Experimental effects of exercise on memory function among mild cognitive impairment: systematic review and meta-analysis

Objective: The objective of this study was to evaluate the experimental effects of exercise on memory function among adults with mild cognitive impairment (MCI).

Methods: A systematic review and meta-analysis were employed. Studies were identified using electronic databases, including PubMed, PsychInfo, SPORTDiscus, and Google Scholar. To be eligible for inclusion, studies had to employ an experimental design, be conducted in humans (no animal models) with mild cognitive impairment, include an exercise intervention arm (either acute exercise or chronic training), and measure memory function (any type) as the outcome measure. Comprehensive Meta-Analysis software was used to compute the standardized mean difference effect size (Cohen’s d) and 95% CI using a random-effects model.

Results: In total, 11 studies met our criteria, contributing to 20 effect size estimates. Among the 20 effect size estimates, 13 contributed to a short-term memory recall, with 7 contributing to a delayed/long-term memory recall. The overall weighted mean effect size was d = 0.30 (95% CI: 0.16–0.44; P < 0.001), indicating a small to medium effect of exercise on improving memory function. For the moderation analysis, there was no evidence of a moderation effect for recall duration (Q = 0.004, df(1), P = 0.95), as exercise (vs. control) demonstrated both short-term (d = 0.31; 95% CI: 0.14–0.47; P < 0.001) and long-term memory (d = 0.29; 95% CI: 0.06–0.53; P = 0.013) benefits.

Conclusion: Current evidence suggests that exercise may help to improve memory function among those with MCI. Safe and progressive forms of exercise should be promoted among MCI patients.     

Passive stiffness of the hamstrings and the rectus femoris in persons after an ACL reconstruction

Objectives: The aim of the article is to investigate the passive stiffness (PS) of rectus femoris and hamstring muscles working for the knee joint in persons after anterior cruciate ligament (ACL) reconstruction surgery.

Methods: Thirty subjects (8 women and 22 men) aged 19–46 (x = 28.2 ± 7) participated in the investigation; an experimental group comprised 15 persons (4 women and 11 men) who underwent ACL reconstruction surgery. The other persons had no knee injury and described themselves as healthy. All the subjects underwent an investigation of the PS of the hamstrings and the rectus femoris on the injured as well as on the healthy leg.

Results: The data shows vital difference in the PS of the hamstring muscles between the healthy and injured limb (p < 0.05), a significant difference in the PS of the rectus femoris (p < 0.001) was noted. Furthermore, the PS level of the hamstring muscles of the operated limb in the experimental group is significantly different to the both legs in control group (p < 0.001).

Conclusions: Injury of the ACL results in a considerable increase in passive stiffness of the hamstring and rectus femoris muscles in both the injured leg and the healthy leg.     

Association between training volume and lower extremity overuse injuries in young female athletes: implications for early sports specialization

Background: Recent studies indicated greater risk of overuse injuries among young female athletes than their male counterparts. However, few studies have focused on female athletes and the effect of single-sport participation on lower extremity overuse injuries.

Objective: The objective of this study is to identify an independent risk variable for lower extremity overuse injuries based on status of sport participations (single- and multisports) in young female athletes.

Methods: In this cross-sectional study, 12–18-year-old female athletes were asked to complete electronic questionnaires describing their current sport participation and previous injury history. Range of motion (ROM), muscular strength, and performance parameters were measured at the time of completion of electronic questionnaires. Potential risk variables were compared between single- and multisport athletes and entered into a logistic regression model. Adjusted odds ratio (aOR), 95% confidence intervals (95% CIs), and p values were recorded to find an association with increased likelihood of lower extremity overuse injuries.

Results: The study cohort comprised 236 female young athletes (single-sport athletes: N = 60, multisport athletes: N = 176). A few variables including age, BMI, weekly hours of training for a sport, knee ROM, ankle ROM, and knee extensor strength were identified as potential risk variables. A logistic regression analysis showed an independent association between increased weekly hours of training for a sport and greater likelihood of histories of lower extremity overuse injuries (aOR = 1.091, 95% CIs: 1.007–1.183, p = .034).

