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Minimally invasive surgical technique In treating recurrent patellar dislocation
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Thursday 1 November Posters / Journal of Science and Medicine in Sport 15 (2012) S127–S187
through to the competition grand final. Three standardised measurement instruments have been developed. The Players’ Baseline Information Form included demographics (age, ethnicity, medical history) and player characteristics (position, play history, injury history). The Player injury Notification Form will be completed by the team medical trainer or other personnel to whom players report for injuries sustained at training and matches. It consists of: the nature, characteristics and mechanism of the injury, onset, environmental conditions, diagnosing/treating person, initial treatment and referral. The Injury Follow-up Form will be completed by the team doctor, physiotherapist or medical/rehabilitation trainer who determines the treatment of the injury and return to training and/or match play. This form includes: diagnosis of the injury, treating person, further referral for medical treatment and/or investigations, number of training sessions and/or matches missed or date for return to play. The players match and training exposure and compliance to completion of forms will also be recorded. Personnel completing the forms will be surveyed to determine the ease of completion, relevance to the team’s requirements, preparedness to adopt, and reasons for not adopting the form. Results: A total of 332 players from 22 teams (Under 16s and Under 18s) within13 clubs have been recruited. Discussion: A standardised methodology for injury reporting and surveillance has been developed for the junior elite RL competition. The findings may enable the identification of risk factors for injuries as well as provide data for a larger study to explore the subsequent reduction in the likelihood of re-injury; the development of safe return to training and play guidelines, and recommendations for training volume and total game exposure to minimise injury from rugby league to achieve sustainable health in elite junior players for their long-term progression in rugby league. This study was supported by the NSW Sporting Injuries Committee http://dx.doi.org/10.1016/j.jsams.2012.11.317 315 Rowing biomechanics and injury prevention P. Rachnavy ∗ Suranaree University of Technololgy Rowing injuries have been occurring from poor technique. Most of the rowing related injuries can be attributed to cumulative stress placed on particular areas of the body by the improper performance of the competitive pattern of movement or training regime. The purpose of this study was to examine if there is a relationship between injury and rowing kinematics. Experiments were conducted in laboratory and on water using a case study design. Body movements were recorded in 6 Thai national rowers during ergometer rowing and on water rowing at 32 strokes/min. The movements of 4 body landmarks (right ankle, knee, hip, shoulder) were record by video camera. Using SIMI software, the angles of the knee and hip segments relative to the horizontal axis were computed. The angles among rowers with and without a history of knee injury were comparing. Significant differences were found between the rowers with and without a history of knee injuries. Statistical analysis indicated that the rowers at higher both hip and knee angles were significant (P = 0.05) in knee injury compare with the rowers at lower hip and knee angles. No differences in the angles among the rowers without an injury history 6 months before the study. Differences in hip and knee angels appear to be related to rowing injury. Preventive knee injury
rowing technique focused on proper angles may be trained for all rowers. http://dx.doi.org/10.1016/j.jsams.2012.11.318 316 Physical activity-related injuries and associated factors in adults from southern Brazil: A population-based study A. Rombaldi ∗ , P. Hallal, F. Vinholes Federal University of Pelotas Introduction: Although physical activity practice improves health, physically active individuals are also susceptible to a higher risk of injuries. Objective: To describe the prevalence of physical activity-related injuries and the associated factors in a representative sample of adults in the city of Pelotas, southern Brazil. Methods: Population-based cross-sectional study including 972 adults (aged 20 to 69 years), of both sexes, residents in the urban area was conducted. The questionnaire included socioeconomic, demographic and behavioral information. To characterize the outcome, after people enumerating all physical activities they practiced, the following question was asked: “Have you ever injured yourself doing one of these physical activities?” The association between the outcome and socioeconomic, demographic and behavioral variables was tested using the chi-square test for heterogeneity and linear trend and a multivariable analysis was performed through Poisson regression with robust variance. Results: The percentage of injuries resulting from physical activity was 22.4%. Among respondents, 49.2% reported involvement in physical activity during leisure time. The most common physical activities were walking (42.6%), soccer playing (21.5%), cycling (18.6%), weight lifting (6.5%) and running (5.5%). Injury chance was associated with sex (men–31.2%), 20 to 34 age group (27.8%), nonwhite skin color (39.2%) and being single (29.8%). Results show a downward trend in physical activity-related injury rates with increasing age. Discussion: The prevalence of injury is high and its occurrence is associated with male gender, young people and non-white skin color. Although active people are at greater risk for the occurrence of lesions and the prevalence of injury is high, people should be encouraged to practice physical activity, because the benefits of an active lifestyle outweigh the risk of injuries occurrence. http://dx.doi.org/10.1016/j.jsams.2012.11.319 317 Minimally invasive surgical technique In treating recurrent patellar dislocation M. Al Muderis 1,2 , S. Stein 1,2 , A. Krimly 1,2,∗ , A. Shamsuldin 1,2 , B. Bosley 1,2 1 2
