The MLG-R muscle injury classification for hamstrings. Examples and guidelines for its use

Abstract

Muscle injuries are very common in sport. In soccer, the most popular sport in the world, the majority of muscle injuries are located in the lower extremity (92–97%); hamstrings (28–37%), quadriceps (19–32%), adductors (19–23%), and calf muscles (12–13%), all of them are biarticular muscles, with a complex architecture and containing a high proportion of fast-twitch fibers.

Football teams have important budgets and spend great amounts of money to win titles; it has been proved that injuries had a significant influence on performance in male professional football, but muscle injuries seem to keep growing. The reason to this is multivariable: there is no consensus regarding hamstring muscle injuries (HMIs) return to play (RTP) criteria in the literature, the time for recovery is highly variable, the increased physical demands during games, or the influence of congested period of games on players health.

Autores: Xavier Valle, Sandra Mechó, Ricard Pruna, Carles Pedret, Jaime Isern, Joan Carles Monllau, Gil Rodas.

Revista: Apunts. Medicina de l’esport

Año de publicación: 2018

Displacement of the nervous system through articular movement by ultrasound. Bibliographic review

Abstract

The nervous system has the capacity to adapt to the mechanical forces of tension, compression and shearing to which it is exposed in daily movements. Reduction of nerve slide may alter its function by increasing neural tension, which may have an adverse effect, contributing to the onset of pain. The objective of the study was to review the current literature regarding the movement of the nervous system and how to measure it. To do this, a search was undertaken in Pubmed and PEDro of articles where neural displacement is measured by the “frame-by-frame cross correlation system” technique. Twenty studies were selected: 14 measured displacement in healthy subjects, and 6 compared some form of peripheral neuropathy. The results show that the peripheral nervous system is displaced during the different movements of body segments to adapt to the space through which it runs, although there is no significant difference in displacement between healthy people and patients with nerve involvement.

Autores: Carle Munné, Carles Pedret.

Revista: Apunts. Medicina de l’esport

Año de publicación: 2018

Support strategies for high competition performance

Abstract

In high-level competition sports one of the most important aims throughout the season is that the player is able to recover as fast as possible to his or her physical and mental baseline condition after exercise so as to safely tackle their sport anew.

Advances in technology and the availability of increasingly more precise diagnostic tests (obtained from blood, urine or saliva samples) have led to a personalised approach to the sportsperson and individualised study of the training/match-recovery balance from a different, more realistic outlook of the situation.

Autores: Ricard Pruna, Antonia Lizarraga, Luis Vergara, Carles Pedret.

Revista: Apunts. Medicina de l’esport

Año de publicación: 2018

Does cognition play a role in injury prevention and return to play in the elite football player? A perspective from the field

Abstract

Cognitive ability is an important, and sometimes underrated, part of football performance. During a match, football players interact with multiple stimuli that target different sensory organs and triggers high cognitive demands that need to be linked with previous knowledge and experience and making and acting on decisions.

Autores: Khatija Bahdur, Ricard Pruna, Henrico Erasmus, Carles Pedret.

Revista: Apunts. Medicina de l’esport

Año de publicación: 2018

Role of the Extracellular Matrix in Muscle Injuries. Histoarchitectural Considerations for Muscle Injuries.

Abstract

In recent years, different classifications of muscle injury have been proposed based on topographic location within the bone-tendon-muscle chain. Furthermore, because the degree and level of extracellular matrix (ECM) involvement might vary greatly, we propose to include histoarchitectural considerations in the gross anatomic description of muscle injuries.

Autores: Balius R, Alomar X, Pedret C, Blasi M, Rodas G, Pruna R, Peña-Amaro J, Fernández-Jaén T.

Revista: Orthopaedic Journal of Sports Medicine

Año de publicación: 2018

Ultrasound classification of traumatic distal biceps brachii tendon injuries.

Abstract

The present work is aimed at analysing ultrasound findings in patients with distal biceps brachii tendon (DBBT) injuries to assess the sensitivity of ultrasound in detecting the different forms of injury, and to compare ultrasound results with magnetic resonance imaging (MRI) and surgical results.

MATERIALS AND METHODS:
A total of 120 patients with traumatic DBBT injuries examined between 2011 and 2015 were analysed. We compared ultrasound results with MRI results when surgery was not indicated and with MRI and surgical results when surgery was indicated.

RESULTS:
For major DBBT injuries (complete tears and high-grade partial tears), the concordance study between exploration methods and surgical results found that ultrasound presented a slight statistically significant advantage over MRI . Minor injuries, in which most tendon fibres remain intact (tendinopathies, elongations and low-grade partial tears), are the most difficult to interpret, as ultrasound and MRI reports disagreed in 12 out of 39 cases and no surgical confirmation could be obtained.

CONCLUSIONS:
Based on present results and previous MRI classifications, we establish a traumatic DBBT injury ultrasound classification. The sensitivity and ultrasound-surgery correlation results in the diagnosis of major DBBT injuries obtained in the present study support the recommendation that ultrasound can be used as a first-line imaging modality to evaluate DBBT injuries.

Autors: de la Fuente J, Blasi M, Martínez S, Barceló P, Cachán C, Miguel M, Pedret C.

Revista: Epub 2017 Nov 24.

Any de publicació: 2017

Spanish Consensus Statement: Clinical Management and Treatment of Tendinopathies in Sport.

