Miscelanea 83S with restricted cubic splines. Results: Overall, mean residual contracture (total ... more Miscelanea 83S with restricted cubic splines. Results: Overall, mean residual contracture (total active extension deficit) at follow-up was 24°, which corresponded to a postprocedure improvement of 65%. Forty-seven percent of patients experienced at least 1 adverse event, with neuropraxia (12%), scar sequelae (12%), and wound healing problems (8%) being the three most common events. Surgeon volume was inversely related to the degree of residual contracture: Every 58 additional procedures performed annually were associated with 5° less residual contracture at follow-up (P, .03). Moreover, surgeon volume had an inverse effect on overall events (odds ratio per 50 additional procedures, 0.86, P, .01). Conclusions: Even among experienced hand surgeons, patients treated by surgeons performing high volumes of Dupuytren surgery had better outcomes in terms of residual contracture and adverse events. The findings of this study suggest that surgeons may improve outcomes by increasing their annual procedural volume for these specific interventions.
Introduction: The discovery of vitamin D muscle receptors in the last few years suggested a signi... more Introduction: The discovery of vitamin D muscle receptors in the last few years suggested a significant role in muscle tissue, pointing out athletes as a special group. Specific data are scarce. Aim: The main aim of the current paper was to provide, for the first time, comparable data about vitamin D status in elite Spanish athletes by sport, age, season and training environment. Methods: Four hundred and eight elite athletes with a mean age of 22.8 ± 8.4 years were recruited from the High-performance sport centre in Barcelona for this cross-sectional study. Athletes from 34 different sports modalities were analysed. Data were available for vitamin D status, training environment, seasonality and number of medical visits. All data were analysed using SPSS version 18.0. Results: Mean 25(OH)D of all athletes was 56.7 ± 23.4 nmol/L. Approximately 82% of the athletes were below the optimal levels, (< 75nmol/l), 45% had moderate deficient levels (< 50 nmol/L) and 6% had severe deficiency (< 27.5 nmol/L). We have observed a steady increase in 25(OH)D concentrations with increasing age (p < 0.01) Highest levels were observed in those subjects training outdoors compared with those training indoor (p.
This study meant to evaluate if compression garments have a protector effect on muscular injury. ... more This study meant to evaluate if compression garments have a protector effect on muscular injury. Nine active males participated in the study ([mean ± SD] age 27.7 ± 10.9 years; height 176.8 ± 3.6 cm; weight 76.1 ± 6.1 kg). Subjects performed a 40 min running test at the velocity of their anaerobic threshold with a negative steep of-10% wearing shorts with compression in one leg and no compression in the other leg using a balanced, randomised design. Muscular displacement was evaluated using a 3D analysis. Tissue damage was assessed by a muscular biopsy performed 48h after the running test. Results indicate a significantly higher muscular displacement in the leg with no compression and an increased muscular damage. This indicates that compression shorts have a protective effect on muscle.
Documento descargado de http://www.apunts.org el 12/04/2013. Copia para uso personal, se prohíbe ... more Documento descargado de http://www.apunts.org el 12/04/2013. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.
Objective: To describe the injury mechanisms and magnetic resonance imaging (MRI) findings in acu... more Objective: To describe the injury mechanisms and magnetic resonance imaging (MRI) findings in acute hamstring injuries of male soccer players using a systematic video analysis. Design: Descriptive case series study of consecutive acute hamstring injuries from September 2017 to January 2022. Setting: Two specialized sports medicine hospitals. Participants: Professional male soccer players aged between 18 and 40 years, referred for injury assessment within 7 days after an acute hamstring injury, with an available video footage of the injury and positive finding on MRI. Independent Variables: Hamstring injury mechanisms (specific scoring based on standardized models) in relation to hamstring muscle injury MRI findings. Main Outcome Measures: Hamstring injury mechanism (playing situation, player/opponent behavior, movement, and biomechanical body positions) and MRI injury location. Results: Fourteen videos of acute hamstring injuries in 13 professional male soccer players were analyzed. Three different injury mechanisms were seen: mixed-type (both sprint-related and stretch-related, 43%), stretchtype (36%), and sprint-type (21%). Most common actions during injury moments were change of direction (29%), kicking (29%), and running (21%). Most injuries occurred at high or very high horizontal speed (71%) and affected isolated proximal biceps femoris (BF) (36%). Most frequent body positions at defined injury moments were neutral trunk (43%), hip flexion 45-90 degrees (57%), and knee flexion ,45 degrees (93%). Magnetic resonance imaging findings showed that 79% were isolated single-tendon injuries. Conclusions: According to a video analysis, most hamstring injuries in soccer occur during high-speed movements. Physicians should suspect proximal and isolated single-tendon-most often BF-hamstring injury, if represented injury mechanisms are seen during game play. In addition to sprinting and stretching, also mixed-type injury mechanisms occur.
