Pediatric Concussions in Contact Sports: A 10-Year Retrospective Analysis of Mechanisms and Associated Symptoms.

Background: Concussions make up a significant proportion of sports injuries. This study aimed to describe the mechanisms of injury and associated symptoms of pediatric patients diagnosed with concussions (age range, 4-17 years) from contact sports.

Hypothesis: Mechanisms of injury would differ based on sex and age, with female athletes and younger athletes aged 4 to 11 years sustaining fewer concussions from player-to-player contact.

The musculoskeletal syndrome of menopause.

Fifty-one percent of humans are born with ovaries. As the ovarian production of estrogen diminishes in midlife and ultimately stops, it is estimated that more than 47 million women worldwide enter the menopause transition annually. More than 70% will experience musculoskeletal symptoms and 25% will be disabled by them through the transition from perimenopause to postmenopause.

Lower Body Weightlifting Injuries Treated in United States Emergency Departments from 2012-2021.

Weightlifting has become an increasingly popular form of exercise that has been shown to have many health benefits but can be dangerous if performed improperly. The objective of this study was to describe the epidemiology of lower body weightlifting injuries in the United States. The National Electronic Injury Surveillance System database was queried from January 1, 2012, to December 31, 2021, for lower body injuries related to using weightlifting equipment.

Quadratus lumborum block provides improved immediate postoperative analgesia and decreased opioid use compared with a multimodal pain regimen following hip arthroscopy.

The purpose of our study was to evaluate the effect on immediate patient outcomes following hip arthroscopy with use of a preoperative, single shot quadratus lumborum (QL) block. We retrospectively reviewed patients who underwent hip arthroscopy following a preoperative QL block. These patients were matched by age and gender to patients who had not received a block.

Significant Chondrocyte Viability Is Present in Acetabular Chondral Flaps Associated With Femoroacetabular Impingement.

Background: Patients presenting with cam deformity of the femoral head and neck sustain repeated trauma to the articular cartilage of the superior acetabulum, with chondral delamination injuries found during hip arthroscopy. Two previous studies reveal conflicting chondrocyte viability data in these traumatic cartilage injuries. The full-thickness nature of flaps may suggest that chondrocytes residing in the cartilage flap matrix in the joint environment would remain viable despite shear trauma.

Update on Anterior Cruciate Ligament Rupture and Care in the Female Athlete.

As female athlete sports participation has continued to increase, the rate of anterior cruciate ligament (ACL) rupture in female athletes has also increased. Individualized, patient-specific treatment is crucial to achieving optimal outcomes; ACL reconstruction must accurately restore native ACL anatomy and address any concomitant injury to secondary stabilizers. Rehabilitation programs should target hip, core, and trunk neuromuscular control; allow adequate time for graft ligamentization; and address the psychosocial needs of the athlete.

Morphologic Risk Factors in Predicting Symptomatic Structural Failure of Arthroscopic Rotator Cuff Repairs: Tear Size, Location, and Atrophy Matter.

Purpose: To evaluate whether morphologic characteristics of rotator cuff tear have prognostic value in determining symptomatic structural failure of arthroscopic rotator cuff repair independent of age or gender.

Methods: Arthroscopic rotator cuff repair cases performed by five fellowship-trained surgeons at our institution from 2006 to 2013 were retrospectively reviewed. Data extraction included demographics, comorbidities, repair technique, clinical examination, and radiographic findings.

Chronic exercise preserves brain function in masters athletes when compared to sedentary counterparts.

Objective: Exercise is beneficial for both the body and the mind, and it has been associated with protective neurocognitive effects, such as increased levels of brain-derived neurotrophic factor and neurogenesis. These effects are linked to the attenuation of age-related mental decline and the preservation of mental capacities in older, physically active adults. This study evaluated whether masters athletes, a highly active population, have better cognitive function compared to age-matched non-athletes based on the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) tool.