Conclusion: Although status of single- or multisports participation was not a significant risk variable, increased training volume was found to be an independent contributing factor for greater likelihood of lower extremity overuse injury histories in 12–18 years female athletes. The current study identified that single-sport athletes trained nearly twice as many hours per week when compared to multisport athletes, which may explain an underlying mechanism of sports specialization.     

High prevalence of vitamin D insufficiency in professional handball athletes

Objectives: Vitamin D affects multiple body functions through the regulation of gene expression. In sports medicine, its influence on musculoskeletal health and performance is of particular interest. Vitamin D insufficiency might decrease athletic performance and increase the risk of musculoskeletal injuries. Several studies have demonstrated vitamin D deficiency in professional athletes; however, the prevalence of vitamin D insufficiency in professional handball players is yet unknown.

Methods: The study was planned as a prospective, non-interventional study. We examined 70 male elite handball athletes (first league) in a pre-competition medical assessment in July. Age, height, weight, body mass index, 25-OH vitamin D, calcium, and parathyroid hormone were evaluated, and a sun exposure score was calculated. Players were then divided into two groups of vitamin D levels: insufficient (<30 ng/mL) and sufficient (≥30 ng/mL).

Results: The mean 25-OH vitamin D level of the 70 players was 33.5 ± 10.9 ng/mL (median 32.2, IQR 26.5–38.9 ng/mL). Thirty-nine (55.7%) had sufficient and 31 (44.3%) insufficient levels. Athletes with sufficient vitamin D levels had significantly lower parathyroid hormone levels than athletes with insufficiency (24.9 ± 12.1 vs. 33.5 ± 15.1 ng/mL, p = 0.02). All other parameters evaluated demonstrated no significant difference between the two groups.

Conclusion: Vitamin D insufficiency is a common finding in professional handball athletes even in summer, which might negatively affect physical performance. Furthermore, it might lead to an increased risk of musculoskeletal injuries and infections. This should be evaluated in further studies.     

Isokinetic flexion strength recovery after ACL reconstruction: a comparison between all inside graft-link technique and full tibial tunnel technique

Introduction: Recently, a new minimally invasive single bundle technique for anatomic ACL reconstruction has been described, called the ‘All-Inside graft-link technique’. One of the advantages of this procedure is the reduced morbidity at the donor site as the graft choice is the quadrupled semitendinosus, thus sparing the gracilis tendon. The aim of this study was to evaluate isokinetic flexion strength recovery in patients who underwent a gracilis sparing technique compared to those with a full-tibial tunnel technique using a doubled gracilis and semitendinosus tendons (DGST) graft.

Methods: Patients were divided into two groups: Group A (22 patients) who underwent ACL reconstruction performed with an All-Inside graft-link technique; Group B (22 patients) who underwent ACL reconstruction with an Out-In technique and DGST graft. At a mean follow-up of 13 months, quadriceps and hamstring isokinetic peak torque deficits were recorded.

Results: In group A, the mean side to side peak torque flexion difference between the operated and non-operated limbs was ?3% and the mean torque at 30° was ?7.5% at high angular velocity (180°/sec); the mean peak flexion torque was 7.2% and the mean torque at 30° was 3.1% at low angular velocity (60°/sec).

In group B, the mean side to side peak flexion torque was ?3.5% and the mean torque at 30° was ?7.6% at high angular velocity (180°/sec); the mean peak flexion torque was ?7.2% and the mean torque at 30° was ?11% at low angular velocity (60°/sec).

A statistically significant difference was found between the two groups at lower angular velocity both for the mean peak flexion torque and the mean torque at 30° (p = 0.009), with better results in the study group.

Discussion/conclusion: Gracilis sparing technique is a minimally invasive technique for ACL reconstruction and yielded a significantly better flexion strength recovery at lower angular velocity compared to a full tibial tunnel technique with DGST for ACL reconstruction.     

