Physicians should implement measures to align expectations
While physicians strive to set realistic expectations for patients undergoing knee and hip joint replacements, a new study reveals that doctor and patient expectations are sometimes not aligned. The study, reported by Hospital for Special Surgery researchers at the American Academy of Orthopedic Surgeons held March 9-13 in New Orleans (poster P140), suggests that steps need to be taken to bridge the expectation gap.
This study is among the first to examine discrepancies in patient and physician expectation with joint replacement surgeries, according to Hassan Ghomrawi, Ph.D., MPH, outcomes research scientist, Biostatistics and Epidemiology, at Hospital for Special Surgery (HSS) in New York, who led the study.
The two joint replacement surgeries studied are known technically as total hip replacement (THR) and total knee replacement (TKR). These procedures are common in individuals over 50 and usually result from normal wear and tear that causes osteoarthritis. At Hospital for Special Surgery alone, nearly 4,000 THRs and 4,000 TKRs are performed each year.
At HSS, patients are required to attend a 90 minute class before surgery where they receive education from a specialized nurse about what they can expect during the surgery and recovery. "A leader in offering such classes, HSS has been giving a preoperative class for many years. This practice is becoming a trend in big hospitals for this type of surgery," Dr. Ghomrawi said. The results from this study indicate that such classes could be refined and steps can be taken to use these classes to improve patient and physician dialogue.
In a study that compared expectations of 42 patients with their doctors through surveys, investigators found clinically meaningful disagreement in 68 percent of patients with 53 percent of the patients' expectations exceeding the expectations of the surgeons.
"The take home message for the surgeon is that inexpensive, educational interventions like a preoperative class can be used to better align the patient's and the surgeon's expectations prior to surgery," said Alejandro Gonzalez Della Valle, M.D., associate attending orthopaedic surgeon at HSS, who was involved with the study. "This may ultimately result in higher perceived outcome."
"If a patient has unrealistic expectations that are not properly trimmed preoperatively or achieved after surgery, the patient will most likely be dissatisfied with some aspects of the final result. Conversely, if the patient has low expectations for function after surgery, it is likely that he or she will not enthusiastically engage in the different phases of the postoperative recovery including physically therapy. That patient will probably have a lower than expected functional result.
"For the patient, the take home message is that it is paramount to discuss the expectations for pain relief and function with the surgeon and in the class before undergoing a total joint replacement to make sure that the expectations of the physician and the patient are similar," said Dr. Gonzalez Della Valle.
The study included patients who were scheduled to receive a hip or knee replacement by a dedicated hip and knee surgeon. Both patient and doctor completed either a THR or TKR recovery expectation questionnaire. The surveys involved various questions with a scale from 1 to 5, ranging from a 1 being "return to normal," to a 4 being "very little improvement," and 5 being "I don't have this expectation."
The hip joint replacement survey had 18 questions involving improvement in psychological well-being, pain relief, ability to walk, ability to stand, getting rid of a limp, getting rid of a cane, ability to go up and down stairs, ability to raise from the sitting position, and improvement in social activities that range from working at a job or doing housework to recreation including the participation in sports. Other questions evaluated the mobility of an individual's hip such as whether a person could cut their own toenails.
The knee joint replacement survey had 19 questions involving improvement in psychological well-being, pain relief, ability to walk different distances, getting rid of a cane, going up and down stairs, kneeling, squatting, using transportation, the ability to be employed, and the ability to participate in recreation, social activities, sports, and sexual activity.
The numbers from each of the questions on the survey were then plugged into a formula that calculated a score ranging from 0 to 100, with 100 being the highest expectation. The study involved 25 patients undergoing THR and 17 patients undergoing TKR. Both patients and doctors completed surveys. The average surgeon expectation score was 75 (range 43 to 93) and the average patient expectation score was 84 (range 47 to 100).
"We observed a lot of variability between what the surgeon expected and what the patient expected. In an ideal world, the expectations of the patient and the surgeon should be similar," Dr. Gonzalez Della Valle said.
Based on results from this pilot study, the National Institutes of Health has awarded Dr. Ghomrawi a five-year career development award. "The hope is to be able to study the relationship between expectation discordance and several outcomes down the road, including rehabilitation outcomes at discharge, and six month and two-year follow-up functional outcomes," Dr. Ghomrawi said. "We are trying to see which items of discordance are clinically meaningful. And then we want to use all this information to improve the doctorpatient dialogue as well as to reassess the class content, so that expectations are aligned."
