Knee injuries in female athletes

Female athletes are at increased risk for certain sports-related injuries, particularly those involving the knee. Factors that contribute to this increased risk are the differences in sports undertaken and in gender anatomy and structure. Gender differences include baseline level of conditioning, lower extremity alignment, physiological laxity, pelvis width, tibial rotation and foot alignment. Sports like gymnastics and cheerleading create a noncontact environment, but can result in significant knee injuries. In quick stopping and cutting sports, females have an increased incidence of anterior cruciate ligament (ACL) injury by noncontact mechanisms. Patellofemoral (PF) disorders are also very common in female athletes. Awareness of these facts helps the sports medicine professional make an accurate diagnosis and institute earlier treatment-focused rehabilitation with or without surgery. Further prospective and retrospective research is needed in areas of epidemiology, mechanisms, severity and types of knee injuries. The goal is to lessen the severity of certain knee injuries and to prevent others.     

Athlete age and sports physical examination findings

BACKGROUND: Interscholastic and intercollegiate athletes commonly visit physician offices to have sports participation examinations (PPEs). Few data exist, however, to help determine the age range for which such examinations are reasonable. The purpose of this study was to determine the percentage of athletes with significant findings on sports PPEs among junior high school, high school, and college-age athletes. METHODS: Analyses were made of 937 consecutive PPEs that were performed by primary care physicians using a standardized form. Subjects were interscholastic athletes of junior high, high school, and college age. Significant findings were defined as those that resulted in any recommendation, ie, change in management, by the examining physician. RESULTS: The incidence of significant findings was 3.4% for the junior high school athletes, 15.4% for high school athletes, and 33.9% for college athletes (P < .001). The overall percentage of athletes disqualified from participating in any sport, which was 1.7%, did not differ significantly across age levels. CONCLUSIONS: In this sample, college and high school athletes were much more likely than junior high school athletes to have significant findings on sports. PPEs. These data cast uncertainty on the necessity of annual PPEs to screen athletes of junior high school age.     

Complete remission of extensive metastatic renal cancer following immunotherapy

In order to assess the extent of the sports injury problem, it is necessary to identify both the incidence and severity of sports injuries. In the literature, the severity of sports injuries is usually described on the basis of 6 criteria: (i) nature of sports injury; (ii) duration and nature of treatment; (iii) sporting time lost; (iv) working time lost; (v) permanent damage; and (vi) monetary cost. It is important to include information on the severity of injuries in a sports injury registration system. This kind of information will help to set targets for preventive strategies. The more severe the injuries sustained, the higher the priority will be to prevent these injuries regardless of the injury incidence. When assessing injury severity one should take into account that, in order to enhance the comparability of research data, uniform definitions are also important in this area of sports injury surveillance. This paper briefly discusses the 6 criteria used to describe the severity of sports injuries.     

Medicated stainless steel ring-165, medicated gamma-intrauterine devices and TCu220C: a multicenter comparative study

PURPOSE: The purpose of this study was to compare tobacco use among high school male athletes with their nonathlete counterparts. We hypothesized that there was an inverse correlation between the intensity level of the sport and frequency of tobacco use. METHODS: Students were surveyed at seven high schools in northwest Louisiana using a 109-item questionnaire. Of the 1,200 males tested, 83% participated in one or more sports. The mean age was 15.8, and mean grade level was 10th. Sixty-seven percent were white, 27% African-American (AA), and 6% other. RESULTS: Forty-one percent of the adolescent males tested were one or more tobacco products, 31% reported cigarette smoking, 21% chewed tobacco, and 18% used snuff. Eleven percent reported using all three tobacco products. Race was a significant determinant of tobacco use, with whites being more likely to use each of the three tobacco products (P < .001). Medium- and high-intensity athletes were significantly (P < .01) less likely to be heavy smokers than athletes participating in low-intensity sports and nonathletes. However, athletes of each intensity sport used chewing tobacco and snuff at significantly higher rates (P < .001) than nonathletes. When race and grade point average were controlled, sports intensity was a significant predictor of smokeless tobacco use but not overall smoking behavior. Both AA and white high school male athletes at all sport intensity levels were using chewing tobacco and snuff at a rate higher at least 1.5 times that of their nonathlete counterparts. CONCLUSIONS: In our study, high school males' sports participation was a predictor of smokeless tobacco use but not overall smoking behavior. Although the probability of AA high school athletes using smokeless tobacco was low compared to whites, the pattern of use was similar across intensity levels of sports.     