Macquarie University Hospital Australian School of Advanced Medicine
Introduction: Recurrent patellar dislocation is one of the most common pathologies affecting the knee joint in young people. The underlying pathology is either soft tissue, bony or combination of both. The literature describes more than 100 different surgical approaches to address recurrent patellar dislocation. The medial patello-femoral ligament (MPFL) has been identified as the primary medial restraint to prevent lateral patellar displacement. The MPFL accounts for 80% of the medial restraining force on the patellar. We
Thursday 1 November Posters / Journal of Science and Medicine in Sport 15 (2012) S127–S187
have developed a minimally invasive technique to reconstruct the torn MPFL, which commonly occurs with patellar dislocation. Method: 21 consecutive patients, 9 males, 12 females were treated with MPFL reconstruction using our minimally invasive technique between 2009 and 2010 by a single surgeon. All patients had recurrent dislocation of the patellar. The age ranged between 14 and 55 years mean being 25 yrs. 12 left, 8 right, 1 bilateral. Pre and post op assessment included Tegner Lysholm Score and Kujala Knee score, MRI and radiological examination. Three different artificial materials as a ligament augment graft were used. The ligament was secured using a screw fixation on the femur and an endobutton on the patella. All underwent arthroscopic surgery at the time to address the intra-articular pathology. Post operatively patients were mobilized with physiotherapy, weight-bearing as tolerated and taken through a range of motion with no bracing. Results: All patients had follow ups with a minimum of two years. Patients were reviewed clinically and radiologically with xrays. Assessment included Tegner Lysholm Score Average of 93 and Kujala Knee score average of 90. High satisfaction was achieved with the majority of patients. All patients returned to pre-injury activities. All but one patient had sense of stability in their knees. Complications included one patellar re-dislocation 18 months following the surgery. One patient had a direct fall on the patellar, which resulted in osteochondral damage to the patellar without dislocation. One patient had a stiff knee that needed manipulation under anaesthetics 12 weeks post surgery with complete resolution. Conclusion: It is well accepted that medial patellar femoral ligament is the main restraint against patellar dislocation. This ligament is injured in the majority of patellar dislocations, so by reconstructing this structure with minimally invasive techniques excellent results can be achieved. This avoids major reconstructive surgery and prolonged rehabilitation, which was the traditional method of management. http://dx.doi.org/10.1016/j.jsams.2012.11.320 318 Characteristics, training loads, injury patterns and stretching habits of Australian Ironman Triathletes W. Ansell 1,∗ , D. Rivett 2 , R. Callister 2 1 2
Pro-Active Physiotherapy and Sports Workshop University of Newcastle
The Ironman triathlon is an individual sport consisting of three disciplines–swimming, cycling and running. This endurance sport has grown in popularity with over 22 races annually worldwide and 24,000 participants. Despite this participation there are insufficient data concerning injuries in the Ironman triathlon and regarding athletes’ stretching and training habits, especially in Australia. The aim of this retrospective cross-sectional study was to investigate the incidence of overuse injuries in this sport according to anatomical site, and their relationships to gender, age, training hours, stretching habits and other factors. Questionnaires were provided in the race packs of 1250 participants of the Australian Ironman Triathlon in 2006. Two hundred and ninety-six questionnaires were returned giving a low response rate of 24% (74.3% male, 25.7% female). In this sample, 86.1% reported suffering an overuse injury related to competition or training in the last year. The most common site of injury was the knee (35.1% of respondents), followed by the lower back (34.1%) and the ankle/foot (30.7%). There was no statistical relationship between incidence of injury and training load, gender or age, however triathletes with a triathlon
S133
