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HOW LONG SHOULD ACUTE ANTERIOR DISLOCATIONS OF THE SHOULDER BE IMMOBILIZED IN EXTERNAL ROTATION? Scheibel M, Kuke A, Nikulka C, Magosch P, et al. American Journal of Sports Medicine 2009;37:1309–1316.
Twenty-two patients
with traumatic
anteroinferior dislocation of the glenohumeral joint were divided
into two groups. Both were immobilized in 30° of external rotation: group 1 (mean age 37.4
years) for 3 weeks,
and group 2 (mean age 29.7 years) for 5 weeks.
Via magnetic resonance imaging
(MRI), displacement and separation of the glenoid labrum and anterior joint effusion were assessed in different arm positions (internal rotation, neutral rotation, 30° of external rotation, maximum external rotation) within 3 days, 3 weeks and 5 weeks after reduction.
Results: No statistically significant differences were found in all parameters comparing
internal rotation with neutral rotation, 30° of external rotation, and maximum external rotation in both groups after 5 weeks. No statistically significant differences were found between both groups
comparing the results of the measured variables during the acute, 3-week and 5-week MRI
examinations. sportEX comment The length of the immobilisation does
not seem to make any difference. What will be interesting is a follow-up study to monitor re-occurrence rates.
A NOVEL MAGNETIC RESONANCE IMAGING CLASSIFICATION OF DISCOID LATERAL MENISCUS BASED ON PERIPHERAL ATTACHMENT. Ahn JH, Lee YS, Ha HC, Shim JS, Lim KS. American Journal of Sports Medicine 2009;37:1564–1569.
Sixty-seven patients (82 knees) were reviewed. The preoperative magnetic resonance imaging (MRI) was checked in 76 of 82 knees. The Lysholm and Ikeuchi grading scales were evaluated. Images were analysed from MRI, and the findings were classified into four categories: no shift, anterocentral shift, posterocentral shift and central shift. Tear-pattern classifications were based on arthroscopic findings: horizontal tear, peripheral tear, horizontal and peripheral tear, posterolateral corner loss, and others. The correlations between MRI tear-pattern classification and surgical methods and the sensitivity, specificity and accuracy of shift in preoperative MRI, according to the existence of peripheral tear when corroborated with arthroscopy, were analysed. Results: The mean preoperative Lysholm score was 77.3 (range 43–97), and the last follow- up Lysholm score had increased to 96.8 (range 84–100; P<0.001). At last follow-up (100% follow-up), the Ikeuchi grading scale scored 48 knees as excellent, 30 as good and 4 as fair. According to the MRI classification, 43 knees were no shift, 6 knees anterocentral shift, 15 knees posterocentral shift and 12 knees central shift. Shift-type knees had a significantly larger number of peripheral tears, and repairs were performed in the shift-type knees (55%) more frequently than in the no-shift-type knees (28%). Among 82 knees, 31 were repaired simultaneously after a central partial meniscectomy.
sportEX comment A school of thought suggests that as a problem knee is going to be operated on by arthroscopy, an MRI is not required. This study disputes that conclusion. Although the final decision regarding procedure is going to be made during arthroscopy after thorough analysis of the tear, the MRI imaging classification provides more information to surgeons in choosing the appropriate treatment methods.
UEFA INJURY STUDY: AN INJURY AUDIT OF EUROPEAN
CHAMPIONSHIPS 2006 TO 2008. Hägglund M, Waldén M, Ekstrand
J. British Journal of Sports Medicine 2009;43:483–489.
Team physicians prospectively recorded individual player exposure and time-loss injuries during 12 European championships (men’s EURO, under 21 and under 19, and women’s under 19) from 2006 to 2008. There were a total of 1594 male and 433 female players. Results: The team physicians reported 224 injuries (45 training, 179 match play) among 208 (10%) players. No differences in training injury incidence were seen between tournaments (range 1.3–3.9 injuries/1000 hours). The men’s EURO tournaments had the highest incidence of match injury (41.6 injuries/1000 hours), followed by the men’s under-21 tournaments (33.9 injuries/1000 hours). The lowest match injury incidence was seen in the women’s under-19 tournaments (20.5 injuries/1000 hours). Training injuries constituted 20% of all injuries and caused 26% of all match unavailability. A greater proportion of match injuries were due to trauma (83% v 47%) and occurred from player contact (75% v 48%) compared with training injuries. A higher frequency of re-injury was found among training injuries than match injuries (20% v 6%). Match injury incidence increased with age, indicating greater risk with higher intensity of play.
sportEX comment Despite being described as
having a relatively low incidence, training injuries were responsible for a quarter of all match unavailability. This could have a major effect on team performance during the tournament and should be the focus of injury- prevention strategies.
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