Epidemiology of school injuries in the northern part of Sweden

The aim of this one-year investigation of school accidents is to obtain more knowledge for preventive work. In the age-group 7-19 years, 547 injuries were registered, mainly at three hospitals. The incidence rate was 25 per 1000 boys and 20 per 1000 girls per year. Most injuries occurred in intermediate and upper secondary school among boys and in upper school among girls. The relative risk of school injury compared with spare-time injury was 1.8 for boys and 2.6 for girls of compulsory school age. Most injuries occurred in sports area (boys: 34%, girls: 46%). The incidence of sports injuries showed no gender differences. The highest incidence rate was found in senior school girls. Twenty-five percent of all injuries were caused by other pupils, intentional violence being one important mechanism. Head injuries were more common among school injuries compared with spare-time injuries.     

Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes

OBJECTIVES: Reliable prevalence data would be useful in assessing the impact of sudden cardiac death in young competitive athletes on the community and designing effective preparticipation screening strategies. BACKGROUND: The frequency with which these catastrophes occur is largely unknown. METHODS: We utilized a circumstance unique to Minnesota in which the precise number of participants and deaths due to cardiovascular disease could be ascertained over a substantial period of time based on a long-standing insurance program for catastrophic injury or death, mandatory for all student athletes engaged in interscholastic sports. RESULTS: Over the 12-year period, 1985/1986 to 1996/1997, inclusive, three sudden deaths due to cardiovascular disease occurred in competitive high school athletes (grades 10-12) during competition or practice. At autopsy, 1 each proved to be due to anomalous origin of the left main coronary artery from the right sinus of Valsalva, congenital aortic valve stenosis (with bicuspid valve) and myocarditis. All three athletes were white and male, 16 or 17 years of age; two competed in cross-country/track and one in basketball. During the study period there were 1,453,280 overall sports participations and 651,695 student athlete participants among the 27 high school sports. The calculated risk for sudden death was 1:500,000 participations and 1:217,400 participants per academic year (or 0.46/100,000, annually). Over a 3-year high school career for a student athlete the estimated risk was 1:72,500. CONCLUSIONS: The risk of sudden cardiac death in a population of high school student athletes was small, in the range of one in 200,000 per year, and was higher in male athletes. The rare occurrence of sudden cardiac death in competitive sports underlines the limitations implicit in structuring productive and cost-effective broad-based preparticipation screening strategies for high school athletes.     

Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data

OBJECTIVE: To determine the acute injury profile in each of six sports and compare the injury rates between the sports. DESIGN: Analysis of national sports injury insurance registry data. SETTING: Finland during 1987-91. SUBJECTS: 621,691 person years of exposure among participants in soccer, ice hockey, volleyball, basketball, judo, or karate. MAIN OUTCOME MEASURES: Acute sports injuries requiring medical treatment and reported to the insurance company on structured forms by the patients and their doctors. RESULTS: 54,186 sports injuries were recorded. Injury rates were low in athletes aged under 15, while 20-24 year olds had the highest rates. Differences in injury rates between the sports were minor in this adult age group. Overall injury rates were higher in sports entailing more frequent and powerful body contact. Each sport had a specific injury profile. Fractures and dental injuries were most common in ice hockey and karate and least frequent in volleyball. Knee injuries were the most common cause of permanent disability. CONCLUSIONS: Based on the defined injury profiles in the different sports it is recommended that sports specific preventive measures should be employed to decrease the number of violent contacts between athletes, including improved game rules supported by careful refereeing. To prevent dental injuries the wearing of mouth guards should be encouraged, especially in ice hockey, karate, and basketball.     

