Search

Context: There is a well-established increased risk of lower-extremity (LE) musculoskeletal (MSK) injury following a sport-related concussion (SRC). Neuromuscular training programs improve biomechanics associated with LE MSK injury and reduce LE MSK injury incidence, but their relative effectiveness in athletes with history of SRC is unknown. The purpose of this study was to evaluate LE MSK injury incidence in female adolescent athletes with history of SRC following a neuromuscular training intervention. Design: Prospective case-control. Methods: Seventy-seven adolescent female athletes aged 12–18 years who participated in soccer, volleyball, or basketball were recruited from a single institutional sports medicine research and performance center to complete a 6-week neuromuscular training program prior to competitive athletic season. Group (Control, History of SRC) comparisons of athlete exposure and relative LE MSK injury risk and rates during the competitive athletic season were assessed. Results: Ten injuries were recorded by 9 athletes. Female athletes who reported history of SRC had increased injury risk (Risk Ratio 3.9, 95% CI, 1.1–13.8, P =.01) and increased injury rate (rate ratio 4.1, 95% CI, 1.1–15.8, P =.03) compared with female athletes without history of SRC. Conclusions: Female adolescent athletes with history of SRC showed a greater risk of LE MSK injury compared with athletes with no history of SRC. Future work is still needed to understand the underlying mechanisms associated with future LE MSK injury following SRC and interventions that ameliorate elevated injury risk. [ABSTRACT FROM AUTHOR]

Quantitative methods to characterize bone contusions and associated cartilage injury remain limited. We combined standardized voxelwise normalization and 3D mapping to automate bone contusion segmentation post‐anterior cruciate ligament (ACL) injury and evaluate anomalies in articular cartilage overlying bone contusions. Forty‐five patients (54% female, 26.4 ± 11.8 days post‐injury) with an ACL tear underwent 3T magnetic resonance imaging of their involved and uninvolved knees. A novel method for voxelwise normalization and 3D anatomical mapping was used to automate segmentation, labeling, and localization of bone contusions in the involved knee. The same mapping system was used to identify the associated articular cartilage overlying bone lesions. Mean regional T1ρ was extracted from articular cartilage regions in both the involved and uninvolved knees for quantitative paired analysis against ipsilateral cartilage within the same compartment outside of the localized bone contusion. At least one bone contusion lesion was detected in the involved knee within the femur and/or tibia following ACL injury in 42 participants. Elevated T1ρ (p = 0.033) signal were documented within the articular cartilage overlying the bone contusions resulting from ACL injury. In contrast, the same cartilaginous regions deprojected onto the uninvolved knees showed no ipsilateral differences (p = 0.795). Automated bone contusion segmentation using standardized voxelwise normalization and 3D mapping deprojection identified altered cartilage overlying bone contusions in the setting of knee ACL injury. [ABSTRACT FROM AUTHOR]

