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Objective: To rate athletes' functional ability and return to sport (RTS) success at the end of their individual, formal, medically prescribed rehabilitation after anterior anterior cruciate ligament (ACL) reconstruction. Methods: In our prospective multicenter cohort study, 88 (42 females) adults aged 18-35 years after acute unilateral ACL rupture and subsequent hamstring grafting were included. All patients were prospectively monitored during their rehabilitation and RTS process until the end of their formal rehabilitation and RTS release. As outcome measures, functional hop and jump tests (front hop, balance hops, and drop jump screening test) and self-report outcomes (Knee Injury and Osteoarthritis Outcome Score, ACL-RTS after injury) were assessed. Literature-based cut-off values were selected to rate each performance as fulfilled or not. Results: At 7.5 months (SD 2.3 months) after surgery, the percentage of participants meeting the functional thresholds ranged from 4% (Knee Injury and Osteoarthritis Outcome Score SPORT) and over 44% (ACL-RTS after injury sum score) to 59% (Knee Injury and Osteoarthritis Outcome Score activities of all daily living) in the self-report and from 29% (Balance side hop) to 69% (normalized knee separation distance) in performance testing. Only 4% fulfilled all the cut-offs, while 45% returned to the same type and level of sport. Participants who successfully returned to their previous sport (type and level) were more likely to be "over-cut-off-performers." Conclusions: The low share of the athletes who fulfilled the functional RTS criteria highlights the importance of continuing the rehabilitation measures after the formal completion to assess the need for and success of, inter alia, secondary-preventive therapies. [ABSTRACT FROM AUTHOR]

Nutritional supplements (NS) are denned as concentrated sources of nutrients and other substances that have a nutritional or physiological effect and that are used in high frequency among athletes. The study aimed to create a prediction profile for young elite athletes to identify those athletes who have a higher relative risk for using NS. The second objective was to examine the hypothesis that the consumption of NS paves a gateway for the use of illicit drugs and doping substances. A self-designed anonymous paper-and-pencil questionnaire was used to examine the prevalence of NS consumption, doping, and illicit drug use in elite athletes with a mean age of 17 years (SD = 4 years). Logistic regression analysis was employed to assess whether NS consumption can be predicted by independent variables (e.g., biographical data, training characteristics, drug consumption behavior) to create the prediction profile for NS use. 55% and 5% of the athletes (n = 536) responded positively to having used NS and illicit drugs, respectively. Nutritional supplement consumption was positively correlated with age (OR: 1.92; CI: 1.21 to 3.05), the desire to enhance performance to become an Olympic or World Champion (OR: 3.72; CI: 2.33 to 6.01), and being educated about NS (OR: 2.76; CI: 1.73 to 4.45). It was negatively correlated with training frequency (OR: 0.55; CI: 0.35 to 0.86) and the use of nicotine (OR: 0.29; CI: 0.1 to 0.74) but did not correlate with illicit drug use and alcohol consumption. The present results show that NS are used on a large scale in elite sports. The prediction profile presented in this article may help to identify those athletes who have a high risk for using NS to plan potential education and prevention models more individually. [ABSTRACT FROM AUTHOR]

Zusammenfassung Vorbereitende Maßnahmen vor der Betreuung von Athleten beinhalten die Erkundung örtlicher Gegebenheiten, die Mitnahme geeigneter medizinischer Ausrüstung und eine Voruntersuchung der Sportler mit Beurteilung der aktuellen Spielfähigkeit. Im Falle einer Verletzung ist die Ersteinschätzung zur Einleitung therapeutischer Maßnahmen essentiell. Hierzu gehören Anamnese und eine präzise klinische Untersuchung. Die Erstversorgung folgt dem bekannten PECH-Schema, wobei Kompression und Kühlung einen besonderen Stellenwert einnehmen. Die Ausfallzeit richtet sich nach der Art und Schwere der Verletzung, relevante epidemiologische Vergleichsdaten sind in der Literatur v.a. für Verletzungen im Fußball zu finden. Bei Verdacht auf eine strukturelle Verletzung sollten im weiteren Verlauf bildgebende Verfahren durchgeführt werden. Summary Medical support of athletes is a critical and complex field. Broad qualification, knowledge of the sport that is medically supported, awareness of local conditions, preparation of appropriate equipment and pre-competition assessment of the athletes are crucial. Medical history and a precise clinical examination after injury are inevitable to find the correct diagnosis for appropriate treatment. Immediate treatment follows the well-known RICE-principle with focus on compression and cooling. Absence from sports depends on the type and grade of injury. Comparable epidemiological data can serve as a benchmark and can be found in the literature especially for football injuries. Injuries that are suspicious to be structural should be examined by imaging. [ABSTRACT FROM AUTHOR]