a Medical Services, Futbol Club Barcelona, Barcelona, Spain b Facultat de Psicologia, Universitat... more a Medical Services, Futbol Club Barcelona, Barcelona, Spain b Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain c CAR Sant Cugat-Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain d Clínica Mapfre de Medicina del Tenis, Barcelona, Spain e Clínica Diagonal, Esplugues de Llobregat, Barcelona, Spain f Department of Scientiic Research, UTC Imaging, Stein, Netherlands g ISEH, University College London Hospitals, London, United Kingdom
Introduction: Conventional ultrasound helps to identify the macroscopic changes produced in the i... more Introduction: Conventional ultrasound helps to identify the macroscopic changes produced in the injured tendon. However, these changes do not correlate well with the symptoms or the response to treatment. The ‘characterization of tissues by ultrasound’ (UTC) evaluates the structure of the tendon in 3 dimensions and classifies it into 4 echotypes. The aim of this study was to investigate the structure of the patellar tendon in basketball players using the UTC technique, and to study the differences between professional and amateur players by comparing the dominant leg with the non-dominant one, and the symptomatic with the asymptomatic ones. Material and methods: The study included 40 patellar tendons (20 basketball players). The structure of the patellar tendon (proximal, medial, and distal) was quantified by means of UTC at the beginning of the pre-season. The within and between observer reliability was measured using the intraclass correlation coefficient (ICC). Results: The mean ...
Introduction: Iliac artery endofibrosis (IAE) is an uncommon disease, poorly studied pathology wi... more Introduction: Iliac artery endofibrosis (IAE) is an uncommon disease, poorly studied pathology with devastating effects and different therapeutic approaches affecting young people who practise intensive sports, especially cyclists. The evolution of the process not only depends on the diagnosis and therapeutic action, but also on the acceptance and attitude of the patient and subsequent professional guidance. Case description: This is the case description of a professional triathlon athlete that had one previous iliac surgical revascularization for an IAE Iliac and was admitted in our department five times with subacute lower limb ischemia affecting both legs between 2013 and 2016. Clinical findings and image tests are reported, as well as medical procedures performed. Indications based on clinical, functional and imaging ratings were clear, but his professional activity was not completely abandoned. Finally, after four endovascular procedures with good immediate results, he was warned of the seriousness of the process since the etiopathogenic reason. At the present moment patient is asymptomatic, under routine controls, working as successful triathlon coach. Discussion and conclusion: The fact that an external mechanical stress is the reason of repeated iliac artery injury suggests that an open surgical approach correcting the external muscular compression or arterial deformation should be a definitive but also aggressive solution according to literature. However, endovascular procedures and new endovascular devices are an increasingly promising option with a very low surgical risk. No matter the revascularization performed, the persistence of sports intensive practice carries a high risk of recurrence. Sport practise cessation is mandatory in some cases in order to assure revascularization long-term patency, but also a well conducted professional orientation is needed to complete the therapeutic action.
Cómo citar este artículo: Hernández G, et al. Caracterización por Ultrasound Tissue Characterizat... more Cómo citar este artículo: Hernández G, et al. Caracterización por Ultrasound Tissue Characterization de los tendones rotulianos de jugadores de baloncesto; comparación entre profesionales versus formativos y asintomáticos versus sintomáticos. Apunts Med Esport. 2017.