"The larger study will be more complex. We will try to analyze the discrepancies that different doctors may have for the same patient and that different doctors have between themselves when assessing the same patient," Dr. Gonzalez Della Valle said. "What are the physician factors and patient factors that can predict higher or lower expectations? The goal of THR and TKR surgeries is to provide durable pain relief and improvement of function so that patients can go back to an enjoyable, productive life. We want to make patients satisfied. We know that hip and knee replacement operations are very successful. But we are trying to go a step further, looking at the psychology of the patient recovery."
Wednesday, March 10, 2010
Tuesday, February 16, 2010
Walking & Glucosamine Linked to Eased Osteoarthritis
"Progressive walking" combined with glucosamine sulphate supplementation has been shown to improve the symptoms of osteoarthritis. Researchers writing in BioMed Central's open-access journal Arthritis Research and Therapy found that patients who walked at least two bouts of 1500 steps each on three days of the week reported significantly less arthritis pain, and significantly improved physical function.
Dr Kristiann Heesch worked with a team of researchers from The University of Queensland, Australia, to carry out the trial in 36 osteoarthritis patients (aged 42-73 years). All patients received the dietary supplement for six weeks, after which they continued to take the supplement during a 12-week progressive walking program. The program, called Stepping Out, includes a walking guide; a pedometer; weekly log sheets and a weekly planner, all intended to help patients adopt the exercise regime.
Seventeen patients were randomly assigned to walk five days per week, while the remaining 19 were instructed to walk three days a week.
The team found that both groups achieved significant improvement in their symptoms, however being encouraged to walk five days a week was notmore effective than being encouraged to walk three days. "These findings are not surprising given that the three-day and five-day walking groups did not differ significantly in the mean number of days actually walked per week, the mean number of daily steps walked, nor their weekly minutes of physical activity," Dr Heesch said. "They provide preliminary evidence that osteoarthritis sufferers can benefit from a combination of glucosamine sulphate and walking 3000 steps per day for exercise, in bouts of at least 1500 steps each, on at least three days per week."
This amount of walking is less than current physical activity recommendations for the general population, but follows the recommendations for people with arthritis.
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Dr Kristiann Heesch worked with a team of researchers from The University of Queensland, Australia, to carry out the trial in 36 osteoarthritis patients (aged 42-73 years). All patients received the dietary supplement for six weeks, after which they continued to take the supplement during a 12-week progressive walking program. The program, called Stepping Out, includes a walking guide; a pedometer; weekly log sheets and a weekly planner, all intended to help patients adopt the exercise regime.
Seventeen patients were randomly assigned to walk five days per week, while the remaining 19 were instructed to walk three days a week.
The team found that both groups achieved significant improvement in their symptoms, however being encouraged to walk five days a week was notmore effective than being encouraged to walk three days. "These findings are not surprising given that the three-day and five-day walking groups did not differ significantly in the mean number of days actually walked per week, the mean number of daily steps walked, nor their weekly minutes of physical activity," Dr Heesch said. "They provide preliminary evidence that osteoarthritis sufferers can benefit from a combination of glucosamine sulphate and walking 3000 steps per day for exercise, in bouts of at least 1500 steps each, on at least three days per week."
This amount of walking is less than current physical activity recommendations for the general population, but follows the recommendations for people with arthritis.
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Most Patients Gain Weight After Knee Replacement Surgery
You'd think folks who've had knee replacement surgery -- finally able to walk and exercise without pain -- would lose weight instead of put on pounds, but surprisingly that's not the case, according to a University of Delaware study.
Researchers Joseph Zeni and Lynn Snyder-Mackler in the Department of Physical Therapy in UD's College of Health Sciences found that patients typically drop weight in the first few weeks after total knee arthroplasty (TKA), but then the number on the scale starts creeping upward, with an average weight gain of 14 pounds in two years.
The study, which was sponsored by the National Institutes of Health, is reported in the Jan. 15 online edition of Osteoarthritis and Cartilage, the official journal of the Osteoarthritis Research Society International.
