Gestion de la douleur chez les athlètes de haut niveau : synthèse ReFORM de la position de consensus du CIO
Link to the article P.M. Tscholl, B. Forthomme, J. Cabri, S. Le Garrec, J.-F. Kaux, P. Edouarda, A. Bourgeois, R. Seil, G. Martens Introduction La déclaration de consensus du CIO sur la gestion de la douleur chez les athlètes de haut niveau émet des recommandations visant à harmoniser les pratiques et à promouvoir une approche multimodale de cette problématique. L’utilisation importante d’antalgiques et d’anti-inflammatoires lors de compétitions de haut niveau montre combien la douleur est un aspect important de la vie des sportif.ve.s. Plusieurs sondages auprès des médecins du sport en charge d’athlètes de haut niveau ont montré que ces médicaments ne sont pas uniquement prescrits pour traiter la blessure et diminuer la douleur ressentie, mais également pour poursuivre la pratique sportive, voire même prévenir des douleurs qui pourraient survenir à l’effort. La bonne gestion de la douleur chez l’athlète de haut niveau reste un champ hautement complexe, nécessitant des notions tant pharmacologiques que cliniques. Une approche multidisciplinaire somatique est nécessaire dans les douleurs chroniques, accompagnée d’une prise en charge biopsychosociale, tout en appliquant les conventions et les règles de bonnes pratiques et de lutte contre le dopage pour maintenir la santé physique et mentale de l’athlète. Faire le bon diagnostic pour choisir le bon traitement L’origine de la douleur, son historique, les facteurs impliqués, représentent la base pour la compréhension et le choix du traitement. Une douleur aiguë post-traumatique ne peut pas être comparée à une douleur chronique, ni à une douleur récurrente ou de type surcharge (Tableau I). L’information douloureuse peut parvenir des tissus endommagés ou d’une inflammation, souvent concomitante en post-traumatique (douleur nociceptive ou inflammatoire), du nerf lui-même (douleur neuropathique lors d’une Stratégies de prise en charge de la douleur. Les options non-pharmacologiques ou non-médicamenteuses sont à envisager en première intention ; elles prennent en compte les facteurs neurobiologiques, psychologiques et cognitifs, contextuels et environnementaux. L’éducation du patient joue un rôle primordial, non seulement pour la compréhension de l’origine multifactorielle de la douleur mais aussi pour optimiser la compliance au traitement. Les différentes modalités thérapeutiques, actives ou passives, s’envisagent de manière individuelle Monitorer l’efficacité du traitement choisi L’objectif du traitement vise à ramener l’athlète à son meilleur niveau de performance, sans douleur et en évitant la récidive. Le/la sportif.ve doit comprendre que l’efficacité thérapeutique n’est pas toujours corrélée avec la guérison tissulaire et ne dépend pas uniquement de l’entrée nociceptive. La communication des objectifs et des différentes étapes de la prise en charge ainsi que la responsabilisation de l’athlète dans ce processus restent essentielles pour maintenir sa confiance et sa Situation particulière Les parathlètes constituent un groupe particulier dans la prise en charge de la douleur. En effet, ils présentent régulièrement des douleurs fantômes ou localisées sur un moignon, parfois de la spasticité ou encore des douleurs en lien avec leur déficience spécifique. Une approche spécialisée s’avère essentielle pour traiter des douleurs chroniques et/ou neuropathiques dans ce contexte. Questions éthiques et culturelles La perception de la douleur ainsi que sa verbalisation peuvent changer en fonction de l’origine de l’athlète, du type de sport pratiqué mais aussi du sexe. Le choix libre et volontaire du/de la sportif.ve de participer à une activité physique « malgré la douleur » ne semble pas toujours évident. Le corps médical se doit d’appliquer le code médical du CIO, insistant sur le fait que « la santé et le bien-être des athlètes sont prioritaires et l’emportent sur les aspects compétitifs, économiques,...
WE ARE MOVING!
