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Sports Medicine and Arthroscopy Review

Erin D Bigler, Tracy J Abildskov, Naomi J Goodrich-Hunsaker, Garrett Black, Zachary P Christensen, Trevor Huff, Dawn-Marie G Wood, John R Hesselink, Elisabeth A Wilde, Jeffrey E Max
Common neuroimaging findings in mild traumatic brain injury (mTBI), including sport-related concussion (SRC), are reviewed based on computed tomography and magnetic resonance imaging (MRI). Common abnormalities radiologically identified on the day of injury, typically a computed tomographic scan, are in the form of contusions, small subarachnoid or intraparenchymal hemorrhages as well as subdural and epidural collections, edema, and skull fractures. Common follow-up neuroimaging findings with MRI include white matter hyperintensities, hypointense signal abnormalities that reflect prior hemorrhage, focal encephalomalacia, presence of atrophy and/or dilated Virchow-Robins perivascular space...
September 2016: Sports Medicine and Arthroscopy Review
George Salvaterra
The major focus of this review is to establish concussion in sport as a silent epidemic in our society that is not an accident. Brain injury has a definitive pattern and distinct nonrandom predictable characteristic. The development of successful head protection requires a scientific database approach to the mechanics of headgear. It is the responsibility of the health care clinician to help with the maintenance of protective standards for headgear and support rule changes to decrease the morbidity and mortality of athletes...
September 2016: Sports Medicine and Arthroscopy Review
Michael Gay
Sports-related concussion also referred to in the literature as mild traumatic brain injury remains a popular area of study for physicians, neurologists, neuropsychologists, neuroimaging, athletic trainers, and researchers across the other areas of brain sciences. Treatment for concussion is an emerging area of focus with investigators seeking to improve outcomes and protect patients from the deleterious short-term and long-term consequences which have been extensively studied and identified. Broadly, current treatment strategies for athletes recovering from concussion have remained largely unchanged since early 2000s...
September 2016: Sports Medicine and Arthroscopy Review
Douglas F Aukerman, Nicholas R Phillips, Craig Graham
Concussions have always been common in sports, but the awareness and associated diagnosis of the condition have been trending upward, gaining significant attention through medical literature, news media, and entertainment. Concussion management in the collegiate athlete is of specific concern, as over 460,000 young adults compete in collegiate athletics annually. The NCAA and other groups have strived to provide consensus guidelines, but many student-athletes still are not being managed as recommended. The return to play process should begin only after a student-athlete is symptom free and has returned to his or her baseline functioning...
September 2016: Sports Medicine and Arthroscopy Review
Harry Bramley, Justin Hong, Christopher Zacko, Christopher Royer, Matthew Silvis
Sport-related concussion typically resolves within a few weeks of the injury; however, persistent symptoms have been reported to occur in 10% to 15% of concussions. These ongoing symptoms can cause significant disability and be frustrating for the patient and family. In addition, factors other than brain injury can cause complications for these patients, such as adjustment disorder or exacerbation of preexisting conditions such as depression or migraine. Individuals with prolonged symptoms of concussion may be classified as having post-concussion syndrome...
September 2016: Sports Medicine and Arthroscopy Review
Peter Arnett, Jessica Meyer, Victoria Merritt, Erin Guty
Barth and colleagues' seminal study using baseline neuropsychological testing as a model for sports concussion management serves as the template for many collegiate sports medicine programs. However, there remains a significant need for an evidence-based strategy in cases where no baseline testing has been conducted. In this article, we further articulate such a model based on work with athletes at our Division I university. The foundation of the model involves base rates of impairment in a typical neurocognitive sports concussion battery, with decision rules that differ slightly for males and females...
September 2016: Sports Medicine and Arthroscopy Review
Linda Papa
Mounting research in the field of sports concussion biomarkers has led to a greater understanding of the effects of brain injury from sports. A recent systematic review of clinical studies examining biomarkers of brain injury following sports-related concussion established that almost all studies have been published either in or after the year 2000. In an effort to prevent chronic traumatic encephalopathy and long-term consequences of concussion, early diagnostic and prognostic tools are becoming increasingly important; particularly in sports and in military personnel, where concussions are common occurrences...
September 2016: Sports Medicine and Arthroscopy Review
Steven Rowson, Megan L Bland, Eamon T Campolettano, Jaclyn N Press, Bethany Rowson, Jake A Smith, David W Sproule, Abigail M Tyson, Stefan M Duma
Concussions can occur in any sport. Often, clinical and biomechanical research efforts are disconnected. This review paper analyzes current concussion issues in sports from a biomechanical perspective and is geared toward Sports Med professionals. Overarching themes of this review include the biomechanics of the brain during head impact, role of protective equipment, potential population-based differences in concussion tolerance, potential intervention strategies to reduce the incidence of injury, and common biomechanical misconceptions...
September 2016: Sports Medicine and Arthroscopy Review
Wayne J Sebastianelli
No abstract text is available yet for this article.
September 2016: Sports Medicine and Arthroscopy Review
Natasha Trentacosta, William C Graham, Wayne K Gersoff
Meniscal allograft transplantation has evolved over the years to provide a state-of-the-art technique for the sports medicine surgeon to utilize in preserving contact mechanics and function of the knee in irreparable meniscal pathology. However, this procedure continues to spark considerable debate on proper tissue processing techniques, acceptable indications, methods of implantation, and potential long-term outcomes.