A limitation to the accurate study of muscle injuries and their management has been the lack of a... more A limitation to the accurate study of muscle injuries and their management has been the lack of a uniform approach to the categorisation and grading of muscle injuries. The goal of this narrative review was to provide a framework from which to understand the historical progression of the classification and grading of muscle injuries. We reviewed the classification and grading of muscle injuries in the literature to critically illustrate the strengths, weaknesses, contradictions or controversies. A retrospective, citation-based methodology was applied to search for English language literature which evaluated or utilised a novel muscle classification or grading system. While there is an abundance of literature classifying and grading muscle injuries, it is predominantly expert opinion, and there remains little evidence relating any of the clinical or radiological features to an established pathology or clinical outcome. While the categorical grading of injury severity may have been a reasonable solution to a clinical challenge identified in the middle of the 20th century, it is time to recognise the complexity of the injury, cease trying to oversimplify it and to develop appropriately powered research projects to answer important questions.
Purpose The purpose of the study is to explain the causeeffect relationship in three patients who... more Purpose The purpose of the study is to explain the causeeffect relationship in three patients who reported combined ruptures of the Achilles tendon and the gastrosoleus complex 6 months after they had received corticosteroids injections for the management of retrocalcaneal bursitis. Methods Three cryopreserved cadavers (three men, three left legs) were examined to assess the anatomic connection between the retrocalcaneal bursa and the Achilles tendon (distal and anterior fibers). Blue triptan medium contrast was injected. Results An unexpected connection between the retrocalcaneal bursa and the anterior fibers of the Achilles tendon was found in all instances. Conclusions Local corticosteroid injection of the retrocalcaneal bursa may help the symptoms of retrocalcanear bursitis, but pose a risk of Achilles tendon rupture. This risk-benefit has to be taken into account when corticosteroid injections are prescribed to professional and high-level athletes.
ABSTRACT Stress fractures in the feet of athletes seldom involve the first metatarsal, with few d... more ABSTRACT Stress fractures in the feet of athletes seldom involve the first metatarsal, with few documented case reports. We report a case of stress fracture in the base of the first metatarsal in a professional fencer with the typical scintigraphic appearance of a fracture line clearly demonstrated by selective pinhole imaging.
Soft tissue injuries still generate much research on the diagnosis, treatment and prevention. Out... more Soft tissue injuries still generate much research on the diagnosis, treatment and prevention. Outcomes from research help clinicians with their decisions, however, there always remains more to know.
Deporte; Examen previo a la participación Resumen El propósito de la exploración genital (EG) dur... more Deporte; Examen previo a la participación Resumen El propósito de la exploración genital (EG) durante el examen previo a la participación (EPP) deportiva es identificar el estado madurativo y descartar cualquier enfermedad genital. Este examen, si bien está recomendado, no se hace de forma rutinaria. Describir la prevalencia de anomalías genitales (AG) y la utilidad de la EG en deportistas jóvenes en este ámbito. Se realizó un estudio descriptivo, transversal, durante 2 temporadas, en 280 jugadores del fútbol formativo de elite. Se detectó el 5,4% de AG, siendo el varicocele un 3,2% y de los que solo el 13% era consciente de su enfermedad antes de la evaluación. Se demuestra una baja prevalencia de AG, si bien, los datos dan fuerza a la recomendación de practicar la EG durante el EPP como una estrategia más de salud preventiva, dado que no es una práctica habitual por el especialista en estos exámenes médicos.
The Orchard Sports Injury Classification System (OSICS) is one of the world's most commonly used ... more The Orchard Sports Injury Classification System (OSICS) is one of the world's most commonly used systems for coding injury diagnoses in sports injury surveillance systems. Its major strengths are that it has wide usage, has codes specific to sports medicine and that it is free to use. Literature searches and stakeholder consultations were made to assess the uptake of OSICS and to develop new versions. OSICS was commonly used in the sports of football (soccer), Australian football, rugby union, cricket and tennis. It is referenced in international papers in three sports and used in four commercially available computerised injury management systems. Suggested injury categories for the major sports are presented. New versions OSICS 9 (three digit codes) and OSICS 10.1 (four digit codes) are presented. OSICS is a potentially helpful component of a comprehensive sports injury surveillance system, but many other components are required. Choices made in developing these components should ideally be agreed upon by groups of researchers in consensus statements.
