The latest medical research on Sports Medicine
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about sports medicine gathered by our medical AI research bot.
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Prevalence and Incidence of Chondral and Meniscal Lesions in Patients Undergoing Primary and Subsequent Revision Anterior Cruciate Ligament Reconstruction: An Analysis of 213 Patients From the SANTI Group.Am J Sports Med
Previous studies have shown a higher prevalence of meniscal and chondral lesions at the time of revision anterior cruciate ligament reconstruction (R-ACLR) compared with primary ACLR procedures. However, studies that follow the development of meniscal and chondral status through primary and subsequent R-ACLR are scarce.
To compare the prevalence of meniscal and chondral injuries in patients undergoing primary ACLR and subsequent R-ACLR.
Case series; Level of evidence, 4.
Patients who underwent ACLR and subsequently needed R-ACLR between January 2009 and February 2018 in a single center were included. A retrospective analysis of prospectively collected data was conducted.
A total of 213 patients were included, with a mean follow-up of 59.7 months. The mean age was 22 years at primary ACLR and 26.1 years at the time of revision. The proportion of meniscal tears was higher at the time of R-ACLR compared with the time of primary reconstruction (70.0% vs 44.6%, respectively; P < .001). Similarly, the prevalence of chondral lesions was significantly higher at the time of revision versus the primary reconstruction (15.5% vs 7.0%, respectively; P = .003).
R-ACLR is associated with a higher rate of concomitant meniscal and chondral lesions than primary ACLR.
Higher pathologic threshold of increased tibial tuberosity-trochlear groove distance should be considered for taller patients.Knee Surg Sports Traumatol Arthrosc
The aim of this study was to evaluate the correlation between tibial tuberosity-trochlear groove distance (TT-TG) and body height or knee size, and to find height-related pathologic thresholds of increased TT-TG.
In patients with patellar instability, TT-TG showed significantly correlation with patient height, femoral width, and tibial width respectively (range r = 0.266-0.283). This correlation was not found in the control group. The pathologic threshold of TT-TG was 18 mm in patients < 169 cm (53%), and the mean TT-TG was 21 mm in patients ≥ 169 cm (54%). There was significant difference in RTH, RTF, and RTT between the two groups. RTH, RTF and RTT have similar large area under the curve (AUC) with TT-TG.
TT-TG showed significant correlation with body height and knee size, respectively. The pathologic threshold of increased TT-TG was suggested to be 21 mm for patients [Formula: see text] 169 cm and 18 mm for patients [Formula: see text] 169 cm. Body height-related pathologic threshold provided a supplement for indications of tibial tuberosity medialization.
A New Approach to Improve the Validity of Doubly Labeled Water to Assess CO2 Production during High-Energy Turnover.Medicine and Science in Sports
Accurate measurement of energy expenditure (EE) using doubly labeled water depends on the estimate of total body water (TBW). The aims of this study were to 1) assess the accuracy of a new approach for estimating TBW and EE during high-energy turnover and 2) assess the accuracy of day-to-day assessment of EE with this new approach.
EE was measured in six healthy subjects (three male) for 5 consecutive days using three doubly labeled water methods: 1) the plateau, 2) slope-intercept, and 3) overnight-slope method, with whole-room indirect calorimetry as reference method. Urine samples were collected every evening and morning. High EE (physical activity level of >2.5) was achieved by cycling 4 h·d-1.
Physical activity level was 2.8 ± 0.1. TBW values were 41.9 ± 6.1, 38.4 ± 5.7, and 40.4 ± 5.8 L for the plateau, slope-intercept, and overnight-slope methods, respectively. The overnight-slope method showed the highest accuracy in estimated CO2 production, when compared with indirect calorimetry over the complete 5-d period (mean ± SD difference, 0.9% ± 1.6%). The plateau method significantly overestimated CO2 production by 4.7% ± 2.6%, whereas the slope-intercept method underestimated CO2 production (-3.4% ± 2.3%). When CO2 production was assessed per day, the overnight-slope method showed an average difference of 9.4% ± 4.5% to indirect calorimetry.