June 2016: Sports Medicine and Arthroscopy Review
Alexander E Weber, Matthew E Gitelis, Mark A McCarthy, Adam B Yanke, Brian J Cole
The treatment of combined knee pathology is a challenging problem that requires careful attention to all aspects of the underlying disease. This is true of the interplay among malalignment and meniscal or articular cartilage restoration in the knee. Optimal outcomes are contingent on a comprehensive preoperative evaluation of patient-specific factors (patient expectations, patient age, and activity level), as well as disease-specific factors of the knee. Surgical intervention for meniscal or chondral deficiencies without attention to malalignment will lead to inferior outcomes...
June 2016: Sports Medicine and Arthroscopy Review
Gregory J Pinkowsky, Jack Farr
Patellofemoral (PF) pain, a subset of anterior knee pain, presents a particularly challenging diagnosis due to the multifactorial etiology. Within this group, assigning the patient's symptoms to a patellofemoral cartilage lesion is indirect; that is, a diagnosis by exclusion as hyaline cartilage is aneural. In addition, these PF compartment lesions are often in conjunction with various comorbidities, for example, malalignment and/or instability. In light of these factors and the high shear and compression stresses at the PF compartment, patellar and trochlear chondral lesions require unique treatment considerations from the tibiofemoral compartments...
June 2016: Sports Medicine and Arthroscopy Review
Tyler Welch, Bert Mandelbaum, Minas Tom
Focal cartilage defects of the knee are relatively common and may increase the risk of developing osteoarthritis. Autologous chondrocyte implantation (ACI) aims to restore the integrity of isolated cartilage lesions through the induction of hyaline-like cartilage formation. Although ACI has traditionally been used as a second-line treatment, recent evidence suggests that ACI should be considered as a first-line treatment option in certain patients. Recent controlled trials also suggest that there are improved clinical outcomes among those patients who undergo ACI over the mid-term and long-term compared with those treated with microfracture or osteochondral autograft/mosaicplasty, regardless of lesion size...
June 2016: Sports Medicine and Arthroscopy Review
Ioannis C Zouzias, William D Bugbee
The technique of osteochondral allograft (OCA) transplantation has been used to treat a wide spectrum of cartilage deficiencies in the knee. Its use has been supported by basic science and clinical studies that show it is a safe and effective treatment option. What sets fresh OCA transplantation apart from other cartilage procedures in the knee, is the ability to treat large defects with mature hyaline cartilage. Studies looking at transplantation of fresh OCAs in the general population have shown reliable pain relief and return to activities of daily living...
June 2016: Sports Medicine and Arthroscopy Review
Dustin L Richter, John A Tanksley, Mark D Miller
Isolated chondral and osteochondral defects of the knee are challenging clinical entities, particularly in younger patients. Cartilage treatment strategies have previously been characterized as palliation (ie, chondroplasty and debridement), repair (ie, drilling and microfracture), or restoration (ie, autologous chondrocyte implantation, osteochondral autograft, and osteochondral allograft). The osteochondral autograft transplantation procedure allows defects to be filled immediately with mature, hyaline articular cartilage by utilizing either an arthroscopic or a mini-open procedure...
June 2016: Sports Medicine and Arthroscopy Review
Alberto Gobbi, Matthew Fishman
Regenerative medicine is a fast-growing field in orthopedic sports medicine. Platelet-rich plasma contains multiple factors that have been shown to augment healing, thereby stimulating its use in multiple areas of acute and chronic injuries. Mesenchymal stem cells have pluripotent potential to form into tissues pertinent to orthopedics, such as cartilage and bone. As such, there is been a surge in the research directed toward steering those stem cells into a particular lineage as part of treatment for a variety of soft-tissue, cartilage, and bone pathologies...
June 2016: Sports Medicine and Arthroscopy Review
Jordan M Case, Jason M Scopp
Chondral injuries in the knee are a common source of pain and morbidity. Treatment of symptomatic chondral defects is challenging due to the limited healing capacity of articular cartilage. Microfracture is the most common surgical technique used to treat chondral defects in the knee and utilizes marrow stimulation to generate a fibrocartilage repair. Microfracture has demonstrated good short-term postoperative outcomes. Long-term outcomes following microfracture are variable, with loss of improvement attributed to the poor mechanical qualities of the fibrous repair tissue...
June 2016: Sports Medicine and Arthroscopy Review
Jason A Grieshober, Michael Stanton, Ralph Gambardella
Chondral defects of the knee are quite common, affecting an estimated 10% to 12% of the population. Symptomatic chondral defects are thought to be persistent and possibly progressive. Less is known about the natural history of asymptomatic chondral lesions. Traditional treatment of chondral lesions has involved arthroscopic debridement with a mechanical shaver. Radiofrequency chondroplasty has been explored as a possible alternative or adjuvant to mechanical chondroplasty. The role of chondroplasty in the setting of knee osteoarthritis is more controversial...
June 2016: Sports Medicine and Arthroscopy Review
Frantz Lerebours, Neal S ElAttrache, Bert Mandelbaum
Osteonecrosis of the knee can be divided into the following 3 categories: primary or Spontaneous osteonecrosis of the knee (SONK), secondary osteonecrosis (ON), and postarthroscopic osteonecrosis. Patient characteristics as well as underlying risk factors can help categorize the type of osteonecrosis and guide treatment. SONK was first described by Ahlback et al in 1968. It is described as a disease of subchondral bone that leads to focal ischemia and bone marrow edema, necrosis, and possible subsequent structural collapse...
June 2016: Sports Medicine and Arthroscopy Review
Frantz Lerebours, Neal S ElAttrache, Bert Mandelbaum
The subchondral zone plays an important role in both the structural and biochemical maintenance of articular cartilage. Knowledge of the structure, function, and pathophysiology of the normal subchondral bone/articular surface interface is essential for an understanding of the pathogenesis of many of the disease entities that we will review in this chapter.
June 2016: Sports Medicine and Arthroscopy Review
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