Young Female Athletes Prone to Career-Ending Knee Injuries
Advancement in Knee Ligament Repair Technology Getting Injured Athletes Back in the Game
High school freshman Nina McDonald recalls simply running for the ball during middle school soccer practice when she felt a pop in her knee, followed by excruciating pain. As she fell to the ground, she remembers thinking she would never be able to play her favorite sport again.
Unfortunately, Nina’s story is familiar to thousands of young female athletes across the country who have torn their anterior cruciate ligaments (ACL). Nearly 400,000 ACL repair procedures are performed annually in the U.S.(1) Though ACL tears are more common in males, females are up to eight times more likely to tear the ligament.(2)
“Recently, there’s been an increase in young female athletes tearing their ACLs, which is the ligament responsible for knee stability and movements such as jumping, cutting and twisting,” explained Nina’s doctor, Tal David, MD, orthopedic sports medicine specialist, San Diego, CA. “This may be due to anatomic and muscular imbalance in females, coupled with increasing opportunity for young girls to play year-round, high level competitive sports such as soccer and volleyball.”
When an athlete tears his or her ACL, it can be potentially career-ending if not treated. However, a recent advancement in knee ligament repair technology is getting athletes back in the game.
Nina’s torn ACL was reconstructed using the AperFix® System, made by Cayenne Medical, a private sports medicine company in Scottsdale, AZ. AperFix is a stronger, less invasive reconstruction option for multiple types of knee ligament tears in males and females.
Traditional ACL surgery uses bone-patellar-bone grafts to reconstruct the torn ligament, which involves removing bone and tendon from the front of the patient’s knee. The AperFix System uses a shorter, stiffer soft tissue graft such as a hamstring tendon. During the procedure, AperFix is used to attach the newly reconstructed ACL at the aperture (opening) of the femoral and tibial tunnels drilled for ligament fixation. This special technique is meant to mimic the patient’s natural anatomy as closely as possible.
“The AperFix System uses a less invasive technique that offers less pain, a shorter recovery and increases knee stability for patients after surgery,” said Dr. David. “In fact, in conjunction with appropriate rehabilitation, some of my patients have been able to get back to their pre-injury level of play faster than I ever thought they could.”
Today, Nina is happy to be back playing soccer with her town club team, and plans to try out for her high school varsity team. When asked how her knee feels after surgery, Nina responded, “My knee feels really stable, and I can do everything I could do before I got the ACL surgery. Girls shouldn’t be afraid to have surgery because it can strengthen your knee. And in the end, you’ll be able to do all the sports that you love like I do.”
Study Examines Heat-Related Illness in High School Athletes
High school athletes are sidelined more than 9,000 days a year because of heat-related illnesses, according to a new CDC analysis.
The analysis, published in this week’s Morbidity and Mortality Weekly Report, looked at 2005-2009 data from the National High School Sports-Related Injury Surveillance Study. The data covered nine sports and estimated national numbers based on a sample of 100 high schools.
Football was the sport associated with the most heat related illnesses and August was the most common month for them to occur, according to CDC’s analysis. The report also found illnesses were most likely to occur during practice, not game time, and more likely to occur among overweight athletes.
The study looked at the incidence of “time-loss heat illness,” defined as illness where a player needed at least one day to recover and missed time on the game field.
Heat-related illnesses included heat cramps, heat exhaustion, and heat stroke — a medical emergency that in the absence of prompt intervention can lead to loss of consciousness, or more permanent serious medical conditions such as neurologic, cardiac, renal, gastrointestinal, hematologic, or muscle dysfunction and subsequently death.
Since 1995, 31 high school football players have died from heat stroke, according to the National Center for Catastrophic Sports Injury Research.
“One death due to heat-related illness is too many,” said Michael McGeehin, director of CDC’s Division of Environmental Hazards and Health Effects. “Heat related illness is preventable; the more we know about how and when it happens, the better we can prepare people who may be most at risk.” Read more
Back to School: Prepare for and Prevent Common Sports Injuries
Don’t overlook preventable, yet serious injuries such as skin infections
As athletes head back to school, many have already gone back to sports. That means an increased possibility of injuries due to heat exhaustion, being out of shape from summer break and being back in direct contact with other athletes.
