Jan 29, 2015
Bulletin Board

Delaying ACL Surgery: A Bad Choice?

Recent research is supporting the theory that having reconstructive surgery as soon as possible after an ACL tear is usually the best route for youth athletes. Waiting could result in further injury and therefore a more difficult surgery.

A study presented at the American Orthopaedic Society for Sports Medicine Specialty Day in February examined medical records of 370 youth athletes who had undergone ACL reconstruction between 2005 and 2011. The group of patients was about half male and half female, and slightly more than half were over 15 years old.

Researchers found that youths who delayed surgery more than 150 days were more likely to develop a medial meniscus tear. “These additional injuries may increase recovery time, inhibit return to play, and worsen long term functional outcomes of the knee,” lead researcher Guillaume Dumont, MD, a third-year resident at the University of Texas Southwestern Medical Center in Dallas, told Medical News Today.

The research falls in line with another study published in The American Journal of Sports Medicine in December 2011. Researchers from the Division of Orthopaedic Surgery at The Children’s Hospital of Philadelphia examined the charts of 70 children with an average age of 13 who had undergone ACL reconstruction between 1995 and 2005.

Twenty-nine of the patients had surgery more than 12 weeks after injury. In these cases, the rate of irreversible injuries–such as medial meniscus tears that could not be repaired and full thickness cartilage injuries–was up to four times higher than in patients who had surgery within 12 weeks of injury.

To view the abstract of the study, “Degeneration of the Knee Joint in Skeletally Immature Patients With a Diagnosis of an Anterior Cruciate Ligament Tear: Is There Harm in Delay of Treatment?” go to: ajs.sagepub.com and search the study title.

Concussion Effects May Linger

The physiological effects of a concussion may last longer than neurocognitive and self-reported symptoms, according to a study published in the February issue of the Journal of Clinical Neurophysiology. Because neurocognitive testing and self-reporting of symptoms are often the only methods used to determine when it is safe for an athlete to return to play, the study suggests that athletes may be returning too soon.

Researchers monitored athletes’ recovery patterns using motor-evoked potentials (MEPs), an electrophysiological measurement that can provide evidence of changes in brain function. They evaluated nine collegiate athletes who had suffered a concussion within the 24 hours prior to observation for 10 days.

During the MEP test, researchers placed electrodes on each participant’s hand or foot and put a magnetic stimulating device over their heads to deliver a brief magnetic stimulation pulse to the brain. The time it took each participant’s limb to react to the pulse was recorded. The participants also took a computerized neurocognitive test and self-reported any symptoms.

The majority of concussed participants reported their most severe symptoms within 24 to 72 hours after the injury, and some reported a resolution of symptoms in just over a week. The neurocognitive test results followed a similar pattern. However, the MEPs indicated increased response time up to 10 days post-injury, even as the participants’ neurocognitive function improved and self-reported symptoms decreased.

“Further investigation of MEPs in concussed athletes is needed, especially to assess how long the disturbances in physiological functioning continue after those initial 10 days post-injury,” lead author Scott Livingston, PhD, PT, ATC, SCS, Director of the UK Concussion Assessment Research Lab and an Assistant Professor at the University of Kentucky, told Science Daily. “But in the meantime, sports medicine personnel caring for concussed athletes should be cautious about relying solely on self-reported symptoms and neurocognitive test performances when making return-to-play decisions.”

The research does not downplay the importance of neurocognitive testing and taking into account athletes’ self-reported symptoms. Both methods are necessary for diagnosing concussions and monitoring their symptoms post-injury.

To read the abstract of the study, “Differential rates of recovery after acute sport-related concussion,” go to: journals.lww.com and search the study title.

Strict Safety Guidelines Suggested In an effort to better protect baseball and softball players from injury, the American Academy of Pediatrics Council on Sports Medicine & Fitness recently updated its safety recommendations for the two sports. According to the Council, emergency medical care facilities report that about 10 percent of sports injuries among patients younger than 15 years old are related to softball or baseball.

The most visible of the suggested changes is head and face protection for pitchers and infielders. The guidelines also suggest discontinuing practice swings in on-deck circles and encourage players to take at least a three-month break from their sports annually.

Other guidelines are pitcher-specific. For example, pitchers would always be taught the proper mechanics for throwing and adhere to strict pitch-count limits with days of rest between outings. Pitchers would also be limited to playing for one team at a time, and restricted from also playing catcher. Finally, it is suggested that pitchers delay throwing curveballs until they are 14 years old and sliders until they are 16 years old.

To download the guidelines, go to: www2.aap.org/sections/sportsmedicine and click on “AAP Policy Statements” under the “Policies & Publications” pull-down menu.

Athletic Trainers Head Overseas

In addition to the athletic competition, the Olympics are a great opportunity for those involved, including sports medicine professionals, to learn about other cultures. When University of South Carolina Team Physician Jeffrey Guy, MD, attended the Beijing Games in 2008, he found China’s schools in sore need of athletic trainers.

Following the Games, Guy helped form the Institute for Western Surgery in China. He also urged Jim Mensch, PhD, ATC, Athletic Training Program Director at USC, to get involved with providing athletic training services in the country.

“Dr. Guy said to me, ‘You need to bring athletic trainers over to China,'” Mensch says. “So I flew over and pitched a proposal to his contact at the Institute about how athletic trainers can provide healthcare services and work with physicians.”

The importance of their services was recognized and arrangements were made to supply graduate athletic training students to the Institute as interns. “We sent four in the first year, and it was unbelievably successful,” Mensch says. “We helped cover international schools in Shanghai and Guangzhou and the schools loved having them. It worked so well that one of the schools hired one of our athletic trainers full-time.”

According to Mensch, the challenges facing the program range from the unique to the familiar. “We were worried about homesickness and getting the athletic trainers integrated into the culture while overcoming the language barrier,” he says. “It’s a scary thought, traveling halfway around the world for an internship.

“Implementing an athletic trainer into a school that’s never had one before is also a complex process,” Mensch continues. “Let’s say a nurse was taking care of all the sprains, knee issues, and shoulder injuries. Then all of sudden, another qualified healthcare professional is there, with a little more expertise in musculoskeletal injuries. The athletic trainer has to work within the school’s existing dynamic.”

While Mensch knows China has benefited from the athletic trainers’ help, he hopes that the experience also helps students see what they are capable of after graduation. “It’s important for athletic trainers to know they have a skill set to not just work with athletes, but to make a big impact on patient populations anywhere in the world,” he says.


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