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The development of an online sports injury management system
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Thursday 16 October Papers / Journal of Science and Medicine in Sport 18S (2014) e23–e71
Image Correlation (DIC) has become a popular method for evaluating displacement/strain fields in an imaged medium and has been used in tracking strain in a variety of biological tissue. DIC is a non-contact optical technique that applies a mathematical correlation function using features inherent to the image to estimate deformation. The present study examined the use of DIC to estimate tissue strain within the superficial and deep portions of the proximal Achilles free tendon. Methods: Ten subjects (8 female, 2 male; age: 26.7 ± 6.4 years; height: 179.5 ± 7.6 cm; weight: 83.8 ± 22.7 kg) took park in this study. Following preconditioning, participants carried out three trials applying 40 Nm of torque against a fixed torque transducer (Futek TFF600, Irvine, CA, USA) over a 1.5 s period while a highresolution (14–7 MHz) ultrasound probe (Ultrasonix, Richmond, Canada) was secured to the posterior calf. Subsequent ultrasound video files were processed using specialised software (EchoSoftTM , Madison, USA). The two regions of interest (ROI) analysed were taken from a portion of the proximal AT originating at the soleusAchilles muscle tendon junction extending distally for 1.5 cm then divided in half visually into superficial and deep components. DIC based strain is represented as a mean value of the composite pixel deformation within an ROI normalised by the mean initial pixel dimensions. Results: ICC values for within-rater repeatability are 0.819 [95% CI: 0.20–0.96] for the superficial region and 0.784 [95% CI: 0.13–0.95] for the deep region. There was significantly (p < 0.001) greater strain in the deep (4.7 ± 0.2 SEM) than the superficial AT (3.4 ± 0.2 SEM). Discussion: These findings suggest that there is potential for using DIC to estimate localised tendon strain within the Achilles tendon and that strain appears to be region dependent at the proximal free tendon. The present study is the first to demonstrate region-dependency for in-vivo Achilles tendon strain response to a common load. Understanding localised strain distribution would provide insight in tissue injury and response to exercise treatment. http://dx.doi.org/10.1016/j.jsams.2014.11.275 86 Autologous tenocyte injection (ATI) for treatment of gluteal tendinopathy: A pilot study M.H. Zheng 1,∗ , T. Bucher 2 , J. Ebert 1 , W. Breidahl 1 , G. Janes 1 1 2
University of Western Australia, Australia Royal Perth Hospital, Australia
Background: Autologous tenocyte injection (ATI) has shown promise in treatment of gluteal tendinopathy. Here we present the results of a pilot study with 24-month follow-up and correlation to the molecular profile of growth factor production by tendon cells. Methods: All patients (n = 12) recruited had a long duration of symptoms (mean 33 months) and had not respond to other nonsurgical treatments including physiotherapy, corticosteroid or PRP injections. Tendon cells were harvested from the patellar tendon through a needle biopsy at the out-patient clinics and propagated in a GMP-licenced laboratory. Cell suspension (at least 5 × 106 cells) in patient serum was injected into the site of pathological gluteal tendons under ultrasound guidance. All patients were assessed pretreatment and at 3-, 6- 12- and 24-months post-treatment with the Oxford Hip Score (OHS), the Merle D’aubigne Postel Score (MDP), the 36-item Short-Form Health Survey (SF-36) and a Visual Analogue Pain Scale (VAS). Magnetic Resonance Imaging (MRI) was performed pre-treatment and at 6-months post-ATI treatment.