The research involved 106 individuals with end-stage osteoarthritis who had knee replacement surgery, and an age-matched, healthy control group of 31 subjects who did not have surgery. Height, weight, quadriceps strength, and self-perceived functional ability were measured during an initial visit to UD's Physical Therapy Clinic, and at a follow-up visit two years later.
"We saw a significant increase in body mass index (BMI) over two years for the surgical group, but not the control group," says Zeni, a research assistant professor at UD. "Sixty-six percent of the people in the surgical group gained weight over the two years -- the average weight gain was 14 pounds."
Those who had the knee replacement surgery started out heavier and ended heavier than the control group. The weaker the surgery patients were, as measured by the strength of the quadriceps, the more weight they gained, Zeni notes.
"These findings are making us re-think the component after total knee surgery and of patients not being in a routine of moving around," says Snyder-Mackler, Alumni Distinguished Professor of Physical Therapy at UD.
She notes that it's critical that people not wait too long to have a knee replaced because their functional level going into surgery typically dictates their functional level after surgery.
Gaining weight after one knee replacement is worrisome because it could jeopardize the patient's other knee. Between 35-50 percent will have surgery on the other side within 10 years, Snyder-Mackler says.
The researchers note that weight gain after a knee replacement needs to be treated as a separate concern and integrated into post-operative care through a combination of approaches, including nutritional counseling to help patients with portion control, and more emphasis on retraining patients with new knees to walk normally.
"For physical therapists and surgeons, the common thinking is that after a patient's knee has been replaced, that patient will be more active," says Snyder-Mackler. "But the practices and habits these patients developed to get around in the years prior to surgery are hard to break, and often they don't take advantage of the functional gain once they get a new knee," she notes.
"We need to re-train patients with new knees to walk more normally and more systematically. And we need to encourage more community participation," Snyder-Mackler adds. "If you're not getting out of the house, you won't gain the benefit. We need people with new knees to get out there -- with the help of their family, their friends, and the community at large."
Researchers Joseph Zeni and Lynn Snyder-Mackler in the Department of Physical Therapy in UD's College of Health Sciences found that patients typically drop weight in the first few weeks after total knee arthroplasty (TKA), but then the number on the scale starts creeping upward, with an average weight gain of 14 pounds in two years.
The study, which was sponsored by the National Institutes of Health, is reported in the Jan. 15 online edition of Osteoarthritis and Cartilage, the official journal of the Osteoarthritis Research Society International.
The research involved 106 individuals with end-stage osteoarthritis who had knee replacement surgery, and an age-matched, healthy control group of 31 subjects who did not have surgery. Height, weight, quadriceps strength, and self-perceived functional ability were measured during an initial visit to UD's Physical Therapy Clinic, and at a follow-up visit two years later.
"We saw a significant increase in body mass index (BMI) over two years for the surgical group, but not the control group," says Zeni, a research assistant professor at UD. "Sixty-six percent of the people in the surgical group gained weight over the two years -- the average weight gain was 14 pounds."
Those who had the knee replacement surgery started out heavier and ended heavier than the control group. The weaker the surgery patients were, as measured by the strength of the quadriceps, the more weight they gained, Zeni notes.
"These findings are making us re-think the component after total knee surgery and of patients not being in a routine of moving around," says Snyder-Mackler, Alumni Distinguished Professor of Physical Therapy at UD.
She notes that it's critical that people not wait too long to have a knee replaced because their functional level going into surgery typically dictates their functional level after surgery.
Gaining weight after one knee replacement is worrisome because it could jeopardize the patient's other knee. Between 35-50 percent will have surgery on the other side within 10 years, Snyder-Mackler says.
The researchers note that weight gain after a knee replacement needs to be treated as a separate concern and integrated into post-operative care through a combination of approaches, including nutritional counseling to help patients with portion control, and more emphasis on retraining patients with new knees to walk normally.
"For physical therapists and surgeons, the common thinking is that after a patient's knee has been replaced, that patient will be more active," says Snyder-Mackler. "But the practices and habits these patients developed to get around in the years prior to surgery are hard to break, and often they don't take advantage of the functional gain once they get a new knee," she notes.
"We need to re-train patients with new knees to walk more normally and more systematically. And we need to encourage more community participation," Snyder-Mackler adds. "If you're not getting out of the house, you won't gain the benefit. We need people with new knees to get out there -- with the help of their family, their friends, and the community at large."
