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Objective Base of thumb OA (BTOA) is a common age-related disease that has a significant negative impact on quality of life, while little is known about the structure and pathways of interface services. Our aim was to assess disease burden, referral pathways, service structure and management pathways in UK interface services. Methods A structured questionnaire was carried out with a participating clinician at each centre to detail the local guidelines and management of BTOA. Five patients referred with BTOA were prospectively identified in each of 32 UK interface centres. Results Most centres (72%) had a local guideline and a standardized treatment regime consisting of education (100%), joint protection (100%), range of motion exercises (84%), strengthening exercises (88%), splintage (100%) and use of assistive devices (78%). No centre routinely offered a steroid injection at the first appointment and no centre had a specific threshold for offering an injection. Injection delivery was variable. Most patients had not been referred previously (82%). Most patients used analgesia (72%), but a minority of patients had been treated with a splint (46%), therapy (43%) and steroid injection (27%) prior to their latest attendance. Conclusion Most BTOA patients newly referred to interface services have been treated with analgesics and have not received comprehensive multimodal intervention. The management of BTOA at interface services is standardized in terms of education, splintage and therapy. However, there is a lack of standardization in terms of both the threshold for, timing of and mode of delivery of injection therapy. [ABSTRACT FROM AUTHOR]

Context and objective: We evaluated the predictive value of serum cartilage oligomeric matrix protein (sCOMP) levels over 20 years on the development of radiographic (RKOA) and painful knee osteoarthritis (KOA) in a longitudinal cohort of middle-aged women. Materials and methods: Five hundred and ninety-three women with no baseline KOA underwent 5-year knee radiographs over 20-years and were asked about knee pain a month before each assessment. A repeated measures logistic regression model was used where the outcomes were recorded at 5, 10, 15 and 20-years follow-up. Results: The highest quartile of sCOMP was associated with increased risk of RKOA with overall OR of 1.97 (95% CI: 1.33–2.91) over 20 years when compared with the lowest sCOMP quartile. The association with painful KOA was similar and also independent, but only when the fourth and third sCOMP quartiles were compared. Discussion and conclusion: This study demonstrates that sCOMP levels are predictive of subsequent structural changes and incidence of painful KOA, independently of age and BMI. [ABSTRACT FROM AUTHOR]

This review considers adipokines as predictive biomarkers for early onset post-traumatic knee osteoarthritis (KOA). Serum concentrations of leptin and resistin can predict radiographic changes and are elevated in early KOA, with higher leptin concentrations independently associated with more severe knee changes. Plasma concentrations of resistin are chronically elevated after injury. Leptin, resistin, chemerin and vistfatin induce catabolic enzymes associated with cartilage degeneration. Available literature on adipokines in post-traumatic KOA pathogenesis suggests that they could contribute to risk prediction of early onset post-traumatic KOA. Further research is needed to further understand the association between adipokines, synovitis and long-term outcomes in this population. [ABSTRACT FROM AUTHOR]

Clinical prediction models in sports medicine that utilize regression or machine learning techniques have become more widely published, used, and disseminated. However, these models are typically characterized by poor methodology and incomplete reporting, and an inadequate evaluation of performance, leading to unreliable predictions and weak clinical utility within their intended sport population. Before implementation in practice, models require a thorough evaluation. Strong replicable methods and transparency reporting allow practitioners and researchers to make independent judgments as to the model's validity, performance, clinical usefulness, and confidence it will do no harm. However, this is not reflected in the sports medicine literature. As shown in a recent systematic review of models for predicting sports injury models, most were typically characterized by poor methodology, incomplete reporting, and inadequate performance evaluation. Because of constraints imposed by data from individual teams, the development of accurate, reliable, and useful models is highly reliant on external validation. However, a barrier to collaboration is a desire to maintain a competitive advantage; a team's proprietary information is often perceived as high value, and so these 'trade secrets' are frequently guarded. These 'trade secrets' also apply to commercially available models, as developers are unwilling to share proprietary (and potentially profitable) development and validation information. In this Current Opinion, we: (1) argue that open science is essential for improving sport prediction models and (2) critically examine sport prediction models for open science practices. [ABSTRACT FROM AUTHOR]

