Spine & Sports Institute

Philippe Tscholl, MD†*, Juan M. Alonso, MD‡§, Gabriel Dollé, MD‡, Astrid Junge, PhD†|| and Jiri Dvorak, MD†||¶

Abstract

Background High use of medication and nutritional supplements has been reported in several sports.

Purpose To document the use of prescribed medication and nutritional supplements in female and male junior, youth, and adult track and field athletes depending on their sports discipline.

Study Design Descriptive epidemiology study.

Methods Analysis of 3 887 doping control forms undertaken during 12 International Association of Athletics Federations World Championships and 1 out-of-competitions season in track and field.

Results There were 6 523 nutritional supplements (1.7 per athlete) and 3 237 medications (0.8 per athlete) reported. Nonsteroidal anti-inflammatory drugs (NSAIDs; 0.27 per athlete, n = 884), respiratory drugs (0.21 per athlete, n = 682), and alternative analgesics (0.13, n = 423) were used most frequently. Medication use increased with age (0.33 to 0.87 per athlete) and decreased with increasing duration of the event (from sprints to endurance events; 1.0 to 0.63 per athlete). African and Asian track and field athletes reported using significantly fewer supplements (0.85 vs 1.93 per athlete) and medications (0.41 vs 0.96 per athlete) than athletes from other continents. The final ranking in the championships was unrelated to the quantity of reported medications or supplements taken. Compared with middle-distance and long-distance runners, athletes in power and sprint disciplines reported using more NSAIDs, creatine, and amino acids, and fewer antimicrobial agents.

Conclusion The use of NSAIDs in track and field is less than that reported for team-sport events. However, nutritional supplements are used more than twice as often as they are in soccer and other multisport events; this inadvertently increases the risk of positive results of doping tests.

Clinical Relevance It is essential that an evidence-based approach to the prescribing of medication and nutritional supplements is adopted to protect the athletes’ health and prevent them from testing positive in doping controls.

Timothy F. Tyler, PT, ATC†‡*, Stephen J. Nicholas, MD‡, Steven J. Lee, MD‡, Michael Mullaney, PT‡ and Malachy P. McHugh, PhD‡

Abstract

Background Glenohumeral internal rotation deficit (GIRD) and posterior shoulder tightness have been linked to internal impingement.

Purpose To determine if improvements in GIRD and/or decreased posterior shoulder tightness are associated with a resolution of symptoms.

Study Design Cohort study; Level of evidence, 3.

Methods Passive internal rotation and external rotation (ER) range of motion (ROM) at 90° of shoulder abduction and posterior shoulder tightness (cross-chest adduction in side lying) were assessed in 22 patients with internal impingement (11 men, 11 women; age 41 ± 13 years). Treatment involved stretching and mobilization of the posterior shoulder. The Simple Shoulder Test (SST) was administered on initial evaluation and discharge. Changes in GIRD, ER ROM, and posterior shoulder tightness were compared between patients with complete resolution of symptoms versus patients with residual symptoms using independent t tests.

Results Patients had significant GIRD (35°), loss of ER ROM (23°), and posterior shoulder tightness (35°) on initial evaluation (all P < .01). Physical therapy (7 ± 2 weeks; range, 3–12 weeks) improved GIRD (26° ± 14°; P < .01), ER ROM loss (14° ± 20°), and posterior shoulder tightness (27° ±19°). The SST improved from 5 ± 3 to 11 ± 1 (P < .01). A greater improvement in posterior shoulder tightness was seen in patients with complete resolution of symptoms (n = 12) compared with patients with residual symptoms (35° vs 18°; P < .05). Improvements in GIRD and ER ROM loss were not different between groups (GIRD, 25° vs 28°, P = .57; ER ROM, 14° vs 15°, P = .84).

Conclusion Resolution of symptoms after physical therapy treatment for internal impingement was related to correction of posterior shoulder tightness but not correction of GIRD.