Knee extensor and flexor strength before and after anterior cruciate ligament reconstruction in a large sample of patients: influence of graft type

Objective: Hamstring and patellar tendon autografts are the most frequently-used graft types for anterior cruciate ligament (ACL) reconstruction, with no consensus on their respective effects on thigh muscle strength. The objective of this study was to re-examine isokinetic knee extensor and flexor strength before and after ACL reconstruction with patellar and hamstring tendon grafts using a single-center and a relatively large database, where surgical, rehabilitation and testing procedures were strictly standardized for all patients.

Methods: A total of 464 patients with a unilateral ACL rupture underwent arthroscopic ACL reconstruction with either patellar or hamstring tendon grafts. Isokinetic concentric strength was evaluated prior to surgery and at 5- and 9-month postoperative follow-ups in different patient subgroups (n = 140, 464 and 215, respectively).

Results: Knee extensor strength was lower in patients operated with the patellar tendon graft at the 5-month (p < 0.05) but not at the 9-month follow-up. Knee flexor strength was lower in patients operated with the hamstring tendon graft at both postoperative time points (p < 0.05). The prevalence of quadriceps weakness was high (66–91%) in both patient groups at both follow-ups.

Conclusion: Overall, postoperative recovery of thigh muscle function seems to be better with the patellar than with the hamstring tendon graft due to the fact that both, knee extensor and flexor strength, were more impaired after ACL reconstruction with the hamstring tendon autograft.     

A randomized comparison of bone-cement K-wire fixation vs. plate fixation of shaft fractures of proximal phalanges

Background: The objective of this study (ClinicalTrials.gov ID: NCT03031015) is to compare the treatments of hand proximal phalanx shaft fractures with external-fixation technique using the combination of K-wires and bone-cement vs. open reduction and internal fixation technique using a miniature plate-and-screw system.

Methods: A total of 107 patients (134 cases) were randomly allocated to group A (67 cases in 56 patients) and B (64 cases in 51 patients). Fingers in group A were treated with bone-cement K-wire fixation, and fingers in group B were treated using a plate-and-screw system.

Results: Follow-ups lasted 2 years. In group A, active range of motion of proximal interphalangeal joint reached 93% ± 6.7% of the opposite fingers. In group B, the data reached 86% ± 14.4% of the opposite fingers. Based on total active motion scoring system, we obtained 21 excellent and 46 good results in group A; and 9 excellent, 50 good, and 5 fair results in group B. There was a significant difference with regards to the function of the fingers (p < 0.05).

Conclusions: The bone-cement K-wire fixation may be another option for the treatment of shaft fractures of proximal phalanges. The minimally invasive technique allows early joint motion, resulting in minimal complications and good functional recovery.     

Platelet rich plasma compared to dry needling in the treatment of non-insertional Achilles tendinopathy

Objectives: The efficacy of platelet rich plasma in the treatment of Achilles tendinopathy is controversial. Despite positive results observed in open studies, randomized controlled trials failed to show difference against saline or rehabilitation. Aims of this retrospective observational study were to compare the efficacy of platelet-rich plasma and dry needling and to assess possible differences age and sex-related.

Methods: Groups of 46 and 38 patients with non-insertional Achilles tendinopathy were treated with platelet-rich plasma and dry needling (once a week for 3 weeks), respectively. At baseline, 3 and 6 months, pain and function scores and the percentage of satisfactory outcomes were evaluated. Sub-group analyses were performed according to age and sex.

Results: At 3 and 6 months no differences in terms of pain and function between groups were observed, but the percentage of subjects reporting satisfactory results, at 6 months, was higher in platelet rich plasma group. Better results were observed in younger subjects, with a greater reduction of pain, improvement of function, and accordingly of the percentage of positive outcomes. A trend toward better results was also observed in males.

Conclusion: Beneficial effects of platelet rich plasma and dry needling in non-insertional Achilles tendinopathy have been observed only in some subjects, but not in others; platelet rich plasma shows a slight superiority against dry needling, mainly in younger persons; finally, a gender difference in the therapeutic response can be hypothesized.     