Fatigue is a phenomenon associated with decreases in both physical and cognitive performances and increases in injury occurrence. Competitive athletes are required to complete demanding training programs with high workloads to elicit the physiological and musculoskeletal adaptations plus skill acquisition necessary for performance. High workloads, especially sudden rapid increases in training loads, are associated with the occurrence of fatigue. At present, there is limited evidence elucidating the underlying mechanisms associating the fatigue generated by higher workloads and with an increase in injury risk. The multidimensional nature and manifestation of fatigue have led to differing definitions and dichotomies of the term. Consequently, a plethora of physiological, biochemical, psychological and performance markers have been proposed to measure fatigue and recovery. Those include self-reported scales, countermovement jump performance, heart rate variability, and saliva and serum biomarker analyses. The purpose of this review is to provide an overview of fatigue and recovery plus methods of assessments. [ABSTRACT FROM AUTHOR]

Background: Meniscus root tears (MRTs) are defined as radial tears within 1 cm of the meniscus root insertion or an avulsion of the meniscus root itself. They lead to altered joint loading because of the failure to convert axial (compressive) loads into hoop stresses. Untreated MRTs can result in altered joint biomechanics and accelerated articular cartilage degeneration and the development of osteoarthritis (OA), yet optimal management remains unclear. Purpose: To review treatment outcomes after acute MRTs by surgical repair, debridement, meniscectomy, or nonoperative treatment. Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the evidence from human clinical studies was conducted with electronic searches of the PUBMED, Medline, EMBASE, and the Cochrane Library databases. One reviewer extracted the data and 2 reviewers assessed the risk of bias and performed synthesis of the evidence. Results: Eleven studies of low to moderate methodological quality were identified. All treatment options improved functional scores after >12 months. Arthroscopic repair may be associated with better functional outcomes when compared with partial meniscectomy and nonoperative management at 12-month follow-up. Radiographic progression of OA occurred in all treatment groups; there was some evidence that this was delayed after repair when compared with other treatments. Baseline severity of meniscal extrusion, varus malalignment, and pretreatment degeneration were predictors of poor functional outcomes. Age was not found to be an independent predictor of functional outcome. Conclusion: The current level 3 and 4 evidence suggests that arthroscopic repair may result in slower progression of radiological deterioration compared with meniscectomy and nonoperative management. The current literature does not support the exclusion of patients from MRT repair on the basis of age. Patients undergoing acute MRT treatments (repair, debridement, or nonoperative) can be expected to experience improvement in functional outcomes after >12 months. The strength of conclusions are limited because of the paucity of high-quality studies on this subject. Further studies, preferably randomized sham controlled trials with function-oriented rehabilitation programs, are needed to compare treatment strategies and stratification of care based on the risk of meniscal extrusion. Registration: CRD42018085092 (PROSPERO). [ABSTRACT FROM AUTHOR]

There is growing interest in the role of predictive analytics in sport, where such extensive data collection provides an exciting opportunity for the development and utilisation of prediction models for medical and performance purposes. Clinical prediction models have traditionally been developed using regression-based approaches, although newer machine learning methods are becoming increasingly popular. Machine learning models are considered 'black box'. In parallel with the increase in machine learning, there is also an emergence of proprietary prediction models that have been developed by researchers with the aim of becoming commercially available. Consequently, because of the profitable nature of proprietary systems, developers are often reluctant to transparently report (or make freely available) the development and validation of their prediction algorithms; the term 'black box' also applies to these systems. The lack of transparency and unavailability of algorithms to allow implementation by others of 'black box' approaches is concerning as it prevents independent evaluation of model performance, interpretability, utility, and generalisability prior to implementation within a sports medicine and performance environment. Therefore, in this Current Opinion article, we: (1) critically examine the use of black box prediction methodology and discuss its limited applicability in sport, and (2) argue that black box methods may pose a threat to delivery and development of effective athlete care and, instead, highlight why transparency and collaboration in prediction research and product development are essential to improve the integration of prediction models into sports medicine and performance. [ABSTRACT FROM AUTHOR]

