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Tag: evidence based medicine

Conservative Management May Reduce Repetitive Concussions

Return to play and risk of repeat concussion in collegiate football players: comparative analysis from the NCAA Concussion Study (1999–2001) and CARE Consortium (2014–2017)          McCrea M, Broglio S, McAllister T, Zhou W, Zhao S, Katz B, Kudela M, Harezlak J, Nelson L, Meier T, Marshall SW, Guskiewicz KM, On behalf of CARE Consortium Investigators. Br J Sports Med. 2019 [Epub ahead of print]https://bjsm.bmj.com/content/early/2019/05/08/bjsports-2019-100579 Take Home Message: College football players diagnosed with a concussion are being managed more conservatively with stricter return-to-play protocols, which may be related to a lower risk of repeat concussions during a season compared to 15 years ago. Over the past 15 years, an increase in concussion awareness and research has lead to new policies, rule changes in sport, and enhanced concussion assessment and management protocols. Understanding how these changes influence outcomes, such as the risk of repeat concussion, may help support current policies and consensus recommendations. Hence, the authors compared data from two prospective cohorts to examine if injury management, return to play (RTP), and risk of repeated concussions among collegiate football players changed over 15 years.Read more »…

Taking Steps after Ankle Sprains (Webinar)

Danielle Torp, a Sports Med Res contributor and PhD Student at the University of North Caroline – Charlotte, leads our webinar entitled “Taking Steps after Ankle Sprains”….

SI Dysfunction? Manipulate it, Exercise it, or BOTH

Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled TrialNejati P, Safarcherati A, & Karimi F.  Pain Physician. 2019; 22:53-61. Full Text Freely AvailableTake Home Message: Overall, exercise and manipulation may provide early improvements for patients with sacroiliac joint dysfunction. However, patients should be re-evaluated before 6 months to determine treatment plans moving forward since the combination of exercise and manipulation was not better than performing exercise or mobilizations alone after 6 months.Sacroiliac joint dysfunction is a common cause of low back pain.  While exercise is considered to be effective for generalized low back pain, it remains unclear what is the best way to treat low back pain caused by sacroiliac joint dysfunction.  The authors of this study conducted a randomized controlled trial to evaluate the effectiveness of exercise therapy, manipulation therapy, and exercises + manipulation therapy among people with sacroiliac joint dysfunction.Read more »…

PASS Passes to Evaluate Success of Anterior Cruciate Ligament Reconstruction

Prospective Evaluation of the Patient Acceptable Symptom State to Identify Clinically Successful Anterior Cruciate Ligament Reconstruction        Vega JF, Jacobs CA, Strnad GJ, Farrow L, Jones MH, Miniaci A, Parker RD, Rosneck J, Saluan P, Williams JS, Spindler KP. Am J Sports Med. 2019 [Epub ahead of print]https://journals.sagepub.com/doi/full/10.1177/0363546519831008Take Home Message: A single Patient Acceptable Symptom State question may be enough to identify a patient who views their knee recovery as unsuccessful after an anterior cruciate ligament reconstruction. Many clinicians omit patient-reported outcome measuresduring evaluations because they are at least in part to time consuming. For example, the Knee Injury and Osteoarthritis Outcome Score (KOOS), which is commonly used following an anterior cruciate ligament reconstruction to measure a patient’s view of their recovery, has over 40 questions. One way to reduce the burden on a patient is to use a single-item, patient-reported outcome measure such as the Patient Acceptable Symptom State (PASS). However, there has been no research to determine if a PASS question could be a surrogate for a lengthier joint-specific patient-reported outcome measure. Hence, the authors conducted a cohort study to determine if the response to a PASS question would relate to a successful outcome 1 year after an…

Repair may be Just as Good as Reconstruction

Acute Anterior Cruciate Ligament Rupture: Repair or Reconstruction?Hoogeslag RAG, Brouwer RW, Boer BC, de Vries AJ, and Huis in ‘t Veld H. Am J Sports Med. 2019. [Epub Ahead of Print].https://journals.sagepub.com/doi/abs/10.1177/0363546519825878Take Home Message: People who receive a dynamic augmented anterior cruciate ligament (ACL) repair have similar outcomes to those who receive an ACL reconstruction during the first 2 years after surgeryMany clinicians have discussed the pros and cons of a surgical reconstruction or conservative care for an anterior cruciate ligament (ACL) rupture. In recent years, there has also been a renewed interest in re-assessing suture repair of a ruptured ACL. Therefore, Hoogeslag and colleagues completed a randomized trial to examine patient-reported, clinical, and radiological outcomes among young adults receiving a dynamic augmented ACL repair or ACL reconstruction.Read more »…

BEAR in Mind: There’s a New ACL Repair Technique on the Block

Bridge-Enhanced Anterior Cruciate Ligament Repair: Two-year results of a first-in-human studyMurray MM, Kalish LA, Fleming BC, Proffen BL, Ecklund K, Kramer DE, Yen YM, & Micheli LJ.  Ortho J Sports Med. 2019; 7(3).  DOI: 10.1177/2325967118824356  https://journals.sagepub.com/doi/abs/10.1177/2325967118824356Take Home Message: Bridge-enhanced anterior cruciate ligament repair is producing similar outcomes to hamstring autograft reconstruction up to 2 years post-surgery. Anterior cruciate ligament (ACL) surgical reconstruction techniques are evolving to improve short- and long-term outcomes for patients after surgery.  A newer approach that is getting a lot of attention is the bridge-enhanced anterior cruciate ligament repair(BEAR). To perform a BEAR, a surgeon repairs the ACL with sutures and a scaffold to promote optimal alignment and healing.  Before large clinical trials can be performed with this new procedure it is critical to have initial results to ensure it is safe and potentially beneficial. Hence, the authors conducted an observational cohort study of 10 participants who received a BEAR and 10 who received a hamstring autograft ACL reconstruction to assess physical exam findings, patient-reported outcomes, and adverse events at one and two years after surgery.Read more »…

The Heat is On – But Many States Are Leaving Us Out in the Cold

The Association between Mandated Preseason Heat Acclimatization Guidelines and Exertional Heat Illness during Preseason High School American Football PracticesKerr ZY, Reigster-Mihalik JK, Pryor RR, Pierpoint LA, Scareno SE, Adams WM, Kucera KL, Casa DJ, & Marshall SW.  Environ Health Perspect. 2019; 127(4).  DOI: 10.1289/EHP4163  https://www.ncbi.nlm.nih.gov/pubmed/30969138 Take Home Message: Mandating the use of the National Athletic Trainers’ Association Inter-Association Task Force (NATA-IATF) “acclimatization” guidelines in high school football is related to fewer athletes experiencing exercise-induced heat illness.  The authors of the 2009 NATA-IATF “acclimatization” guidelines aimed to reduce exertional heat illnesses, which include heat stroke, heat syncope, heat exhaustion, and heat edema. Some state high school athletic associations have implemented these guidelines, yet the effectiveness of these guidelines is unknown.  Kerr and his colleagues assessed the relationship between state high school athletic associations adopting the NATA-IATF guidelines and the rate of exertional heat illnesses among high school students during preseason American football practices.Read more »…