A review of femoroacetabular impingement and hip arthroscopy in the athlete.

Femoroacetabular impingement (FAI) is increasingly recognized as a pathological condition of the hip in athletes. Although it is not always symptomatic, the bone structure leading to FAI and its associated pathology can result in significant pain and performance decline in athletes. Recognition of athletes with symptomatic FAI is of the utmost importance, as prompt treatment is necessary in order to maintain desired sports activity levels and preserve joint function.

The role of mobility as a protective factor of cognitive functioning in aging adults: a review.

Context: Over 33 chronic disease states and health disorders, including obesity and type 2 diabetes, are grouped into what is known as sedentary death syndrome. All these conditions are positively affected by 30 minutes of brisk exercise daily. In addition, only 30% of aging is based on genetics, with 70% on lifestyle.

Unicompartmental arthritis in the aging athlete: osteotomy and beyond.

The vitality of the aging athlete is largely dependent on continued mobility and pain-free motion. The early onset of osteoarthritis often has devastating consequences for these athletes and if left untreated, mobility declines and eventually prevents sporting activities all together. Recent advances in operative treatment for unicompartmental arthritis of the knee aim to delay the need for total joint arthroplasty by preserving or restoring the form and function of the knee to allow for continued sport participation.

Masterful care of the aging triathlete.

Current endurance champions are turning in winning performances in their late 30s and 40s. These masters-age athletes present a special challenge to Sport Medicine practitioners who in previous decades have simply advised masters-aged athletes to stop competing to prevent or treat injury. The fact is, many of the physical changes commonly attributed to aging alone are actually due to the rages of sedentary aging.

Biological approaches to improve skeletal muscle healing after injury and disease.

Skeletal muscle injury and repair are complex processes, including well-coordinated steps of degeneration, inflammation, regeneration, and fibrosis. We have reviewed the recent literature including studies by our group that describe how to modulate the processes of skeletal muscle repair and regeneration. Antiinflammatory drugs that target cyclooxygenase-2 were found to hamper the skeletal muscle repair process.

Biologic approaches to enhance rotator cuff healing after injury.

Background: Despite the advances in surgical procedures to repair the rotator cuff, there is a high incidence of failure. Biologic approaches, such as growth factor delivery and stem cell and gene therapy, are potential targets for optimization to improve the outcome of rotator cuff therapies and reduce rates of reinjury. This article outlines the current evidence for growth factor and stem cell therapy in tendon healing and the augmentation of rotator cuff repair.

Chronic exercise preserves lean muscle mass in masters athletes.

Aging is commonly associated with a loss of muscle mass and strength, resulting in falls, functional decline, and the subjective feeling of weakness. Exercise modulates the morbidities of muscle aging. Most studies, however, have examined muscle-loss changes in sedentary aging adults.

Activation of MKK3/6, SAPK, and ATF-2/c-jun in ACL fibroblasts grown in 3 dimension collagen gels in response to application of cyclic strain.

Signal transduction pathways involved in response to cyclic tensile strain and strain deprivation in anterior cruciate ligament (ACL) fibroblasts grown in 3D collagen gels were investigated. Application of cyclic tensile strain resulted in significant activation (phosphorylation) of MKK3/6, SAPK and their downstream target transcription factors, ATF-2 and c-jun, while strain deprivation resulted in a decrease in these kinases and transcription factors. These data suggest that ACL fibroblasts cultured in 3D collagen gels respond to the mechanical environment and provide a useful system for determination of the molecular mechanisms involved in the regulation of proliferation and matrix turnover by mechanical load.

Model-based tracking of the hip: implications for novel analyses of hip pathology.

This study investigated the efficacy of a combined high-speed, biplane radiography and model-based tracking technique to study hip joint kinematics and arthrokinematics. Comparing model-based tracking to the gold standard of radiostereometric analysis using implanted metal beads, joint translation was measured with a bias of 0.2 mm and a precision of 0.