The overnight-slope method resulted in a more accurate estimation of CO2 production and EE compared with the plateau or slope-intercept method over a 5-d period in high physical activity conditions. Day-to-day determination of EE using the overnight-slope method was more accurate than diet recall and several standard prediction equations in athletes.
Increased Mass-Specific Maximal Fat Oxidation Rate with Small versus Large Muscle Mass Exercise.Medicine and Science in Sports
Skeletal muscle perfusion and oxygen (O2) delivery are restricted during whole-body exercise because of a limited cardiac output (Q˙). This study investigated the role of reducing central limitations to exercise on the maximal fat oxidation rate (MFO) by comparing mass-specific MFO (per kilogram of active lean mass) during one-legged (1L) and two-legged (2L) cycling. We hypothesized that the mass-specific MFO would be higher during 1L than 2L cycling.
Twelve male subjects (V̇O2peak, 59.3 ± 8.4 mL·kg-1·min-1; mean ± SD) performed step-incremental 2L- (30%-80% of V̇O2peak) and 1L (50% of 2L power output, i.e., equal power output per leg) cycling (counterbalanced) while steady-state pulmonary gas exchanges, Q˙ (pulse-contour analysis), and skeletal muscle (vastus lateralis) oxygenation (near-infrared spectroscopy) were determined. MFO and the associated power output (FatMax) were calculated from pulmonary gas exchanges and stoichiometric equations. A counterweight (10.9 kg) was added to the contralateral pedal arm during 1L cycling. Leg lean mass was determined by DEXA.
The absolute MFO was 24% lower (0.31 ± 0.12 vs 0.44 ± 0.20 g·min-1, P = 0.018), whereas mass-specific MFO was 52% higher (28 ± 11 vs 20 ± 10 mg·min-1·kg-1, P = 0.009) during 1L than 2L cycling. FatMax was similar expressed as power output per leg (60 ± 28 vs 58 ± 22 W, P = 0.649). Q˙ increased more from rest to exercise during 1L than 2L cycling when expressed per active leg (ANOVA main effect: P = 0.003). Tissue oxygenation index and Δ[deoxy(Hb + Mb)] were not different between exercise modes (ANOVA main effects: P ≥ 0.587), indicating similar skeletal muscle fractional O2 extraction.
Mass-specific MFO is increased by exercising a small muscle mass, potentially explained by increased perfusion and more favorable conditions for O2 delivery than during whole-body exercise.
Cross-Sectional and Longitudinal Associations of Lifestyle Behaviors with Pericardial Adipose Tissue: The MESA Study.Medicine and Science in Sports
We examined associations of sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous intensity physical activity (MVPA) with pericardial adipose tissue (PAT).
Adults from the Multi-Ethnic Study of Atherosclerosis were included from exam years 1 (2000-2002; N = 6057; mean age, 62.2 yr; 52.9% female, 38.0% White; 12.8% Chinese American, 26.7% African American, 22.5% Hispanic American), 2 (2002-2004), and 3 (2004-2005). Weekly volume of SB, LPA, and MVPA (in MET-hours per week) was reported using a questionnaire. PAT volume (in cubic centimeters) was quantified using computed tomography, analysis of covariance, and repeated-measures linear mixed models with adjustment for covariates (sociodemographics, cardiovascular disease risk factors, inflammation, waist circumference) tested cross-sectional and longitudinal associations, respectively.
In cross-sectional analysis, the highest tertile of SB (β = 2.71; 95% confidence interval (CI), 0.69 to 4.73; P < 0.01) and the middle tertile of MVPA (β = -1.97; 95% CI, -3.92 to -0.02; P < 0.05) were associated with PAT, whereas no association was observed for LPA in fully adjusted models. In longitudinal models, SB, LPA, and MVPA were not associated with PAT in the full study sample; however, LPA was inversely associated with PAT among Whites in stratified analysis (β = -0.54; 95% CI, -0.95 to -0.13; P < 0.05).
Lower SB and higher LPA (among Whites only) and MVPA may be associated with lower PAT, but additional longitudinal research is needed.