In situ use of the King-Devick eye tracking test and changes seen with sport-related concussion: saccadic and blinks counts

Objectives: Sport-related concussion (SRC) can result in impaired oculomotor function. Oculomotor performance, measured utilizing the King-Devick/Eye Tracking test (K-D/ET), is reported to be able to identify sub-optimal brain function. The objectives of the study were to determine the diagnostic accuracy of the K-D/ET in identifying SRC occurring from game participation and to perform a comparative analysis on saccade and blink counts for each K-D card individually and total counts between baseline and post-concussion.

Methods: Nineteen male Australian Football players were assessed on the K-D/ET test. Those suspected of having SRC secondary to a head impact were also tested.

Results: Participants recorded a slower time on the third (20.2 ± 4.6 s) screen when compared with the first (p = 0.0424) and second (p = 0.0150) screens. The number of blinks was higher on the third (2.9 ± 2.9) when compared with the second (p = 0.0057) screen. There was decrease of the K-D/ET total times between pre- and post-game (p = 0.1769). Participants who sustained a head impact recorded slower mean total K-D time (p = 0.7322), fewer mean total saccades (p = 0.0112), and more mean blinks (p = 0.8678) compared with their baseline scores. The assessment of blinks was the most sensitive measure for potential SRC (0.67). The K-D/ET duration was the most specific measure for potential SRC (0.88). An increase in the number of blinks had a fair specificity of 0.69.

Conclusion: The rapid number-naming component of the K-D test is an assessment tool which quantifies impairment to oculomotor function and has been validated as a diagnostic tool for SRC. The clinical usefulness of the eye tracking component of the K-D/ET test is that it may be an effective method to assess concussions with the eye tracking component serving as a measure of progression and return to play. However, more research is required at the adult and youth level.     

Accuracy of internet images of ligamentous knee injuries

Background: The internet is an easily accessible resource for both providers and patients. Despite this, the internet is not peer reviewed, leaving searches subject to inaccuracies, especially with regards to medical information. The purpose of this study was to review internet images of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) tears using two popular search engines: Google and Bing.

Methods: A search query was performed on both Google and Bing for the following terms: ‘ACL tear’, ‘PCL tear’, ‘MCL tear’ and ‘LCL tear’. The first 100 images of each individual search were analyzed by three independent orthopedists.

Results: The inter-rater reliability was very good for PCL tear on Bing (Cronbach’s alpha = 0.89) and excellent (Cronbach’s alpha > 0.9) for the remainder of the search queries. When comparing Google to Bing, the only significant difference occurred in the ACL group, with Bing returning a significantly greater number of correct images 60%, 95% CI: 53.2 – 66.7%) compared to Google (45% correct, 95% CI: 38.1–51.8%), p = 0.034. With regards to the other ligaments Bing was more accurate than Google for PCL (39% versus 38%), and LCL (32% to 30%). Both sites were 48% accurate for MCL tear.

Conclusion: Ultimately, our study revealed that physicians should take an active role in making high quality, easy to understand medical resources and anatomic diagrams available to their patients to avoid confusion and enhance understanding when querying the internet for additional information regarding their condition.     

Oral health among Dutch elite athletes prior to Rio 2016

Objectives: Elite athletes are at high risk for poor oral health. A screening program to assess oral health and create dental awareness can improve oral health among elite athletes but has not been performed in the Netherlands before. We summarize the first results from such a screening conducted in Dutch elite athletes of the Nederlands Olympisch Committee*Nederlandse Sport Federatie (NOC*NSF, Dutch Olympic Committee).

Methods: In this cross-sectional study, 800 Dutch athletes eligible for the Olympic and Paralympic Games in Rio de Janeiro 2016 were invited to a costless and voluntary oral examination. The decayed, missing, and filled teeth-index (DMFT), the basic erosive wear examination (BEWE) and the Dutch Periodontal Screening-index (DPSI) were used to evaluate athlete’s oral health. Information on sociodemographic variables and sport performance were collected in questionnaires.

