Objective: To describe a clinical treatment algorithm for posterior ankle impingement (PAI) syndrome in professional football players. Material and methods: A case series of 26 elite professional football players diagnosed and treated for posterior ankle impingement syndrome were included for the study. All of the athletes received conservative treatment with physical therapy modalities initially. If the first line medical treatment and rehabilitation was ineffective to alleviate the symptoms, ultrasound-guided corticosteroid injection was proposed and thereafter the patients underwent posterior ankle arthroscopy if the complaints are still unresolved. The pain scores (AOFAS, VAS), and time to return to play were the main outcome measures. Results: The complaints of 18 (69.2%) players were subsided with non-surgical treatment whereas three of acute cases and five of the chronic cases did not respond to medical treatment and arthroscopic surgery was performed for eight athletes. Eighteen players returned to training for a mean time of 36.3 days (24e42 days) after conservative treatment. The patients who underwent arthroscopic surgery returned to training for a mean time of 49.8 days (42e56 days) after the surgery. All athletes returned to their previous level of competition after treatment without any complications or recurrence in a mean follow-up 36.5 months (19e77 months). Conclusion: Non-surgical treatment modalities were effective in 2/3 of posterior ankle impingement syndrome in elite football players. On the other hand, posterior ankle arthroscopy is safe and effective treatment option for posterior ankle impingement syndrome if the conservative treatment fails. Level of evidence: Level IV, Therapeutic study

Objective: Mastalgia is often ignored by physicians although it is the most common breast-related complaint among women. The effectiveness of exercise therapy for mastalgia is unclear. The aim of this study is to investigate the effects of exercise on mastalgia. Methods: A randomized controlled trial was conducted with twenty women with complaints of mastalgia fulfilling the inclusion and exclusion criteria. Patients were randomly assigned to the control group and to the exercise group. Sports brassiere, refraining from caffeine- and methylxanthine-containing foods, and simple analgesics were recommended for two groups. In the exercise group, an exercise program was conducted three times a week for 6 weeks. Participants in both groups were evaluated for breast pain and using the Short-Form Health Survey (SF-36) questionnaire before and six weeks after study. Serum cytokine levels were also collected and analyzed. Results: No significant differences were detected with respect to age, body mass index, menopausal status, psychiatric condition, and existence of unexplained pain syndromes between the groups. Total breast pain scores were similar in both groups. The sensory component of breast pain questionnaire and visual analogue scale values significantly improved via exercise in only exercise group (p = 0.012 and p = 0.016). There was no significant difference between groups in serum levels of cytokines. SF-36 subscale scores for general health and social functioning significantly improved in the control group and scores for role physical, bodily pain, and social functioning improved in exercise group. Conclusions: Based on our preliminary findings, exercise treatment is beneficial for patients with mastalgia and it can be suggested by clinicians.

Helvacı G, et al. Nutr Res Pract. 2023 Aug;17(4):762-779. https://doi.org/10.4162/nrp.2023.17.4.762

VISA-P questionnaire assesses to severity of symptoms and treatment effects in athletes with patellar tendinopathy. The purpose of this study was to translated VISA-P questionnaire into Turkish language and to determine its validity and reliability. The English version of VISA-P questionnaire was translated into Turkish according to the internationally recommended guidelines. Test–retest reliability was determined on 89 participants with time interval 24 h. To determine validity of Turkish VISA-P, 31 (17 male, 14 female) healthy students, 34 (20 male, 14 female) patients with patellar tendinopathy (diagnosed by physical examination and ultrasonography) and 24 (16 male, 8 female) volleyball players (at risk populations) were completed VISA-P-Tr. Internal consistency was determined with Cronbach’s alpha. Intraclass correlation coefficients (ICCs) were calculated to analyse test–retest reliability. To assessment of discrimination, VISA-P-Tr scores compared all groups using the Mann–Whitney-U test. The VISA-P-Tr questionnaire showed good test–retest reliability (The Cronbach’s alpha was 0.79 and 0.78 respectively and ICC was 0.96). The VISA-P-Tr score (mean ± SD) were 93.7 ± 8.9 and 94.0 ± 8.1 for healthy students, 81.1 ± 13.7 and 80.7 ± 13.4 for volleyball players, 58.8 ± 12.1 and 58.5 ± 11.0 for athletes with patellar tendinopathy. The translated Turkish version of VISA-P has good internal consistency and good reliability and validity. Therefore VISA-P-Tr is useful to evaluate symptoms and follow the treatment effect in athletes with patellar tendinopathy.