coach had a lower injury rate. Participants reported stretching less before training (41.2%) than after training (67.2%). Among those participants who stretched, the most commonly stretched muscle groups were the hamstrings (88.9%), calves (88.5%) and quadriceps (86.1%). The lower back (61.5%), upper back (31.8%) and shoulder (53.4%) muscles were not stretched by as many participants. Lower back injuries had a significant association with cycling (n = 101, r = 0.256, p = 0.01). A strong positive trend was demonstrated between stretching after training and a reduction in total injuries (p = 0.059).The health professional intervention most utilised by participants was physiotherapy. The overuse injuries in Ironman triathlons in other countries were reported to be most common in the knee, ankle/foot and lower back, which was confirmed in this study of Australian Ironman triathletes. These areas injury need further investigation, to develop interventions to prevent or minimise injuries in this population. There is a need to educate physiotherapists on the injury profile of these athletes, so they are better prepared to treat and design interventions to prevent these types of injuries. http://dx.doi.org/10.1016/j.jsams.2012.11.321 319 The effectiveness and dose-response relationship of extracorporeal shock wave therapy in lower limb tendinopathy: A systematic review S. Mani-Babu, C. Barton ∗ , D. Morrissey Centre for Sports and Exercise Medicine, Queen Mary University Introduction: There is accumulating evidence of the utility of Extracorporeal Shock Wave Therapy (ESWT) for treating greater trochanteric pain syndrome (GTPS), patellar tendinopathy (PT) and Achilles tendinopathy (AT). This systematic review evaluates i) the effectiveness of ESWT in these common conditions and ii) whether there is a relationship between the protocols (e.g. dosage) used and ESWT effectiveness. Methods: PubMed, Embase, Web of Science, Cochrane and CINAHL databases were searched in January 2012 for primary research investigating the effectiveness of ESWT. Quality assessment was performed using the Downs and Black Criteria. Additionally, effect size calculations and data pooling were completed where possible. Results: Nineteen studies of varying methodological quality were identified, of which 12 provided adequate data to complete effect size calculations. Most studies contained small numbers, and randomisation and blinding was often lacking. The number of impulses, number of sessions, interval between sessions and the use of local anaesthetic varied between studies. A wide range of outcome measures were used including the Visual Analogue Scale and the Victorian Institute of Sport Assessment Questionnaire were used most frequently. When treating GTPS, ESWT was more effective than a control intervention in the short (<12 months) and long term (>12 months), and more effective than home training at three months. Additionally, ESWT produced inferior outcomes to cortisone injection at one month, but superior outcomes at 12 months. When treating PT, ESWT appears to be more effective than a control, but shows no additional benefit in comparison to surgery in the short and long term. When treating AT, ESWT was found to be more effective than a control intervention in the short and long term. When comparing ESWT to an eccentric loading program in mid-portion AT, outcomes were similar. However, for insertional AT, ESWT produced superior outcomes in the short and long term compared to eccentric loading. Additionally, combining ESWT with
Thursday 1 November Posters / Journal of Science and Medicine in Sport 15 (2012) S127–S187
through to the competition grand final. Three standardised measurement instruments have been developed. The Players’ Baseline Information Form included demographics (age, ethnicity, medical history) and player characteristics (position, play history, injury history). The Player injury Notification Form will be completed by the team medical trainer or other personnel to whom players report for injuries sustained at training and matches. It consists of: the nature, characteristics and mechanism of the injury, onset, environmental conditions, diagnosing/treating person, initial treatment and referral. The Injury Follow-up Form will be completed by the team doctor, physiotherapist or medical/rehabilitation trainer who determines the treatment of the injury and return to training and/or match play. This form includes: diagnosis of the injury, treating person, further referral for medical treatment and/or investigations, number of training sessions and/or matches missed or date for return to play. The players match and training exposure and compliance to completion of forms will also be recorded. Personnel completing the forms will be surveyed to determine the ease of completion, relevance to the team’s requirements, preparedness to adopt, and reasons for not adopting the form. Results: A total of 332 players from 22 teams (Under 16s and Under 18s) within13 clubs have been recruited. Discussion: A standardised methodology for injury reporting and surveillance has been developed for the junior elite RL competition. The findings may enable the identification of risk factors for injuries as well as provide data for a larger study to explore the subsequent reduction in the likelihood of re-injury; the development of safe return to training and play guidelines, and recommendations for training volume and total game exposure to minimise injury from rugby league to achieve sustainable health in elite junior players for their long-term progression in rugby league. This study was supported by the NSW Sporting Injuries Committee http://dx.doi.org/10.1016/j.jsams.2012.11.317 315 Rowing biomechanics and injury prevention P. Rachnavy ∗ Suranaree University of Technololgy Rowing injuries have been occurring from poor technique. Most of the rowing related injuries can be attributed to cumulative stress placed on particular areas of the body by the improper performance of the competitive pattern of movement or training regime. The purpose of this study was to examine if there is a relationship between injury and rowing kinematics. Experiments were conducted in laboratory and on water using a case