Search

Håkan Alfredson,1,2 Markus Waldén,3,4 David Roberts,3 Christoph Spang5– 7 1Department of Community Medicine and Rehabilitation, Sports Medicine, Umeå University, Umeå, Sweden; 2Alfredson Tendon Clinic, Capio Ortho Center Skåne, Malmö, Sweden; 3Capio Ortho Center Skåne, Malmö, Sweden; 4Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 5Department of Integrative Medical Biology, Anatomy Section, Umeå University, Umeå, Sweden; 6Private Orthopaedic Spine Center, Würzburg, Germany; 7Institute for Sports Science, Würzburg University, Würzburg, GermanyCorrespondence: Håkan Alfredson, Department of Community Medicine and Rehabilitation, Sports Medicine, Umeå University, Umeå, 90187, Sweden, Tel +46 (0) 702288441, Email hakan.alfredson@umu.sePurpose: Midportion Achilles tendinopathy is a relatively common condition. This study aimed to investigate the presence of a normal Achilles tendon, but a tendinopathic plantaris tendon, in a large and consecutive prospective sample of patients referred to a specialised tendon clinic for midportion Achilles tendon pain not responding to non-surgical treatment.Patients and Methods: A total of 105 consecutive tendons were operated on in 81 patients (62 males) suffering from painful midportion Achilles tendon pain. Clinical examination, ultrasound (US) and colour Doppler (CD) examination, and wide awake local anaesthetic no tourniquet (WALANT) surgery were performed in all patients.Results: For 19/105 (18%) tendons from 14 patients, clinical examination suspected plantaris tendinopathy alone as there was a distinct tenderness on the medial side, but no thickening of the Achilles tendon. US examination followed by surgery confirmed the diagnosis.Conclusion: Midportion Achilles tendon pain is not always related to Achilles tendinopathy since pain related to the plantaris tendon alone was found in almost every fifth patient. Consequently, there is an obvious need for proper examination to identify the pain source and establish a correct diagnosis before treatment.Keywords: Achilles tendinopathy, surgery, plantaris, consecutive, ultrasound

Matilda Lundblad,1,2 Martin Hägglund,2,3 Christoffer Thomeé,2 Eric Hamrin Senorski,4 Jan Ekstrand,2,5 Jón Karlsson,1,2 Markus Waldén2,5 1Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 2Football Research Group, Linköping University, Linköping, Sweden; 3Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; 4Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 5Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, SwedenCorrespondence: Matilda LundbladDepartment of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg Göteborgsvägen 31, Mölndal SE-43180, SwedenTel +46-761-050606Email matildalundblad@gmail.comBackground: There is limited epidemiological information on injury rates and injury mechanisms for lateral collateral ligament (LCL) and posterior cruciate ligament (PCL) injuries in male professional soccer. In addition, time trends and lay-off times for these injuries have not yet been determined.Aim: To determine injury rates and circumstances of LCL and PCL injuries over 17 seasons in men’s professional soccer.Methods: A prospective cohort study, in which 68 professional European soccer teams were followed over 17 consecutive seasons (2001/2002 to 2017/2018). The teams’ medical staff recorded player exposure and time-loss injuries. Lay-off time was reported as the median and the first and third quartile. Injury rate was defined as the number of injuries per 1000 player-hours.Results: One hundred and twenty-eight LCL and 28 PCL injuries occurred during 2,554,686 h of exposure (rate 0.05 and 0.01/1000 h, respectively). The median lay-off time for LCL injuries was 15 (Q1=7, Q3=32) days, while it was 31 days for PCL injuries (Q1=15, Q3=74). The match injury rate for LCL injuries was 11 times higher than the training injury rate (0.21 vs 0.02/1000 h, rate ratio [RR] 10.5, 95% CI 7.3 to 15.1 p< 0.001) and the match injury rate for PCL injuries was 20 times higher than the training injury rate (0.056 vs 0.003/1000 h, RR 20.1, 95% CI 8.2 to 49.6, p< 0.001). LCL injuries saw a significant annual decrease of approximately 3.5% (p=0.006). In total, 58% (63/108) of all LCL injuries and 54% (14/26) of all PCL injuries were related to contact mechanism.Conclusion: This study with prospectively registered data on LCL and PCL injuries in men’s professional soccer shows that the median lay-off from soccer for LCL and PCL injuries is approximately 2 and 4 weeks respectively. These rare knee ligament injuries typically occur during matches and are associated with a contact injury mechanism.Keywords: football, epidemiology, knee, ligament

John W Orchard,1 Markus Waldén,2 Martin Hägglund,3 Jessica J Orchard,1 Ian Chivers,4 Hugh Seward,5 Jan Ekstrand21School of Public Health, University of Sydney, Sydney, NSW, Australia; 2Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden; 3Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden; 4Native Seeds, Cheltenham, VIC, Australia; 5Australian Football League Medical Officers Association, Melbourne, VIC, AustraliaAbstract: Australian Football League (AFL) teams in northern (warmer) areas generally have higher rates of injury than those in southern (cooler) areas. Conversely, in soccer (football) in Europe, teams in northern (cooler) areas have higher rates of injury than those in southern (warmer) areas, with an exception being knee anterior cruciate ligament (ACL) injuries, which are more common in the southern (warmer) parts of Europe. This study examined relative injury incidence in the AFL comparing 9,477 injuries over 229,827 player-weeks from 1999–2012. There was a slightly higher injury incidence for teams from warmer parts of Australia (relative risk [RR] 1.05, 95% confidence interval [CI] 1.01–1.10) with quadriceps strains (RR 1.32, 95% CI 1.10–1.58), knee cartilage injuries (RR 1.42, 95% CI 1.16–1.74), and ankle sprains (RR 1.17, 95% CI 1.00–1.37) all being more likely in warmer region teams. Achilles injuries followed a reverse pattern, tending to be more common in cooler region teams (RR 0.70, 95% CI 0.47–1.03). In conclusion, common findings from the AFL and European soccer are that ankle sprains and ACL injuries are generally more likely in teams playing in warmer climate zones, whereas Achilles tendinopathy may be more likely in teams playing in cooler zones. These injuries may have climate or surface risk factors (possibly related to types and structure of grass and shoe-surface traction) that are universal across different football codes.Keywords: climate, grass, shoe-surface traction, Australian football, soccer

Methodological considerations of football injury epidemiology have only scarcely been described. The aim of this study was to evaluate the inter-rater agreement in injury capture rate and injury categorization for data registered in two different prospective injury surveillance audits studying the same two Norwegian male professional football clubs for two consecutive seasons, 2008-2009. One audit used team-based exposure ( TBE) recording and the other individual-based exposure ( IBE). The number of injuries recorded and corresponding injury rates (injuries/1000 h exposure) were compared between audits. Cohen's kappa and prevalence-adjusted bias-adjusted kappa ( PABAK) coefficients were calculated for injury variables. Of 323 injuries included, the IBE audit captured 318 (overall capture rate 98.5%, training 98.9%, match 97.8%) and the TBE audit 303 injuries (overall capture rate 93.8%, training 91.4%, match 97.1%). Agreement analysis showed kappa and PABAK coefficients regarded as almost perfect (> 0.81) for 8 of 9 injury variables, and substantial (ƙ 0.75) for the variable injury severity. In conclusion, the capture rate for training injuries was slightly higher with IBE recording, and inter-agreement in injury categorization was very high. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine the value of quantitative and qualitative MRI and 11C acetate PET/CT parameters in predicting regional lymph node (LN) metastasis of newly diagnosed prostate cancer (PCa).