Our Human Motion Lab is moving to brand new facilities. The new lab will be open for both patients and athletes and we will be able to assess not only running kinematics on the treadmill but also overground walking kinetics and much more. We foresee opening our lab in September 2022. The support of the Fondation André Losch is greatly appreciated. Stay tuned! Your LIROMS team
Way for improvement: Primary survey on concussion knowledge of sports stakeholders in three European countries
Link to the article A.Thibaut, J.-F.Kaux, G.Marten, A.Urhausen, P.Tscholl, D.Hannouche, S.Le Garrec, M.Crema, L.Winkler, J.Cabri, S.Leclerc Objective. Evaluate knowledge on concussion management in three countries participating to the ReFORM group. Methods. In this cross-sectional survey, the target population consisted of eighty-five participants of an educational conference on concussion's management given in Switzerland, Luxembourg and Belgium in September 2019. Thirty-eight participants responded an online anonymous survey out of 85 (45%). They answered to 22 multiple choice questions regarding their knowledge on concussion diagnosis, management and treatment prior the conference. Two were excluded (not working in sport nor healthcare professionals). Participants were medical doctors (28%), healthcare professionals (41.5%), coaches (14%), physical trainers (5.5%), or stakeholders from different positions in sport (11%). Numbers of years working in sport varied from 34% > 15 years, 41% for 5–15 years and 25% for 0–4 years. Level of sport involved included recreational, international and professional athletes. Results. In total, 50% of the participants were not aware of international guidelines for the management of concussions, 76% and 83% were not familiar with the stepwise “return to sport” and “return to learn” protocols, respectively. Ninety-two percent responded that an education program for athletes would be necessary. Important discrepancies were found on who is responsible for recognition and diagnostic of concussion (e.g., physician, physiotherapist or coach) and its assessment and management tools. Conclusion. This pilot survey highlights the lack of common knowledge about concussion diagnosis, management and treatment. A larger survey is underway to better identify specific needs of each country in the ReFORM group and offer adapted training programs.
L’instabilité controlatérale du bassin, le valgus du genou et l’hyperpronation du pied sont-ils des signes cliniques fréquemment observé chez les coureurs à pied blessés ?
Presentation on the Congrèss National de Médicine et traumatologie du sport Amandine Bodson, Jan Cabri, Roland Krecke, Paul Gette ABSTRACT Le nombre de coureurs augmente considérablement chaque année et, par conséquent, le nombre de blessures de surcharge. De précédentes recherches ont démontré que certains paramètres cinématiques peuvent être liés a ces blessures. Trois paramètres cinématiques peuvent engendrer ces lésions : l’instabilité controlatérale du bassin, le valgus du genou et l’hyperpronation du pied. Objectifs : Identifier si les trois variables cinématiques susmentionnées sont des signes cliniquement pertinents d'une éventuelle blessure. Vérifier si on observe des différences dans la cinématique entre les membres inférieurs. Enfin, analyser s'il existe une corrélation entre la localisation de la lésion et les trois paramètres cinématiques pour les jambes blessées des coureurs. Des analyses biomécaniques de la course sur tapis roulant ont été réalisées sur 50 coureurs blessés et 13 coureurs non blessés à l'aide d'un système d’analyse de mouvement tridimensionnel (9 caméras Miqus System, Qualisys AB, Gothenburg, Suède). Sept variables cinématiques, pendant la phase d'appui, ont été comparées entre les coureurs blessés et les coureurs sains tout en contrôlant leur vitesse de course. Afin d'éliminer la redondance et d'augmenter la puissance de notre modèle statistique, seules trois variables sont restées pertinentes : l'angle maximal d'ADD de la hanche, l'angle maximal d'ADD du genou et l'angle maximal d'éversion de l'arrière-pied. Résultats : La MANCOVA n'a révélé aucune différence significative entre les groupes de coureurs blessés et non blessés(p=0,164)pourlesvariablescontrôlantl’instabilitécontrolatéraledubassin,levalgusdugenouet l’hyperpronation du pied avec la vitesse comme covariable. Cependant, des différences significatives entre les participants masculins et féminins pour le pic d'ADD de la hanche (p=0.006) ont été trouvées. Les femmes démontrent une ADD de hanche plus importante que les hommes (moyenne= 16,9° ; SD 3,8 et 14° ; SD 4,0 respectivement). La vitessedecourseainfluencéplusieursvariablescinématiques,àsavoirl'ADDmaximaledelahanche(p=0,002)et l'éversion maximale de l'arrière-pied (p= < 0,001). Les résultats du test T de l'échantillon apparié ont révélé que les membres inférieurs de la population de coureurs blessés ne présentaient pas de différences significatives en ce qui concerne les angles du pic d'ADD de la hanche (p=0,372), du genou (p=0,343) et du pic d'éversion de l'arrière-pied (p=0,804) lors de la phase d’appui. Quant à l'analyse de régression logistique multiple, la relation entre l'ensemble des variablesetlalocalisationdelablessuren'amontréaucunerelationsignificativepourlepied(p=0,535),la jambe inférieure (p=0,017), le genou (p=0,465) ou la hanche (p=0,109). Conclusion : Les paramètres cinématiques de l’instabilité controlatérale du bassin, du valgus du genou et de l’hyperpronation du pied sont influencés par le type de population, la vitesse de course et la localisation de la blessure. Une sous-classification de la présentation cinématique de chaque blessure liée à la course à pied pourrait aider les cliniciens dans leur processus de raisonnement clinique et pourrait cibler la stratégie d'intervention.