study design. Body movements were recorded in 6 Thai national rowers during ergometer rowing and on water rowing at 32 strokes/min. The movements of 4 body landmarks (right ankle, knee, hip, shoulder) were record by video camera. Using SIMI software, the angles of the knee and hip segments relative to the horizontal axis were computed. The angles among rowers with and without a history of knee injury were comparing. Significant differences were found between the rowers with and without a history of knee injuries. Statistical analysis indicated that the rowers at higher both hip and knee angles were significant (P = 0.05) in knee injury compare with the rowers at lower hip and knee angles. No differences in the angles among the rowers without an injury history 6 months before the study. Differences in hip and knee angels appear to be related to rowing injury. Preventive knee injury
rowing technique focused on proper angles may be trained for all rowers. http://dx.doi.org/10.1016/j.jsams.2012.11.318 316 Physical activity-related injuries and associated factors in adults from southern Brazil: A population-based study A. Rombaldi ∗ , P. Hallal, F. Vinholes Federal University of Pelotas Introduction: Although physical activity practice improves health, physically active individuals are also susceptible to a higher risk of injuries. Objective: To describe the prevalence of physical activity-related injuries and the associated factors in a representative sample of adults in the city of Pelotas, southern Brazil. Methods: Population-based cross-sectional study including 972 adults (aged 20 to 69 years), of both sexes, residents in the urban area was conducted. The questionnaire included socioeconomic, demographic and behavioral information. To characterize the outcome, after people enumerating all physical activities they practiced, the following question was asked: “Have you ever injured yourself doing one of these physical activities?” The association between the outcome and socioeconomic, demographic and behavioral variables was tested using the chi-square test for heterogeneity and linear trend and a multivariable analysis was performed through Poisson regression with robust variance. Results: The percentage of injuries resulting from physical activity was 22.4%. Among respondents, 49.2% reported involvement in physical activity during leisure time. The most common physical activities were walking (42.6%), soccer playing (21.5%), cycling (18.6%), weight lifting (6.5%) and running (5.5%). Injury chance was associated with sex (men–31.2%), 20 to 34 age group (27.8%), nonwhite skin color (39.2%) and being single (29.8%). Results show a downward trend in physical activity-related injury rates with increasing age. Discussion: The prevalence of injury is high and its occurrence is associated with male gender, young people and non-white skin color. Although active people are at greater risk for the occurrence of lesions and the prevalence of injury is high, people should be encouraged to practice physical activity, because the benefits of an active lifestyle outweigh the risk of injuries occurrence. http://dx.doi.org/10.1016/j.jsams.2012.11.319 317 Minimally invasive surgical technique In treating recurrent patellar dislocation M. Al Muderis 1,2 , S. Stein 1,2 , A. Krimly 1,2,∗ , A. Shamsuldin 1,2 , B. Bosley 1,2 1 2
Macquarie University Hospital Australian School of Advanced Medicine
Introduction: Recurrent patellar dislocation is one of the most common pathologies affecting the knee joint in young people. The underlying pathology is either soft tissue, bony or combination of both. The literature describes more than 100 different surgical approaches to address recurrent patellar dislocation. The medial patello-femoral ligament (MPFL) has been identified as the primary medial restraint to prevent lateral patellar displacement. The MPFL accounts for 80% of the medial restraining force on the patellar. We
Thursday 1 November Posters / Journal of Science and Medicine in Sport 15 (2012) S127–S187
have developed a minimally invasive technique to reconstruct the torn MPFL, which commonly occurs with patellar dislocation. Method: 21 consecutive patients, 9 males, 12 females were treated with MPFL reconstruction using our minimally invasive technique between 2009 and 2010 by a single surgeon. All patients had recurrent dislocation of the patellar. The age ranged between 14 and 55 years mean being 25 yrs. 12 left, 8 right, 1 bilateral. Pre and post op assessment included Tegner Lysholm Score and Kujala Knee score, MRI and radiological examination. Three different artificial materials as a ligament augment graft were used. The ligament was secured using a screw fixation on the femur and an endobutton on the patella. All underwent arthroscopic surgery at the time to address the intra-articular pathology. Post operatively patients were mobilized with physiotherapy, weight-bearing as tolerated and taken through a range of motion with no bracing. Results: All patients had follow ups with a minimum of two years. Patients were reviewed clinically and radiologically with xrays. Assessment included Tegner Lysholm Score Average of 93 and Kujala Knee score average of 90. High satisfaction was achieved with the majority of patients. All patients returned to pre-injury activities. All but one patient had sense of stability in their knees. Complications included one patellar re-dislocation 18 months following the surgery. One patient had a direct fall on the patellar, which resulted in osteochondral damage to the patellar without dislocation. One patient had a stiff knee that needed manipulation under anaesthetics 12 weeks post surgery with complete resolution. Conclusion: It is well accepted that medial patellar femoral ligament is the main restraint against patellar dislocation. This ligament is injured in the majority of patellar dislocations, so by reconstructing this structure with minimally invasive techniques excellent results can be achieved. This avoids major reconstructive surgery and prolonged rehabilitation, which was the traditional method of management. http://dx.doi.org/10.1016/j.jsams.2012.11.320 318 Characteristics, training loads, injury patterns and stretching habits of Australian Ironman Triathletes W. Ansell 1,∗ , D. Rivett 2 , R. Callister 2 1 2