More than 30 million athletes participate in sports each year in the United States with the most common types of sport-related injuries being sprains (mostly ankle), muscle strains, bone or growth plate injuries, repetitive motion injuries, and heat-related illness.(1) However, according to the National High School Sports-Related Injury Surveillance Study, skin infections also are a top injury for certain sports(2) and a recent review of infectious disease outbreaks found that skin diseases accounted for more than 50 percent of all infectious diseases in competitive sports.(3)
Concussions, fractures and sprains typically occur at full speed and often a fraction of an inch can separate a good move from a severe injury. There are steps that can be taken to help minimize the chance of injury, such as assuring proper protective equipment is used at all times.
Yet, skin infections such as Methicillin-resistant Staphylococcus aureus (MRSA) are preventable if athletes, coaches and parents are educated and execute a plan for prevention. In July, the National Athletic Trainers’ Association (NATA) issued a new position statement on Preventing Skin Diseases in Athletics in order to raise awareness about how to prevent skin infections in sports. Read more
Sleep Apnea Therapy improves golf game
Men Find New Motivation for Using CPAP
Golfers who undergo treatment for sleep apnea may improve their golf game as well as their overall health, shows new research. A new study presented at CHEST 2009, the 75th annual international scientific assembly of the American College of Chest Physicians (ACCP), found that golfers with obstructive sleep apnea (OSA) who received nasal positive airway pressure (NPAP) for their disorder improved their daytime sleepiness scores and lowered their golf handicap by as much as three strokes. Researchers suggest that the possibility of improving your golf game may be a significant motivator to improve NPAP compliance rates among golfers.
“More so than many sports, golf has a strong intellectual component, with on-course strategizing, focus, and endurance being integral components to achieving good play,” said Marc L. Benton, MD, FCCP, Atlantic Sleep and Pulmonary Associates, Madison, NJ. “OSAS can lead to daytime sleepiness, fatigue, and cognitive impairment, all side effects which can negatively impact a person’s ability to golf to the best of one’s ability.”
Dr. Benton and colleague Neil S. Friedman, RN, RPSGT, from Morristown Memorial Hospital, Madison, NJ, evaluated the impact of NPAP on the golf handicap index (HI) of 12 golfers with diagnosed moderate to severe OSA. HI was recorded upon study entry, as was the Epworth sleepiness scale (ESS), a validated questionnaire used to assess daytime sleepiness, and a sleep questionnaire (SQ) developed by the authors. After 20 rounds of golf while receiving NPAP treatment (approximately 3 to 5 months), the treatment group demonstrated a significant drop in average HI, 12.4 (+/- 3.5) to 11.0 (+/- 4.7). Patients in the study group also improved their ESS score, 11.8 (+/- 6.6) to 5.5 (+/- 3.6), and the SQ score, 14.3 (+/- 7.5), to 3.1 (+/- 3.1). A control group of 12 subjects demonstrated no change in HI, ESS score, or SQ score during this study.
“As any golfer knows, when your ability to think clearly or make good decisions is compromised, the likelihood of playing your best is greatly diminished,” said Dr. Benton. “Through treatment with NPAP, we can improve many cognitive metrics, such as attention span, memory, decision-making abilities, and frustration management, which may, in turn, positively affect a person’s golf game.”
Results of the study also showed that the best golfers, defined as HI <12, had the biggest improvements in their game. Within this group, the average HI dropped from 9.2 (+/- 2.9) to 6.3 (+/- 3.0); the SQ score from 10.8 (+/- 1.9), to 2.8 (+/- 2.6).
“The biggest handicap improvements occurred in the lower handicap, often older golfers. This group typically would be expected to trend in the opposite direction due to age-related deterioration in strength and endurance,” said Mr. Friedman. “The drop in handicap among the better golfers probably reflected that the major limiting factor was not golf skill but cognitive compromise that improved when the sleep apnea was treated.”
Dr. Benton estimates that there are 1 to 3 million regular golfers (regular defined as 10 or more rounds per year) who have OSA, and most are undiagnosed or untreated. However, even when proper treatment is offered, it is only effective if it is used regularly. In men, studies have reported compliance rates as low as 40 percent. Patients cite many reasons for noncompliance with NPAP, including discomfort, inconvenience, cost, noise, or embarrassment. In the current study, nearly all patients in the treatment group had a compliance rate of above 90 percent.