Objective: To systematically review literature enabling the comparison of the efficacy of pharmaceutical treatments for tinea pedis in adults. Design: Systematic review of randomised controlled trials (RCTs) with mycological cure as the primary outcome. Secondary outcomes did include the clinical assessment of resolving infection or symptoms, duration of treatment, adverse events, adherence, and recurrence. Eligibility Criteria: Study participants suffering from only tinea pedis that were treated with a pharmaceutical treatment. The study must have been conducted using an RCT study design and recording age of the participant > 16 years of age. Results: A total of seven studies met the inclusion criteria, involving 1042 participants. The likelihood of resolution in study participants treated with terbinafine was RR 3.9 (95% CI: 2.0–7.8) times those with a placebo. Similarly, the allylamine butenafine was effective by RR 5.3 (95% CI: 1.4–19.6) compared to a placebo. Butenafine was similarly efficacious to terbinafine RR 1.3 (95% CI: 0.4–4.4). Terbinafine was marginally more efficacious than itraconazole, RR 1.3 (95% CI: 1.1–1.5). Summary/Conclusion: Topical terbinafine and butenafine treatments of tinea pedis were more efficacious than placebo. Tableted terbinafine and itraconazole administered orally were efficacious in the drug treatment of tinea pedis fungal infection. We are concerned about how few studies were available that reported the baseline characteristics for each treatment arm and that did not suffer greater than 20% loss to follow-up. We would like to see improved reporting of clinical trials in academic literature. Registration name: Treatment's for athlete's foot—systematic review with meta-analysis [CRD42020162078]. [ABSTRACT FROM AUTHOR]

The article presents the discussion on letters.

Blood flow restriction training (BFR-t) data are heterogeneous. It is unclear whether rehabilitation with BFR-t after an anterior cruciate ligament (ACL) injury is more effective in improving muscle strength and muscle size than standard rehabilitation.To review outcomes after an ACL injury and subsequent reconstruction in studies comparing rehabilitation with and without BFR-t.Systematic review. Level of evidence, 3.A search of English-language human clinical studies published in the past 20 years (2002-2022) was carried out in 5 health sciences databases, involving participants aged 18-65 undergoing rehabilitation for an ACL injury. Outcomes associated with muscle strength, muscle size, and knee-specific patient-reported outcome measures (PROMs) were extracted from studies meeting inclusion criteria and compared.The literature search identified 279 studies, of which 5 met the selection criteria. Two studies suggested that BFR-t rehabilitation after an ACL injury improved knee or thigh muscle strength and muscle size compared with rehabilitation consisting of comparable and higher load resistance training, with two studies suggesting the opposite. The single study measuring PROMs showed improvement compared to traditional rehabilitation, with no difference in muscle strength or size.BFR-t after an ACL injury seems to benefit muscle strength, muscle size, and PROM scores compared with standard rehabilitation alone. However, only 1 large study included all these outcomes, which has yet to be replicated in other settings. Further studies utilizing similar methods with a common set of outcome measures are required to confirm the effects of BFR-t on ACL rehabilitation. [ABSTRACT FROM AUTHOR]