Results: In total, 116 Dutch elite athletes were included in the study. The median (90%-range) DMFT-score was 3.0 (0.0–16.0), the median BEWE-score was 2.0 (0.0–10.0), and the mean± SD DPSI-score was 2.0 ± 0.73. Oral health-related quality of life was generally high, although only 28.2% of the athletes reported never having problems with their dentition or mouth. In 43% of the athlete’s clinical findings were reported which needed a direct referral to the general dentist.

Conclusion: Oral health in this subsample of Dutch elite athletes was surprisingly affected as almost half of them needed dental treatment. Further research is needed to allow conclusions about oral health in Dutch elite athletes more broadly. However, regular screening of oral health incorporated into the general preventive health care of elite athletes is necessary to ensure athletes are fully healthy during competitions like the Olympic and Paralympic Games.     

Changes in knee extensor strengths before and after medial patellofemoral ligament reconstruction

Objective: Quadriceps dysfunction has been suggested as a complication after medial patellofemoral ligament (MPFL) reconstruction. The purpose of this study was to investigate changes in knee extensor strength before and after MPFL reconstruction.

Methods: Twenty patients who underwent MPFL reconstruction for unilateral recurrent patellar dislocation (18 females and 2 males; mean age 20.8 ± 7.6 years) were examined. The peak isometric torque at 60° and 90° of knee flexion and isokinetic knee extensor strength at speeds of 60°/s and 90°/s in operated and non-operated legs were measured using a dynamometer preoperatively and 6 months, 1 year, and 2 years postoperatively. The following parameters were evaluated: (1) body weight-adjusted muscle strength, (2) improvement index (post-/preoperative value × 100) (%), and (3) extensor strength ratio (operated/non-operated value × 100) (%).

Results: The mean knee extensor strength in both operated and non-operated legs significantly increased 2 years after surgery compared with that before surgery. At 2 years postoperatively, the improvement indexes of the isometric knee extensor strength at 60° and 90° and of the isokinetic knee extensor strength at 60°/s and 90°/s were 237%, 192%, 318%, and 186%, respectively, in the operated legs and 144%, 124%, 140%, and 140%, respectively, in the non-operated legs. At 2 years postoperatively, the mean isometric knee extensor strength ratios at 60° and 90° and the isokinetic knee extensor strength ratios at 60°/s and 180°/s were 81%, 84%, 81%, and 82%, respectively.

Conclusions: Knee extensor strength was improved in most patients after MPFL reconstruction, at least compared with that before surgery, although an approximately 20% deficit against the non-operated legs remained even 2 years after surgery.     

Modifications of the Dmax method in comparison to the maximal lactate steady state in young male athletes

Objective: To investigate the influence of different approaches for first-rise determination on the accuracy of Dmax as an estimate of the maximal lactate steady state (MLSS).

Methods: Seventeen male cyclists and 18 male runners with different levels of endurance performance completed graded exercise tests either on a cycle ergometer or treadmill to determine Dmax, calculated by the final data point and five modifications of the first rise in blood lactate concentration. Two or more constant load tests over 30 min were performed to determine MLSS. Differences between the modifications of the first rise in blood lactate concentration as well as the corresponding Dmax variants and MLSS were tested, using one-way repeated measure ANOVA with Bonferroni post-hoc tests, and illustrated, using the Bland–Altman method. The absolute agreement was observed, using intra-class correlation coefficients, based on a single measure, absolute agreement, 2-way mixed effects model.

Results: The peak power output/running velocity of the groups averaged 275 ± 43 W and 4.3 ± 0.4 m · s^?1, respectively. The mean power output/running velocity at MLSS was 229 ± 38 W and 3.77 ± 0.38 m · s^?1. For both running and cycling the original Dmax described by Cheng et al. was significantly lower than MLSS (p < 0.01). All modifications showed good agreement with MLSS (ICC ≥0.75). According to the Bland–Altman method the mean differences of the modifications compared to MLSS in cycling ranged from ?7 (43) to 2 (41) W. In running the mean differences ranged from ?0.12 (0.34) to ?0.08 (0.35) m· s^?1.