Optimizing performance through intrinsic motivation and attention for learning: prevention rehabilitation exercise play (OPTIMAL PREP) training strategies incorporate motor learning principles to enhance movement acquisition and retention. We aimed to use OPTIMAL PREP biofeedback to evaluate its potential to improve quadriceps and hamstring torque production in patients with anterior cruciate ligament reconstruction (ACL-R). Thirteen subjects 23 6 19 months post ACL-R completed 5 concentric quadriceps/hamstrings repetitions on an isokinetic dynamometer for each limb and counterbalanced condition at 60°·s21. For the control condition, subjects were instructed to perform the exercise "as hard and fast as possible." For the OPTIMAL PREP condition, subjects were additionally told that "Research shows that if you focus on moving the line on the screen (external focus) you will exhibit greater quadriceps output (enhanced expectancies)" and were given the choice of graphical representation for the biofeedback (autonomy support). Quadriceps and hamstrings peak torque, rate of force development, and torque-angle waveforms were analyzed with 23 2 RMANOVAs (a priori h2 p .0.06). The ACL-R limb demonstrated increased quadriceps peak torque in the OPTIMAL PREP condition than in the control condition (h2 p 5 0.13, interaction p 5 0.21, pairwise Cohen's d 5 0.63). Anterior cruciate ligament reconstruction limb quadriceps deficits remained near terminal extension (14-45°; peak Cohen's d 5 0.57, p, 0.001). For hamstrings peak torque, we observed moderate effects for condition (OPTIMAL PREP greater; h2 p 5 0.10, p 5 0.29) and limb (uninvolved greater; h2 p 5 0.13, p 5 0.22). Easily implementable OPTIMAL PREP training strategies improved ACL-R limb quadriceps torque production, resulting in between-limb parity. However, asymmetries still existed near terminal extension. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of a 10-month neuromuscular training (NMT) intervention on muscle architecture, isometric force production, and stretch-shortening cycle (SSC) function. Thirty-seven girls aged 6-12 years were placed into gymnastics + NMT (gNMT; n = 15), gymnastics only (GYM; n = 10), or maturity-matched control (CON; n = 12) groups. The gNMT group followed a 10-month NMT program in addition to gymnastics training, whereas the GYM group only participated in gymnastics training. Isometric midthigh pull (IMTP) and drop jump (DJ) kinetics were measured, in addition to muscle thickness, fascicle length, and pennation angle of the gastrocnemius medialis at baseline and at 4, 7, and 10 months. A3 x 4 (group x time) repeated-measures ANCOVA (covariate, % predicted adult height) was used to evaluate within-group changes. Significance level was set at p < 0.05. Significant interaction effects were observed in muscle thickness, absolute (PFabs) and relative peak force (PFrel) in the IMTP and various DJ variables. The gNMT group demonstrated improvements in muscle thickness, IMTP PFabs and PFrel, and DJ kinetics, most commonly evidenced from 7 months onward. The GYM group's muscle thickness also significantly improved, accompanied by improvements in some DJ kinetics. The CON group did not experience any desirable changes. Overall, NMT elicited positive changes in muscle thickness, PFabs and PFrel, and SSC function to a greater extent than gymnastics training alone or growth and maturation. As most adaptations took 7 months, longer-term NMT programs should be implemented with youth female gymnasts. [ABSTRACT FROM AUTHOR]

Background: The ideal graft for anterior cruciate ligament (ACL) reconstruction (ACLR) in young athletes has a high return-to-sport (RTS) rate and a low reinjury rate. Quadriceps tendon autografts are being used with increasing frequency for ACLR in this population, despite a paucity of evidence to support their use. Purpose: To report the RTS rate, ipsilateral reinjury rate, and contralateral ACL injury rate in a young athletic population undergoing primary ACLR using an all–soft tissue quadriceps tendon (ASTQT) autograft. Study Design: Cases series; Level of evidence, 4. Methods: Patients aged 14 to 22 years who underwent primary ACLR using an ASTQT autograft by a single surgeon between January 1, 2005, and April 30, 2020, were identified via electronic medical records and contacted ≥24 months after ACLR to complete a survey regarding subsequent ipsilateral or contralateral ACL injuries and RTS. Patients who had undergone previous ACLR (ipsilateral or contralateral) were excluded. Results: A total of 656 patients (330 male, 326 female; mean age, 17.9 years) were identified, and 395 patients completed the survey (60.2%; 174 male, 221 female; mean age, 17.8 years) with a mean follow-up of 73 ± 29 months (range, 24-139 months). The RTS rate was high (male: 87.7%; female: 82.8%; P =.19). Male and female patients had similar rates of revision ACLR (male: 12.6%; female: 10.0%; P =.40) and contralateral ACL injuries (male: 13.8%; female: 11.3%; P =.46). Conclusion: A high RTS rate and similar rates of ipsilateral and contralateral ACL injuries were found for male and female patients in a young athletic population undergoing primary ACLR using an ASTQT autograft. These results help one to better understand the utility of ASTQT grafts to support successful ACLR in young athletic populations, for which ASTQT grafts appear to yield favorable outcomes. [ABSTRACT FROM AUTHOR]