Miscelanea 83S with restricted cubic splines. Results: Overall, mean residual contracture (total ... more Miscelanea 83S with restricted cubic splines. Results: Overall, mean residual contracture (total active extension deficit) at follow-up was 24°, which corresponded to a postprocedure improvement of 65%. Forty-seven percent of patients experienced at least 1 adverse event, with neuropraxia (12%), scar sequelae (12%), and wound healing problems (8%) being the three most common events. Surgeon volume was inversely related to the degree of residual contracture: Every 58 additional procedures performed annually were associated with 5° less residual contracture at follow-up (P, .03). Moreover, surgeon volume had an inverse effect on overall events (odds ratio per 50 additional procedures, 0.86, P, .01). Conclusions: Even among experienced hand surgeons, patients treated by surgeons performing high volumes of Dupuytren surgery had better outcomes in terms of residual contracture and adverse events. The findings of this study suggest that surgeons may improve outcomes by increasing their annual procedural volume for these specific interventions.
Introduction: The discovery of vitamin D muscle receptors in the last few years suggested a signi... more Introduction: The discovery of vitamin D muscle receptors in the last few years suggested a significant role in muscle tissue, pointing out athletes as a special group. Specific data are scarce. Aim: The main aim of the current paper was to provide, for the first time, comparable data about vitamin D status in elite Spanish athletes by sport, age, season and training environment. Methods: Four hundred and eight elite athletes with a mean age of 22.8 ± 8.4 years were recruited from the High-performance sport centre in Barcelona for this cross-sectional study. Athletes from 34 different sports modalities were analysed. Data were available for vitamin D status, training environment, seasonality and number of medical visits. All data were analysed using SPSS version 18.0. Results: Mean 25(OH)D of all athletes was 56.7 ± 23.4 nmol/L. Approximately 82% of the athletes were below the optimal levels, (< 75nmol/l), 45% had moderate deficient levels (< 50 nmol/L) and 6% had severe deficiency (< 27.5 nmol/L). We have observed a steady increase in 25(OH)D concentrations with increasing age (p < 0.01) Highest levels were observed in those subjects training outdoors compared with those training indoor (p.
This study meant to evaluate if compression garments have a protector effect on muscular injury. ... more This study meant to evaluate if compression garments have a protector effect on muscular injury. Nine active males participated in the study ([mean ± SD] age 27.7 ± 10.9 years; height 176.8 ± 3.6 cm; weight 76.1 ± 6.1 kg). Subjects performed a 40 min running test at the velocity of their anaerobic threshold with a negative steep of-10% wearing shorts with compression in one leg and no compression in the other leg using a balanced, randomised design. Muscular displacement was evaluated using a 3D analysis. Tissue damage was assessed by a muscular biopsy performed 48h after the running test. Results indicate a significantly higher muscular displacement in the leg with no compression and an increased muscular damage. This indicates that compression shorts have a protective effect on muscle.
Documento descargado de http://www.apunts.org el 12/04/2013. Copia para uso personal, se prohíbe ... more Documento descargado de http://www.apunts.org el 12/04/2013. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.
Objective: To describe the injury mechanisms and magnetic resonance imaging (MRI) findings in acu... more Objective: To describe the injury mechanisms and magnetic resonance imaging (MRI) findings in acute hamstring injuries of male soccer players using a systematic video analysis. Design: Descriptive case series study of consecutive acute hamstring injuries from September 2017 to January 2022. Setting: Two specialized sports medicine hospitals. Participants: Professional male soccer players aged between 18 and 40 years, referred for injury assessment within 7 days after an acute hamstring injury, with an available video footage of the injury and positive finding on MRI. Independent Variables: Hamstring injury mechanisms (specific scoring based on standardized models) in relation to hamstring muscle injury MRI findings. Main Outcome Measures: Hamstring injury mechanism (playing situation, player/opponent behavior, movement, and biomechanical body positions) and MRI injury location. Results: Fourteen videos of acute hamstring injuries in 13 professional male soccer players were analyzed. Three different injury mechanisms were seen: mixed-type (both sprint-related and stretch-related, 43%), stretchtype (36%), and sprint-type (21%). Most common actions during injury moments were change of direction (29%), kicking (29%), and running (21%). Most injuries occurred at high or very high horizontal speed (71%) and affected isolated proximal biceps femoris (BF) (36%). Most frequent body positions at defined injury moments were neutral trunk (43%), hip flexion 45-90 degrees (57%), and knee flexion ,45 degrees (93%). Magnetic resonance imaging findings showed that 79% were isolated single-tendon injuries. Conclusions: According to a video analysis, most hamstring injuries in soccer occur during high-speed movements. Physicians should suspect proximal and isolated single-tendon-most often BF-hamstring injury, if represented injury mechanisms are seen during game play. In addition to sprinting and stretching, also mixed-type injury mechanisms occur.