Visit from Norwegian School of Sport Sciences
On the 25th of April 2022, we received a visit from three researchers of the Sports Medicine Department of the Norwegian School of Sport Sciences (NSSS): Caroline Kooy Tveiten, Marie Pedersen and Anouk Urhausen. All three are connected to the Oslo Sports Trauma Research Center and work in the field of ACL injuries. Meeting in the Sportfabrik (Differdange). Left to Right: Caroline Kooy Tveiten, Marie Pedersen and Anouk Urhausen
Luxembourg Academy of Sports Medicine, Physiotherapy & Science - Program
The program of the 2022 sports science lectures is online Link to the program
Dr Caroline MOUTON is the winner of the JEO Young Researcher Award in Clinical Science
The Jury of the JEO Award for Young Researcher in Clinical Science has selected Dr Caroline MOUTON as the winner of the JEO Award for Young Researcher in Clinical Science. https://jeo.esska.org LIROMS is very proud to work with Dr Caroline MOUTON as a scientific collaborator from CHL. Congratulations to her! Link to the article
Osteochondrosis dissecans of the knee joint in the athlete
Brockmeyer M., Nührenbörger C., Seil R., Madry H. Osteochondrosis dissecans am Kniegelenk beim Sportler. Arthroskopie (2022). https://doi.org/10.1007/s00142-022-00515-9 Link to the article Abstract The treatment of osteochondritis dissecans (OD) of the knee represents a not uncommon challenge in the clinical routine. This is especially the case for physically active patients, players in mass sports and competitive athletes as the long recovery times associated with the treatment of OD are often not compatible with the heightened expectations of young athletes. In such cases, the treatment of OD is normally stage adjusted. This requires a temporally adapted and individual treatment concept. Despite the existing treatment guidelines, the decision for conservative or surgical treatment is not infrequently complicated by the limited diagnostic accuracy of the imaging procedures. As the current scientific literature on the ability of patients to resume sporting activities after OD and the influence of the strain of the sport on the short-term and long-term outcomes after OD treatment is low, further high-quality clinical studies are needed.
The knee in elite level sports
Link to the article Magosch A., Mouton C., Seil R., Tischer T., Urhausen A.P., 17 January 2022 Arthroskopie - https://doi.org/10.1007/s00142-022-00517-7 The knee joint is one of the most frequently injured body regions in many sports. Particularly in elite sports, knee injuries are often severe injuries accounting for long periods of absence from several weeks to months and significantly influencing the athlete’s career. In addition to the acute injury the high risk of recurrent injuries and long-term effects as well as secondary injuries and a continuing high impact on the knee joint play an important role in elite sports. A better understanding of the injury circumstances and identification of risk factors are therefore crucial to improve primary prevention strategies. Furthermore, a comprehensive understanding of the structural damage occurring after an injury is also necessary to continually optimize therapeutic interventions. The rapid development of technology in recent years has considerably contributed to a better understanding of the total amount of knee injuries and their origin. Due to the rapid improvement of novel therapeutic and particularly surgical procedures, medicine is increasingly succeeding in helping elite athletes to regain their previous performance level even in the case of complex injuries; nevertheless, professional and elite athletes require individually adapted treatment options and rehabilitation measures in order to ensure a rapid return to sport.