Objective: The aim of this study is to evaluate early phase depression and anxiety in the proffessional athletes who underwent anterior cruciate ligament (ACL) reconstruction and compare them with the functional improvement of knee. Methods: Thirty-eight patients (35 males, 3 females; mean age±SD: 26.84±8.03) were included in this study. Measurements were obtained immediately following the operation and at Week 6 of postoperative rehabilitation. Depression and anxiety symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS), and knee function was evaluated by Lysholm Knee Scoring Scale (LKSS). Results: Change in total LKSS scores from the time of admission (56.4±20.2) to the end of the sixth week (78.7±13.8) was significant (t=–8.21, p<0.001). Neither the HADS depression nor the HADS anxiety scores were above the cutoff values in the 2 assessments. Significant difference was noted in HADS anxiety scores between the time of admission (6.21±3.50) and at the sixth week (5.33±3.33) (t=2.02, p=0.05). However, HADS depression scores were not statistically different between the 2 evaluations (5.95±3.68 and 5.35±3.50 at admission and Week 6 week, respectively) (t=1.07, p=0.29). Changes between the 2 LKSS and HADS anxiety assessments were negatively correlated (r=–0.49, p=0.002), but there no correlation was detected between the total LKSS and HADS score changes. Conclusion: The decline of the signs of anxiety and depression at the sixth week of rehabilitation indicate that proper rehabilitation positively affects the emotional status of ACL reconstruction patients. Özet Amaç: Bu çalışmada, hamstring otogrefti ile ÖÇB onarımı sonrası erken dönemde, sporcularda anksiyete ve depresif belirti şiddeti ölçülmüş ve takipte bu belirtilerin diz fonksiyonunun yeniden kazanılmasıyla ilişkili olup olmadığı araştırılmıştır. Hastalar ve Yöntem: Çalışmaya hamstring otogrefti ile ÖÇB onarımı yapılan ve yaş ortalaması 26,84±8,03 olan 35 i erkek 3 ü kadın olmak üzere toplam 38 profesyonel sporcu hasta alınmıştır. Ölçümler ÖÇB onarımından hemen sonra ve 6. haftalarda yapılmıştır. Anksiyete ve depresyon belirtileri Hastane Anksiyete Depresyon Ölçeği (HADO) ile ölçülmüş, fonksiyonel değerlendirme ise Lysholm Diz Skorlama Ölçeği (LDSÖ) ile yapılmıştır. Bulgular: LDSÖ toplam puanı rehabilitasyonun başlangıcında 56.4±20.2, altıncı haftanın sonunda ise 78.7±13.8 olarak bulunmuştur. Toplam LDSÖ puanındaki değişim istatistiksel olarak anlamlıdır (t=-8.21, p<0.001). HADÖ-Depresyon ve HADÖ-Anksiyete puanları her iki değerlendirmede de eşik değerin altındadır. Öte yandan birinci ve altıncı haftadaki HADÖ-Anksiyete puanları arasındaki fark istatistiksel olarak anlamlı bulunmuştur (sırasıyla 6.21±3.50 ve 5.33±3.33 t=2.02, p=0.05). Başvuru esnasındaki ve altıncı haftadaki HADÖ-Depresyon puanları arasında ise anlamlı bir fark saptanmamıştır (sırasıyla 5.95±3.68 ve 5.35±3.50 t=1.07, p=0,29). İlk değerlendirme ve altıncı haftadaki LDSÖ toplam puanları arasındaki değişim ile HADÖ-Anksiyete ve HADÖ-Depresyon alt ölçek toplam puanlarındaki değişim arasında negatif korelasyon vardır (sırasıyla, r=-0.49, p=0.002 ve r=-0.44, p=0.006). Çıkarımlar: ÖÇB onarımı sonrası ilk altı haftada sporcuların anksiyete ve depresyon belirtileri yaşamaları rehabilitasyonu olumsuz etkileyebilir. Altı haftalık rehabilitasyon sonrasında, anksiyete belirtilerindeki düşmenin anlamlı olması ve rehabilitasyon sürecinde fonksiyonalitenin artması ile depresyon ve anksiyete belirtileri arasında negatif korelasyon saptanması, uygun rehabilitasyon sürecinin, profesyonel sporcularda ek psikiyatrik/psikolojik destek olmaksızın kaygı ve duygudurum belirtileri üzerinde etkili olduğunu göstermektedir.