BALTIMORE, MD–As interest in concussion rates and prevention strategies at all levels continues to grow, one population that appears to have increasing head injury rates is collegiate football players. The concussion rate in three college football programs has doubled in recent years, according to research.
“We monitored concussions at three service academies in the 2009-2010 and 2010-2011 football seasons, and saw the combined number of reports increased from 23 to 42 in this timespan,” noted Kelly G. Kilcoyne, MD, lead author from Walter Reed National Military Medical Center in Washington, DC.
The increase comes after a 2010 NCAA concussion management initiative that requires athletic programs to report concussions signs and symptoms and then remove players from play.
“The timing of the new NCAA regulations and the increase in reported concussions could certainly be attributed to under-reporting from players and coaches in the past,” Kilcoyne noted. “Such an increase is still notable, and we need continued studies in football and other sports to find out more.” The study compiled concussion data from practices and games at the United States Military Academy, United States Naval Academy and the United States Air Force Academy, all Division I Athletic Programs. All patients were males between the ages of 18 and 22, with players rosters around 150 for practices and 90 for games.
Nonsurgical Treatment Beneficial for SLAP Tears
BALTIMORE, MD—Surgically repairing a painful shoulder injury in baseball players known as a SLAP tear (superior labral) varies widely and often does not allow for return to play at the same level as before the injury. However, researchers suggested that nonsurgical treatment may be more beneficial.
“Our research showed that nonsurgical treatment of SLAP tears was more often successful than surgery, and in position players more frequently than for pitchers,” said David Lintner, MD, lead researcher from Methodist Center for Sports Medicine in Houston, Texas. “We need more research to determine why the nonsurgical treatment was more beneficial to one population than the other, but our findings did illustrate that nonsurgical treatment should be preferred.
Lintner and his team performed a retrospective review of a 119 professional baseball players within a single organization who had persistent shoulder pain that limited their ability to compete. Sixty-eight patients had MRI-documented SLAP lesions and had failed initial physical therapy. All patients were initially treated non-surgically according to an algorithm focused on correcting the scapular dyskinesia and posterior capsular tightness. Of the 68 subjects with confirmed SLAP lesions, 45 were pitchers. Return to competition appeared to occur at a higher rate for position players than pitchers (73% vs. 40%).
“Returning to the same level of competition as before the injury, is almost always difficult for an athlete, and surgery is often thought of as the best avenue. With additional research, orthopaedists are finding different routes to treat some of the most common throwing injuries,” said Lintner.
Common Athletic Hip Disorder Increases Chances for Sports Hernia
BALTIMORE, MD—A sports hernia is a common cause of groin pain in athletes, however until recently, little has been known about why they occur. Femoral acetabular impingement (FAI) may be associated with an increased risk for sports hernia, according to data presented.
“Our study illustrated that those patients with FAI tend to have a change in hip biomechanics which in turn leads to increased stress across the groin. With these stresses a sports hernia (tear to the oblique abdominal muscles), is more likely to occur,” said lead author, Kostas Economopoulos, MD from the University of Virginia Department of Orthopaedics.
The researchers performed a retrospective review of all patients who were evaluated for sports hernias at their institution and who underwent surgical treatment from 1999-2011. Forty-three patients underwent 56 sports hernia repairs in their study. MRI, CT scans or plain x-rays were performed to look for radiological signs of FAI. Of the 43 patients, 37 or 86 percent had some form of FAI visible on radiological examinations.
“We hope that our study encourages physicians who see sports hernia and chronic groin pain in athletes to further investigate the possibility of FAI and in turn can recommend better treatment options for this puzzling condition,” said Economopoulos.
Osteoarthritis Risk Not Diminished in Double Bundle ACL Surgeries
BALTIMORE, MD—Osteoarthritis progression is not more likely in patients who have undergone single-bundle anterior cruciate ligament (ACL) reconstruction, researchers reported.
“While previous studies have shown the benefits of double bundle ACL reconstruction compared to single bundle, none have focused on the long-term effects of osteoarthritis(OA),” noted Jongkeun Seon, MD, corresponding author from Chonnam National University Hwasun Hospital. “A final follow-up in our study showed 9.6 percent of the double bundle group and 10 percent of the single bundle group having signs of OA progression, which is an insignificant difference.”
Out of 112 patients examined, including 89 men and 23 women, all recovered full range of motion within six months of surgery, with functional and physical results similar in the two test groups. While ACL surgeries provide these improvements, an estimated 50% of patients develop osteoarthritis over time. Different surgical procedures are continually debated as being more or less effective. “Our study shows little connection between the on-set of osteoarthritis and single or double bundle surgery,” said Seon. “Patients over the age of 40 at time of surgery did show OA change more frequently, however. We need to continue examining these patients as they age to see if the number of cases continues to increase.”
Arthroscopic Reconstruction Technique Yields Good Clinical Outcomes in Athletes
BALTIMORE, MD—A common, painful hip condition in elite athletes may be repaired with an improved surgical technique, according to researchers.
In our review of 21 male, elite athletes who had a hip pain and instability issues (hypoplastic or labrum tear), 81 percent returned to play at a similar level as before they were hurt, after receiving an arthroscopic reconstruction technique using an ipsilateral iliotibial band autograft,” said research author, Marc J. Philippon, MD, of the Steadman Philippon Research Institute in Vail, Colorado.
Researchers followed 17 of the 21 patients who had an average age of 28 years, for more than 32 months. The professional athletes participated in soccer, hockey, football, skiing, baseball, basketball, and ice skating. During this time, all but 2 of the patients had improved clinical outcomes on various mobility indexes. Patient satisfaction was also increased.
Labral tears in the hip are often associated with a traumatic injury, such as dislocation. However, researchers say they are increasingly seeing hip issues due to repetitive motions and underlying structural abnormalities.
“The proper function of the labrum in the hip is a critical component of mobility for any athlete. When this area gets hurt, repair can be difficult. Our review study highlights that a majority of athletes can return to a solid level of play utilizing the ipsilateral iliotibal band autograft and physical therapy. While additional research needs to be performed on the technique, we are hopeful that its increased use will allow more athletes the ability to return to the sports they love,” said Philippon.
PRP Therapy Safe and Effective for Cartilage Damage
BALTIMORE, MD—When it comes to treating cartilage tears in athletes, platelet rich plasma (PRP) therapy is a safe and effective method of treatment, research reported.
“Using PRP therapy to repair cartilage is still relatively experimental, but studies like this show it’s not only safe, but also offers a significant improvement in function and quality of life for patients,” said Elizaveta Kon, MD, lead author for the study and Director of Nano- Biotecnology Laboratory at the Rizzoli Orthopaedic Institute in Bologna, Italy. “None of the patients treated experienced complications like infection, deep vein thrombosis, or fever.”
During the study, 180 patients were treated for chronic pain or swelling of the knee with either PRP therapy or viscosupplementation, a more common hyaluronic acid-based treatment for cartilage damage. A total of 109 patients, with an average age of 56 years, reached a final evaluation. Both treatment groups demonstrated significant improvement based on higher post-treatment International Knee Documentation Committee scores, which measure pain and basic function in follow-up interviews.
“As athletic participation has grown,” Kon noted, “new problems like cartilage lesions, or tears, continue to emerge. Finding the right approach to treatment is difficult, but PRP has emerged as a viable option according to our research.”
Kon also noted that long-term follow-ups for PRP treatments are needed to further evaluate the overall effectiveness of the therapy for future patients.