COSL Medical Directors' Hearing
Link to the website LIROMS president Prof. Dr. Romain Seil was received by his Royal Highness the Grand Duke of Luxembourg. Photo © Maison du Grand-Duc / Kary Barthelmey
ReFORM webinar: Safesport 21/01/2022 - Luxembourg Academy of Sports Medicine, Physiotherapy & Science
If you missed the webinar from January 21st, you will find it here : https://www.youtube.com/watch?v=dzrv8SmbLJA https://reform-sportscimed.org/webinaire-reform-sur-la-prevention-des-abus-dans-le-sport/?bmid=8d7bc0ffd9b3&source_from=invitation
Five years-results of a nationwide database on sudden cardiac events in sports practice in Luxembourg
Link to the article Besenius E., Cabri J., Delagardelle C., Stammet P., Urhausen A. (2022). Five years-results of a nationwide database on sudden cardiac events in sports practice in Luxembourg. Dtsch Z Sportmed. 2022; 73: 24-29. doi:10.5960/dzsm.2021.505 The aim of this project was to create a national database to determine sports-related sudden cardiac event (SCE) burden in Luxembourg. Systematic data collection was carried out from 2015 until 2019 (5 years). Cases of SCE met the following criteria: (1) any major cardiac adverse event, (2) occurring during or until one hour after a sports activity (3) on national territory or outside Luxembourg by a Luxembourgish resident or sports license hol- der. The victim or family were contacted to inquire on the SCE by means of a standardized questionnaire. In total, 43 SCE cases were registered. The incidence was 2.6 cases/year/100000 physically active inhabitants. The 43 events occurred in 41 persons (40 males, 1 female), at an average age of 49.7 years. Seventeen events were fatal. The most concerned sports were cycling (17 cases), followed by football (5), and run- ning (4). Twenty-four victims suffered a sudden cardiac arrest, of which 16 received cardiopulmonary resuscitation (CPR). Eight (33%) of those survived. The survival rate was highest in patients receiving immediate CPR after SCE. The incidence of SCE related to sports in Luxembourg is rela- tively high and mainly affects middle-aged men during cycling. Bystander CPR significantly improves the chances of survival.
Exercise-Based Injury Prevention in High-Level and Professional Athletes: Narrative Review and Proposed Standard Operating Procedure for Future Lockdown-Like Contexts After COVID-19
Link to the article Martens G, Delvaux F, Forthomme B, Kaux J-F, Urhausen A, Bieuzen F, Leclerc S, Winkler L, Brocherie F, Nedelec M, Morales-Artacho AJ, Ruffault A, Macquet A-C, Guilhem G, Hannouche D, Tscholl PM, Seil R, Edouard P and Croisier J-L (2021) Exercise-Based Injury Prevention in High-Level and Professional Athletes: Narrative Review and Proposed Standard Operating Procedure for Future Lockdown-Like Contexts After COVID-19. Front. Sports Act. Living 3:745765. doi: 10.3389/fspor.2021.745765 Sports injury prevention has become an essential field of sports medicine and science. It aims at reducing the impact of injuries on sports participation and improving long-term health (Engebretsen and Bahr, 2005). Implementing exercise- based prevention programs has been shown to be efficient in reducing the occurrence of injuries (Lauersen et al., 2014) but is still poorly applied on the field (Bahr et al., 2015). The major COVID-19 pandemic might have further compromised this implementation by drastically restricting daily life and physical activities. As most communities are preparing to live with the SARS-CoV-2 virus for a long haul, and since successive lockdown-like situations are likely to happen in the future either from this virus, other pandemics or other similar contexts, there is a need to anticipate and establish future recommendations to help exercise-based prevention program implementation in field contexts. The aim of this work was therefore two-fold: (1) to review the current literature on the impact of COVID-19 on sports participation and identify potential gaps in terms of injury prevention and (2) to provide Standard Operating Procedure to promote and conduct exercise-based injury prevention in high-level or professional athletes under lockdown-like contexts, based on both the available literature and the international sports medicine and science experiences.
