Page 12 - ISAKOS 2020 Newsletter Volume 2
P. 12

Injury Prevention Programs with Plyometric and Strengthening Exercises Improve On-Field Performance
Daphne I. Ling, Nicholas A. Cepeda, Niv Marom, Bridget Jivanelli, Robert G. Marx
Systematic Review
Injury Prevention Programs (IPPs) have been shown to be highly efficacious for protecting young athletes from ACL and other lower-extremity injuries. In practice, however, the effectiveness of these programs has been limited because of poor adherence among coaches of organized sports teams. The authors hypothesized that a change in messaging from injury reduction to performance enhancement may be an effective strategy for improving adherence. To provide support for this hypothesis, the authors conducted a systematic review to address whether implementing IPPs can also provide benefits on sports performance as measured by on-field tests. Studies were selected for inclusion if they evaluated on-field performance testing before and after participation in the IPP or compared the IPP with another program or control. Studies were excluded if they evaluated programs without an explicit focus on injury prevention or reported on injury risk factors that were not related to athletic performance. The results of performance testing were summarized into the following categories: balance, sprinting, agility, jumping, physical fitness, and sport-specific skills. The analysis indicated that that IPPs can have beneficial effects on measures of sports performance and physical fitness. Factors that resulted in significant improvement included longer frequency and duration of IPP as well as the inclusion of plyometric and muscle-strengthening exercises. The authors concluded that enhanced performance on tests that can be conducted on the field with existing equipment may help to convince coaches and athletes to improve adherence to the IPP exercises.
ACL Injuries in Female Athletes
Nicholas Vaudreuil, Justin Roe, Lucy Salmon, Elvire Servien, Carola van Eck
Current Concepts Review
Female athletes represent a unique challenge for sports medicine providers. Care for skeletally mature female athletes requires an understanding of the distinct physiology, risk factors, and injury patterns that have been described in this population. ACL injuries are commonly observed in female athletes, especially those involved in high-risk sports such as soccer, basketball, lacrosse, and volleyball. Women have been shown to be at a higher risk for ACL injury compared with their male peers, even those competing in the same sport. Several factors must be considered when discussing the increased risk of ACL injuries in women. Anatomical factors and altered landing mechanics alignment contribute to increased forces in the ACL.
A variety of other factors, including altered neuromuscular profiles, hormonal factors, and genetic factors, all may play a role in the increased predisposition toward ACL injury among female athletes. Prevention strategies such as proprioceptive training may be helpful, especially for at-risk activities such as landing and cutting drills. Optimal surgical management, including graft choice, is an area of debate. Postoperatively, return-to-sport protocols are not well standardized for female athletes. Women have a lower return-to-sport frequency, and psychological factors such as fear of reinjury are often cited as a predominant factor. More research is needed to elicit the reasons for physical and psychological differences between men and women in order to clarify optimal postoperative management.
Biological Approaches to the Treatment of Osteoarthritis
Eric J. Cotter, Rachel M. Frank, Bert Mandelbaum
Current Concepts Review
The current treatment options for osteoarthritis include weight loss, activity modification, anti-inflammatory medications, steroid intra-articular injections, lubricating hyaluronic acid injections, and arthroplasty for end- stage cases. In recent decades, there has been interest in identifying biological treatment modalities to slow the progression of the disease and preserve native joints. The most commonly investigated biological treatments include platelet-rich plasma, bone marrow aspirate concentrate, and adipose-derived mesenchymal stem cells. The existing literature has demonstrated the anti-inflammatory properties of orthobiologics, but no treatment has clearly demonstrated significant joint preservation properties, including the ability to reverse the progression of osteoarthritis. In the majority of studies, these injection treatments have been shown to be safe. Research is ongoing to identify optimal indications, preparations, compositions, safety profiles, and clinical outcomes of biological therapies. This article reviews the current evidence on the use of biologics for the treatment of osteoarthritis as well as recent statements made by orthopaedic subspecialty groups on this important topic.
Doxycycline Improves Tendon and Cartilage Pathologies in Preclinical Studies
Robert S. Dean, David H. Kahat, Nathan R. Graden, Nicholas N. DePhillipo, Robert F. LaPrade
Current Concepts Review
Matrix metalloproteinases (MMPs), which are enzymes that are elevated during states of inflammation, have specifically been linked to cartilage, tendon, and bone pathologies. Concentrations of these enzymes fluctuate naturally with

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