Participation in high-impact sports predicts bone mineral density in senior olympic athletes.

Background: Loss of bone mineral density (BMD) and resultant fractures increase with age in both sexes. Participation in resistance or high-impact sports is a known contributor to bone health in young athletes; however, little is known about the effect of participation in impact sports on bone density as people age.

Hypothesis: To test the hypothesis that high-impact sport participation will predict BMD in senior athletes, this study evaluated 560 athletes during the 2005 National Senior Games (the Senior Olympics).

Stem cells for the treatment of skeletal muscle injury.

Skeletal muscle injuries are extremely common, accounting for up to 35%-55% of all sports injuries and quite possibly affecting all musculoskeletal traumas. These injuries result in the formation of fibrosis, which may lead to the development of painful contractures, increases patients' risk for repeat injuries, and limits their ability to return to a baseline or pre-injury level of function. The development of successful therapies for these injuries must consider the pathophysiology of these musculoskeletal conditions.

Age-related rates of decline in performance among elite senior athletes.

Background: Age-related disability and lost independence currently plague one third of older Americans. Many causes of disability, lost muscle mass and bone mineral density, are modifiable with exercise. Most exemplary of successful aging are the Senior Olympians; this group of vital athletes exhibit persistently high levels of functional capacity.

Osteoporosis in men.

Osteoporosis is a significant threat to aging bone in men. Thirty percent of hip fractures occur in men; during initial hospitalization and the first year after fracture, the mortality rate is twice that of women. Nevertheless, osteoporosis in men is grossly underdiagnosed and undertreated.

Bilateral sacroiliac joint dislocation without associated fracture or anterior pelvic ring injuries.

SI joint dislocations are serious injuries. They are often associated with posterior fractures or anterior ring disruptions. This case report documents the outcome of a patient with an uncommon injury involving bilateral SI joint dislocation without associated anterior pelvic injuries or posterior pelvic fracture.

Synergistic enhancement of bone formation and healing by stem cell-expressed VEGF and bone morphogenetic protein-4.

We investigated the interaction between angiogenic and osteogenic factors in bone formation and bone healing with ex vivo gene therapy using muscle-derived stem cells genetically engineered to express human bone morphogenetic protein-4 (BMP4), VEGF, or VEGF-specific antagonist (soluble Flt1). Our results show that although VEGF alone did not improve bone regeneration, it acted synergistically with BMP4 to increase recruitment of mesenchymal stem cells, to enhance cell survival, and to augment cartilage formation in the early stages of endochondral bone formation. These early effects, coupled with accelerated cartilage resorption, eventually led to a significant enhancement of bone formation and bone healing.

BMP4-expressing muscle-derived stem cells differentiate into osteogenic lineage and improve bone healing in immunocompetent mice.

Recent advances in molecular biology have led the way for novel approaches to improve bone healing. The ideal growth factor, vector, and delivery systems for producing bone in an immune competent animal model, however, have yet to be identified. Using a retrovirus encoding BMP4 and recently isolated muscle-derived stem cells (MDSCs), we demonstrated the following: MDSCs undergo osteogenic differentiation in response to BMP4 in a dose-dependent manner; retrovirus encoding BMP4 can efficiently transduce MDSCs, both enhancing osteogenic differentiation and inhibiting myogenic differentiation; transduced MDSCs can produce high levels of functional BMP4 as they differentiate toward an osteogenic lineage; allogeneic transduced MDSCs can induce robust de novo bone formation in immunocompetent mice despite the presence of an immune reaction, demonstrating the ability of this retroviral-BMP4-muscle construct to provide sufficient stimuli for osteoinduction in vivo; MDSCs appear to deliver BMP4, respond to the human BMP4 in an autocrine manner, and actively participate in bone formation, thus serving both osteoinductive and osteoproductive roles; and the BMP4-expressing MDSCs can induce bone formation and improve bone healing in a critical-sized skull defect in immunocompetent mice.