“Providers typically attempt to maximize compliance with NPAP by promoting its medical benefits or warning patients of the risks involved in not being treated, but this approach does not always work,” said Dr. Benton. “In the case of this study, the possibility of improving one’s ability to play golf appears to have been a significant motivation to improve treatment compliance.”
“Compliance with CPAP therapy is an ongoing issue in the treatment of patients with sleep apnea,” said Kalpalatha Guntupalli, MD, FCCP, President of the American College of Chest Physicians. “Finding new and more effective ways to increase CPAP compliance based on individual motivations is definitely encouraged.”
Source: American College of Chest Physicians
Rate of skin infections in high school and college athletes continues to grow
Athletic Trainers are Key to Prevention
A recent survey of nearly 650 athletic trainers across the U.S. revealed that in the past 12 months nearly 76 percent of the respondents’ athletic programs, mostly high school- and college-based, bacterial or viral skin infections have developed. This is up from 73 percent in 2008 and 67 percent in 2007.(1) (2) The good news – infection rates of Methicillin-resistant Staphylococcus aureus (MRSA), a type of staph infection that is resistant to many common antibiotics, stabilized at 49 percent, the same as reported in 2008. (2)
The survey, conducted every year since 2006 at the National Athletic Trainers’ Association (NATA) annual meeting, also showed a significant increase in athletic trainers’ roles in educating key groups including athletes (87 percent, up from 80 percent in 2008), coaches (80 percent, up from 62 percent in 2008) and athletes’ families (40 percent, up from 30 percent in 2008). This is important since these groups are often the “first responders” when it comes to early identification and treatment of a skin infection such as MRSA or sports-related injury.
“While we would like to see the estimated number of skin infections decrease, we are encouraged by the role athletic trainers increasingly play in educating and supporting athletes, coaches and families,” said Marjorie J. Albohm, MS, ATC, president of NATA. “MRSA continues to be an issue our members face on and off the field, but so are heat exhaustion, H1N1 and head concussions. Athletic Trainers deal with everything from cuts and sprains to potentially life threatening injuries on a daily basis.”
MRSA is usually spread from person-to-person through direct skin contact or contact with shared items or surfaces such as towels, used bandages, hot and cold tubs, or weight-training equipment that have come in contact with the bacteria. MRSA infections in the community are usually manifested as skin infections, such as pimples and boils that are red, swollen and painful. MRSA can be life threatening when it enters the body through scrapes and scratches, potentially leading to blood and joint infections, and pneumonia. As the number of cases of MRSA has increased in the community, so have contact sports-related infections. (cite)
To help prevent transmission of infections and illnesses such as MRSA, H1N1 or seasonal flu, it is often recommended that athletes wash with cleansers that contain 4 percent chlorhexidine gluconate (CHG). CHG bonds to the skin and continues to actively kill germs for up to six hours without leaving a residue. This offers protection between washings and during competition. CHG has been used in hospitals and operating rooms for decades to help prevent the spread of infection.
“Washing with a cleanser that contains CHG can be especially helpful in amateur sports, since many athletes at that level do not shower immediately before or after activities. By washing even just the hands and arms before an activity, the risk of infection can be dramatically reduced,” said Jack Doornbos, executive director, Molnlycke Health Care, the health care company that supported the survey.
In fact, last year the National Football League Players Association (NFLPA) noted that “the single most important thing for prevention is hand-washing with soap and water, or if MRSA is known to be present, with chlorhexidene (Hibiclens).(3)” Hibiclens® skin cleanser is one over-the-counter cleanser that contains 4 percent CHG and has been proven to kill germs on contact and bond with the skin to keep killing microorganisms for up to six hours without leaving a residue. The same cleanser with alcohol is available as a wipe called Hibistat® for on-the-go needs. Both are available at drug stores and pharmacies in the first aid section. For more information about CHG or to download free educational materials about MRSA and sports, visit hibiclens.com/athletes.html.
(1) Molnlycke Health Care, NATA survey of Athletic Trainers, June 2007.
(2) Molnlycke Health Care, NATA Survey of Athletic Trainers, June 2008.
(3) www.NFLplayers.com, “An Increasingly Common Bacterial Infection”, November 28, 2008, Dr. Thom Mayer.
Source: Molnlycke Health Care US, LLC