Sports-related injuries increase healthcare cost burden, and in some instances have harmful long term physical and psychological implications. There is currently a lack of comprehensive data on temporal injury trends across professional North American sports. The purpose of this study was to compare temporal trends, according to incidence and time-loss injuries, by body part in professional baseball, basketball, football, and ice hockey. Public injury data from Major League Baseball, National Basketball Association, National Football League, and National Hockey League from 2007 to December 2019 were extracted and used. A mean of 62.49 injuries per 100 players per season was recorded for all professional sports. The groin/hip/thigh reported the greatest season proportional injury incidence for baseball, football, and ice hockey, with the groin/hip/thigh as the third highest injury incidence in basketball. When stratifying by more specific body part groupings, the knee demonstrated the greatest injury proportional incidence for basketball, football, and ice hockey, with the knee as the third highest proportional injury incidence for baseball. There was an increased in basketball ankle injuries following 2011–2012 season. Football and ice hockey reported the greatest concussion proportion incidence, with football demonstrating an increase in concussions over time, and a substantial increase in concussions from the 2014 to 2015 season. These publicly extracted data and findings can be used as a shared resource for professional baseball, basketball, football, and ice hockey for future individual and across sport collaborations concerning resource allocation and decision making in order to improve player health. [ABSTRACT FROM AUTHOR]

Objectives Synovitis in symptomatic knee OA (KOA) is common and is associated with joint symptoms. Optimal synovial measurement on MRI is, however, unclear. Our aims were to examine the relationship between MRI measures of synovitis and knee symptoms in symptomatic KOA. Methods Data from a randomized, multicentre, placebo-controlled trial (UK-VIDEO) of vitamin-D therapy in symptomatic KOA were utilized. Participants reported knee symptoms using WOMAC at baseline and annually. On contrast-enhanced (CE) MRI, synovial thickness was measured using established, semi-quantitative methods whilst synovial tissue volume (STV) was assessed as absolute STV (aSTV) and relative to the width of femoral condyle (rSTV). STV of the infrapatellar region was also assessed. Associations between synovial measures and symptoms were analysed using multiple linear regression modelling. Results No linear association was observed between knee symptoms and synovitis thickness scores. Whole-joint aSTV (0.88, 95% CI: 0.17, 1.59) and infrapatellar aSTV (5.96, 95% CI: 1.22, 10.7) were positively associated with knee pain. Whole-joint rSTV had a stronger association with pain (7.96, 95% CI: 2.60, 13.33) and total scores (5.63, 95% CI: 0.32, 10.94). Even stronger associations were found for infrapatellar rSTV with pain (55.47, 95% CI: 19.99, 90.96), function (38.59, 95% CI: 2.1, 75.07) and total scores (41.64, 95% CI: 6.56, 76.72). Conclusions Whole-joint and site-specific infrapatellar STV measures on CE-MRI were associated with knee pain, respectively. Volumes relative to the size of the femoral condyle may be promising outcome measures in KOA trials. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis (OA) is a heterogeneous disease, and identification of its subgroups/phenotypes can improve patient treatment and drug development. We aimed to identify homogeneous OA subgroups/phenotypes using pain development over time; to understand the interplay between pain and functional limitation in time course; and to investigate subgroups' responses to available pharmacological and surgical treatments. We used group-based trajectory modelling to identify pain trajectories in the phase-3 VIDEO trial (n = 474, 3-year follow-up) and also in the Osteoarthritis Initiative cohort study (n = 4796, 9-year follow-up). We extended trajectory models by (1) fitting dual trajectories to investigate the interplay between pain and functional limitation over time, and (2) including analgesic use as a time-varying covariate. Also, we investigated the relationship between trajectory groups and knee replacement in regression models. We identified 4 pain trajectory groups in the trial and 6 in the cohort. These overlapped and led us to define 4 OA phenotypes: low-fluctuating, mild-increasing, moderate-treatment-sensitive, and severe-treatment-insensitive pain. Over time, functional knee limitation followed the same trajectory as pain with almost complete concordance (94.3%) between pain and functional limitation trajectory groups. Notably, we identified a phenotype with severe pain that did not benefit from available treatments, and another one most likely to benefit from knee replacement. Thus, knee OA subgroups/phenotypes can be identified based on patients' pain experiences in studies with long and regular follow-up. We provided a robust approach, reproducible between different study designs, which informs clinicians about symptom development and delivery of treatment options and opens a new avenue toward personalized medicine in OA. [ABSTRACT FROM AUTHOR]