Results: Molecular evaluation of autologous tendon cells showed a profile of growth factor production in all of the injected cells. These growth factors include fibroblast growth factor, Platelet-derived growth factor beta and transforming growth factor beta. A single injection of tendon cells into the site of gluteal tendinopathy showed statistically significant improvements (p < 0.05) in the VAS, OHS, MDP score, and the Physical Component Score subscale of the SF-36 at 3 months. Continued improvement was observed at 24 months. One patient opted to undergo surgery after 12 months. All patients completed the Patient Satisfaction Questionnaire at 12-months post-treatment: 67% (n = 8) were either ‘satisfied’ or ‘highly satisfied’ with the outcome of their procedure. However, MRI assessment showed little notable changes in the radiological appearance of tendinopathic tissue due to the complexity of the anatomical features of gluteal tendon. Discussion: ATI significantly improved clinical outcome in patients with chronic gluteal tendinopathy at 24 months. We remain guarded about the level of efficacy given the small sample size, however this study has shown promise to plan a larger randomised controlled study. http://dx.doi.org/10.1016/j.jsams.2014.11.276 87 The development of an online sports injury management system J. Young 1,∗ , L. O’Sullivan-Pippia 2 1 2
Report Injury, Australia Twelve9teen Sports Physiotherapy, Australia
Documentation of sporting injuries on the sideline is thought to be poor for a number of reasons, including lack of time, familiarity with players and current longhand A4 reporting formats. This translates to a lack of analysis of injury trends over time that could influence future practice. We have sought to rectify this situation by the gradually implementation of new and innovative practices to extract meaningful data from all interactions with injured athletes. We began by condensing the longhand form, without losing important descriptive information, such as the mechanism of injury. It was set out with a logical progression that aided the diagnostic process for novice clinicians. The form size was reduced to A5 so that it was easy to use at the sideline. Data was then extracted and analysed using spreadsheeting software. In an effort to improve the process of data collection and collation from multiple clinicians on a weekly basis, an online sports injury management system was developed that allowed sports trainers, physiotherapists and doctors to document injuries directly to a secure, centralised database. The system was custom built to be simple to use, yet able to capture a range of injury variables. Once submitted, injury reports are instantly made visible to other clinicians allowing for streamlined patient follow up and improved continuity of care. The system also allows for the instantaneous production of summary statistics, greatly simplifying end of season injury analysis. We feel that the transition to an online system has been a significant step forward to improve the collection, storage and analysis of medico-legally appropriate injury reports. We plan to use the collected data to contribute to the medical literature in the area of sports injury, particularly within the adolescent population, for which the software is currently being utilised. http://dx.doi.org/10.1016/j.jsams.2014.11.277
Thursday 16 October Papers / Journal of Science and Medicine in Sport 18S (2014) e23–e71
Image Correlation (DIC) has become a popular method for evaluating displacement/strain fields in an imaged medium and has been used in tracking strain in a variety of biological tissue. DIC is a non-contact optical technique that applies a mathematical correlation function using features inherent to the image to estimate deformation. The present study examined the use of DIC to estimate tissue strain within the superficial and deep portions of the proximal Achilles free tendon. Methods: Ten subjects (8 female, 2 male; age: 26.7 ± 6.4 years; height: 179.5 ± 7.6 cm; weight: 83.8 ± 22.7 kg) took park in this study. Following preconditioning, participants carried out three trials applying 40 Nm of torque against a fixed torque transducer (Futek TFF600, Irvine, CA, USA) over a 1.5 s period while a highresolution (14–7 MHz) ultrasound probe (Ultrasonix, Richmond, Canada) was secured to the posterior calf. Subsequent ultrasound video files were processed using specialised software (EchoSoftTM , Madison, USA). The two regions of interest (ROI) analysed were taken from a portion of the proximal AT originating at the soleusAchilles muscle tendon junction extending distally for 1.5 cm then divided in half visually into superficial and deep components. DIC based strain is represented as a mean value of the composite pixel deformation within an ROI normalised by the mean initial pixel dimensions. Results: ICC values for within-rater repeatability are 0.819 [95% CI: 0.20–0.96] for the superficial region and 0.784 [95% CI: 0.13–0.95] for the deep region. There was significantly (p < 0.001) greater strain in the deep (4.7 ± 0.2 SEM) than the superficial AT (3.4 ± 0.2 SEM). Discussion: These findings suggest that there is potential for using DIC to estimate localised tendon strain within the Achilles tendon and that strain appears to be region dependent at the proximal free tendon. The present study is the first to demonstrate region-dependency for in-vivo Achilles tendon strain response to a common load. Understanding localised strain distribution would provide insight in tissue injury and response to exercise treatment. http://dx.doi.org/10.1016/j.jsams.2014.11.275 86 Autologous tenocyte injection (ATI) for treatment of gluteal tendinopathy: A pilot study M.H. Zheng 1,∗ , T. Bucher 2 , J. Ebert 1 , W. Breidahl 1 , G. Janes 1 1 2
