing and currently amounts to 9.1 per 1000 matches played. A conservative treatment leads to a quicker RTC, while frequency and time to RDE were similar regardless of treatment. The increasing incidence of shoulder dislocations in professional football necessitates an analysis of relevant injury mechanisms and the implementation of specific preventive measures. LEVEL OF EVIDENCE: Level III.


Assuntos
Volta ao Esporte , Luxação do Ombro , Futebol , Humanos , Masculino , Alemanha/epidemiologia , Luxação do Ombro/epidemiologia , Luxação do Ombro/cirurgia , Futebol/lesões , Estudos Retrospectivos , Incidência , Adulto , Volta ao Esporte/estatística & dados numéricos , Adulto Jovem , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/cirurgia
15.
J ISAKOS ; 9(4): 502-509, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38490437

RESUMO

OBJECTIVES: The purpose of this study was to compare clinical outcomes of medial quadriceps tendon-femoral ligament reconstruction (MQTFLR) and medial patellofemoral ligament reconstruction (MPFLR) among patients with recurrent lateral patellar instability. METHODS: A retrospective matched-cohort study was conducted involving patients who underwent MQTFLR or MPFLR with or without tibial tubercle osteotomy (TTO) from 2019 to 2021. Subjects were matched 1:1 on age, concomitant osteochondral allograft (OCA), concomitant TTO, and follow-up time. Measured outcomes included 90-day complications, Visual Analog Scale (VAS) knee pain, return to sport/work, Kujala score, Tegner score, and MPFL-Return to Sport after Injury (MPFL-RSI) score. Outcomes were compared between groups using Mann-Whitney U-test for continuous variables and Fisher's exact test for categorical variables. P-values <0.05 were considered significant. RESULTS: Ten MQTFLR patients (mean age 28.7 years, 80% female, mean follow-up 19.7 months) and ten MPFLR patients (mean age 29.1 years, 90% female, mean follow-up 28.3 months) were included in the study. One MQTFLR patient (10%) and three MPFLR patients (30%) underwent reoperation for postoperative arthrofibrosis. Postoperative VAS resting pain was not significantly different between the groups (MQTFLR mean 1.1, MPFLR mean 0.6, p â€‹= â€‹0.31). There were no significant differences in rates of recurrent subluxations (MQTFLR 20%, MPFLR 0%, p â€‹= â€‹0.47), return to sport (MQTFLR 50%, MPFLR 75%, p â€‹= â€‹0.61), return to work (MQTFLR 100%, MPFLR 88%, p â€‹= â€‹1.00), or MPFL-RSI pass rate (MQTFLR 75% vs. MPFLR 38%, p â€‹= â€‹0.31). CONCLUSION: There were no significant differences in knee pain and function, return to work, and rates of recurrent patellar instability between patients who underwent MQTFLR versus MPFLR, though these results should be interpreted with caution given the small sample size and potential selection bias. LEVEL OF EVIDENCE: III.


Assuntos
Instabilidade Articular , Ligamentos Articulares , Humanos , Feminino , Masculino , Adulto , Estudos Retrospectivos , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Resultado do Tratamento , Luxação Patelar/cirurgia , Adulto Jovem , Músculo Quadríceps/cirurgia , Volta ao Esporte/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/métodos , Articulação Patelofemoral/cirurgia , Recidiva , Osteotomia/métodos
16.
Eur J Orthop Surg Traumatol ; 34(4): 1871-1876, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38436745

RESUMO

PURPOSE: To compare clinical outcomes and the rate of return to sport among patients that have undergone minimally invasive repair versus open approach of an acute Achilles tendon rupture. METHODS: Patients who underwent surgical repair of acute Achilles tendon rupture at a single urban academic institution from 2017 to 2020 with minimum 2-year follow-up were reviewed retrospectively. Preinjury sport participation and preinjury work activity information, the Achilles tendon Total Rupture Score (ATRS), the Tegner Activity Scale, Patient-Reported Outcomes Measurement Information System for mobility and pain interference were collected. RESULTS: In total, 144 patients were initially included in the study. Of these, 63 patients were followed with a mean follow-up of 45.3 ± 29.2 months. The mean operative time did not significantly differ between groups (p = 0.938). Patients who underwent minimally invasive repair returned to sport at a rate of 88.9% at a mean of 10.6 ± 5.8 months, compared to return rate of open procedures of 83.7% at 9.5 ± 5.5 months. There were no significant differences in ATRS (p = 0.246), Tegner (p = 0.137) or VAS pain (p = 0.317) scores between groups. There was no difference in cosmetic satisfaction between PARS and open repair groups (88.4 vs. 76.0; p = 0.244). CONCLUSION: Patients who underwent minimally invasive repair of acute Achilles tendon ruptures demonstrate no significant differences with respect to cosmesis, operative time, patient-reported outcomes and the rate and level of return to activities when compared to an open approach. LEVEL OF EVIDENCE: III.