Background: Osgood Schlatter disease (OSD) is the most common knee condition in adolescent athletes aged 9‐16. Without evidence to guide clinical practice, it is unclear how OSD is managed. The aim of this study was to investigate how international healthcare professionals (general practitioners, physiotherapists, rheumatologists, sports and exercise medicine doctors, and orthopedic surgeons) diagnose and manage OSD. Methods: This mixed‐method study used a convergent parallel design. A quantitative questionnaire and semi‐structured interview covered prognosis, diagnosis, treatment, and return to play of adolescents with OSD. For quantitative data, those who reported likely/very likely considered "for" and unlikely/very unlikely "against" (for specific diagnostic/management strategy). Qualitative data analysis used a phenomenological approach. Results: Two hundred and fifty‐one healthcare professionals completed the questionnaire. The most common diagnostic criterion was pain at the tibial tuberosity (97% for). The most common treatments were patient education (99%) and exercise therapy (92%). Other treatment options were more heterogeneous, for example, pain medication (31% for and 34% against). Managing training load (97%), pain intensity (87%), and psychological factors (86%) were considered the most important factors influencing the return to activities. Several themes emerged from the interviews (on N = 20) including imaging, pain management, family, and psychosocial factors influencing prognosis. Conclusion: Diagnosis criteria of OSD were relatively well agreed upon, whereas the triangulation of qualitative and quantitative data showed heterogeneity of treatments. Psychosocial factors including family were highlighted as critical in the management of OSD. [ABSTRACT FROM AUTHOR]

This is a unique presentation of common injury in a young professional athlete. The sensitivity of typical acute clinical signs in athletes is not known. Adequate splinting and early graded mobilization are key for successful rehabilitation, which was shorter than reported in the literature. [ABSTRACT FROM AUTHOR]

Introduction: Musculoskeletal injuries are common during military and other occupational physical training programs. Employers have a duty of care to reduce employees' injury risk, where females tend to be at greater risk than males. However, quantification of principle co-factors influencing the sex-injury association, and their relative importance, remain poorly defined. Injury risk co-factors were investigated during Royal Air Force (RAF) recruit training to inform the strategic prioritization of mitigation strategies.Material and Methods: A cohort of 1,193 (males n = 990 (83%); females n = 203 (17%)) recruits, undertaking Phase-1 military training, were prospectively monitored for injury occurrence. The primary independent variable was sex, and potential confounders (fitness, smoking, anthropometric measures, education attainment) were assessed pre-training. Generalized linear models were used to assess associations between sex and injury.Results: In total, 31% of recruits (28% males; 49% females) presented at least one injury during training. Females had a two-fold greater unadjusted risk of injury during training than males (RR = 1.77; 95% CI 1.49-2.10). After anthropometric, lifestyle and education measures were included in the model, the excess risk decreased by 34%, but the associations continued to be statistically significant. In contrast, when aerobic fitness was adjusted, an inverse association was identified; the injury risk was 40% lower in females compared with males (RR = 0.59; 95% CI: 0.42-0.83).Conclusions: Physical fitness was the most important confounder with respect to differences in males' and females' injury risk, rather than sex alone. Mitigation to reduce this risk should, therefore, focus upon physical training, complemented by healthy lifestyle interventions. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate age- and sex-specific effects of obesity, metabolic syndrome (MetS) and its components on back pain in middle-aged and older English individuals.Methods: We used data from the English Longitudinal Study of Ageing, wave 2 (2004-2005). Body mass index (BMI) expressed the obesity, while MetS was defined according to revised Adult Treatment Panel (ATP) III criteria. We assessed associations between obesity, MetS and its components with presence and severity of back pain and provided estimates per strata, middle-aged (50-64years) and older (65-79years), women and men.Results: The study sample included 3328 participants, 1021 and 835 middle-aged women and men and 773 and 699 older women and men, respectively. We found that BMI (OR=1.07, 95% CI 1.05-1.09), MetS (OR=1.47, 95% CI 1.22-1.77), high waist circumference (WC), high triglycerides (TG), and high fasting blood glucose were associated with the presence of back pain. Effects of BMI were consistent across the strata. However, MetS was associated with back pain only in women, middle-aged (OR=1.59, 95% CI 1.14-2.21) and older (OR=1.43, 95% CI 1.01-2.05). The MetS component driving this association was high WC, supported by high TG in older women. Higher BMI, presence of MetS, high blood pressure and TG were associated with back pain severity.Conclusions: We found that obesity was associated with the presence and severity of back pain, irrespective of age and sex. However, we found women-specific effects of MetS driven by high WC, indicating that metabolic dysregulation contributes to back pain pathophysiology in women. [ABSTRACT FROM AUTHOR]

