Sports Medicine Feature

The sample was small but the results of the study encouraging to sufferers with knee pain. Participants in a study of 30 patients who received a series of three weekly injections of autologous conditioned plasma (ACP) experienced a 78% improvement in their knee pain at 12 months. Patients in the control group, who were injected with a saline solution, experienced a 7% improvement. The study, reported on by Pam Harrison, a contributing writer for MedPage Today, was conducted by the Columbia Orthopaedic Group of Columbia, Missouri.

"The primary objective of the current study was to determine the safety of ACP, and the secondary objective was to determine the efficacy of ACP in patients with primary osteoarthritis of the knee, ” Patrick A. Smith, M.D., wrote in the American Journal of Sports Medicine in a report on the study.

He said, "The results confirmed the study's hypothesis that no differences were present for outcomes related to patient safety, while significant improvements related to efficacy between ACP and placebo groups were present throughout the study duration."

According to Harrison, the study was sanctioned by the Food and Drug Administration (FDA) and was the first trial specifically to assess the safety and efficacy of intra-articular, platelet-rich plasma (PRP) injections for the treatment of knee OA.

Researchers assigned all of the patient–participants to three treatment visits, one week apart, followed by three follow-up visits. The last follow-up visit took place 12 months after the participants received their first injection.

The investigational group received three intra-articular injections of ACP at 1-week intervals, while the control group received three intra-articular injections of saline on the same schedule.

The test used to measure the participants’ response was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Smith reported that, "The lower overall WOMAC scores for the ACP group were statistically different from the WOMAC scores for the placebo group starting at 2 weeks. And a statistically significant decrease in WOMAC scores when compared with baseline was seen in the ACP group starting at 1 week. The decrease remained statistically significant throughout the study duration."

Often times in sports medicine, athletes see surgical repair of their injury as the quickest and most effective way to get them back in the game, and while that is often true, a recent study by Houston Methodist Orthopedics and Sports Medicine suggests that even after surgical repair some athletes still play fewer games and have shorter career spans.

In “Performance and Return to Sport After Forearm Fracture Open Reduction and Internal Fixation in National Football League Players” published in the August 2017 issue of HAND, Joshua D. Harris, M.D., a Houston Methodist Orthopedics surgeon and colleagues investigated how well open reduction and internal fixation (ORIF) of a forearm fracture sped up recovery and decreased missed games in the National Football League (NFL).

The researchers compared NFL players who underwent ORIF of a forearm fracture while in the NFL to matched controls. Thirty-six surgeries were analyzed and out of them 92% of the players were able to return to the NFL and most did so within approximately five months of their surgery. However, although they returned at their preoperative performance level and played similarly to the control group, ultimately the controls had a longer NFL career (p < .001) and played in more games per season (p = .026) than players who underwent surgery. In addition, there was a decrease (p =.013) in games/season for defensive backs following surgery.

Harris told OTW that “the cases and controls in the study were matched by position, age, years of experience in NFL, and performance data prior to the surgery date in order eliminate confounding variables. This left the forearm fracture as the only variable to account for the shorter career and fewer games.”

“This is likely secondary to the need for high speed and high impact use of the arms in tackling,” he added.

Harris said that this however doesn’t mean that another treatment would necessarily offer better results. Previous studies have shown that surgical fixation of forearm fractures leads to faster recovery and decreased games missed for elite athletes.

In two new studies evaluating clavicle fracture treatments in National Football League (NFL) players, researchers at Houston Methodist Orthopedic and Sports Medicine in Texas found that treatment decisions are multifactorial and that it is important for physicians to educate patients on the risks and benefits of all treatment options.

In “Performance and Return-to-Sport After Clavicle Open Reduction and International Fixation in National Football League Players” published in the August issue of the Orthopaedic Journal of Sports Medicine, Joshua D. Harris, M.D., an orthopedic surgeon with Houston Methodist, and his team determined return-to-sport (RTS) rates in National Football League players after clavicle fracture open reduction and international fixation (ORIF), postoperative career length and games per season, pre- and postoperative performance and compared them to control players.