Pro-Active Physiotherapy and Sports Workshop University of Newcastle
The Ironman triathlon is an individual sport consisting of three disciplines–swimming, cycling and running. This endurance sport has grown in popularity with over 22 races annually worldwide and 24,000 participants. Despite this participation there are insufficient data concerning injuries in the Ironman triathlon and regarding athletes’ stretching and training habits, especially in Australia. The aim of this retrospective cross-sectional study was to investigate the incidence of overuse injuries in this sport according to anatomical site, and their relationships to gender, age, training hours, stretching habits and other factors. Questionnaires were provided in the race packs of 1250 participants of the Australian Ironman Triathlon in 2006. Two hundred and ninety-six questionnaires were returned giving a low response rate of 24% (74.3% male, 25.7% female). In this sample, 86.1% reported suffering an overuse injury related to competition or training in the last year. The most common site of injury was the knee (35.1% of respondents), followed by the lower back (34.1%) and the ankle/foot (30.7%). There was no statistical relationship between incidence of injury and training load, gender or age, however triathletes with a triathlon
S133
coach had a lower injury rate. Participants reported stretching less before training (41.2%) than after training (67.2%). Among those participants who stretched, the most commonly stretched muscle groups were the hamstrings (88.9%), calves (88.5%) and quadriceps (86.1%). The lower back (61.5%), upper back (31.8%) and shoulder (53.4%) muscles were not stretched by as many participants. Lower back injuries had a significant association with cycling (n = 101, r = 0.256, p = 0.01). A strong positive trend was demonstrated between stretching after training and a reduction in total injuries (p = 0.059).The health professional intervention most utilised by participants was physiotherapy. The overuse injuries in Ironman triathlons in other countries were reported to be most common in the knee, ankle/foot and lower back, which was confirmed in this study of Australian Ironman triathletes. These areas injury need further investigation, to develop interventions to prevent or minimise injuries in this population. There is a need to educate physiotherapists on the injury profile of these athletes, so they are better prepared to treat and design interventions to prevent these types of injuries. http://dx.doi.org/10.1016/j.jsams.2012.11.321 319 The effectiveness and dose-response relationship of extracorporeal shock wave therapy in lower limb tendinopathy: A systematic review S. Mani-Babu, C. Barton ∗ , D. Morrissey Centre for Sports and Exercise Medicine, Queen Mary University Introduction: There is accumulating evidence of the utility of Extracorporeal Shock Wave Therapy (ESWT) for treating greater trochanteric pain syndrome (GTPS), patellar tendinopathy (PT) and Achilles tendinopathy (AT). This systematic review evaluates i) the effectiveness of ESWT in these common conditions and ii) whether there is a relationship between the protocols (e.g. dosage) used and ESWT effectiveness. Methods: PubMed, Embase, Web of Science, Cochrane and CINAHL databases were searched in January 2012 for primary research investigating the effectiveness of ESWT. Quality assessment was performed using the Downs and Black Criteria. Additionally, effect size calculations and data pooling were completed where possible. Results: Nineteen studies of varying methodological quality were identified, of which 12 provided adequate data to complete effect size calculations. Most studies contained small numbers, and randomisation and blinding was often lacking. The number of impulses, number of sessions, interval between sessions and the use of local anaesthetic varied between studies. A wide range of outcome measures were used including the Visual Analogue Scale and the Victorian Institute of Sport Assessment Questionnaire were used most frequently. When treating GTPS, ESWT was more effective than a control intervention in the short (<12 months) and long term (>12 months), and more effective than home training at three months. Additionally, ESWT produced inferior outcomes to cortisone injection at one month, but superior outcomes at 12 months. When treating PT, ESWT appears to be more effective than a control, but shows no additional benefit in comparison to surgery in the short and long term. When treating AT, ESWT was found to be more effective than a control intervention in the short and long term. When comparing ESWT to an eccentric loading program in mid-portion AT, outcomes were similar. However, for insertional AT, ESWT produced superior outcomes in the short and long term compared to eccentric loading. Additionally, combining ESWT with