Conclusion: We suggest using the first rise in blood lactate concentration for calculating Dmax instead of the first data point of a lactate curve as originally described. The approach of first rise determination has no substantial influence on the accuracy of Dmax compared to MLSS in cycling and running.     

Treatment of Bennett fractures with tension-band wiring through a small incision under loupes and a headlight

Purpose: The aim of the study was to present a novel treatment strategy for Bennett fractures using a tension-band wiring technique performed through a small incision with loupes and a headlight. Additionally, this study compared this technique with the conventional percutaneous pinning technique.

Methods: Between January 2014 and January 2017, the tension-band wiring technique was used in 37 patients with Bennett fractures (study group). The range of motion, pinch and grip strengths, and hand function were assessed at the final follow-up. A control group comprising 35 patients treated with the percutaneous pinning technique was included in the study for comparison. A p-value <0.05 was considered statistically significant. (Clinical Trial Registration number: ISRCTN64894535 at http://www.isrctn.com/ISRCTN64894535)

Results: No fixation failure or infection occurred in either group. Radiographic fracture healing was achieved in all cases. Follow-up lasted over 1 year. The mean Kapandji opposition score was 9.31 (range 8–10) points in the study group and 8.45 (range 7–10) points in the control group (p < 0.05). The mean Disabilities of the Arm, Shoulder, and Hand score was 1.06 (range 0–2) in the study group and 1.77 (range 0–3) in the control group (p < 0.05). The mean Smith and Cooney Score were 90 (range 80–100) in the study group and 85 (range 75–100) in the control group (p < 0.05).

Conclusions: The tension-band wiring technique using loupes and headlights enables reduction and fixation of Bennett fractures under direct visualization of the deep operative field. Restoration of thumb function using the tension-band wiring technique is significantly better than that observed with the conventional percutaneous pinning technique.     

A systematic review of injuries in gymnastics

Objectives: To identify all studies of gymnastics injuries and assess injury rates, types, locations, and causes.

Methods: Seven electronic and two grey literature databases were searched. Two reviewers independently assessed titles/abstracts, abstracted data, and calculated average rates weighted by study size.

Results: One study (n = 963) of three Olympic games (2008,2012,2016) provided injury rates for females of 86.4/1000gymnasts and males 79.9. For 29 databases one study of males (n = 64) provided a rate of 8.8 injuries/1000hours/AE (AE = athletic-exposure) and three of females varied rates (8.5, 9.4, and 91). Three studies for males (n = 153) provided a weighted average rate of 1.4 injuries/1000hours/training, and for females six studies (n = 476) 1.5 injuries. Four studies of males (n = 286) provided a weighted average of 678 injuries/1000gymnasts per year and eight studies of females (n = 1,764) a rate of 306. Of 19 surveys, eight provided rates for females (n = 1,463) of 596 injuries/gymnast per year and two for males (n = 40) a rate of 1,036. In the Olympics injuries were preponderately lower limb (63%) then trunk (23%) and upper limb (14%); injury type was sprains (35%) followed by tendinopathy/arthritis/impingements (17%), contusions (10%), and fractures (7%). Five database studies provided injury location data for 274 males: averages weighted by study size were upper extremity 42.8%, lower extremity 33.6%, torso/spine 11.8%, and head/neck 4.9% and 12 studies with 843 females provided average rates for lower extremity 51%, upper extremity 30.8%, torso/spine 13% and head/neck 0.8%. Official gymnastics organizations’ websites provide no readily available data about injury rates or methods of prevention.

Conclusions: Studies need to collect comprehensive data for injury rates by training/competitions, gender, age, injury location/type/cause. Studies could assess whether trainers and physiotherapists monitoring gymnasts closely for injury risk would reduce injuries. Studies including randomized controlled trials (RCTs) of interventions in training, videotaping and performance feedback to reduce injury rates would be helpful.     