University of Western Australia, Australia Royal Perth Hospital, Australia
Background: Autologous tenocyte injection (ATI) has shown promise in treatment of gluteal tendinopathy. Here we present the results of a pilot study with 24-month follow-up and correlation to the molecular profile of growth factor production by tendon cells. Methods: All patients (n = 12) recruited had a long duration of symptoms (mean 33 months) and had not respond to other nonsurgical treatments including physiotherapy, corticosteroid or PRP injections. Tendon cells were harvested from the patellar tendon through a needle biopsy at the out-patient clinics and propagated in a GMP-licenced laboratory. Cell suspension (at least 5 × 106 cells) in patient serum was injected into the site of pathological gluteal tendons under ultrasound guidance. All patients were assessed pretreatment and at 3-, 6- 12- and 24-months post-treatment with the Oxford Hip Score (OHS), the Merle D’aubigne Postel Score (MDP), the 36-item Short-Form Health Survey (SF-36) and a Visual Analogue Pain Scale (VAS). Magnetic Resonance Imaging (MRI) was performed pre-treatment and at 6-months post-ATI treatment.
Results: Molecular evaluation of autologous tendon cells showed a profile of growth factor production in all of the injected cells. These growth factors include fibroblast growth factor, Platelet-derived growth factor beta and transforming growth factor beta. A single injection of tendon cells into the site of gluteal tendinopathy showed statistically significant improvements (p < 0.05) in the VAS, OHS, MDP score, and the Physical Component Score subscale of the SF-36 at 3 months. Continued improvement was observed at 24 months. One patient opted to undergo surgery after 12 months. All patients completed the Patient Satisfaction Questionnaire at 12-months post-treatment: 67% (n = 8) were either ‘satisfied’ or ‘highly satisfied’ with the outcome of their procedure. However, MRI assessment showed little notable changes in the radiological appearance of tendinopathic tissue due to the complexity of the anatomical features of gluteal tendon. Discussion: ATI significantly improved clinical outcome in patients with chronic gluteal tendinopathy at 24 months. We remain guarded about the level of efficacy given the small sample size, however this study has shown promise to plan a larger randomised controlled study. http://dx.doi.org/10.1016/j.jsams.2014.11.276 87 The development of an online sports injury management system J. Young 1,∗ , L. O’Sullivan-Pippia 2 1 2
Report Injury, Australia Twelve9teen Sports Physiotherapy, Australia
Documentation of sporting injuries on the sideline is thought to be poor for a number of reasons, including lack of time, familiarity with players and current longhand A4 reporting formats. This translates to a lack of analysis of injury trends over time that could influence future practice. We have sought to rectify this situation by the gradually implementation of new and innovative practices to extract meaningful data from all interactions with injured athletes. We began by condensing the longhand form, without losing important descriptive information, such as the mechanism of injury. It was set out with a logical progression that aided the diagnostic process for novice clinicians. The form size was reduced to A5 so that it was easy to use at the sideline. Data was then extracted and analysed using spreadsheeting software. In an effort to improve the process of data collection and collation from multiple clinicians on a weekly basis, an online sports injury management system was developed that allowed sports trainers, physiotherapists and doctors to document injuries directly to a secure, centralised database. The system was custom built to be simple to use, yet able to capture a range of injury variables. Once submitted, injury reports are instantly made visible to other clinicians allowing for streamlined patient follow up and improved continuity of care. The system also allows for the instantaneous production of summary statistics, greatly simplifying end of season injury analysis. We feel that the transition to an online system has been a significant step forward to improve the collection, storage and analysis of medico-legally appropriate injury reports. We plan to use the collected data to contribute to the medical literature in the area of sports injury, particularly within the adolescent population, for which the software is currently being utilised. http://dx.doi.org/10.1016/j.jsams.2014.11.277