Background: An implementation gap exists between the evidence supporting physical activity in the prevention and management of long-term medical conditions and clinical practice. Person-centred conversations, i.e. focussing on the values, preferences and aspirations of each individual, are required from healthcare professionals. However, many currently lack the capability, opportunity, and motivation to have these conversations. This study uses the Behaviour Change Wheel (BCW) to inform the development of practical and educational resources to help bridge this gap.Methods: The BCW provides a theoretical approach to enable the systematic development of behaviour change interventions. Authors followed the described eight-step process, considered results from a scoping review, consulted clinical working groups, tested and developed ideas across clinical pathways, and agreed on solutions to each stage by consensus.Results: The behavioural diagnosis identified healthcare professionals' initiation of person-centred conversations on physical activity at all appropriate opportunities in routine medical care as a suitable primary target for interventions. Six intervention functions and five policy categories met the APEASE criteria. We mapped 17 Behavioural Change Techniques onto BCW intervention functions to define intervention strategies.Conclusions: This study uses the BCW to outline a coherent approach for intervention development to improve healthcare professionals' frequency and quality of conversations on physical activity across clinical practice. Time-sensitive and role-specific resources might help healthcare professionals understand the focus of their intervention. Educational resources aimed at healthcare professionals and patients could have mutual benefit, should fit into existing care pathways and support professional development. A trusted information source with single-point access via the internet is likely to improve accessibility. Future evaluation of resources built and coded using this framework is required to establish the effectiveness of this approach and help improve understanding of what works to change conversations around physical activity in clinical practice. [ABSTRACT FROM AUTHOR]

To investigate the association between markers of synovial inflammation and matrix turnover (MRI-based and serum biomarkers) and knee symptoms in established knee osteoarthritis (KOA). This cross-sectional study utilised data from a randomised, multicentre placebo-controlled trial (UK-VIDEO) of vitamin D therapy in symptomatic KOA. Data on serum biomarkers, type III collagen degradation (C3M), metabolite of C-reactive protein (CRPM) and cartilage oligomeric matrix protein (COMP), were available at baseline whilst contrast-enhanced (CE) MRI data were acquired in a subsample at baseline and annually. Knee symptoms were assessed using WOMAC at all visits. We examined the cross-sectional association between knee symptoms and three MRI-based and three serum markers of synovitis and matrix turnover, respectively. A total of 447 participants were included in the serum and 136 participants in the MRI analyses. MRI-defined medial perimeniscal synovitis was positively associated with knee pain and, suprapatellar and medial perimeniscal synovitis with knee function in multivariate analysis. We observed a statistically significant, negative association between a higher concentration of serum C3M and CRPM and knee pain, respectively. Furthermore, the highest CRPM quartile was negatively associated with knee function. Our findings suggest that, in established painful radiographic KOA, MRI-defined medial perimeniscal and suprapatellar synovitis were positively associated with knee symptoms. Serum-based C3M and CRPM markers were negatively associated with knee symptoms. Pain fluctuations are common in KOA and a better understanding of the relationship between markers of synovitis and matrix turnover and knee symptoms would facilitate a more accurate assessment of temporal changes in disease progression. [ABSTRACT FROM AUTHOR]