Marc J. Philippon, MD†*, Douglass R. Weiss, MD‡, David A. Kuppersmith†, Karen K. Briggs, MPH† and Connor J. Hay†

Abstract

Background Hip injuries are common among professional hockey players in the National Hockey League (NHL).

Hypothesis Professional hockey players will return to a high level of function and ice hockey after arthroscopic labral repair and treatment of femoroacetabular impingement.

Study Design Case series; Level of evidence, 4.

Methods Twenty-eight professional hockey players (NHL) were unable to perform at the professional level due to unremitting and debilitating hip pain. Players underwent arthroscopic labral repair and were treated for femoroacetabular impingement from March 2005 to December 2007. Players who had bilateral hip symptoms were excluded. Athletes completed the Modified Harris Hip Score preoperatively and postoperatively and also completed a patient satisfaction questionnaire postoperatively. Return to sport was defined as the player resuming skating for training or participation in the sport of ice hockey.

Results The average age at the time of surgery was 27 years (range, 18–37). There were 11 left hips and 17 right hips. Player positions included 9 defensemen, 12 offensive players, and 7 goaltenders. All players had labral lesions that required repair. In addition, all patients had evidence of femoroacetabular impingement at the time of surgery. The average time to return to skating/hockey drills was 3.4 months. The average time to follow-up was 24 months (range, 12–42). The Modified Harris Hip Score improved from 70 (range, 57–100) preoperatively to an average of 95 (range, 74–100) at follow-up. The median patient satisfaction was 10 (range, 5–10). Two players had reinjury and required additional hip arthroscopy.

Conclusion Treatment of femoroacetabular impingement and labral lesions in professional hockey players resulted in successful outcomes, with high patient satisfaction and prompt return to sport.

Background Articular cartilage injury in the athlete’s knee presents a difficult clinical challenge. Despite the importance of returning injured athletes to sports, information is limited on whether full sports participation can be successfully achieved after articular cartilage repair in the knee.

Hypothesis Systematic analysis of athletic participation after articular cartilage repair will demonstrate the efficacy of joint surface restoration in high-demand patients and help to optimize outcomes in athletes with articular cartilage injury of the knee.

Study Design Systematic review.

Methods A comprehensive literature review of original studies was performed to provide information about athletic participation after articular cartilage repair. The athlete’s ability to perform sports postoperatively was assessed by activity outcome scores, rate of return to sport, timing of the return, level of postoperative sports participation, and the continuation of athletic activity over time.

Results Twenty studies describing 1363 patients were included in the review, with an average follow-up of 42 months. Return to sports was possible in 73% overall, with highest return rates after osteochondral autograft transplantation. Time to return to sports varied between 7 and 18 months, depending on the cartilage repair technique. Initial return to sports at the preinjury level was possible in 68% and did not significantly vary between surgical techniques. Continued sports participation at the preinjury level was possible in 65%, with the best durability after autologous chondrocyte transplantation. Several factors affected the ability to return to sport: athlete’s age, preoperative duration of symptoms, level of play, lesion size, and repair tissue morphology.

Conclusion Articular cartilage repair in the athletic population allows for a high rate of return to sports, often at the preinjury level. Return to sports participation is influenced by several independent factors. The findings provide pertinent information that is helpful for the clinical decision-making process and for the management of the athlete’s postoperative expectations.

1. Kai Mithoefer, MD†‡*,
2. Karen Hambly, PT, MCSP†§,
3. Stefano Della Villa, MD†||,
4. Holly Silvers, MPT†¶ and
5. Bert R. Mandelbaum, MD¶
6. Kai Mithoefer, MD†‡*,
7. Karen Hambly, PT, MCSP†§,
8. Stefano Della Villa, MD†||,
9. Holly Silvers, MPT†¶ and
10. Bert R. Mandelbaum, MD¶

Background Double-bundle anterior cruciate ligament (ACL) reconstruction has several potential advantages over single-bundle reconstruction with hamstring tendons. However, there are still controversies regarding tunnel placement in tibial and femoral attachments.