Friday, January 29, 2010
Most patients gain weight after getting a new knee,
You'd think folks who've had knee replacement surgery -- finally able to walk and exercise without pain -- would lose weight instead of put on pounds, but surprisingly that's not the case, according to a University of Delaware study.
Researchers Joseph Zeni and Lynn Snyder-Mackler in the Department of Physical Therapy in UD's College of Health Sciences found that patients typically drop weight in the first few weeks after total knee arthroplasty (TKA), but then the number on the scale starts creeping upward, with an average weight gain of 14 pounds in two years.
The study, which was sponsored by the National Institutes of Health, is reported in the Jan. 15 online edition of Osteoarthritis and Cartilage, the official journal of the Osteoarthritis Research Society International.
The research involved 106 individuals with end-stage osteoarthritis who had knee replacement surgery, and an age-matched, healthy control group of 31 subjects who did not have surgery. Height, weight, quadriceps strength, and self-perceived functional ability were measured during an initial visit to UD's Physical Therapy Clinic, and at a follow-up visit two years later.
“We saw a significant increase in body mass index (BMI) over two years for the surgical group, but not the control group,” says Zeni, a research assistant professor at UD. “Sixty-six percent of the people in the surgical group gained weight over the two years -- the average weight gain was 14 pounds.”
Those who had the knee replacement surgery started out heavier and ended heavier than the control group. The weaker the surgery patients were, as measured by the strength of the quadriceps, the more weight they gained, Zeni notes.
“These findings are making us re-think the component after total knee surgery and of patients not being in a routine of moving around,” says Snyder-Mackler, Alumni Distinguished Professor of Physical Therapy at UD.
She notes that it's critical that people not wait too long to have a knee replaced because their functional level going into surgery typically dictates their functional level after surgery.
Gaining weight after one knee replacement is worrisome because it could jeopardize the patient's other knee. Between 35-50 percent will have surgery on the other side within 10 years, Snyder-Mackler says.
The researchers note that weight gain after a knee replacement needs to be treated as a separate concern and integrated into post-operative care through a combination of approaches, including nutritional counseling to help patients with portion control, and more emphasis on retraining patients with new knees to walk normally.
“For physical therapists and surgeons, the common thinking is that after a patient's knee has been replaced, that patient will be more active,” says Snyder-Mackler. “But the practices and habits these patients developed to get around in the years prior to surgery are hard to break, and often they don't take advantage of the functional gain once they get a new knee,” she notes.
“We need to re-train patients with new knees to walk more normally and more systematically. And we need to encourage more community participation,” Snyder-Mackler adds. “If you're not getting out of the house, you won't gain the benefit. We need people with new knees to get out there -- with the help of their family, their friends, and the community at large.”
Researchers Joseph Zeni and Lynn Snyder-Mackler in the Department of Physical Therapy in UD's College of Health Sciences found that patients typically drop weight in the first few weeks after total knee arthroplasty (TKA), but then the number on the scale starts creeping upward, with an average weight gain of 14 pounds in two years.
The study, which was sponsored by the National Institutes of Health, is reported in the Jan. 15 online edition of Osteoarthritis and Cartilage, the official journal of the Osteoarthritis Research Society International.
The research involved 106 individuals with end-stage osteoarthritis who had knee replacement surgery, and an age-matched, healthy control group of 31 subjects who did not have surgery. Height, weight, quadriceps strength, and self-perceived functional ability were measured during an initial visit to UD's Physical Therapy Clinic, and at a follow-up visit two years later.
“We saw a significant increase in body mass index (BMI) over two years for the surgical group, but not the control group,” says Zeni, a research assistant professor at UD. “Sixty-six percent of the people in the surgical group gained weight over the two years -- the average weight gain was 14 pounds.”
Those who had the knee replacement surgery started out heavier and ended heavier than the control group. The weaker the surgery patients were, as measured by the strength of the quadriceps, the more weight they gained, Zeni notes.
“These findings are making us re-think the component after total knee surgery and of patients not being in a routine of moving around,” says Snyder-Mackler, Alumni Distinguished Professor of Physical Therapy at UD.
She notes that it's critical that people not wait too long to have a knee replaced because their functional level going into surgery typically dictates their functional level after surgery.
