http://www.smarttjournal.com The most accessed research articles published by Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012-05-04T00:00:00Z Background: The only three randomized trials on the treatment of MTSS were all performed in military populations. The treatment options investigated in this study were not previously examined in athletes. This study investigated if functional outcome of three common treatment options for medial tibial stress syndrome (MTSS) in athletes in a non-military setting was the same. Methods: The study design was randomized and multi-centered. Physical therapists and sports physicians referred athletes with MTSS to the hospital for inclusion. 81 athletes were assessed for eligibility of which 74 athletes were included and randomized to three treatment groups. Group one performed a graded running program, group two performed a graded running program with additional stretching and strengthening exercises for the calves, while group three performed a graded running program with an additional sports compression stocking. The primary outcome measure was: time to complete a running program (able to run 18 minutes with high intensity) and secondary outcome was: general satisfaction with treatment. Results: 74 Athletes were randomized and included of which 14 did not complete the study due a lack of progress (18.9%). The data was analyzed on an intention-to-treat basis. Time to complete a running program and general satisfaction with the treatment were not significantly different between the three treatment groups. Conclusion: This was the first randomized trial on the treatment of MTSS in athletes in a non-military setting. No differences were found between the groups for the time to complete a running program.Trial registrationCCMO; NL23471.098.08 http://www.smarttjournal.com/content/4/1/12 Maarten Hendrik Moen Leonoor Holtslag Eric Bakker Carl Barten Adam Weir Johannes Tol Frank Backx Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, null:12 2012-03-30T00:00:00Z doi:10.1186/1758-2555-4-12 /content/figures/1758-2555-4-12-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 12 2012-03-30T00:00:00Z XML This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms). The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not be used as it results in joint stiffness, muscle atrophy and loss of proprioception. Traditional Chinese medicine such as herbs, massage and acupuncture were well applied in China in managing sports injuries, and was reported to be effective in relieving pain, reducing swelling and edema, and restoring normal ankle function. Finally, the best practice of sports medicine would be to prevent the injury. Different previous approaches, including designing prophylactice devices, introducing functional interventions, as well as change of games rules were highlighted. This paper allows the readers to catch up with the previous researches on ankle sprain injury, and facilitate the future research idea on sport-related ankle sprain injury. http://www.smarttjournal.com/content/1/1/14 Daniel Fong Yue-Yan Chan Kam-Ming Mok Patrick Yung Kai-Ming Chan Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2009, null:14 2009-07-30T00:00:00Z doi:10.1186/1758-2555-1-14 /content/figures/1758-2555-1-14-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 14 2009-07-30T00:00:00Z XML Background: Traumatic injury and surgical meniscectomy of a medial meniscus are known to cause subsequent knee osteoarthritis. However, the difference in the prevalence of osteoarthritis caused by the individual type of the medial meniscal tear has not been elucidated. The aim of this study was to investigate what type of tear is predominantly responsible for the degradation of articular cartilage in the medial compartment of knee joints. Methods: Five hundred and forty eight cadaveric knees (290 male and 258 female) were registered in this study. The average age of cadavers at death was 78.8 years old (range: 52-103 years). The knees were macroscopically examined and their medial menisci were classified into four groups according to types of tears: "no tear", "radial tear of posterior horn", "other types of tear" and "worn-out meniscus" groups. The severity of cartilage degradation in their medial compartment of knee joints was evaluated using the international cartilage repair society (ICRS) grading system. We statistically compared the ICRS grades among the groups using Mann-Whitney U test. Results: The knees were assigned into the four groups: 416 "no tear" knees, 51 "radial tear of posterior horn" knees, 71 "other types of tear" knees, and 10 "worn-out meniscus" knees. The knees with substantial meniscal tears showed the severer ICRS grades of cartilage degradation than those without meniscal tears. In addition, the ICRS grades were significantly severer in the "radial tear of posterior horn" group than in the "other types of tear" group, suggesting that the radial tear of posterior horn in the medial meniscus is one of the risk factors for cartilage degradation of joint surface. Conclusions: We have clarified the relationship between the radial tear of posterior horn in the medial meniscus and the severer grade of cartilage degradation. This study indicates that the efforts should be made to restore the anatomical role of the posterior horn in keeping the hoop strain, when patients' physical activity levels are high and the tear pattern is simple enough to be securely sutured. http://www.smarttjournal.com/content/2/1/1 Akinori Kan Midori Oshida Shigemi Oshida Masato Imada Takumi Nakagawa Shuji Okinaga Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2010, null:1 2010-01-12T00:00:00Z doi:10.1186/1758-2555-2-1 /content/figures/1758-2555-2-1-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 1 2010-01-12T00:00:00Z XML Anterior cruciate ligament (ACL) injury is common in knee joint accounting for 40% of sports injury. ACL injury leads to knee instability, therefore, understanding knee stability assessments would be useful