General and local muscular fatigue is postulated to negatively alter lower limb biomechanics; however, few prospective studies have been done to examine the effect of fatigue on tuck-jump performance. The tuck-jump assessment (TJA) is a criteria-based visual screening tool designed to identify neuromuscular deficits associated with anterior cruciate ligament (ACL) injury. Use of kinetics during the TJA after an intense sport-specific fatigue protocol may identify fatigue-induced neuromuscular deficits associated with ACL injury risk. To examine the effects of a sport-specific fatigue protocol on visually evidenced (2-dimensional) technical performance of repeated tuck jumps and lower limb kinetic stabilization. Cross-sectional study. Laboratory. Twelve female netball athletes (age = 20.8 ± 2.6 years, height = 170.0 ± 0.04 cm, mass = 67.5 ± 7.4 kg). Participants performed 1 set of a TJA before and after a sport-specific fatigue protocol. Paired t tests and effect sizes were used to evaluate differences and the magnitude of differences in TJA scoring criterion, kinetics, and kinetic stabilization prefatigue to postfatigue. A small increase was observed for vertical relative lower extremity stiffness postfatigue (P =.005; Hedges g = 0.45). Peak center-of-mass displacement, time of jump cycle, ground contact time, flight time, jump height, and vertical net impulse decreased with small to moderate effect sizes (P <.01; Hedges g range, 0.41–0.74). No differences were observed for TJA composite scores, peak vertical ground reaction force, and stabilization indices of kinetic variables after the fatigue protocol (P >.05). Kinetic analysis of repeated tuck jumps after a fatigue protocol identified an altered jumping strategy, which was not identifiable via visual 2-dimensional assessment. However, based on kinetic measures, fatigue induces a stiffer jumping strategy, and practitioners should consider assessing load attenuation strategies that may not be visually evident when evaluating ACL-injury risk factors in athletes who are fatigued. [ABSTRACT FROM AUTHOR]

BackgroundEarly sport specialization is not a requirement for success at the highest levels of competition and is believed to be unhealthy physically and mentally for young athletes. It also discourages unstructured free play, which has many benefits.PurposeTo review the available evidence on early sports specialization and identify areas where scientific data are lacking.Study designThink tank, roundtable discussion.ResultsThe primary outcome of this think tank was that there is no evidence that young children will benefit from early sport specialization in the majority of sports. They are subject to overuse injury and burnout from concentrated activity. Early multisport participation will not deter young athletes from long-term competitive athletic success.ConclusionYouth advocates, parents, clinicians, and coaches need to work together with the sport governing bodies to ensure healthy environments for play and competition that do not create long-term health issues yet support athletic competition at the highest level desired.

Background: Young athletes who specialize early in a single sport may subsequently be at increased risk of injury. While heightened injury risk has been theorized to be related to volume or length of exposure to a single sport, the development of unhealthy, homogenous movement patterns, and rigid neuromuscular control strategies may also be indicted. Unfortunately, traditional laboratory assessments have limited capability to expose such deficits due to the simplistic and constrained nature of laboratory measurement techniques and analyses. Methods: To overcome limitations of prior studies, the authors proposed a soccer-specific virtual reality header assessment to characterize the generalized movement regularity of 44 young female athletes relative to their degree of sport specialization (high vs low). Participants also completed a traditional drop vertical jump assessment. Results: During the virtual reality header assessment, significant differences in center of gravity sample entropy (a measure of movement regularity) were present between specialized (center of gravity sample entropy: mean = 0.08, SD = 0.02) and nonspecialized center of gravity sample entropy: mean = 0.10, SD = 0.03) groups. Specifically, specialized athletes exhibited more regular movement patterns during the soccer header than the nonspecialized athletes. However, no significant between-group differences were observed when comparing participants' center of gravity time series data from the drop vertical jump assessment. Conclusions: This pattern of altered movement strategy indicates that realistic, sport-specific virtual reality assessments may be uniquely beneficial in exposing overly rigid movement patterns of individuals who engage in repeated sport specialized practice. [ABSTRACT FROM AUTHOR]