Gaining weight after one knee replacement is worrisome because it could jeopardize the patient's other knee. Between 35-50 percent will have surgery on the other side within 10 years, Snyder-Mackler says.
The researchers note that weight gain after a knee replacement needs to be treated as a separate concern and integrated into post-operative care through a combination of approaches, including nutritional counseling to help patients with portion control, and more emphasis on retraining patients with new knees to walk normally.
“For physical therapists and surgeons, the common thinking is that after a patient's knee has been replaced, that patient will be more active,” says Snyder-Mackler. “But the practices and habits these patients developed to get around in the years prior to surgery are hard to break, and often they don't take advantage of the functional gain once they get a new knee,” she notes.
“We need to re-train patients with new knees to walk more normally and more systematically. And we need to encourage more community participation,” Snyder-Mackler adds. “If you're not getting out of the house, you won't gain the benefit. We need people with new knees to get out there -- with the help of their family, their friends, and the community at large.”
Tuesday, January 12, 2010
NFL players with Achilles tendon injuries
More than a third of National Football League (NFL) players who sustained an Achilles tendon injury were never able to return to professional play according to research in the current issue of Foot & Ankle Specialist (published by SAGE). The injured players who did return to active play averaged a 50% reduction in their power ratings.
The aim of the study was to document the epidemiology of Achilles tendon ruptures in the NFL and to quantify the impact of these injuries on player performance. Previous studies have looked at the occurrence of Achilles tendon ruptures in elite athletes in general, but very little was known about how often that type of injury occurred specifically in the NFL or how it affected the athlete's future ability to play.
Researchers looked at publicly available NFL data including websites that summarized games, statistics and injuries, to identify players who sustained complete Achilles tendon rupture. Also noted were such variables as the player's position, age, and number of years in the league prior to the injury. In addition, yearly performance statistics were collected for the players for the years before and after the injuries.
The study found that Achilles tendon ruptures can be career-altering injuries. Nearly 36% of players who sustained this injury never returned to play in the NFL and the ones who were able to return were never able to return to their pre-injury levels of play.
"This article provides a novel approach to shed light on valuable epidemiologic data for Achilles tendon ruptures among NFL players and the functional outcome of the injury," write authors Selene G. Parekh, Walter H. Wray, III, Olubusola Brimmo, Brian J. Sennett and Keith L. Wapner. "Future studies with the cooperation of the NFL and their official injury database are needed to fully evaluate the impact of Achilles injuries in this at-risk population."
The aim of the study was to document the epidemiology of Achilles tendon ruptures in the NFL and to quantify the impact of these injuries on player performance. Previous studies have looked at the occurrence of Achilles tendon ruptures in elite athletes in general, but very little was known about how often that type of injury occurred specifically in the NFL or how it affected the athlete's future ability to play.
Researchers looked at publicly available NFL data including websites that summarized games, statistics and injuries, to identify players who sustained complete Achilles tendon rupture. Also noted were such variables as the player's position, age, and number of years in the league prior to the injury. In addition, yearly performance statistics were collected for the players for the years before and after the injuries.
The study found that Achilles tendon ruptures can be career-altering injuries. Nearly 36% of players who sustained this injury never returned to play in the NFL and the ones who were able to return were never able to return to their pre-injury levels of play.
"This article provides a novel approach to shed light on valuable epidemiologic data for Achilles tendon ruptures among NFL players and the functional outcome of the injury," write authors Selene G. Parekh, Walter H. Wray, III, Olubusola Brimmo, Brian J. Sennett and Keith L. Wapner. "Future studies with the cooperation of the NFL and their official injury database are needed to fully evaluate the impact of Achilles injuries in this at-risk population."
Injection of platelet-rich plasma doesn't help
Newer treatment for Achilles tendon disorder does not appear to be effective
An apparently increasingly used treatment method for a type of Achilles tendon disorder that includes injection of platelet-rich plasma into the tendon does not appear to result in greater improvement in pain or activity compared to placebo, according to results of a preliminary study published in the January 13 issue of JAMA.
"Overuse injury of the Achilles tendon is a frequent problem that often affects sport participants but also inactive middle-aged individuals. An estimated 30 percent to 50 percent of all sports-related injuries are tendon disorders," the authors write. Approximately 25 percent to 45 percent of patients eventually require surgery following ineffective conservative treatment. "There is a clear need for improved conservative therapy."