for diagnosis of ACL injury, comparison between operation treatments and establishing return-to-sport standard. This article firstly introduces a management model for ACL injury and the contribution of knee stability assessment to the corresponding stages of the model. Secondly, standard clinical examination, intra-operative stability measurement and motion analysis for functional assessment are reviewed. Orthopaedic surgeons and scientists with related background are encouraged to understand knee biomechanics and stability assessment for ACL injury patients. http://www.smarttjournal.com/content/1/1/20 Mak-Ham Lam Daniel Fong Patrick Yung Eric Ho Wood-Yee Chan Kai-Ming Chan Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2009, null:20 2009-08-27T00:00:00Z doi:10.1186/1758-2555-1-20 /content/figures/1758-2555-1-20-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 20 2009-08-27T00:00:00Z XML Background: Basketball is the second most popular sport in Nigeria after football and is commonly played by adolescents. Prospective studies on adolescent basketball players in Nigeria are lacking. Such studies will help to develop injury counter-measures. Hence, this study aimed at determining the incidence and pattern of injuries among adolescent basketball players in Nigeria. Methods: A prospective observational study involving 141 adolescent basketball players (75 boys and 66 girls; with age range 15 - 18 years) who participated in the 2010 National Finals of the Nigeria Nestle Milo Basketball Competition. Basketball-related injury data were collected by an assessor during the competition using a standardized basketball injury report form. Data were analyzed using descriptive and inferential statistics. Results: A total of 32 injuries were recorded with an incidence of 22.7 injuries per 100 participants same for boys and girls. This is equivalent to 1.1 injury per match for boys and 0.9 injuries per match for girls. Jumping/landing was the most common cause of injury (28.1%, N = 9). Most of the injuries were at the lower extremities (75%, N = 24); with majority at the knee joint (40.6%, N = 13). Ligament sprain was the most common types of injury. The pattern of injuries among boys did not significantly differ from that of girls (P>0.05). Most injuries (N = 13, 41%) occurred in the offensive half of the court and cryotherapy was the most frequently used treatment modality. Conclusion: The overall incidence of match injury among adolescent amateur basketball players during a national competition in Nigeria was 22.7 injuries per 100 participants; equivalence of 1.0 injury per match. The pattern of injuries was similar in both genders and consistent with what has been previously reported in literature for adolescent basketball players. Exercise-based injury prevention programmes aimed at improving core strength and neuromuscular control at the lower limbs may help reduce the incidence of injuries. http://www.smarttjournal.com/content/4/1/15 Oluwatoyosi Babatunde Alex Owoeye Ashiyat Kehinde Akodu Bayonle Matt Oladokun Sunday Rufus Akinwumi Akinbo Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, null:15 2012-05-04T00:00:00Z doi:10.1186/1758-2555-4-15 /content/figures/1758-2555-4-15-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 15 2012-05-04T00:00:00Z PDF Background: Untreated chronic shoulder dislocation eventually leads to functional disability and pain. Open reduction with different fixation methods have been introduced for most chronic shoulder dislocation. We hypothesized that open reduction and simultaneous Bankart lesion repair in chronic anterior shoulder dislocation obviates the need for joint fixation and leads to better results than previously reported methods. Methods: Eight patients with chronic anterior dislocation of shoulder underwent open reduction and capsulolabral complex repair after an average delay of 10 weeks from injury. Early motion was allowed the day after surgery in the safe position and the clinical and radiographic results were analyzed at an average follow-up of one year. Results: The average Rowe and Zarin's score was 86 points. Four out of eight shoulders were graded as excellent, three as good and one as fair (Rowe and Zarins system). All patients were able to perform their daily activities and they had either mild or no pain. Anterior active forward flexion loss averaged 18 degrees, external active rotation loss averaged 17.5 degrees and internal active rotation loss averaged 3 vertebral body levels. Mild degenerative joint changes were noted in one patient. Conclusion: The results show that the overall prognosis for this method of operation is more favorable than the previously reported methods and we recommend concomitant open reduction and capsulolabral complex repair for the treatment of old anterior shoulder dislocation.Level of EvidenceTherapeutic study, Level IV (case series [no, or historical, control group]) http://www.smarttjournal.com/content/2/1/15 Alireza Rouhani Amirmohammad Navali Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2010, null:15 2010-06-16T00:00:00Z doi:10.1186/1758-2555-2-15 /content/figures/1758-2555-2-15-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 15 2010-06-16T00:00:00Z XML Successful anterior cruciate ligament reconstruction with a tendon graft necessitates solid healing of the tendon graft in the bone tunnel. Improvement of graft healing to bone is crucial for facilitating an early and aggressive rehabilitation and ensuring rapid return to pre-injury levels activity. Tendon graft healing in a bone tunnel requires bone ingrowth into the tendon. Indirect Sharpey fiber formation and direct fibrocartilage fixation confer different anchorage strength and interface properties at the tendon-bone interface. For enhancing tendon graft-to-bone healing, we introduce a strategy that includes the use of periosteum, hydrogel supplemented with periosteal progenitor cells and bone morphogenetic protein-2, and a periosteal progenitor cell sheet. Future studies include