Bruce Reider

BACKGROUND: Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport- or setting-specific consensus statements on sports injury (and, eventually, illnesses) epidemiology to date. OBJECTIVE: To further strengthen consistency in data collection, injury definitions, and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. STUDY DESIGN: Consensus statement of the International Olympic Committee (IOC). METHODS: The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups, and a 3-day consensus meeting in October 2019. RESULTS: This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems, severity of health problems, capturing and reporting athlete exposure, expressing risk, burden of health problems, study population characteristics, and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). CONCLUSION: The IOC encourages ongoing in- and out-of-competition surveillance programs and studies to describe injury and illness trends and patterns, understand their causes, and develop measures to protect the health of the athlete. The implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.

Eighty patients with persistent clinical and functional instability of the knee due to anterior cruciate ligament insufficiency underwent the operation reported, in which one-third of the patellar ligament substitutes for the cruciate ligament and extraarticular tendon transfers, medial and lateral, augment the substitution. The patients were followed for a minimum of two years, and fifty returned for personal evaluation. The average follow-up was thirty-three months, with a range of two to five years. There were thirty-five male and fifteen female patients. The average age was twenty-three years. The average interval from initial injury to the index operation was two years. Meniscal tears and articular changes were noted in most of the patients. Forty-three (86 per cent) of the fifty patients had at least one torn meniscus, twenty-seven patients (54 per cent) had significant degenerative articular changes, and fourteen (28 per cent) had patellar articular changes. In the procedure described, eccentric placement of the tibial and femoral tunnels for more accurate placement of the patellar ligament substitute is essential. The over-all results were graded as excellent in thirty knees, good in seventeen, fair in one, and a failure in two. One knee that was classified as a failure showed excellent stability, but the patient had significant pain from chondromalacia of the patella, while significant pain and hyperesthesia from a neuroma was the reason for failure in the second patient.

Sixteen patients who had unilateral deficiency of the anterior cruciate ligament and ten healthy control subjects were analyzed during level walking, jogging, and ascending and descending stairs. Kinematic and kinetic findings for the right and left hips, knees, and ankles of all of the patients and control subjects were recorded during each activity. Substantial differences from normal function were observed for both limbs of the patients during level walking and during jogging. The magnitude of the maximum moment that tended to flex the knee was reduced the most (140 per cent) during level walking. It was reduced less (30 per cent) during jogging, it was not changed while the patient descended stairs, and it was slightly increased while he or she ascended stairs. The reduction in the magnitude of the flexion moment about the knee was interpreted as the patient's effort to reduce or avoid contraction of the quadriceps. Reduction of the flexion moment reduces any contraction of the quadriceps because there must be a mechanical balance between the external moment (due to body weight and the weight and inertia of the segment of the limb) that tends to flex the knee and an internal moment (generated by contraction of the quadriceps) that tends to extend the knee. This so-called quadriceps-avoidance gait was related to the angle of flexion of the knee when the maximum flexion moment occurred during each activity. This angle of flexion was 20 degrees during walking, 40 degrees during jogging, and approximately 60 degrees during stair-climbing.(ABSTRACT TRUNCATED AT 250 WORDS)

For the past five years we have attempted to correct knee instability due to rupture of the posterior cruciate ligament with a procedure that employs a free graft of one-third of the patellar tendon with its tibial and patellar attachments. This procedure was done for chronic instability in thirty-three patients and was combined with primary repair of an acute mid-substance tear of the posterior cruciate ligament in fifteen patients. Moderate to severe articular injury of the medial femoral condyle was found at operation in 48 per cent of the patients with chronic injury. Seventy-one per cent of the patients for whom the interval between injury and ligament reconstruction was two to four years, and 90 per cent of those for whom the interval was more than four years, showed articular injury of the medial femoral condyle. Only 31 per cent of the patients, however, had preoperative radiographic findings that indicated femoral articular damage. Twenty-three of the twenty-five patients with a minimum follow-up of two years returned for evaluation. All of the ten patients who had had a repair and reconstruction of an acute ligament injury (whose average follow-up was forty-one months) had a static and functional result that was graded as good or excellent. Of the thirteen patients for whom surgery was done for chronic instability (whose average follow-up was thirty-one months), the over-all static and functional result was graded as good or excellent in eleven. These results indicate that the use of one-third of the patellar tendon for reconstruction in patients with acute mid-substance tears as well as in patients with symptomatic chronic instability of the posterior cruciate ligament is an effective procedure for achieving static and functional stability of the knee.

Background: Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport- or setting-specific consensus statements on sports injury (and, eventually, illnesses) epidemiology to date. Objective: To further strengthen consistency in data collection, injury definitions, and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. Study Design: Consensus statement of the International Olympic Committee (IOC). Methods: The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups, and a 3-day consensus meeting in October 2019. Results: This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems, severity of health problems, capturing and reporting athlete exposure, expressing risk, burden of health problems, study population characteristics, and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE extension—the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). Conclusion: The IOC encourages ongoing in- and out-of-competition surveillance programs and studies to describe injury and illness trends and patterns, understand their causes, and develop measures to protect the health of the athlete. The implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.