Relevance of Frequency-Domain Analyses to Relate Shoe Cushioning, Ground Impact Forces and Running Injury Risk: A Secondary Analysis of a Randomized Trial With 800+ Recreational Runners
Link to the article Malisoux L, Gette P, Backes A, Delattre N, Cabri J and Theisen D (2021) Relevance of Frequency-Domain Analyses to Relate Shoe Cushioning, Ground Impact Forces and Running Injury Risk: A Secondary Analysis of a Randomized Trial With 800+ Recreational Runners. Front. Sports Act. Living 3:744658. doi: 10.3389/fspor.2021.744658 Running is characterized by the repetition of many, almost identical movements with limited variations (Mann et al., 2015). During the stance phase of each step, a ground reaction force (GRF) is applied to the body. The shape of the vertical component of the GRF over time is approximately that of a mass-spring impact (McMahon and Cheng, 1990). In most runners, two distinct peaks are easily detectable on a plot of the vertical GRF vs. time (Malisoux et al., 2021). The first peak (Fz1, often termed vertical impact peak force) occurs within the first 50 ms after initial contact and is referred to as the impact peak, while the second peak (Fz2) occurring approximately at mid stance phase is referred to as the active peak. Fz1 originates from the rapid deceleration of the support leg segments at initial contact, although the magnitude of the peak mainly depends on the contribution of the rest of the body. Fz2 is associated with the active motion of the rest of the body when the center of mass reaches its minimum vertical position during the stance phase (Bobbert et al., 1991). While Fz1 may not always be visually detectable in time-domain plots in runners with specific foot strike patterns (i.e., mid-and forefoot strike), (Lieberman et al., 2010), some studies provided evidence of a vertical impact force in all strike patterns (Gruber et al., 2011, 2017). The cumulative load applied to the musculoskeletal system resulting from several thousand steps taken during each training session may lead to an overuse injury, especially if inadequate recovery is provided between stress applications (Hreljac, 2004). For decades, it has been assumed that some running-related injuries are typically associated with the landing phase (e.g., stress fracture, tendinopathy), because of the stress resulting from the collision between the body and the ground (Cavanagh and Lafortune, 1980; Bobbert et al., 1991; Wit et al., 1995). The main arguments are that forces observed during distance running are 1.5–2 times larger than those occurring in walking, a rapid increase in force immediately follows initial contact, and a runner covering 20 km per week will cumulate more than 10,000 impacts on each leg over a seven-day period. During the landing phase, eccentric contractions are observed in some of the muscles controlling the movement (e.g., ankle-dorsiflexors or plantar flexors depending on the foot strike pattern, quadriceps muscles), which may cause large forces and high internal mechanical stress (Bobbert et al., 1991). Large muscular forces may also cause high stress on the tendons and their bony attachments. Consequently, biomechanical factors related to vertical GRF have often been studied during running, with Fz1, Fz2 and loading rate being among the most investigated variables. Surprisingly, the current knowledge on the relationship between impact force characteristics, such as Fz1 or vertical instantaneous loading rate, and injury risk is still inconsistent (Nigg et al., 2015; Theisen et al., 2016; Ceyssens et al., 2019). This is mainly due to small sample sizes, as well as differences in the populations investigated and study designs in research conducted so far (Nigg et al., 2015; Theisen et al., 2016; Ceyssens et al., 2019). Grimston et al. (1991) already observed a greater Fz1 in female runners with a history of stress fracture compared to non-stress-fracture runners, although the question whether these greater forces are a cause or a consequence of having suffered a stress fracture could not be addressed with such a study design. 25 years later, a meta-analysis confirmed that loading rate was higher in runners with a history of stress fracture (van der Worp et al., 2016). A similar effect was found from the studies that included runners with all running-related injury types compared with those without injuries. However, these conclusions are mostly based on case-control designs. A prospective study investigated impact forces as a potential injury risk factor in female runners, but no difference was observed between injured and uninjured runners (Davis et al., 2016). Secondary analyses showed that Fz1 and loading rates were greater in runners with a medically diagnosed injury compared to those who had never reported any previous injury. However, these results were based on a limited sample size (n = 32), the analysis was retrospective in nature, and running exposure (i.e., distance or hours of practice) was not taken into account, which severely limits the conclusions