Abstract

On October 15, 2016, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of the Spanish Society for Sports Traumatology (SETRADE), the Spanish Society of Sports Medicine (SEMED), the Spanish Association of Medical Services for Football Clubs (AEMEF), the Spanish Association of Medical Services for Basketball Clubs (AEMB), F.C. Barcelona, and Clínica CEMTRO. The purpose was to consider the most appropriate clinical management and treatment of tendinopathies in sports, based on proven scientific data described in the medical literature as well as on each expert’s experience. Prior to the meeting, each expert received a questionnaire regarding clinical management and treatment of tendinopathies in sports. The present consensus document summarizes the answers to the questionnaire and the resulting discussion and consensus regarding current concepts on tendinopathies in sports.

Autors:  Fernandez-Jaén T, Rey GÁ, Angulo F, Cuesta JA, Loureda RA, España FÁ, Ayala J, Matas RB, Pazos FB, de Dios Beas Jiménez J, Rosell JC, Fernandez CC, Del Pilar Doñoro Cuevas M, Ros FE, Colmenero JE, de Prado JF, García Cota JJ, Garrido González JI, de Vega CG, Santander MG, Herrador Munilla MÁ, Ruiz FI, Díaz FJ, Fernandez AM, Marqueta PM, Muñoz Benito JJ, Vilás RO, Pedret C, Teres XP, Amaro JP, Grifell JP, San Roque JP, Parenteu CR, Serna JR, Font GR, Álvarez MS, Marchori CS, Perez LT, Durán RU, Del Valle Soto M, Villalón Alonso JM, García PG.

Revista: Orthop J Sports Med. 2017 Oct 31;5(10)

Any de publicació: 2017

Semimembranosus Muscle Injuries In Sport. A Practical MRI use for Prognosis

Abstract

The aim of this work was to study semimembranosus musculotendinous injuries (SMMTI) and return to play (RTP). The hypothesis is that some related anatomic variables of the SM could contribute to the prognosis of RTP. The retrospective study was done with 19 athletes who suffered SMMTI from 2010 to 2013 and in whose cases a 3.0T MRI was performed. We evaluated the A, B, C SM regions damaged and calculated the relative length and percentage of cross-sectional area (CSA) affected. We found the correlation of these variables with RTP. The data was regrouped in those cases where the part C of the injury was of interest and those in which the C region was unscathed (pooled parts). We used the Mann-Whitney U test and there was a higher RTP when the injury involved the C part of SM (49.1 days; 95% CI [27.6– 70.6]) compared to non-C-part involvement (27.8 days; 95% CI [19.5–36.0]). The SMMTI with longer RTP typically involves the C part with or without participation of the B part. In daily practice, the appearance on MRI of an altered proximal tendon of the SM indicates that the injury affects the C region and therefore has a longer RTP.

Autors: Ramon Balius, Mireia Bossy, Carles Pedret, Lluís Capdevila, Xavier Alomar, Bryan Heiderscheit, Gil Rodas

Revista: Sports Medicine International Open 2017; 1: E94–E100

Any de publicació: 2017

Caracterización por Ultrasound Tissue Characterization de los tendones rotulianos de jugadores de baloncesto; comparación entre profesionales versus formativos y asintomáticos versus sintomáticos

Abstract

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 echo-types. 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 asymptomatic 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 ages of the 10 professional players and 10 amateur players were 28.1 years (SD 4.5) and 17.6 years (SD 1.3), respectively. The thickness of the patellar tendon was greater in the professional players, in the dominant leg, and in symptomatic tendons. There were no significant differences in the echo-types, except in the case of echo-type II in the proximal portion of the right patellar tendon, between professional and amateur players. Similarly, there was a difference in echo-type III and IV of the proximal portion of the right tendon between symptomatic and asymptomatic players. A good, high reliability was found with these techniques.

Conclusions
The ultrasound pattern of the patellar tendons of basketball players has been characterised using UTC. The thickness of the tendon is greater in professional players than in amateur players. It has also been observed that the symptomatic tendons are thicker than in asymptomatic ones. There were no significant differences in the UTC patterns between professional and amateur players, or between symptomatic and asymptomatic ones.

Autors: Gemma Hernández, David Domínguez, JordiMoreno, Lluís Tilac , Lluís Capdevila, Carles Pedret, Hansvan Schief, Gil Rodas

Revista: Apunts. Medicina de l’Esport Volume 52, Issue 194, April–June 2017, Pages 45-52

Any de publicació: 2017

Ultrasound-Guided Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg.

Abstract

Chronic exertional compartment syndrome is characterized by exertional pain and elevated intracompartmental pressures affecting the leg in physically active young people. In patients who have failed conservative measures, fasciotomy is the treatment of choice. This study presents a new method for performing fasciotomy using high-resolution ultrasound (US) guidance and reports on the clinical outcomes in a group of these patients. Over a 3-year period, 7 consecutive patients with a total of 9 involved legs presented clinically with anterior compartment chronic exertional compartment syndrome, which was confirmed by intracompartmental pressure measurements before and after exercise. After a US examination, fasciotomy under US guidance was performed. Preoperative and postoperative pain and activity levels were assessed as well as number of days needed to “return to play.” All patients had a decrease in pain, and all except 1 returned to presymptomatic exercise levels with a median return to play of 35 days.

Autors: Balius R, Bong DA, Ardèvol J, Pedret C, Codina D, Dalmau A. J

Revista: Ultrasound Med, 35:823-9.

Any de publicació: 2016.

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