Chronic Achilles tendinopathy is a degenerative condition characterized by pain, swelling and decreased activity. Platelet-rich plasma (PRP) injections is a treatment method recently introduced to improve tendon regeneration. Several recent reports indicated promising results with this treatment method, although these conclusions were based on laboratory studies and on clinical studies with important limitations, according to background information in the article.
Robert J. de Vos, M.D., of Erasmus University Medical Center, Rotterdam, the Netherlands, and colleagues conducted a study to compare the effects on pain and functional outcome of a PRP injection with a placebo injection for patients with chronic Achilles tendinopathy. The trial included 54 patients ages 18 to 70 years and was conducted between Aug. 2008 and Jan. 2009, with follow-up until July 16, 2009. Patients were randomized to eccentric exercises (usual care; exercises involved stretching the Achilles tendon while contracting the calf muscle) with either a PRP injection (PRP group) or saline injection (placebo group). A questionnaire (Victorian Institute of Sports Assessment-Achilles [VISA-A]), used to gauge pain and activity level, was completed at the beginning of the study and at 6, 12, and 24 weeks.
The researchers found that the average VISA-A score improved significantly after 24 weeks within the PRP group and within the placebo group. After adjustment for different variables, including the duration of symptoms, there was no significant difference in improvement on the VISA-A scores at the different follow-up times between these two treatment groups.
There was also no significant difference in secondary outcome measures, which included subjective patient satisfaction and the number of patients returning to their desired sport.
"Among patients with chronic midportion Achilles tendinopathy treated with an eccentric exercise program, a PRP injection compared with a saline injection did not result in greater improvement in pain and activity. Therefore, we do not recommend this treatment for chronic midportion Achilles tendinopathy," the authors write.
"These findings are important and clinically relevant as PRP is thought to be growing in popularity and recent reviews supported its use for chronic tendon disorders."
An apparently increasingly used treatment method for a type of Achilles tendon disorder that includes injection of platelet-rich plasma into the tendon does not appear to result in greater improvement in pain or activity compared to placebo, according to results of a preliminary study published in the January 13 issue of JAMA.
"Overuse injury of the Achilles tendon is a frequent problem that often affects sport participants but also inactive middle-aged individuals. An estimated 30 percent to 50 percent of all sports-related injuries are tendon disorders," the authors write. Approximately 25 percent to 45 percent of patients eventually require surgery following ineffective conservative treatment. "There is a clear need for improved conservative therapy."
Chronic Achilles tendinopathy is a degenerative condition characterized by pain, swelling and decreased activity. Platelet-rich plasma (PRP) injections is a treatment method recently introduced to improve tendon regeneration. Several recent reports indicated promising results with this treatment method, although these conclusions were based on laboratory studies and on clinical studies with important limitations, according to background information in the article.
Robert J. de Vos, M.D., of Erasmus University Medical Center, Rotterdam, the Netherlands, and colleagues conducted a study to compare the effects on pain and functional outcome of a PRP injection with a placebo injection for patients with chronic Achilles tendinopathy. The trial included 54 patients ages 18 to 70 years and was conducted between Aug. 2008 and Jan. 2009, with follow-up until July 16, 2009. Patients were randomized to eccentric exercises (usual care; exercises involved stretching the Achilles tendon while contracting the calf muscle) with either a PRP injection (PRP group) or saline injection (placebo group). A questionnaire (Victorian Institute of Sports Assessment-Achilles [VISA-A]), used to gauge pain and activity level, was completed at the beginning of the study and at 6, 12, and 24 weeks.
The researchers found that the average VISA-A score improved significantly after 24 weeks within the PRP group and within the placebo group. After adjustment for different variables, including the duration of symptoms, there was no significant difference in improvement on the VISA-A scores at the different follow-up times between these two treatment groups.
There was also no significant difference in secondary outcome measures, which included subjective patient satisfaction and the number of patients returning to their desired sport.
"Among patients with chronic midportion Achilles tendinopathy treated with an eccentric exercise program, a PRP injection compared with a saline injection did not result in greater improvement in pain and activity. Therefore, we do not recommend this treatment for chronic midportion Achilles tendinopathy," the authors write.