Isolation and characterization of nocardicin B

The incidence of nonfatal neck injuries in high school football was determined by performing preseason examinations in 104 active high school players and 75 college freshman candidates. Coaches of all 430 Iowa high schools were asked to recall the number of players experiencing significant neck pain during the season. A detailed questionnaire for each injury was also completed by a sample population of 60 coaches. The incidence of roentgenographic evidence of neck injuries was as high as 32% and was related to years of experience. Injury was most likely to occur to a linebacker or a defensive halfback when they tackled the ball carrier. In the preseason examination, half the players who volunteered a history of significant neck pain had abnormal x-ray films.     

Orthopaedic implant infections: current management strategies

A small femoral notch width index has been reported as a predictive factor for anterior cruciate ligament injury and implicated in the higher incidence of anterior cruciate ligament injuries in female athletes. Notch-plasty has been recommended for the unaffected knees of patients who have torn one anterior cruciate ligament and whose notch width index falls one standard deviation below "normal". However, the symmetry of the notch width index has not been specifically studied. We compared the notch width index in both knees of 40 male and 40 female patients. Half of the patients in each group had anterior cruciate ligament injuries, all from a noncontact mechanism. We found that the notch width indexes of the right and left knees of the same patient are essentially symmetrical, regardless of sex or anterior cruciate ligament status. Although the female patients tended to have smaller notch width indexes than the male patients, the difference was not statistically significant. Moreover, the ranges of notch width indexes in male and female patients overlapped considerably. Finally, there was no difference in notch width index between patients with and without anterior cruciate ligament tears. These findings suggest that the notch width index alone is not the critical etiologic factor in the patient with a unilateral anterior cruciate ligament tear. Furthermore, the increased incidence of anterior cruciate ligament tears in female patients compared with male patients in the same sports cannot be attributed to notch width index alone.     

Predictors of injury in ice hockey players. A multivariate, multidisciplinary approach

Eighty-six male high school ice hockey players participated in this prospective study to determine both the incidence of injury in high school ice hockey and the influence of physical, situational, and psychosocial factors. Physical factors included height, weight, vision, previous injuries, musculoskeletal abnormalities, and injuries present at the time of screening evaluations. Situational factors examined were level of participation, playing time, player position, and games versus practices. Psychosocial factors such as confidence, stress, social support, positive states of mind, and mood states were also examined to determine their influences on injury. Twenty-seven injuries occurred during the 1994 to 1995 season. As hypothesized, the overall incidence of injury in high school hockey games (34.4 per 1000 player-game hours) was less than the incidence of injury in Junior A hockey (96.1 per 1000 player-game hours) and was more than previously reported for Bantam youth hockey (10.9 per 1000 player-game hours). Injuries occurred more often in games than in practices, usually as a result of collisions. Physical factors such as player position and previous injuries did not significantly predict injuries, but players in the high playing time group were more likely to be injured. Psychosocial factors of low vigor and high fatigue as measured by the Incredibly Short Profile of Mood States (ISPOMS) significantly predicted high school ice hockey injuries.     

Lateral ankle sprains and instability problems

The lateral ankle complex is the most frequently injured single structure in athletes, consisting of 38% to 45% of all injuries. One-sixth of all sports injury loss time is from ankle sprains. In North America, ankle inversion sprains are considered "de rigeur" for basketball participation.     

Nursing and the law. 6. Clinical responsibility

Surveillance for parachute-related injuries was conducted at Fort Bragg, North Carolina, between May 1993 and December 1994. During this 20-month period, lower-extremity injuries (27% of all injuries), axial skeletal (back and neck) strains and sprains (19.3%), and closed head injuries (18.4%) were the leading causes of injury. The incidence of injuries requiring emergency care was 8/1,000 jumps. This rate is well within the jump injury planning estimate, suggesting that airborne training and operations are conducted in a safe and effective manner at Fort Bragg.     