Hypothesis The macroscopically normal ACL consists of small bundles about 1 mm in diameter. Detailed observation of the divided smaller bundles will achieve better understanding of the tunnel placement in anatomic ACL reconstruction.

Study Design Descriptive laboratory study.

Methods This study used 20 cadaveric knees. The ACL was divided into anteromedial and posterolateral bundles, then separated into 10 small bundles of 2-mm diameters, with preservation of their attachment sites marked with color markers. The positional relationship between the femoral and tibial attachments of each small bundle was investigated.

Results A layered positional correlation of small bundles was found between the tibial and femoral attachments. Small bundles aligned in the anterior-posterior direction in the tibia corresponded to the bundles aligned in a high-low direction in the femur in flexion. The femoral attachment pattern was relatively similar in each specimen; however, the tibial attachment showed 2 patterns: an oblique type (12 of 20) and a transverse type (8 of 20). The posterior portion of the posterolateral bundle was separately attached to the medial and lateral portions of the tibial attachment. There was no fibrous insertion in the center of the posterior portion of the ACL tibial attachment in any specimen. In this bare area, there was fat tissue and vascular bundles.

Conclusion Small bundles constituting the ACL showed a relatively layered arrangement between 2 attachments. The tibial attachment showed 2 patterns of oblique and transverse types, and the vascular bundles were located in the center of the posterolateral bundle.

Clinical Relevance The results of this study of the normal ACL will provide insights for surgeons when placing grafts during anatomic ACL reconstruction.

1. Kenji Hara, MD, PhD*,
2. Tomoyuki Mochizuki, MD, PhD*†,
3. Ichiro Sekiya, MD, PhD*†,
4. Kumiko Yamaguchi, MD, PhD‡,
5. Keiichi Akita, MD, PhD‡ and
6. Takeshi Muneta, MD, PhD*§||

Background High use of medication and nutritional supplements has been reported in several sports.

Purpose To document the use of prescribed medication and nutritional supplements in female and male junior, youth, and adult track and field athletes depending on their sports discipline.

Study Design Descriptive epidemiology study.

Methods Analysis of 3 887 doping control forms undertaken during 12 International Association of Athletics Federations World Championships and 1 out-of-competitions season in track and field.

Results There were 6 523 nutritional supplements (1.7 per athlete) and 3 237 medications (0.8 per athlete) reported. Nonsteroidal anti-inflammatory drugs (NSAIDs; 0.27 per athlete, n = 884), respiratory drugs (0.21 per athlete, n = 682), and alternative analgesics (0.13, n = 423) were used most frequently. Medication use increased with age (0.33 to 0.87 per athlete) and decreased with increasing duration of the event (from sprints to endurance events; 1.0 to 0.63 per athlete). African and Asian track and field athletes reported using significantly fewer supplements (0.85 vs 1.93 per athlete) and medications (0.41 vs 0.96 per athlete) than athletes from other continents. The final ranking in the championships was unrelated to the quantity of reported medications or supplements taken. Compared with middle-distance and long-distance runners, athletes in power and sprint disciplines reported using more NSAIDs, creatine, and amino acids, and fewer antimicrobial agents.

Conclusion The use of NSAIDs in track and field is less than that reported for team-sport events. However, nutritional supplements are used more than twice as often as they are in soccer and other multisport events; this inadvertently increases the risk of positive results of doping tests.

Clinical Relevance It is essential that an evidence-based approach to the prescribing of medication and nutritional supplements is adopted to protect the athletes’ health and prevent them from testing positive in doping controls.

1. Philippe Tscholl, MD†*,
2. Juan M. Alonso, MD‡§,
3. Gabriel Dollé, MD‡,
4. Astrid Junge, PhD†|| and
5. Jiri Dvorak, MD†||¶