a Medical Services, Futbol Club Barcelona, Barcelona, Spain b Facultat de Psicologia, Universitat... more a Medical Services, Futbol Club Barcelona, Barcelona, Spain b Facultat de Psicologia, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain c CAR Sant Cugat-Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain d Clínica Mapfre de Medicina del Tenis, Barcelona, Spain e Clínica Diagonal, Esplugues de Llobregat, Barcelona, Spain f Department of Scientiic Research, UTC Imaging, Stein, Netherlands g ISEH, University College London Hospitals, London, United Kingdom
Introduction: Conventional ultrasound helps to identify the macroscopic changes produced in the i... more Introduction: Conventional ultrasound helps to identify the macroscopic changes produced in the injured tendon. However, these changes do not correlate well with the symptoms or the response to treatment. The ‘characterization of tissues by ultrasound’ (UTC) evaluates the structure of the tendon in 3 dimensions and classifies it into 4 echotypes. The aim of this study was to investigate the structure of the patellar tendon in basketball players using the UTC technique, and to study the differences between professional and amateur players by comparing the dominant leg with the non-dominant one, and the symptomatic with the asymptomatic ones. Material and methods: The study included 40 patellar tendons (20 basketball players). The structure of the patellar tendon (proximal, medial, and distal) was quantified by means of UTC at the beginning of the pre-season. The within and between observer reliability was measured using the intraclass correlation coefficient (ICC). Results: The mean ...
Introduction: Iliac artery endofibrosis (IAE) is an uncommon disease, poorly studied pathology wi... more Introduction: Iliac artery endofibrosis (IAE) is an uncommon disease, poorly studied pathology with devastating effects and different therapeutic approaches affecting young people who practise intensive sports, especially cyclists. The evolution of the process not only depends on the diagnosis and therapeutic action, but also on the acceptance and attitude of the patient and subsequent professional guidance. Case description: This is the case description of a professional triathlon athlete that had one previous iliac surgical revascularization for an IAE Iliac and was admitted in our department five times with subacute lower limb ischemia affecting both legs between 2013 and 2016. Clinical findings and image tests are reported, as well as medical procedures performed. Indications based on clinical, functional and imaging ratings were clear, but his professional activity was not completely abandoned. Finally, after four endovascular procedures with good immediate results, he was warned of the seriousness of the process since the etiopathogenic reason. At the present moment patient is asymptomatic, under routine controls, working as successful triathlon coach. Discussion and conclusion: The fact that an external mechanical stress is the reason of repeated iliac artery injury suggests that an open surgical approach correcting the external muscular compression or arterial deformation should be a definitive but also aggressive solution according to literature. However, endovascular procedures and new endovascular devices are an increasingly promising option with a very low surgical risk. No matter the revascularization performed, the persistence of sports intensive practice carries a high risk of recurrence. Sport practise cessation is mandatory in some cases in order to assure revascularization long-term patency, but also a well conducted professional orientation is needed to complete the therapeutic action.
Cómo citar este artículo: Hernández G, et al. Caracterización por Ultrasound Tissue Characterizat... more Cómo citar este artículo: Hernández G, et al. Caracterización por Ultrasound Tissue Characterization de los tendones rotulianos de jugadores de baloncesto; comparación entre profesionales versus formativos y asintomáticos versus sintomáticos. Apunts Med Esport. 2017.
