Article: Effects of the COVID-19 confinement period on physical conditions in young elite soccer players - The Journal of Sports Medicine and Physical Fitness 2021 September;61(9):1252-7 - Minerva Medica - Journals

Arthrofibrosis is a devastating complication after Anterior Cruciate Ligament reconstruction (ACLr) characterized by a muscle weakness secondary to an arthrogenic muscle inhibition process. The loss of knee isokinetic strength due to arthrogenic muscle inhibition may be more important after arthrofibrosis, compared to an ACLr population with no complication. The isokinetic strength deficit [Limb Symmetry Index (LSI) at 60 and 180°/s of angular speed] was measured at 4, 7 and 12 post‐operative months. Knee function, return to running and return to sport were evaluated. A comparison of the Quadriceps and the Hamstring LSI between patients with arthrofibrosis and those without post‐operative complication was performed according to time and taking into consideration the type of surgical procedure. 539 primary ACLr patients were assessed. The arthrofibrosis group presented at 4, 7 and 12 post‐operative months a Quadriceps LSI significantly lower compared to the control group, without influence of the graft procedure (LSI: 38, 53, 68% vs 63, 73, 85% at 60°/s, respectively). The Hamstring LSI was significantly lower at 4 and 7 post‐operative months, but comparable at 12 months with an influence of the Hamstring procedure. Knee function was significantly lower at 4 and 7 post‐operative months. Few arthrofibrosis ACLr patients returned to running at 7 post‐operative months (6.8% vs 69.9%; p < .0001). An important and durable Quadriceps muscle weakness occurred after arthrofibrosis, whatever the type of graft procedure. This is explained by an Arthrogenic muscle inhibition which compromised the return to sport at the same level until 12 post‐operative months.Highlights An important and durable quadriceps muscle weakness occurred after arthrofibrosis. The arthrogenic muscle inhibition was significant on the operated side independently of the type of the graft procedure. Arthrogenic muscle inhibition compromised the return to sport at the same level until 12 post‐operative months.

The majority of anterior cruciate ligament (ACL) injuries occur during non-contact mechanisms. Knowledge of the risk factors would be relevant to help prevent athletes’ injuries. We aimed to study risk factors associated with non-contact ACL injuries in a population of athletes after ACL reconstruction. From a cohort of 307 athletes, two populations were compared according to the non-contact or contact mechanism of ACL injury. Gender, age and body mass index (BMI) were reported. Passive knee alignment (valgus and extension), knee laxity (KT-1000 test), and isokinetic knee strength were measured on the non-injured limb. The relationship between these factors and the non-contact sport mechanism was established with models using logistic regression analysis for the population and after selection of gender and cut-offs of age, BMI and knee laxity calculated from Receiver Operating Characteristics curve area and Youden index. Age, BMI, antero-posterior laxity, isokinetic knee strength, passive knee valgus and passive knee extension were associated with non-contact ACL injury. According to the multivariate model, a non-contact ACL injury was associated with non-modifiable factors, age (OR: 1.05; p = 0.001), passive knee extension (OR: 1.14; p = 0.001), and with one modifiable factor (Hamstring strength: OR: 0.27; p = 0.01). For women, only passive knee valgus was reported (OR: 1.27; p = 0.01). Age, passive knee extension and weak Hamstring strength were associated with a non-contact ACL injury. Hamstring strengthening could be proposed to prevent ACL injury in young male athletes or in case of knee laxity.

Thoracic outlet syndrome (TOS) is a rare and heterogeneous syndrome secondary to a compression of the neurovascular bundle in the thoracic outlet area. Muscle hypertrophy is recognized to induce vascular or neurogenic compression, especially in sports involving upper-arm solicitation. Athletes represent a distinctive population because of a specific management due to an ambitious objective, which is returning to high-level competition. We evaluated the scientific literature available for the management of TOS in athletes. Article research extended to March 2021 without other restriction concerning the date of articles publication. The search was performed independently by two assessors. A first preselection based on the article titles was produced, regarding their availability in English or French and a second preselection was produced after reading the abstracts. In case of doubt, a third assessor’s advice was asked. Case reports were selected only if the sport involved was documented, as well as the level of practice. Cohorts were included if data about the number and the sport level of athletes were detailed. Seventy-eight articles were selected including 40 case reports, 10 clinical studies and 28 reviews of literature. Baseball pitchers seem to be highly at risk of developing a TOS. The surgical management appears particularly frequent in this specific population. The prognosis of TOS in athletes seems to be better than in the general population, possibly due to their better physical condition and their younger age. Some studies showed interesting and encouraging results concerning return to previous sport level. Literature shows a strong link between TOS and certain sports. Unfortunately, this syndrome still lacks rigorous diagnostic criteria and management guidelines for athletes.

Neurogenic thoracic outlet syndrome (NTOS) is a disabling condition. Its diagnosis remains challenging and is mainly guided by examination. Yet, electrophysiological evaluations are the gold standard for diagnosis of entrapment syndromes. We aimed to assess the interest of electrophysiological evaluation to diagnose NTOS. A systematic literature research was performed using PubMed, ScienceDirect, Embase, Cochrane and Google Scholar databases to collect studies reporting results of electrophysiological assessment of patients with NTOS. Then, a meta-analysis was conducted. Nine studies were eligible and concerned two hundred and thirteen patients. Results were heterogenous among studies and the quality of evidence was very low to moderate. Data could not evaluate sensitivity or specificity of electrophysiological evaluations for NTOS. The meta-analysis found significantly decreased amplitudes of medial antebrachial cutaneous nerve SNAP (sensory nerve action potential), ulnar SNAP, median CMAP (compound motor action potential) and ulnar CMAP. Needle examination found abnormalities for the abductor pollicis brevis, first dorsal interosseous and adductor digiti minimi. Unlike most upper-limb entrapment syndromes, nerve conduction assessment only provided clues in favour of NTOS. Decreased amplitude for ulnar SNAP, medial antebrachial cutaneous SNAP, median CMAP and ulnar CMAP should be assessed, as well as needle examination. Larger studies are needed to evaluate the sensitivity and specificity of electrophysiology in NTOS diagnosis.