that can be drawn. Another plausible explanation for the inconsistent evidence could be that the relationship between impact forces and injury risk, if it exists, is not linear, but U-shaped. In this case, risk factors should not be analyzed as continuous variables, as in most previous studies, but instead be categorized using certain cutoffs (Bahr and Holme, 2003), thus transforming a continuous variable into a categorical or grouping variable. According to this method, runners with values in the upper or lower range of a given variable would be compared to a reference group, e.g., those with values within one standard deviation (SD) around the mean of the entire cohort. Despite the absence of prospective evidence on the role of impact force in injury development, it has been suggested that paradigms leading to a decrease or elimination of impact forces, such as changes in strike pattern (Lieberman et al., 2010; Cheung and Davis, 2011; Daoud et al., 2012) or increased shoe cushioning (Richards et al., 2009) would reduce injury risk. For instance, a 2-week gait retraining program aiming at lowering loading rate was effective in reducing injury risk in novice runners (Chan et al., 2018a). The protective effect of greater shoe cushioning has also been recently demonstrated in a randomized trial including 800+ recreational runners (Malisoux et al., 2020), where the participants having received the Soft shoe version had a lower injury risk compared to those having received the Hard version (Sub hazard rate ratio–SHR = 1.52; 95% Confidence Interval−95% CI = 1.07 to 2.16; Soft shoe group is the reference), (Malisoux and Theisen, 2020). In the same trial (Malisoux et al., 2020), all runners were tested in the allocated study shoes at baseline on an instrumented treadmill. One of the main findings was the greater Fz1 observed in the Soft shoe version (Malisoux et al., 2021). This may appear counterintuitive with regards to the initial goal of the cushioning systems (i.e., lower Fz1), but the observation was consistent with previous studies (Baltich et al., 2015; Chan et al., 2018b; Kulmala et al., 2018). An explanation for this “impact peak anomaly” has previously been provided (Shorten and Mientjes, 2011). The vertical GRF signal is actually a superimposition of low frequency (non-impact) and high-frequency (impact) load components (Shorten and Mientjes, 2011). In other words, the true impact force that originates from the collision of the lower leg segment with the ground is superimposed to the active force which depends primarily on the rest of the body (Bobbert et al., 1991). A previous study showed that softer shoes tend not only to attenuate the magnitude of the high-frequency impact peak, but also to delay its occurrence (Shorten and Mientjes, 2011). Consequently, the higher Fz1 observed in shoes with greater cushioning results from the greater relative contribution of the low-frequency load component to Fz1. Furthermore, Fz1 and loading rate were shown to be poorly correlated with tibial load bone metrics computed using a rigid body model (Matijevich et al., 2019), which suggests that Fz1 and loading rate may be unreliable indicators of musculoskeletal loading. Thus, the magnitude of Fz1 is not an appropriate indicator of impact intensity and running shoe impact alteration (Shorten and Mientjes, 2011; Matijevich et al., 2019; Malisoux et al., 2021). The main purpose of this study was to investigate whether the protective effect of the Soft shoe version observed previously (Malisoux et al., 2020) could be explained by an alteration of decomposed impact force characteristics using frequency-domain analyses. Therefore, the first objective of the study was to investigate the effect of shoe cushioning on the time, magnitude and frequency characteristics of peak forces using frequency-domain analyses by comparing baseline data from the two study groups (i.e., participants who received the Hard and Soft shoe version, respectively). We hypothesized that the Soft shoe version would be associated with a lower impact peak force, a delayed occurrence, and a lower vertical loading rate of the high-frequency signal (Shorten and Mientjes, 2011). Consistently, we also hypothesized that frequency of peak signal power, mean frequency, as well as power sum of the high frequency signal would be lower with the Soft shoe version. However, we did not expect any difference between the experimental groups in the magnitude and timing of the peak force of the low frequency signal. Our secondary objective was to investigate which of these force characteristics measured at baseline are prospectively associated with the risk of incurring a running-related injury. We hypothesized that a lower impact peak force, a delayed occurrence, and a lower vertical loading rate of the high-frequency signal would be associated with lower injury risk. We also expected that lower frequency of peak signal power, mean frequency, as well as power sum of the high frequency signal would be associated with lower injury risk.