Risk factors for stress fractures in track and field athletes. A twelve-month prospective study

The aim of this 12-month prospective study was to investigate risk factors for stress fractures in a cohort of 53 female and 58 male track and field athletes, aged 17 to 26 years. Total bone mineral content, regional bone density, and soft tissue composition were measured using dual-energy x-ray absorptiometry and anthropometric techniques. Menstrual characteristics, current dietary intake, and training were assessed using questionnaires. A clinical biomechanical assessment was performed by a physical therapist. The incidence of stress fractures during the study was 21.1% with most injuries located in the tibia. Of the risk factors evaluated, none was able to predict the occurrence of stress fractures in men. However, in female athletes, significant risk factors included lower bone density, a history of menstrual disturbance, less lean mass in the lower limb, a discrepancy in leg length, and a lower fat diet. Multiple logistic regression revealed that age of menarche and calf girth were the best independent predictors of stress fractures in women. This bivariate model correctly assigned 80% of the female athletes into their respective stress fracture or nonstress fracture groups. These results suggest that it may be possible to identify female athletes most at risk for this overuse bone injury.     

Sports injuries in team handball. A one-year prospective study of sixteen men's senior teams of a superior nonprofessional level

One hundred eighty-six players of 16 teams in 2 male team handball senior divisions were observed prospectively for 1 season to study the injury incidence in relation to exposure in games and practices. Ninety-one injuries were recorded. Injury incidence was evaluated at 2.5 injuries per 1000 player-hours, with a significantly higher incidence in game injuries (14.3 injuries per 1000 game-hours) compared with practice injuries (0.6 injuries per 1000 practice-hours). Practice injury incidence was higher in the lower performance level group, and game injury incidence was higher in the high-level group. The upper extremity was involved in 37% of the injuries, and the lower extremity in 54%. The knee was the most commonly injured joint, followed by the finger, ankle, and shoulder. Knee injuries were the most severe injuries, and they were more frequent in high-level players. There was an increase in the severity of injury with respect to performance level. The injury mechanism revealed a high number of offensive injuries, one-third of them occurring during a counterattack. The injury pattern showed certain variations with respect to player position and performance level. Prophylactic equipment was used by a majority of players at the higher performance level.     

Women's injuries in collegiate sports. A preliminary comparative overview of three seasons

The purpose of this article was to provide a preliminary overview of the injury experiences among collegiate women athletes which were reported to the National Athletic Injury/Illness Reporting System (NAIRS) during its first 3 operational years (1975 to 1978). More dissimilarities in injury patterns were observed between women's sports than between comparable men and women's sports. The results thereby are interpreted that injuries to women athletes are essentially sport-related, not sex-related. Further investigative reports on women athletic injuries should be delimited to respective sports and over a period of time. Attention should be given to the patterns of injury within a sport, including shifts in patterns, so that practicable preventive measures can be perceived, implemented, and subsequently evaluated.     

Screening for gonorrhea and chlamydia by DNA amplification in adolescents attending middle school health centers. Opportunity for early intervention

GOAL: To determine prevalence and incidence of Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) infection and assess risk factors predictive for such infections in a middle school-based clinic sample. STUDY DESIGN: 170 female students and 43 male students making 256 and 47 visits, respectively, > or = 30 days apart, in urban middle school clinics for primary care screening, reproductive health, or illness/injury were routinely asked to provide urine specimens for GC and CT ligase chain reaction testing if sexually active in the preceding 3-month period. Information regarding prior sexually transmitted diseases, reason for visit, and sexual risk behaviors was obtained. RESULTS: GC: 11.4% of female student and 2.1% of male student tests were positive. Incidence was 34.0 cases/1,000 person months (95% Confidence interval [CI]: 19.5-67.5). Median time to first positive and repeat positive test was 4.6 and 2.6 months, respectively. For CT: 16.4% of female student and 2.1% of male student tests were positive. Incidence was 57.5 cases/1,000 person months (95% CI: 35.2-93.8). Median time to first positive and repeat positive CT test was 6.0 and 4.8 months, respectively. Assessed risk factors failed to specify a candidate screening population. CONCLUSION: These data suggest that all sexually active adolescent girls in this high risk setting should be offered testing for GC and CT at least twice per year, regardless of age or other sexual risk behaviors and that STD control efforts in high risk middle schools should be encouraged.     

