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AAOS Now

Published 10/1/2013

Studies Tackle Sports Injuries

Stress fractures, ankle pain, and elbow surgery were among the topics covered at the 2013 annual meeting of the American Orthopaedic Society for Sports Medicine. The following summaries review three of the studies presented.

Reducing stress fracture risk
According to Kenneth L. Cameron, PhD, MPH, ATC, director of orthopaedic research at Keller Army Hospital, West Point, N.Y., programs to improve movement patterns may help prevent stress fractures in athletes and military personnel.

“Several potentially modifiable muscular and biomechanical factors may be playing a part in the increased rates of stress fractures in athletes and military personnel,” said Dr. Cameron. “Injury prevention programs targeted to address these movement patterns may help reduce stress fracture risk.”

Based on data from the JUMP-ACL cohort—an existing study of military cadets detailing motion analysis during a jump landing task at the initiation of each participant’s military career—researchers studied 1,843 individuals from the 2009–2012 class years who underwent baseline testing in 2005–2008 and had no previous history of stress fracture. During the follow-up period, 94 individuals sustained a lower extremity stress fracture.

The incidence rate for stress fracture injuries among females was nearly three times that among males. Compared to those with greater than 5° of knee valgus, individuals with neutral or varus knee alignment experienced considerably lower incidence rates for stress fracture. Individuals with greater than 5° of internal knee rotation exhibited rates for stress fracture that were two to four times higher than those with neutral or external knee rotation alignment.

The study was supported by research grants from the Congressionally Directed Medical Research Program’s Peer-Reviewed Medical Research Program and the National Institute of Arthritis, Musculoskeletal, and Skin Diseases. Dr. Cameron’s coauthors of “Biomechanical Risk Factors for Lower Extremity Stress Fracture” include Karen Y. Peck, MEd, ATC; Brett D. Owens, MD; Steven J. Svoboda, MD; Darin A. Padua, PhD, ATC; Lindsay J. DiStefano, PhD, ATC; Anthony I. Beutler, MD; and Stephen W. Marshall, BSc, DAgrSc, PhD.

Topical gel helps ankle sprains
A commonly used topical gel may also be useful in treating athletes with ankle sprains, according to the results of a German study. Patients using the gel showed a quick and significant improvement over nonusers in categories such as pain-on-movement (POM), ankle swelling, and total joint function scores.

“We examined 205 patients injured with acute lateral ankle sprains, including 102 who received diclofenac sodium topical gel (DSG) 1% treatment and 103 who were treated with a placebo gel. DSG-treated users demonstrated better POM scores and less ankle swelling circumference than those in the placebo group,” noted lead author Hand-Georg Predel, MD, from the German Sports University, Köln, Germany. At the study’s end, the gel-treated group had an average total joint function score of 79.7 versus 47.0 for the placebo group.

The study was performed at six primary care centers and included male and female patients 18 years and older who had experienced a sprain within 12 hours of treatment. Each group applied the treatment or placebo gel four times daily for 7 days.

“Athough 96 percent of the gel-treated patients reported feeling good or very good by the end of the study, only 13 percent of the placebo group reported similar feelings. It seems that this treatment option not only helps injured athletes feel better, but also gets them back in the game sooner,” said Dr. Predel.

Dr. Predel’s coauthor for “Diclofenac Sodium Topical Gel (DSG) 1% reduces swelling and tenderness and improves ankle joint function in subjects with acute ankle sprain: A randomized, double-blind, placebo-controlled trial” is Bruno Giannetti, MD, PhD.

UCL surgery in baseball players
Baseball players undergoing ulnar collateral ligament (UCL) surgery are able to return to the same or higher level of competition for an extended period of time, according to Daryl C. Osbahr, MD, of MedStar Union Memorial Hospital in Baltimore.

“Previous studies showed successful return to play after UCL surgery, but we were also able to evaluate each athlete’s career longevity and reason for retirement,” said Dr. Osbahr. “These players typically returned to play within a year of surgery and averaged an additional 3.6 years of playing time, a significant amount considering the extensive nature of this surgery in a highly competitive group of athletes. They also typically did not retire from baseball secondary to continued elbow problems.”

The study examined 256 high school, college, and professional baseball players, who were contacted an average of 12.6 years after their UCL reconstruction. Approximately 83 percent of these athletes were able to return to the same or higher level of competition.

Although approximately 95 percent of the athletes studied had retired by the minimum 10-year follow-up, practically all still participated in throwing at a recreational level, and most reported no elbow pain.

Dr. Osbahr’s coauthors for “Long-term outcomes after ulnar collateral ligament reconstruction in competitive baseball players: Follow-up with a minimum of 10 years” include E. Lyle Cain Jr, MD; B. Todd Raines, MA, ATC; Dave Fortenbaugh, PhD; Jeffrey R. Dugas, MD; and James R. Andrews, MD.

Disclosure information: (Stress Fractures) Dr. Cameron, Ms. Peck—No conflicts; Dr. Owens—Mitek, Musculoskeletal Transplant Foundation, SLACK Incorporated, American Journal of Sports Medicine (AJSM), Orthopedics, Orthopedics Today, American Orthopaedic Society for Sports Medicine (AOSSM), Society of Military Orthopaedic Surgeons; Dr. Svoboda— AAOS, AOSSM, American Board of Orthopaedic Surgery, Inc.; Drs. Padua, DiStephano, and. Beutler—no information; Dr. Marshall—Journal of Athletic Training, Medicine and Science in Sport and Exercise, AOSSM. (Ankle Sprains) Dr. Predel—No conflicts; Dr. Giannetti— Pharming Group NV, The Netherlands; Novartis. (UCL Surgery) Dr. Osbahr— DePuy, A Johnson & Johnson Company, AOSSM; Dr. Cain—no information; Mr. Raines, Dr. Fortenbaugh—no conflicts; Dr. Dugas—Biomet, Arthrex, Inc., Osiris, Mitek, Biomet Sports, Smith & Nephew, Stryker, Cayenne, American Journal of Orthopaedics, AJSM, AOSSM; Dr. Andrews—Biomet Sports Medicine, Bauerfiend, Theralase, MiMedx, Physiotherapy Associates, Patient Connection, Connective Orthopaedics, Fast Health Corporation.