The patellofemoral pain syndrome (PFPS) is a possible cause for anterior knee pain, which predominantly affects young female patients without any structural changes such as increased Q-angle or significant chondral damage. This literature review has shown that PFPS development is probably multifactorial with various functional disorders of the lower extremity. Biomechanical studies described patellar maltracking and dynamic valgus in PFPS patients (functional malalignment). Causes for the dynamic valgus may be decreased strength of the hip abductors or abnormal rear-foot eversion with pes pronatus valgus. PFPS is further associated with vastus medialis/vastus lateralis dysbalance, hamstring tightness or iliotibial tract tightness. The literature provides evidence for a multimodal non-operative therapy concept with short-term use of NSAIDs, short-term use of a medially directed tape and exercise programmes with the inclusion of the lower extremity, and hip and trunk muscles. There is also evidence for the use of patellar braces and foot orthosis. A randomized controlled trial has shown that arthroscopy is not the treatment of choice for treatment of PFPS without any structural changes. Patients with anterior knee pain have to be examined carefully with regard to functional causes for a PFPS. The treatment of PFPS patients is non-operative and should address the functional causes. Level of evidence V. [ABSTRACT FROM AUTHOR]

Background Patellofemoral pain syndrome (PFPS) is a frequent cause of anterior knee pain predominantly affecting young female patients who do not have significant chondral damage. Development of PFPS is probably multifactorial, involving various knee, hip, and foot kinematic factors. Biomechanical studies have described patellar maltracking and dynamic valgus (functional malalignment) in patients with patellofemoral pain syndrome. The literature provides evidence for short-term use of nonsteroidal anti-inflammatory drugs; short-term medially directed taping; and exercise programs focusing on the lower extremity, hip, and trunk muscles. Evidence supporting the use of patellar braces is limited because previous studies have been low quality. The aim of this article is to publish the design of a prospective randomized trial that examines the outcomes of patients with PFPS after treatment with a new patellar brace (Patella Pro) that applies medially directed force on the patella. Methods/Design For this multicenter trial, 156 patients (adolescents and young adults) with PFPS were recruited from orthopedic practices and orthopedic hospitals and randomly allocated to 3 months of supervised physiotherapy in combination with the Patella Pro brace or supervised physiotherapy alone. The primary outcome measures are pain (numerical analog scale); knee function (Kujala score and Knee Injury and Osteoarthritis Outcome Score); and self-reported perception of recovery at baseline, 6 weeks, 3 months, and 1 year. Discussion Only limited evidence for the use of a patellar brace for the treatment of PFPS exists in the literature. Disputable evidence for the use of orthoses for PFPS patients has been presented in one meta-analysis, in which only one of three studies found the effect of a medially directed patellar brace to be significant. Because of these low-quality studies, the authors concluded that this evidence should be regarded as limited, and we feel there is a need for further well-designed studies to evaluate the effect of patellar bracing on PFPS-related pain. The Patella Pro study is a prospective randomized trial in which supervised physiotherapy in combination with a patellar brace is compared with supervised physiotherapy alone. This trial started in April 2012 and finished in October 2013. [ABSTRACT FROM AUTHOR]