Crowding stress and violent injuries among behaviorally inhibited rhesus macaques.

Environmental stressors and stable individual differences in human behavior have both been implicated etiologically in injuries. Because stress-related injuries are difficult to study experimentally in humans, the authors examined injury incidence in a troop of 21 male and 15 female free-ranging rhesus macaques (Macaca mulatta) before, during, and after a 6-month group confinement. Individual differences in behavioral inhibition to novelty were assessed, using multiple, quantified observations of behavior by 3 independent raters during 3 previous years. Incidence and severity of medically attended injuries were ascertained from veterinary records over a 2-year study period. A 5-fold increase in the incidence of injuries was documented during confinement stress, and an interaction was found between the stressor and behavioral inhibition in the prediction of injury incidence. Highly inhibited animals had significantly higher injury rates during confinement, compared with their uninhibited peers, but equal or lower rates in the low stress periods that preceded and followed confinement. Inhibited individuals appeared to have been specifically targeted for violence during the group stressor but were protected under normative, more predictable conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic mapping of the mouse stromal cell-derived factor gene (Sdf1) to mouse and rat chromosomes

OBJECTIVE: To establish the demographics of ski injury in relation to age, gender, and perceived cause during a representative season to identify potential injury prevention strategies. SETTING: Blackcomb Mountain, a world class ski resort in British Columbia, Canada. METHODS: Data were collected from the lift ticket records and from ski patrol injury reports for one season, November to May 1991-2. RESULTS: There were 720,066 skier and snowboarder day visits counted by the mountain's lift ticket records, with a total of 2,092 injury reports (incidence 2.91 per 1,000 day visits). Of those with significant injuries (those requiring physician care), 1,210 (58%) were male. The highest injury rate was among children (age 7-12) and teens (age 13-17) with incidences of 3.18 and 3.34 significant injuries per 1,000 skier days, respectively. Head and face injuries constituted 17% and 22% of injuries, respectively in these groups. Overall 22% of head and face injuries were severe enough to cause loss of consciousness or clinical signs of concussion. This was the body region injured most frequently in males. For females over 7 years of age, the knee was the most common site of injury. For youths, the incidence of injuries during school organized activities was 25% higher than during other outings. CONCLUSIONS: The vulnerability of school group participants suggests special education is warranted. The high incidence of head injuries, particularly among young males, needs to be addressed. In light of the high proportion of this group who already wear helmets, the role of helmets in both protection and possible causation of head injury needs objective research.     

Kikuchi''s histiocytic necrotizing lymphadenitis associated with ruptured silicone breast implant

Mortality rates and injuries requiring medical treatment associated with sports and exercise are generally low. However, higher injury rates are reported for athletes and members of sports clubs. This study focuses on the sport- and exercise-related injury rate for various age and sex groups in the general population and how sport and exercise injury rates compare with those for other activities. The data presented are based on telephone interviews. Of the participants (N = 6,596), 335 (5.1%) reported having sustained an injury in the previous month; 46% of injuries among males and 14% of those among females were sport or exercise related. The data show a downward trend in sport- and exercise-related injury rates with increasing age. It is concluded that, as a proportion of all injuries sustained, the sport- and exercise-related injury rate is high, particularly among males. Possible future research on sport- and exercise-related injuries is discussed.