The Timing of Thigh Muscle Activity Is a Factor Limiting Performance in the Deceleration Phase of the 100-m Dash.Medicine and Science in Sports
We aimed to examine the timing of electromyography activity of the rectus femoris (RF) and biceps femoris (BF) in both legs, as well as spatiotemporal variables (running speed (RS), step frequency (SF), step length (SL)) between the maximal speed (Max) phase (50-70 m) and the deceleration (Dec) phase (80-100 m) of the 100-m dash.
Nine track and field athletes performed the 100-m dash with maximal effort. Spatiotemporal variables of each 10-m section were measured. A portable wireless data logger was attached to the subject's lower back to record electromyographies. We calculated onset/offset timing (%) of RF and BF in both legs using a Teager-Kaiser Energy Operator filter (e.g., ipsilateral leg RF onset is "iRF-onset," contralateral leg BF onset is "cBF-onset") in a running cycle.
The decreased RS in the Dec phase (P < 0.001) was due to a decreased SF (P < 0.001). Moreover, iRF-onset (P = 0.002), iRF-offset (P = 0.008), iBF-offset (P = 0.049), and cBF-offset (P = 0.017) in the Dec phase lagged in the running cycle as compared with the Max phase. Furthermore, the time difference between the swing leg RF activity (iRF-onset) and the contact leg BF activity (cBF-onset; "Scissors1") became bigger in the Dec phase (P = 0.041). Significant negative correlations were found between ΔiRF-onset and ΔSF (P = 0.045), and between ΔiBF-offset and ΔSF (P = 0.036).
The decreased RS and SF in the Dec phase of the 100-m dash would be the delayed timing of the RF and BF activities in the same leg as well as the disturbed interleg muscular coordination.
Gait Biomechanics and Balance Associate with Talar and Subtalar T1ρ Relaxation Times in Those with Chronic Ankle Instability.Medicine and Science in Sports
This study aimed to determine associations between T1ρ relaxation times of talar and subtalar articular cartilage and commonly altered gait biomechanics and postural control outcomes in those with chronic ankle instability (CAI).
Fifteen individuals with CAI (21.13 ± 1.81 yr) completed a T1ρ magnetic resonance imaging as well as a postural control and an overground gait assessment. Talocrural and subtalar cartilage was segmented manually to calculate T1ρ relaxation times. Greater T1ρ relaxation times were interpreted as decreased proteoglycan content. Pearson product-moment bivariate correlations examined the relationships between T1ρ relaxation times and the gait biomechanics and postural control outcomes.
Across multiple variables, worse postural control demonstrated moderate to strong associations (range, 0.433-0.642 and -0.713) with greater talar T1ρ relaxation times. At the subtalar joint, greater T1ρ relaxation times were associated with lower peak vertical ground reaction forces, lower average vertical ground reaction force loading rates, and lower peak loading rates (range, -0.438 to -0.622). At the talar dome, greater talar T1ρ relaxation times were associated with increased knee extensor moments (r = 0.457), as well as greater knee flexion (r = 0.482) and knee adduction (r = 0.407) at initial contact. Larger step spatiotemporal gait parameters also associated with greater talar and subtalar T1ρ relaxation times (range, 0.434-0.697).
In individuals with CAI, worse postural control and altered kinematic, kinetic, and spatiotemporal outcomes demonstrate moderate to strong associations with greater talar T1ρ and/or subtalar relaxation times (i.e., less proteoglycan content). Associations between modifiable neuromechanical variables and greater T1ρ relaxation times may represent potential therapeutic interventions to mitigate ankle joint degeneration in those with CAI.
Surgical management of concurrent lateral ankle instability and osteochondral lesions of the talus increases dynamic sagittal ankle range of motion.Knee Surg Sports Traumatol Arthrosc
A biomechanical study, in which imaging modalities are used to strictly include patients with concurrent lateral ankle instability (LAI) and osteochondral lesions of the talus (OLT), is needed to demonstrate the static and dynamic ankle range of motion (ROM) restriction in these patients, and determine whether ankle ROM restriction can be corrected postoperatively.