A limitation to the accurate study of muscle injuries and their management has been the lack of a... more A limitation to the accurate study of muscle injuries and their management has been the lack of a uniform approach to the categorisation and grading of muscle injuries. The goal of this narrative review was to provide a framework from which to understand the historical progression of the classification and grading of muscle injuries. We reviewed the classification and grading of muscle injuries in the literature to critically illustrate the strengths, weaknesses, contradictions or controversies. A retrospective, citation-based methodology was applied to search for English language literature which evaluated or utilised a novel muscle classification or grading system. While there is an abundance of literature classifying and grading muscle injuries, it is predominantly expert opinion, and there remains little evidence relating any of the clinical or radiological features to an established pathology or clinical outcome. While the categorical grading of injury severity may have been a reasonable solution to a clinical challenge identified in the middle of the 20th century, it is time to recognise the complexity of the injury, cease trying to oversimplify it and to develop appropriately powered research projects to answer important questions.
Purpose The purpose of the study is to explain the causeeffect relationship in three patients who... more Purpose The purpose of the study is to explain the causeeffect relationship in three patients who reported combined ruptures of the Achilles tendon and the gastrosoleus complex 6 months after they had received corticosteroids injections for the management of retrocalcaneal bursitis. Methods Three cryopreserved cadavers (three men, three left legs) were examined to assess the anatomic connection between the retrocalcaneal bursa and the Achilles tendon (distal and anterior fibers). Blue triptan medium contrast was injected. Results An unexpected connection between the retrocalcaneal bursa and the anterior fibers of the Achilles tendon was found in all instances. Conclusions Local corticosteroid injection of the retrocalcaneal bursa may help the symptoms of retrocalcanear bursitis, but pose a risk of Achilles tendon rupture. This risk-benefit has to be taken into account when corticosteroid injections are prescribed to professional and high-level athletes.
ABSTRACT Stress fractures in the feet of athletes seldom involve the first metatarsal, with few d... more ABSTRACT Stress fractures in the feet of athletes seldom involve the first metatarsal, with few documented case reports. We report a case of stress fracture in the base of the first metatarsal in a professional fencer with the typical scintigraphic appearance of a fracture line clearly demonstrated by selective pinhole imaging.
Soft tissue injuries still generate much research on the diagnosis, treatment and prevention. Out... more Soft tissue injuries still generate much research on the diagnosis, treatment and prevention. Outcomes from research help clinicians with their decisions, however, there always remains more to know.
Deporte; Examen previo a la participación Resumen El propósito de la exploración genital (EG) dur... more Deporte; Examen previo a la participación Resumen El propósito de la exploración genital (EG) durante el examen previo a la participación (EPP) deportiva es identificar el estado madurativo y descartar cualquier enfermedad genital. Este examen, si bien está recomendado, no se hace de forma rutinaria. Describir la prevalencia de anomalías genitales (AG) y la utilidad de la EG en deportistas jóvenes en este ámbito. Se realizó un estudio descriptivo, transversal, durante 2 temporadas, en 280 jugadores del fútbol formativo de elite. Se detectó el 5,4% de AG, siendo el varicocele un 3,2% y de los que solo el 13% era consciente de su enfermedad antes de la evaluación. Se demuestra una baja prevalencia de AG, si bien, los datos dan fuerza a la recomendación de practicar la EG durante el EPP como una estrategia más de salud preventiva, dado que no es una práctica habitual por el especialista en estos exámenes médicos.
The Orchard Sports Injury Classification System (OSICS) is one of the world's most commonly used ... more The Orchard Sports Injury Classification System (OSICS) is one of the world's most commonly used systems for coding injury diagnoses in sports injury surveillance systems. Its major strengths are that it has wide usage, has codes specific to sports medicine and that it is free to use. Literature searches and stakeholder consultations were made to assess the uptake of OSICS and to develop new versions. OSICS was commonly used in the sports of football (soccer), Australian football, rugby union, cricket and tennis. It is referenced in international papers in three sports and used in four commercially available computerised injury management systems. Suggested injury categories for the major sports are presented. New versions OSICS 9 (three digit codes) and OSICS 10.1 (four digit codes) are presented. OSICS is a potentially helpful component of a comprehensive sports injury surveillance system, but many other components are required. Choices made in developing these components should ideally be agreed upon by groups of researchers in consensus statements.
Uploads
Papers by Lluis Til