According to the data, 16 players with 17 surgeries were analyzed. Fifteen players (94.1%) returned to sport in the NFL at a mean 211.3 ± 144.7 days post-surgery. 7 or 44% returned within the same season. The overall rate for remaining in the NFL one year after surgery was 88.2%.

The researchers concluded that “there is a high rate of RTS in the NFL after clavicle fracture ORIF. Players who underwent clavicle fracture ORIF played in a similar number of games per season and had similar career lengths in the NFL as controls.”

They added, “Quarterbacks and running backs had significantly worse postoperative performance scores when compared with postindex matched controls.”

In “Performance and Return-to-Sport After Nonoperative Treatment of Clavicle Fractures in National Football League Players” published in the August 2017 issue of Orthopedics, Harris and his colleagues were looking instead at the return-to-sport rate of NFL players after nonoperative treatment of clavicle fractures. They also looked at posttreatment career length and games per season, pre-and posttreatment performance and posttreatment performance compared with control players.

Of the 30 players analyzed, 96.9% were able to return to sport as a mean of 244.4 ± 119.6 days. Eight of the players were able to return to the game the same season as their injury. The researchers found that while the players with nonoperative treatment have similar career length to controls (p > .05), wide receivers played fewer games per season (p = .043).

Coracoid fractures, fractures of the coracoid bone that connects the cranial edge of the sternum to the shoulder joint complex, are rare in a sports setting, but when they do happen it is usually due to trauma and in the presence of an associated acromioclavicular (AC) Joint injury in the shoulder complex, according to a new study, “Prevalence and Management of Coracoid Fracture Sustained During Sporting Activities and Time to Return to Sport: A Systematic Review,” published in the March 2018 issue of the American Journal of Sports Medicine.

The researchers conducted a systematic review of studies published between January 1970 and April 2017 to identify coracoid fractures sustained during sporting activities and to determine prevalence of these fractures, types of treatment and return to sport rate.

According to the data, 21 cases of coracoid fractures occurred during this time period. Acute trauma was responsible for 71% (n = 15/21) of the fractures. The rest were secondary to fatigue fractures. In addition, in 60% of the athletes who sustained acute trauma, AC joint injury was also present. Athletes who experienced fatigue fractures however didn’t have concurrent AC joint injury.

When it comes to treatment, 76% (n=16/21) of the patients were able to be treated nonoperatively and only 3 of the 16 reported having complications. The mean overall time to return to sport was 2.8±2.0 months, with no differences between those who had traumatic or fatigue fractures or between those with or without AC joint injury. Types of treatment didn’t seem to influence return to sport rate either.

The researchers wrote, “Coracoid fractures secondary to sporting activities are rare, occurring primarily from direct trauma with associated AC joint injury, and are treated successfully with nonoperative management.”

Researchers from Duke University and the University of Rochester have made progress in determining what is going on with patients who have intra-articular fractures and—even after anatomic fracture reduction—develop ankle arthritis.

Twenty-one patients with an intra-articular ankle fracture were included in this study. The research team set out to characterize the inflammatory cytokine and matrix metalloproteinase (MMP) composition in the synovial fluid of patients with these fractures.

Samuel Adams, M.D. is assistant professor of Orthopaedic Surgery and director of Foot and Ankle Research at Duke University Medical Center. He told OTW, “This work was performed because despite excellent reduction of ankle fractures, a large majority of intra-articular fractures develop ankle arthritis. Therefore, there must be other forces at play. This study demonstrated that at the time of injury there is a large pro-inflammatory response in the ankle joint. While this study does not correlate this inflammatory response to ankle arthritis, we hypothesize that this initial inflammation can initiate an inflammatory cascade of cartilage damage and synovitis. Most readers may question the fact that ‘inflammation’ is the first step in healing of all tissues. This is true, but one must remember that the inflammation healing response is intended for the fractured bone and not the healthy cartilage and synovium in the ankle joint that is in direct communication with the fracture healing. I recommend a thorough irrigation of the joint at the time of fracture fixation or a needle or arthroscopic lavage at the time of external fixation to reduce the inflammatory burden.”