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The outbreak of the novel coronavirus (COVID-19) has resulted in upward of 14 million confirmed cases and >597,000 deaths worldwide as of July 19, 2020. The current disruption in sports activities caused by COVID-19 presents a challenge to physicians, coaches, and trainers in discerning best practices for a safe return to sport. There is a distinct need to develop and adopt consistent measures for resumption of sports activities, including training and competition, in a way that places the health and well-being of athletes at the forefront while also protecting coaches, allied staff, and spectators. This article provides an overview of the effects of COVID-19 in the athletic population and presents considerations for training during the pandemic, as well as guidelines for return to sports as restrictions are lifted.

Background: Men's lacrosse has been one of the fastest growing team sports in the United States, at both the collegiate and high school levels. Uniquely, it combines both continuous overhead and contact activity. Thus, an understanding of its injury epidemiology and mechanisms is vital. Shoulder injuries have been shown to be common in the sport, but thus far there has been no dedicated analysis of these injuries with which to better inform injury prevention strategies., Study Design: Descriptive epidemiology study., Methods: All athlete exposures (AEs) and shoulder injuries reported to the National Collegiate Athletic Association (NCAA) Injury Surveillance System for intercollegiate men's lacrosse athletes from 2004-2005 through 2008-2009 were collected. Type of injury was documented and the injury incidence per 1000 AEs was calculated. Event type, injury mechanism, specific injury, outcome, and time lost were recorded. Statistical analysis was performed using 95% CIs, calculated based on a normal approximation to Poisson distribution., Results: There were a total of 124 observed shoulder injuries during 229,591 monitored AEs. With weights, this estimates 1707 shoulder injuries over 2,873,973 AEs, for an incidence of 0.59 per 1000 AEs (95% CI, 0.56-0.62). The incidence of shoulder injury during competition was 1.89 per 1000 AEs (95% CI, 1.76-2.02), compared with 0.35 per 1000 AEs (95% CI, 0.33-0.38) during practice. Acromioclavicular joint injuries were most common (0.29 per 1000 AEs; 95% CI, 0.27-0.31). Labral injuries and instability events were also frequent (0.11 per 1000 AEs; 95% CI, 0.10-0.13). Player-to-player contact caused 57% of all shoulder injuries, with 25% due to contact with the playing surface. The average time lost was 11.0 days, with 41.9% of all shoulder injuries requiring ≥10 days. Clavicle fractures and posterior shoulder dislocation were particularly severe, with no athletes returning to play during the same season., Conclusion: Shoulder injuries are common in NCAA men's lacrosse and are an important source of lost playing time. Acromioclavicular injuries were the most frequent injury in this series, but labral and instability injuries were also common. In this increasingly popular contact sport, an understanding of the epidemiology and mechanism of shoulder injuries may be used to improve protective equipment and develop injury prevention., (© 2016 The Author(s).)

Background: The in situ forces of the anteromedial (AM) and posterolateral bundles (PL) of the anterior cruciate ligament (ACL) under simulated functional loads such as simulated muscle loads have not been reported. These data are instrumental for improvement of the anatomical double-bundle ACL reconstruction., Hypothesis: The load-sharing patterns of the 2 bundles are complementary under simulated muscle loads., Study Design: Descriptive laboratory study., Methods: Eight cadaveric knees in this study were sequentially studied using a robotic testing system. Each knee was tested under 3 external loading conditions including (1) a 134-N anterior tibial load; (2) combined rotational loads of 10 N x m of valgus and 5 N x m internal tibial torques; and (3) a 400-N quadriceps muscle load with the knee at 0 degrees , 15 degrees , 30 degrees , 60 degrees , and 90 degrees of flexion. The in situ forces of the 2 bundles of ACL were determined using the principle of superposition., Results: Under the anterior tibial load, the PL bundle carried peak loads at full extension and concurrently had significantly lower force than the AM bundle throughout the range of flexion (P <.05). Under the combined rotational loads, the PL bundle contributed to carrying the load between 0 degrees and 30 degrees , although less than the AM bundle. Under simulated muscle loads, both bundles carried loads between 0 degrees and 30 degrees . There was no significant difference between the 2 bundle forces at all flexion angles (P > .05)., Conclusion: Under externally applied loads, in general, the AM bundle carried a greater portion of the load at all flexion angles, whereas the PL bundle only shared the load at low flexion angles. The bundles functioned in a complementary rather than a reciprocal manner to each other., Clinical Relevance: The data appear to support the concept that both bundles function in a complementary manner. Thus, how to re-create the 2 bundle functions in an ACL reconstruction should be further investigated.

Background: We hypothesized that there no need to position the foot in plantarflexion after operative repair of an Achilles tendon rupture., Methods: In five fresh cadaver lower extremity specimens, the static tension in the Achilles tendon was measured as the ankle was sequentially dorsiflexed from 30, to 20, to 10, to 0 degrees of plantarflexion. The tendon was then transected and repaired using a modified Krakow locking loop suture technique. The tension in the tendon was again measured as the foot was sequentially dorsiflexed through the same range of motion: 30, to 20, to 10, to 0 degrees. The repair was then tensile tested to failure., Results: The intact Achilles tendons generated on average 10 N, 10 N, 15.8 N and 31.9.0 N of tension at 30, 20, 10, and 0 degrees of plantarflexion, respectively. After a modified Krakow locking loop repair, the tension across the repair site was 10 N, 11.46 N, 18.4 N, and 30.3 N at 30, 20, 10, and 0 degrees of plantarflexion. Thus, moving the ankle from 30 degrees to neutral placed an additional force of 21.9 N on the intact tendon and 20.3 N on the repaired tendon. The mean tensile strength of the modified Krakow repair was 598.6 N (range 167 1129 N)., Conclusions: The tension in the repaired tendon at neutral position is only a small percentage (6.4%) of the strength of the tendon when operatively repaired by a modified Krakow locking loop suture technique., Clinical Relevance: Our results suggest that the ankle joint does not have to be positioned in plantarflexion after operative repair using the described technique.