Assuntos
Tendão do Calcâneo , Procedimentos Cirúrgicos Minimamente Invasivos , Duração da Cirurgia , Volta ao Esporte , Traumatismos dos Tendões , Humanos , Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Estudos Retrospectivos , Volta ao Esporte/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Masculino , Feminino , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Adulto , Pessoa de Meia-Idade , Resultado do Tratamento , Medidas de Resultados Relatados pelo Paciente , Recuperação de Função Fisiológica
17.
Eur J Orthop Surg Traumatol ; 34(4): 1957-1962, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38472435

RESUMO

INTRODUCTION: After an ankle sprain, up to 20% of patients may develop chronic lateral ankle instability (CLAI) requiring surgical treatment. The objective of this study was to investigate the functional outcomes and rates of return to sport activities in a cohort of non-athlete patients with chronic lateral ankle instability (CLAI) who underwent the opened Brostrom-Gould technique (BGT). MATERIALS AND METHODS: Seventy-nine patients (seventy-nine feet) from three different centers undergoing BGT were reviewed. For clinical and functional analysis, the AOFAS ankle-hindfoot scale was applied and rates of return to sport activities were assessed. Correlation of Δ-AOFAS and rates of return to sport activities with all variables analyzed was performed. RESULTS: Mean AOFAS score improved from 64.6 to 97.2 (p < 0.001). Sixty-one (77.2%) returned to preinjury activities and 18 (22.8%) changed to a lower-level modality. Symptoms of instability were related to Δ-AOFAS (p = 0.020). Change in the sport activity was related to pain and symptoms of instability (p = 0.41 and p < 0.001). CONCLUSION: Recreational athlete patients who underwent the BGT demonstrated excellent functional outcomes after a mean follow-up of 7 years. Residual pain and symptoms of instability after surgery were the main complaints associated with limitations in physical activities.


Assuntos
Traumatismos do Tornozelo , Instabilidade Articular , Volta ao Esporte , Humanos , Volta ao Esporte/estatística & dados numéricos , Masculino , Feminino , Adulto , Instabilidade Articular/cirurgia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/etiologia , Seguimentos , Traumatismos do Tornozelo/cirurgia , Traumatismos do Tornozelo/fisiopatologia , Adulto Jovem , Resultado do Tratamento , Recuperação de Função Fisiológica , Pessoa de Meia-Idade , Estudos Retrospectivos , Adolescente , Articulação do Tornozelo/cirurgia , Articulação do Tornozelo/fisiopatologia , Procedimentos Ortopédicos/métodos
18.
J Arthroplasty ; 39(8): 1988-1995.e5, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38367903

RESUMO

BACKGROUND: Data on sports/physical activity participation following unicompartmental knee arthroplasty (UKA) and patello-femoral arthroplasty (PFA) is variable and limited. The purpose of this study was to assess participations, outcomes, and limitations in sports following UKA and PFA. METHODS: Patients who underwent UKA and PFA at a single institution from 2015 to 2020 were surveyed on sports participation before and after surgery. Data was correlated with perioperative patient characteristics and outcome scores. Among 776 patients surveyed, 356 (50%) patients responded. Of respondents, 296 (83.1%) underwent UKA, 44 (12.6%) underwent PFA, and 16 (4.5%) underwent both UKA/PFA. RESULTS: Activity participation rates were 86.5, 77.3, and 87.5% five years prior, and 70.9, 61.4, and 75% at one year prior to UKA, PFA, and UKA/PFA, respectively. Return to sports rates were 81.6, 64.7, and 62.3% at mean 4.6 years postoperatively, respectively. The most common activities were recreational walking, swimming, cycling, and golf. Patients returned to a similar participation level for low-impact activities, whereas participation decreased for intermediate- and high-impact activities. Patients participating in activities had higher postoperative Knee Injury and Osteoarthritis Outcome Score Joint Replacement (P < .001), 12-Item Short Form Physical Component Score (P = .045) and Mental Component Score (P = .012). Activity restrictions were reported among 25, 36.4, and 25% of UKA, PFA, and UKA/PFA patients, respectively, and were more commonly self-imposed than surgeon-directed. CONCLUSIONS: Though UKA patients' postoperative sports participation may improve compared to one year preoperatively, participation for patients surgically treated for isolated osteoarthritis is decreased compared to 5 years preoperatively and varies among patient subsets.