Outcome of isolated posterior cruciate ligament reconstruction at mean 6.3-year follow up: a consecutive case series

Objectives: There is a paucity of reporting on surgical outcomes of isolated posterior cruciate ligament reconstruction (PCLR). We hypothesize that isolated PCL injuries failing nonoperative treatment achieve good outcomes and are able to return to sport following PCLR.

Methods: A retrospective analysis was performed to identify patients with isolated PCL injuries that underwent reconstruction between 2001 and 2014. Patients with multi-ligamentous injury or another concomitant knee pathology were excluded. Medical records were reviewed for demographic, clinical and operative data. Patients were contacted for administration of a telephone-based questionnaire which included the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation form, Lysholm-Tegner scales, Marx activity scale (MAS), return to sport status, and patient satisfaction instruments.

Results: A total of 15 isolated PCL reconstructions in 14 patients with a mean age of 27.5 years (range 17–43) met the study inclusion criteria; mean follow up was 6.3 years (range 1.4–15.2). Pre-operatively, the primary complaint was knee instability in all patients; on physical examination, lack of a firm end point during posterior drawer testing was found in 93% (14/15) of the knees. In total, 12 of 15 knees underwent transtibial, single-bundle PCLR and three of 15 underwent tibial inlay, double bundle PCLR. Graft types included: quadriceps autograft (7/15), Achilles allograft (6/15), and hamstring autograft (2/15). There were no graft failures in our patient cohort. At most recent follow up the mean scores respectively on the IKDC form, Lysholm-Tegner scales and MAS were (standard deviation): 77.3 (16.5), 83.1 (17.9), 6.13 (2.6), and 7.1 (6.0). All fourteen patients were athletes prior to their injury and 79% (11/14) returned to sport and overall patient satisfaction was 9.2/10.

Conclusions: Isolated PCLR provides good outcomes at mean medium-term follow up with restoration of function, high rate of return to sport and overall patient satisfaction.     

Musculoskeletal and head injuries in the Ultimate Fighting Championship (UFC)

Objectives: Mixed martial arts (MMA) has witnessed a surge in popularity worldwide. This study explores the musculoskeletal and head injuries sustained in the professional fights of the Ultimate Fighting Championship (UFC), and establishes associations between injury profiles and impactful contributory factors.

Methods: The Nevada State Athletic Commission database was screened for ringside physician reports of UFC fights between January 2016 and July 2018. Information on the fighter’s gender, weight, injury, way of finish, and match result were collected. Injury rates were calculated and statistical analyses were conducted to determine significant associations among variables. P-values <0.05 were considered significant (95% CI).

Results: A total of 291 injuries were recorded in 285 fights from nine weight divisions. The overall injury rate was 51 per 100 athletic exposures (AE). Males predominantly partook in 249 matches (87%) and had higher injury rates (54 injuries per 100 AE) than females (30 injuries per 100 AE). Decision was the most common way a match ended. Knockouts (KOs) were significantly higher in males (36%) than in females (14%, P = 0.0007). Submissions were significantly higher in females (36%) than in males (16%, P = 0.001). Head injuries (67%) were the most common injuries reported with a rate of 34 per 100 AE. Upper limb injuries were significantly higher in females (40%) than in males (14%, P = 0.0003). Lower limb injuries were significantly higher in males (19%) than in females (5%, P = 0.01). Head injuries were significantly associated with KOs (P < 0.0001). Upper limb injuries (P = 0.032) and lower limb injuries (P = 0.034) were significantly associated with matches that ended with Decision. Trend-line analyses showed that as weight division increases, overall injury rates, head injuries, lower limb injuries, and KOs’ frequency increase, whereas upper limb injuries, Submission frequency, and Decision frequency decrease.

Conclusion: MMA has a high injury rate. Gender, way of finish, and weight play an important role in predicting fight outcomes and injury profiles. Injury prevention policies must be entertained to limit injury risk in MMA.