RESUMO
INTRODUCTION: Core muscle injuries (CMI) are common in every sport. To minimize lost playing time, providers apply various nonsurgical treatments, including platelet-rich plasma, corticosteroids, ultrasound (US)-guided percutaneous tenotomy, and prolotherapy. Limited data exist with regard to their effectiveness. We chose to review a cohort of consecutive professional and collegiate athletes who sustained CMI at various points within their seasons and underwent a combination of US-guided percutaneous needle "tenotomy" and corticosteroid injections to complete the remainder of their seasons. METHODS: Twenty-five consecutive collegiate or professional athletes with CMI involving the rectus abdominis-adductor aponeurotic plate were included in this retrospective study. Athletes with concomitant symptomatic hip femoroacetabular impingement were included in the study. The primary outcome measure was whether athletes completed their seasons. Secondary measures were weeks played after the procedures (delay until surgery), need for repeat procedures, and outcomes after eventual surgery. Postoperative performance was assessed via interviews at 6 wk and 6 months postoperatively. RESULTS: Twenty-one of 25 (84%) athletes completed their seasons. On average, athletes returned to play 3 d (range, 1-9 d) after the procedures. Surgical repair was delayed a mean of 18 wk (range, 2-44 wk). Seven athletes had concomitant symptomatic femoroacetabular impingement and six underwent combined hip arthroscopy and core muscle repairs. Among 17 patients who eventually had core muscle surgery alone (no hip surgery), 82% (14 of 17) reported performing at their preinjury level at 6 wk. At 6 months, 96% of postop athletes (22 of 23) reported performing at their preinjury level. CONCLUSIONS: Temporizing CMI with US-guided percutaneous tenotomy and corticosteroid injections is effective in allowing continued sport participation among high-level athletes and does not negatively affect postoperative outcomes.
Assuntos
Traumatismos Abdominais/terapia , Corticosteroides/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Traumatismos em Atletas/terapia , Reto do Abdome/lesões , Tenotomia/métodos , Ultrassonografia de Intervenção/métodos , Traumatismos Abdominais/diagnóstico por imagem , Corticosteroides/uso terapêutico , Adulto , Anti-Inflamatórios/uso terapêutico , Traumatismos em Atletas/diagnóstico por imagem , Desempenho Atlético , Terapia Combinada , Feminino , Seguimentos , Humanos , Injeções Intramusculares , Masculino , Estudos Retrospectivos , Volta ao Esporte , Tempo para o Tratamento , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: The effect of platelet-rich plasma (PRP) treatment on recovery in acute hamstring injuries is controversial. Previous study results are inconsistent, and a standardized therapeutic approach has not been established yet. PURPOSE: To assess the treatment effect using a combination of hematoma aspiration and muscle strain PRP injection in partial hamstring muscle tears (grade 2 strains) in athletes. METHODS: Magnetic resonance imaging of athletes with grade 2 hamstring strains were reviewed from 2013 to 2018. From 2013 to 2015, athletes were treated conservatively, and from 2016 to 2018, with a combination of ultrasound-guided hematoma aspiration and PRP muscle strain injection. The outcome, including return-to-play (in days) and recurrence rate, was compared retrospectively between both groups (conservative vs aspiration/PRP) using ANOVA and Fisher's exact test. There was no significant difference in age, type of sport, and muscle involvement (including injury grade/location, hamstring muscle type, and length/cross-sectional area of the strain). RESULTS: Fifty-five athletes (28 treated conservatively, 27 with hematoma aspiration/PRP injection) were included. Average return-to-play time (mean) was 32.4 d in the conservative group and 23.5 d in the aspiration/PRP group (P < 0.001). Recurrence rate of the hamstring strain was 28.6% (8/28) in the conservative treatment group and less than 4% (1/27) in the aspiration/PRP group (P = 0.025). CONCLUSIONS: Athletes with grade 2 hamstring strains treated with a combination of hematoma aspiration and PRP injection had a significantly shorter return-to-play and a lower recurrence rate compared with athletes receiving conservative treatment.
Assuntos
Traumatismos em Atletas/terapia , Músculos Isquiossurais/lesões , Hematoma/terapia , Paracentese/métodos , Plasma Rico em Plaquetas , Volta ao Esporte , Adolescente , Adulto , Humanos , Estudos Retrospectivos , Adulto JovemRESUMO
Lower abdominal and groin injuries are among the most common causes of pain and lost playing time in sports. Perhaps the most important obstacle in understanding these injuries is the lack of consensus on nomenclature. There have been numerous advances in recent years in the understanding, prevention, diagnosis, and treatment of these injuries. The purpose of this review is to provide a general perspective on the current understanding of these injuries and a summary of recent advances.
Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Virilha/lesões , Músculo Esquelético/lesões , Tronco/lesões , Atletas , Traumatismos em Atletas/fisiopatologia , HumanosRESUMO
PURPOSE: The aim of this study was to determine an association between fall-related hip and/or pelvic fractures and gluteus medius and minimus atrophy. METHODS: Retrospective review of 64 patients with fall-related hip/pelvic fractures and 96 age- and sex-stratified controls was performed. Gluteus medius, gluteus minimus, tensor fascia lata, and iliopsoas atrophy was scored using a standard scale. Statistical analysis was performed. RESULTS: There is a significant difference (P < 0.0001) in gluteus medius and minimus atrophy in the fracture versus control groups. Presence of gluteus atrophy was predictive of fall-related fracture (odds ratio, 2.15; 95% confidence interval, 1.08-4.31). There is no significant difference in tensor fascia lata (P = 0.47) or iliopsoas (P = 0.15) atrophy between the 2 groups. Gluteus atrophy increased with age (r = 0.41, P < 0.0001). In unilateral fractures, there is a significant difference (P = 0.0002) in ipsilateral versus contralateral gluteus medius atrophy. CONCLUSIONS: Gluteus medius and minimus muscle atrophy is greater in fall-related hip/pelvic fractures, which may predispose the elderly to falls.
Assuntos
Acidentes por Quedas/estatística & dados numéricos , Fraturas do Quadril/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Atrofia Muscular/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Feminino , Quadril/diagnóstico por imagem , Fraturas do Quadril/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia Muscular/complicações , Pelve/lesões , Estudos RetrospectivosRESUMO
Magnetic resonance imaging (MRI) has become the standard of care imaging modality for a difficult, often misunderstood spectrum of musculoskeletal injury termed athletic pubalgia or core muscle injury. Armed with a dedicated noncontrast athletic pubalgia protocol and a late model phased array receiver coil, the musculoskeletal imager can play a great role in effective diagnosis and treatment planning for lesions, including osteitis pubis, midline pubic plate lesions, and rectus abdominis/adductor aponeurosis injury. Beyond these established patterns of MRI findings, there are many confounders and contributing pathologies about the pelvis in patients with activity related groin pain, including internal and periarticular derangements of the hip. The MRI is ideally suited to delineate the extent of expected injury and to identify the unexpected visceral and musculoskeletal lesions.