"These findings are important and clinically relevant as PRP is thought to be growing in popularity and recent reviews supported its use for chronic tendon disorders."
Monday, January 11, 2010
Program may prevent knee injuries
A soccer-specific exercise program that includes individual instruction of athletes appears to reduce the risk of knee injuries in young female players, according to a report in the January 11 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Soccer is a dominant cause of sports-related injuries in part because of its increasing popularity, according to background information in the article. Between 2000 and 2006, the number of female soccer players around the world increased by 19 percent, to 26 million. "The most frequent and severe type of injury among soccer players is to the legs, especially the knees. The anterior cruciate ligament (ACL) injury incidence is highest among young athletes," the authors write. "Knee injuries, and especially ACL ruptures, may have long-term consequences, including a long absence from soccer, incomplete recovery and secondary osteoarthritis of the knee."
Ashkan Kiani, M.D., of Uppsala Primary Care, Uppsala County Council, Sweden, and colleagues assessed an intervention program specifically designed to reduce the risk of soccer-related knee injuries among 1,506 13- to 19-year-old Swedish female players. The program featured strengthening exercises designed to achieve an improved motion pattern, reducing strain on the knee joint. The training sessions were integrated into the regular soccer practices and required no additional equipment. In addition, players, parents and team leaders attended a seminar to raise awareness of injury risk.
During 2007, 777 girls on 48 teams participated in the program and 729 players on 49 teams served as controls. Three knee injuries, including one non-contact injury (not involving another player), occurred among players participating in the program, compared with 13 knee injuries and 10 non-contact injuries among girls in the control group. Therefore, the program was associated with a 77 percent reduction in the incidence of knee injuries and a 90 percent reduction in the incidence of non-contact knee injuries.
"The rate of injury was not only lower among teams participating in the preventive program but the injuries that did occur were also less severe," the authors write. All three injuries in the intervention group were categorized as major, but all three players regained full activity within six months. Among the control participants, most injuries were severe, and only four of the 13 regained full activity within six months.
Coaches reported their teams' adherence to the program at two time periods, after the preseason training period and after the competitive season. Of the 48 teams participating in the intervention, 45 (94 percent) reported a high adherence of at least 75 percent. "The high compliance rate in this study suggests that the program is easy to implement and incorporate into regular soccer practice," the authors conclude.
Soccer is a dominant cause of sports-related injuries in part because of its increasing popularity, according to background information in the article. Between 2000 and 2006, the number of female soccer players around the world increased by 19 percent, to 26 million. "The most frequent and severe type of injury among soccer players is to the legs, especially the knees. The anterior cruciate ligament (ACL) injury incidence is highest among young athletes," the authors write. "Knee injuries, and especially ACL ruptures, may have long-term consequences, including a long absence from soccer, incomplete recovery and secondary osteoarthritis of the knee."
Ashkan Kiani, M.D., of Uppsala Primary Care, Uppsala County Council, Sweden, and colleagues assessed an intervention program specifically designed to reduce the risk of soccer-related knee injuries among 1,506 13- to 19-year-old Swedish female players. The program featured strengthening exercises designed to achieve an improved motion pattern, reducing strain on the knee joint. The training sessions were integrated into the regular soccer practices and required no additional equipment. In addition, players, parents and team leaders attended a seminar to raise awareness of injury risk.
During 2007, 777 girls on 48 teams participated in the program and 729 players on 49 teams served as controls. Three knee injuries, including one non-contact injury (not involving another player), occurred among players participating in the program, compared with 13 knee injuries and 10 non-contact injuries among girls in the control group. Therefore, the program was associated with a 77 percent reduction in the incidence of knee injuries and a 90 percent reduction in the incidence of non-contact knee injuries.
"The rate of injury was not only lower among teams participating in the preventive program but the injuries that did occur were also less severe," the authors write. All three injuries in the intervention group were categorized as major, but all three players regained full activity within six months. Among the control participants, most injuries were severe, and only four of the 13 regained full activity within six months.
Coaches reported their teams' adherence to the program at two time periods, after the preseason training period and after the competitive season. Of the 48 teams participating in the intervention, 45 (94 percent) reported a high adherence of at least 75 percent. "The high compliance rate in this study suggests that the program is easy to implement and incorporate into regular soccer practice," the authors conclude.
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