the use of cytokines, gene therapy, stem cells, platelet-rich plasma, and mechanical stress for tendon-to-bone healing. These strategies are currently under investigation, and will be applied in the clinical setting in the near future. http://www.smarttjournal.com/content/1/1/21 Chih-Hwa Chen Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2009, null:21 2009-09-23T00:00:00Z doi:10.1186/1758-2555-1-21 /content/figures/1758-2555-1-21-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 21 2009-09-23T00:00:00Z XML Background: Lateral Patella dislocations are common injuries seen in the active and young adult populations. Our study focus was to evaluate medial patellofemoral ligament (MPFL) injury patterns and associated knee pathology using Magnetic Resonance Imaging studies. Methods: MRI studies taken at one imaging site between January, 2007 to January, 2008 with the final diagnosis of patella dislocation were screened for this study. Of the 324 cases that were found, 195 patients with lateral patellar dislocation traumatic enough to cause bone bruises on the lateral femoral trochlea and the medial facet of the patella were selected for this study. The MRI images were reviewed by three independent observers for location and type of MPFL injury, osteochondral defects, loose bodies, MCL and meniscus tears. The data was analyzed as a single cohort and by gender. Results: This study consisted of 127 males and 68 females; mean age of 23 yrs. Tear of the MPFL at the patellar attachment occurred in 93/195 knees (47%), at the femoral attachment in 50/195 knees (26%), and at both the femoral and patella attachment sites in 26/195 knees (13%). Attenuation of the MPFL without rupture occurred in 26/195 knees (13%). Associated findings included loose bodies in 23/195 (13%), meniscus tears 41/195 (21%), patella avulsion/fracture in 14/195 (7%), medial collateral ligament sprains/tears in 37/195 (19%) and osteochondral lesions in 96/195 knees (49%). Statistical analysis showed females had significantly more associated meniscus tears than the males (27% vs. 17%, p = 0.04). Although not statistically significant, osteochondral lesions were seen more in male patients with acute patella dislocation (52% vs. 42%, p = 0.08). Conclusion: Patients who present with lateral patella dislocation with the classic bone bruise pattern seen on MRI will likely rupture the MPFL at the patellar side. Females are more likely to have an associated meniscal tear than males; however, more males have underlying osteochondral lesions. Given the high percentage of associated pathology, we recommend a MRI of the knee in all patients who present with acute patella dislocation. http://www.smarttjournal.com/content/1/1/17 Patrick Guerrero Xinning Li Ketan Patel Michael Brown Brian Busconi Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2009, null:17 2009-07-30T00:00:00Z doi:10.1186/1758-2555-1-17 /content/figures/1758-2555-1-17-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 17 2009-07-30T00:00:00Z XML A rare case of multilevel transverse process stress fractures as a cause of low back ache in a professional cricket player has been presented. The report discusses the possible mechanism of such an injury in a cricket player and also highlights the preventive and therapeutic aspects of management in such patients. The report also stresses upon the need for early identification of such sports related injuries to prevent long term morbidity in the athletes. http://www.smarttjournal.com/content/3/1/8 Kamal Bali Vishal Kumar Vibhu Krishnan Dharm Meena Saurabh Rawall Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2011, null:8 2011-04-10T00:00:00Z doi:10.1186/1758-2555-3-8 /content/figures/1758-2555-3-8-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 8 2011-04-10T00:00:00Z XML With the presented case we strive to introduce combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) as new diagnostic imaging modality and illustrate the possible clinical value in patients after ACL reconstruction. We report the case of a painful knee due to a foreign body reaction and delayed degradation of the biodegradable interference screws after ACL reconstruction. The MRI showed an intact ACL graft, a possible tibial cyclops lesion and a patella infera. There was no increased fluid collection within the bone tunnels. The 99mTc-HDP-SPECT/CT clearly identified a highly increased tracer uptake around and within the tibial and femoral tunnels and the patellofemoral joint. On 3D-CT out of the SPECT/CT data the femoral graft attachment was shallow (50% along the Blumensaat's line) and high in the notch. At revision arthroscopy a diffuse hypertrophy of the synovium, scarring of the Hoffa fat pad and a cyclops lesion of the former ACL graft was found. The interference screws were partially degraded and under palpation and pressure a grey fluid-like substance drained into the joint. The interference screws and the ACL graft were removed and an arthrolysis performed.In the case presented it was most likely a combination of improper graft placement, delayed degradation of the interference screws and unknown biological factors. The too shallow and high ACL graft placement might have led to roof impingement, chronic intraarticular inflammation and hence the delayed degradation of the screws.SPECT/CT has facilitated the establishment of diagnosis, process of decision making and further treatment in patients with knee pain after ACL reconstruction. From the combination of structural (tunnel position in 3D-CT) and metabolic information (tracer uptake in SPECT/CT) the patient's cause of the pain was established. http://www.smarttjournal.com/content/2/1/24 Michael Hirschmann Tom Adler Helmut Rasch Hugli Rolf Niklaus Friederich Markus Arnold Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2010, null:24 2010-09-16T00:00:00Z doi:10.1186/1758-2555-2-24 /content/figures/1758-2555-2-24-toc.gif Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 1758-2555 ${item.volume} 24 2010-09-16T00:00:00Z XML