Round table: Nutritional impact on injury preventions and immune system
Video from the round table : Nutrional impact on injury preventions and immune system Speakers: T. Diderich, M. Jacobs, S. Rosquin (LIHPS, Luxembourg) Organised by the Luxembourgish Academy for Sports Medicine, Sports Physiotherapy and Sports Science
Training During the COVID‐19 Lockdown: Knowledge, Beliefs, and Practices of 12,526 Athletes from 142 Countries and Six Continents
Link to the article LIROMS is proud to announce the publication of a major study co-authored by Prof. Axel Urhausen. Washif, J.A., Farooq, A., Krug, I. et al. Training During the COVID-19 Lockdown: Knowledge, Beliefs, and Practices of 12,526 Athletes from 142 Countries and Six Continents. Sports Med (2021). https://doi.org/10.1007/s40279-021-01573-z Objective Our objective was to explore the training-related knowledge, beliefs, and practices of athletes and the influence of lockdowns in response to the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods Athletes (n = 12,526, comprising 13% world class, 21% international, 36% national, 24% state, and 6% recreational) completed an online survey that was available from 17 May to 5 July 2020 and explored their training behaviors (training knowledge, beliefs/attitudes, and practices), including specific questions on their training intensity, frequency, and session duration before and during lockdown (March–June 2020). Results Overall, 85% of athletes wanted to “maintain training,” and 79% disagreed with the statement that it is “okay to not train during lockdown,” with a greater prevalence for both in higher-level athletes. In total, 60% of athletes considered “coaching by correspondence (remote coaching)” to be sufficient (highest amongst world-class athletes). During lockdown, < 40% were able to maintain sport-specific training (e.g., long endurance [39%], interval training [35%], weightlifting [33%], plyometric exercise [30%]) at pre-lockdown levels (higher among world-class, international, and national athletes), with most (83%) training for “general fitness and health maintenance” during lockdown. Athletes trained alone (80%) and focused on bodyweight (65%) and cardiovascular (59%) exercise/training during lockdown. Compared with before lockdown, most athletes reported reduced training frequency (from between five and seven sessions per week to four or fewer), shorter training sessions (from ≥ 60 to < 60 min), and lower sport-specific intensity (~ 38% reduction), irrespective of athlete classification. Conclusions COVID-19-related lockdowns saw marked reductions in athletic training specificity, intensity, frequency, and duration, with notable within-sample differences (by athlete classification). Higher classification athletes had the strongest desire to “maintain” training and the greatest opposition to “not training” during lockdowns. These higher classification athletes retained training specificity to a greater degree than others, probably because of preferential access to limited training resources. More higher classification athletes considered “coaching by correspondence” as sufficient than did lower classification athletes. These lockdown-mediated changes in training were not conducive to maintenance or progression of athletes’ physical capacities and were also likely detrimental to athletes’ mental health. These data can be used by policy makers, athletes, and their multidisciplinary teams to modulate their practice, with a degree of individualization, in the current and continued pandemic-related scenario. Furthermore, the data may drive training-related educational resources for athletes and their multidisciplinary teams. Such upskilling would provide athletes with evidence to inform their training modifications in response to germane situations (e.g., COVID related, injury, and illness).
Sportmedica Congress 2021 - Welcome
New methods in sports risk assessment and performance analysis - 16th October 2021 The International Sportmedica Congress will be organised in its 7th edition on 16th October 2021 by the Luxembourg Societies for Sports Medicine (SLMS) and Sports Physiotherapy (SLKS) together with the Luxembourg Academy of Sports Medicine, Physiotherapy and Science and its partners. The venue will be the "d'Coque" in Luxembourg. Previous editions covered a broad variety of topics: 1996 La force musculaire2000 L'évolution de l'entrainement du sportif2004 La pratique sportive chez l'enfant2008 Optimisation de l'activité physique2013 Sports Medicine and Science in Prevention and Rehabilitation: New Standards for Luxembourg2016 Wettkampfmedizin - Medicine in competition In 2021 the congress theme will be “New methods in sports risk assessment and performance analysis" featuring 5 international speakers. The aim is to organise a practice-oriented congress, the target audience being trainers, coaches, medical staff members, athletes, and scientists in the field. The different topics that will be treated are biomechanics, injury prevention, performance, anti-doping, and monitoring. The Sportmedica Congress will provide ample occasion to summarize existing knowledge and stimulate discussions between different stakeholders. The congress was postponed from 2020 to the 16th of October 2021 in an effort to organise a fruitful congress, all while respecting the necessary precautions due to the ongoing pandemic situation. The congress will thus be held as Covid-Check event, where the entry is reserved exclusively for people who have been vaccinated, recovered, or tested negative (either by means of an on-site self-test or by means of a certified negative result: PCR in the last 72h or antigen test in the last 48h). www.sportmedica.lu