Assuntos
Artroplastia do Joelho , Volta ao Esporte , Humanos , Artroplastia do Joelho/métodos , Volta ao Esporte/estatística & dados numéricos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Osteoartrite do Joelho/cirurgia , Esportes , Recuperação de Função Fisiológica , Resultado do Tratamento , Articulação Patelofemoral/cirurgia , Articulação do Joelho/cirurgia , Inquéritos e Questionários
19.
Neurosurgery ; 95(2): 339-346, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38358270

RESUMO

BACKGROUND AND OBJECTIVES: While spinal cord neurapraxia (SCN) is a documented pathology in athletes, guidance for neurosurgeons evaluating these patients is sparse. Therefore, in a cohort of adolescent athletes with SCN, we sought to (1) review their presentation and management and (2) describe outcomes and return-to-play (RTP). METHODS: A single-center, retrospective case series was conducted to examine adolescent athletes diagnosed with SCN from 2017 to 2022. SCN was defined as an episode of bilateral upper and/or lower extremity weakness/numbness after an impact during sport. Collected variables included demographics, presentation, management, outcomes, and RTP. RESULTS: Six patients were included (mean age = 14.5 ± 2.1 years, 100.0% male). Three American football players sustained tackle injuries, 1 ice hockey and 1 basketball player fell and landed on their head/neck, and 1 weight lifter sustained an axial load of weights to his neck. Motor symptoms ranged from quadriplegia to partial weakness. Full symptom resolution was seen in 6/6 patients: in <1 day for 3 patients, 2-3 days for 2 patients, and 1-2 months for 1 patient. All 6/6 patients received computed tomography of head/cervical spine and MRI of cervical spine, half of whom received computed tomography and MRI of thoracic/lumbar spine. No patient had congenital stenosis or abnormal T2 signal on MRI. Specific RTP recommendations varied. All 6 patients/parents were contacted at a mean of 16.6 ± 2.6 months from the injury. All patients returned to play at a mean of 5.7 ± 3.3 months. All 6 patients returned to their previous sports. Across all patients, no recurrence or neurological sequelae was endorsed in the follow-up period. CONCLUSION: Six athletes with SCN with no imaging abnormalities and full symptom resolution were able to RTP to their previous sport without future consequence. Symptom duration may not be clinically useful in determining the feasibility of RTP. Follow-up studies are warranted in this patient cohort to standardize RTP recommendations.


Assuntos
Traumatismos em Atletas , Volta ao Esporte , Humanos , Masculino , Adolescente , Estudos Retrospectivos , Volta ao Esporte/estatística & dados numéricos , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/complicações , Atletas/estatística & dados numéricos , Criança
20.
J ISAKOS ; 9(3): 378-385, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38242500

RESUMO

IMPORTANCE: Return to sport (RTS) is considered an indicator of successful recovery after anterior cruciate ligament reconstruction (ACLR). In recent years, there has been major interest in documenting RTS following anterior cruciate ligament (ACL) injury. Despite women being at increased risk for ACL injuries and a global increase in women's participation in sports, research has not adequately focused on female athletes. OBJECTIVE: The purpose of this study is to conduct a systematic review and meta-analysis evaluating the RTS rate in female athletes after ACLR. We hypothesize that most of the female athletes can RTS. EVIDENCE REVIEW: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electronic databases (PubMed, Embase, and Epistemonikos) were searched for articles reporting RTS rates and contextual data in female athletes. The following search terms were used: "anterior cruciate ligament reconstruction" OR "ACL reconstruction" AND "female" OR "women" AND "return to sports" OR "return to play" to retrieve all relevant articles published between 2003 and 2023. A quality assessment of the included studies was conducted. FINDINGS: Fifteen articles were included, reporting on 1456 female athletes participating in pivoting sports. The included studies comprised 9 cohorts, 1 case-control study, 2 case series, 2 descriptive epidemiology studies, and 1 observational study. Eight out of fifteen studies focused solely on elite-level athletes. The participants had a mean age of 23.13 years. Soccer was the most prevalent sport among the participants, accounting for 49.7% of all athletes included. All 15 studies reported an RTS rate, yielding a meta-proportion of 69% [95% CI, 58-80%] for RTS. Nine articles reported the average time to RTS, which was 10.8 months [95% CI, 8.7-12.8 months]. CONCLUSIONS: This systematic review demonstrates that a majority of female athletes (69 â€‹%) can RTS participation at an average of 10.8 months, however, the available information is insufficient, and quantitative data and reasons for not returning to play are lacking. Future studies should establish return-to-play criteria in this population and determine reasons for not returning to play. LEVEL OF EVIDENCE: III.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Atletas , Volta ao Esporte , Humanos , Reconstrução do Ligamento Cruzado Anterior/métodos , Feminino , Volta ao Esporte/estatística & dados numéricos , Lesões do Ligamento Cruzado Anterior/cirurgia , Atletas/estatística & dados numéricos , Traumatismos em Atletas/cirurgia
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