Anterior knee pain is one of the most common causes of persistent problems after implantation of a total knee replacement. It can occur in patients with or without patellar resurfacing. As a result of the surgical procedure itself many changes can occur which may affect the delicate interplay of the joint partners in the patello-femoral joint. Functional causes of anterior knee pain can be distinguished from mechanical causes. The functional causes concern disorders of inter- and intramuscular coordination, which can be attributed to preoperative osteoarthritis. Research about anterior knee pain has shown that not only the thigh muscles but also the hip and trunk stabilising muscles may be responsible for the development of a dynamic valgus malalignment. Dynamic valgus may be a causative factor for patellar maltracking. The mechanical causes of patello-femoral problems after knee replacement can be distinguished according to whether they increase instability in the joint, increase joint pressure or whether they affect the muscular lever arms. These causes include offset errors, oversizing, rotational errors of femoral or tibial component, instability, maltracking and chondrolysis, patella baja and aseptic loosening. In these cases, reoperation or revision is often necessary. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the presupposed preventive residual mechanical effectiveness of the widespread use of adhesive elastic ankle tape after a nonlaboratory, realistic soccer-specific outfield intervention reflecting a soccer halftime. Design: A prospective nonrandomized test-retest design was used. Setting: Laboratory. Participants: Seventeen professional male outfield players (mean age, 25.5) without any signs of chronic ankle instability. Intervention: Participants were investigated before and after a 45-minute soccer-specific field intervention. Main Outcome Measures: The passive inversion range of motion (ROM) of the ankle was tested unloaded on a self-developed inversion device with and without a standardized ankle tape before and after the intervention. Additionally, electromyography signal was taken to assure the inactivity of the protective evertor muscles, and reliability tests for the inversion device (test-retest and trial to trial) were conducted in 12 healthy controls. Results: Tape restricted the maximum passive inversion ROM of the uninjured ankle significantly to 50.3%. The protection declined nearly completely after 45 minutes of outfield soccer performance to a negligible nonsignificant ROM restriction of 9.7%. Pearson correlation coefficient for the reliability was 0.931 (P ≤ 0.001) for the test-retest and 0.983 (P ≤ 0.001) for the trial-to-trial test. Conclusions: The initial significant protection of external ankle-tape support declines almost completely without relevant remaining residual mechanical effect after 45 minutes, reflecting a soccer halftime. The so far presupposed residual mechanical effectiveness of tape to prevent injury is increasingly irrelevant during soccer performance and consequently antidromic to the increasing injury risk toward the end of a soccer halftime. [ABSTRACT FROM AUTHOR]

Aim: Endurance capacity of each individual soccer player can notably influence a team’s success. The opinion about the necessity of generic endurance specific training in soccer, especially in adolescent athletes, still varies widely. Methods: We examined n = 38 elite premier league youth soccer players from three different age groups and with a different amount of endurance specific training. Two identical graded incremental exercise tests were performed before and after a 5 weeks training intervention. Besides soccer specific training, the different groups absolved either 25–30% (U16 and U19) or < 5% (U17) of generic endurance specific training as well as soccer specific endurance training. After the training intervention the alterations of blood lactate concentration (La-), the individual anaerobic threshold (LT) as well as the 4 mmol/-1 threshold were determined. Results: Running velocity of the U16 and U19 players at individual anaerobic threshold and at the 4 mmol/-1 threshold increased significantly. In contrast, no changes of the LT or 4 mmol/-1 threshold could be detected for the U17 players. Conclusions: The individual endurance capacity of young elite soccer players can be improved significantly, even over a short preseason period, by performing an adequate amount of generic endurance specific training. [ABSTRACT FROM AUTHOR]

Summary: The lateral ankle sprain is the most frequent injuries in athletes. Many patients suffer from chronic complaints after an acute ankle sprain despite treatment. The risk of a second ankle sprain is 2-5 fold increased, especially in athletes. There is no correlation between severity of injury and chronic problems. Especially patients with a grade I sprain have a higher risk for chronic problems than patients with a severe injury. Therefore prevention should play an important role. The healing process of the torn ligaments can be divided in three different phases (inflammatory phase, proliferation phase, and regenerative phase). Clinical studies could demonstrate advantages for operative and non operative treatment. Regarding possible complications of surgery treatment of choice is non operative. For non operative treatment stabilization of the ankle can be achieved with plaster casts, stable and semi rigid orthosis, tape or elastic bandages. The amount of stabilization should be adapted to the different phases of ligament healing. Furthermore there is some evidence that the non operative treatment should be supported by a sensomotoric training program. [Copyright &y& Elsevier]