The functional outcomes of patients with concurrent LAI and OLT were significantly worse than those of healthy subjects preoperatively, but were partially improved postoperatively. Patients had decreased static and dynamic ROM preoperatively, and static ROM did not significantly increase postoperatively (preoperative, 39.6 ± 11.3; postoperative, 44.9 ± 7.1; healthy, 52.0 ± 4.6; p = 0.021). Patients showed increased dynamic ankle flexion ROM (preoperative, 41.2 ± 11.6; postoperative, 53.6 ± 9.0; healthy, 53.9 ± 3.4; p = 0.012) postoperatively, as well as increased peroneus longus activation (preoperative, 35.8 ± 12.0; postoperative, 55.4 ± 25.1; healthy, 71.9 ± 13.4; p = 0.002) and muscle co-contraction of the tibialis anterior and peroneus longus (preoperative, 69.4 ± 23.4; postoperative, 88.4 ± 9.3; healthy, 66.2 ± 18.1; p = 0.045).
Patients with concurrent LAI and OLT had decreased static and dynamic sagittal ankle ROM and altered neuromuscular activation patterns. The arthroscopic modified Broström procedure and microfracture did not significantly increase the static sagittal ankle ROM. However, the dynamic sagittal ankle ROM, peroneus longus activation and muscle co-contraction of the tibialis anterior and peroneus longus increased postoperatively.
Anatomical implications of the subvastus approach on major vascular injury during a distal femoral osteotomy: a computed tomographic venography study.Knee Surg Sports Traumatol Arthrosc
This study evaluated major vascular injury risk in distal femoral osteotomy (DFO) via the subvastus approach and examined the relationship between the posterior border of the vastus medialis (VM) and the superficial femoral artery (SFA) and vein (SFV).
Case series, Level IV.
As the slice shifted proximally, the VMA significantly increased (24.9 ± 8.5, 36.3 ± 8.8, 47.4 ± 11.8, 59.9 ± 14, 70.3 ± 13.7 degrees, respectively, p < 0.001 between all slices) and moved posteromedially from a medial direction. FAA (94.2 ± 7, 86.9 ± 9.2, 78.4 ± 9.7, 71.4 ± 9.8, 66.6 ± 10.5 degree, respectively, p < 0.001 between all slices) and FVA (100.6 ± 4.9, 98.3 ± 5.9, 93.7 ± 7.5, 88 ± 9.2, 81.1 ± 10.5 degrees, respectively, p < 0.001 between all slices) decreased and moved from a posterolateral to a posteromedial direction, while VMAD (35.4 ± 7.8, 24.1 ± 7.3, 14.3 ± 6, 8.4 ± 7, 6.2 ± 6.3 mm, respectively, p < 0.001 between all slices) and VMVD significantly decreased (42.7 ± 7.3, 32 ± 7.4, 22.4 ± 6.8, 14.5 ± 10.6, 8.7 ± 7.1 mm, respectively, p < 0.001 between all slices). The average vertical distance was 36 ± 9.3 mm (range 18.6-61.5 mm). The body height and the patellar length significantly affected the vertical distance.
The posterior border of the VM shifted posteromedially from distal to proximal and contacted the SFA at an average of 36 mm from the suprapatellar border. Surgeons should be aware of the risk of major vascular injury during exposure and osteotomy.
An anatomo-functional implant positioning technique with robotic assistance for primary TKA allows the restoration of the native knee alignment and a natural functional ligament pattern, with a faster recovery at 6 months compared to an adjusted mechanical technique.Knee Surg Sports Traumatol Arthrosc
An anatomo-functional implant positioning (AFIP) technique in total knee arthroplasty (TKA) could restore physiological ligament balance (symmetric gap in extension, asymmetric gap in flexion). The purposes were to compare (1) ligament balancing in extension and flexion after TKA in the AFIP group, (2) TKA alignment, implant positioning and patellar tracking between AFIP and adjusted mechanical alignment (aMA) techniques, (3) clinical outcomes between both groups at 12 months.
III retrospective therapeutic case control series.
In the AFIP group, there was no significant difference between the medial and lateral gap laxity in extension (NS). A significant opening of the lateral gap was observed in flexion compared to extension (mean: + 2.9 mm; p < 0.0001). The mean postoperative HKA angle was comparable between both groups (177.3° ± 2.1 in the AFIP group vs 176.8° ± 3.2; NS). In the AFIP group, the femoral anatomy was restored (90.9° ± 1.6) and the tibial varus was partially corrected (87.4° ± 1.8). The improvement of Knee and Function KSS at 6 months was better in the AFIP group (59.3 ± 11.9 and 51.7 ± 20, respectively, versus 49.3 ± 9.7 and 20.8 ± 13; p < 0.001).
The AFIP concept allowed the restoration of the native knee alignment and a natural functional ligament pattern. With a more physiological target for ligament balancing, the AFIP technique had equivalent clinical outcomes at 12 months compared to aMA, with a faster recovery.
Functional Resistance Training Improves Thigh Muscle Strength after ACL Reconstruction: A Randomized Clinical Trial.Medicine and Science in Sports
Quadriceps weakness is common after anterior cruciate ligament (ACL) reconstruction, resulting in prolonged disability and increased risk for re-injury and osteoarthritis. Functional resistance training (FRT) combines resistance training with task-specific training and may prove beneficial in restoring quadriceps strength. The primary purpose of this study was to determine if a walking specific FRT program (e.g., resisted walking) improves knee strength in individuals after ACL reconstruction.
Thirty participants were randomized into one of three groups: 1) FRT with a customized knee BRACE applied to the ACL leg, 2) FRT with elastic BAND tethered to the ankle of the ACL leg, or 3) a TARGET MATCH condition where no resistance was externally applied. Participants in all groups received training while walking on a treadmill 2-3 times per week for 8 weeks. Isometric knee extension and flexion strength were measured prior to the start of the intervention (PRE), after the intervention (POST), and 8 weeks after intervention completion (POST-2).
The BRACE group had greater knee extensor strength compared with the TARGET MATCH group at POST and POST-2 (p < 0.05). The BRACE group had greater knee flexor strength than the TARGET MATCH group at POST and POST-2 (p < 0.05) and the BAND group at POST (p < 0.05).
FRT applied via a customized knee brace results in improvements in knee extensor and flexor strength after ACL reconstruction. FRT is a beneficial adjuvant to ACL rehabilitation and leads to better strength compared to standard of care.
Muscle Forces during Weightbearing Exercises in Medial Knee Osteoarthritis and Varus Malalignment: A Cross-sectional Study.Medicine and Science in Sports
To test the hypothesis that common weightbearing exercises generate higher lower-limb muscle forces but do not increase medial tibiofemoral contact force (MTCF) when compared to walking in people with medial knee osteoarthritis and varus malalignment.
Twenty-eight participants aged ≥50 years with medial knee osteoarthritis and varus malalignment were recruited from the community. Three-dimensional lower-body motion, ground reaction forces and surface electromyograms from 12 lower-limb muscles were acquired during five squat, lunge, single-leg heel raise and walking trials, performed at self-selected speeds. An electromyogram-informed neuromusculoskeletal model with subject-specific bone geometry was used to estimate muscle forces (N) and bodyweight (BW) normalised MTCF. The peak forces for muscle groups (knee extensors, knee flexors, ankle plantar flexors and hip abductors) and peak MTCF were compared to walking using a multivariate analysis of variance model.
There was a significant main effect (p < 0.001). Post-hoc tests (mean difference [95% confidence intervals]) showed that compared to walking, participants generated higher peak knee extensor and flexor forces during squatting (extensor: 902 N [576, 1227], flexor: 192 N [9.39, 375]) and lunging (extensor: 917 N [604, 1231], flexor: 496 N [198, 794]), and lower peak hip abductor force during squatting (-1975 N [-2841, -1108]) and heel raises (-1217 N [-2131, -303]). Compared to walking, MTCF was lower during squatting (-0.79 BW [-1.04, -0.53]) and heel raises (-0.27 BW [-0.50, -0.04]). No other significant differences were observed.
Participants generated higher peak knee flexor and extensor forces during squatting and lunging but did not increase peak MTCF compared to walking. Clinicians can use these findings to reassure themselves and patients that weightbearing exercises in these positions do not adversely increase forces within the osteoarthritic joint compartment.