Sportmedica Congress 2021 - Presentation Dr. Prof. Christophe Ley
The use of artificial intelligence in sports medicine - quo vadis? - Christophe Ley, PhD, Prof - Dept. Mathematics @ Université de Luxembourg www.sportmedica.lu
Sportmedica Congress 2021 - Presentation Dr. Prof. Bernd Grimm
Wearable technology in sports and prevention – Bernd Grimm, PhD, Prof - Human Motion, Orthopaedics, Sports Medicine, Digital Methods @ Luxembourg Institute of Health www.sportmedica.lu
Sportmedica Congress 2021 - Presentation MD Detlef Thieme
Innovative research in antidoping - Detlef Thieme, MD - Institute of Doping Analysis and Sports Biochemistry, Dresden, Germany www.sportmedica.lu
Sportmedica Congress 2021 - Presentation Dr. Prof. Jan Cabri
Innovative movement analysis - Jan Cabri, PhD, Prof - Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science www.sportmedica.lu
Sportmedica Congress 2021 - Presentation Dr. Prof. Caroline Nicol
Running pattern dynamics in a simulated reduced gravity - Caroline Nicol, PhD, Prof - Institut des Sciences du Mouvement Etienne Jules Marey @ Aix-Marseille Université www.sportmedica.lu
Bulletin of the Luxembourg Society of Medical Sciences
Link to the Bulletin Article from Prof. Dr med Axel URHAUSEN " Return to sport after Covid-19" page 35 to 38
Does prevention pay off? Economic aspects of sports injury prevention: a systematic review
Link to the article Lutter C, Jacquet C, Verhagen E, Seil R, Tischer T. Does prevention pay off? Economic aspects of sports injury prevention: a systematic review. Br J Sports Med. 2021 Oct 1:bjsports-2021-104241. doi: 10.1136/bjsports-2021-104241. Objective: To identify, summarise and critically assess economic evaluation studies on sports injury prevention strategies. Design: Systematic review. Data sources: PubMed, SportDiscuss. Eligibility criteria for selecting studies: The current literature was searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Economic analyses published since 2010 were checked for inclusion. The methodological quality of the studies was assessed using the Oxford Level of Evidence for economic and decision analysis; underlying randomised controlled trials (RCTs) were rated according to the Physiotherapy Evidence Database (PEDro) Scale, and risk of bias was assessed using the Revised Cochrane risk-of-bias tool. Results: Ten studies fulfilled the inclusion criteria. The quality assessment revealed limited data quality. For trial-based analysis, underlying RCTs were of good quality and had a low risk of bias. Prevention concepts for general injury reduction showed effectiveness and cost savings. Regarding specific injury types, the analysis of the studies showed that the best data are available for ankle, hamstring and anterior cruciate ligament injuries. Measures using specific training interventions were the predominant form of prevention concepts; studies investigating these concepts showed cost-effectiveness with total cost savings between €24.82 and €462 per athlete. Conclusion: Injury prevention strategies that were studied are cost-effective. However, estimates and outcomes vary throughout the included studies, and precluded pooling of existing data. Knowledge about the cost-effectiveness of evaluated prevention measures will help improve the acceptance and application of prevention initiatives.
Congratulations to our President Prof. Dr. Romain Seil who was awarded honorary member of the French Academy of Surgery
Congratulations to our President Prof. Dr. Romain Seil who was awarded honorary member of the French Academy of Surgery by its President Prof. Henry Coudane from Nancy. The Academy has a long tradition and goes back to Louis the XIVth. Its goal is to display, recognize and promote excellence in surgery from France and related countries. It is a special honor to get this recognition for his clinical and scientific work from such a prestigious institution by one of Luxembourg’s big neighbour countries. This is of special value since such promotion of surgical science has no tradition in our small country.
VUB LUXEMBOURG CHAIR
LIROMS is very proud of its partnership with the Vrije Univesiteit Brussel (VUB) to create the Luxembourg Chair for Translational Research in Human Motion, Sports Injury Prevention and Health. link
Developing, Implementing, and Applying Novel Techniques During Systematic Reviews of Primary Space Medicine Data
Link to the article Winnard A, Caplan N, Bruce-Martin C, Swain P, Velho R, Meroni R, Wotring V, Damann V, Weber T, Evetts S, Laws J. Developing, Implementing, and Applying Novel Techniques During Systematic Reviews of Primary Space Medicine Data. Aerosp Med Hum Perform. 2021 Aug 1;92(8):681-688. doi: 10.3357/AMHP.5803.2021. PMID: 34503621. LIROMS supported a study aiming to identify new ways to review “space medicine” data done by the Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom; the Department of Physiotherapy, LUNEX International University of Health, Differdange, Luxembourg; Human Performance in Space, International Space University, Strasbourg, France; the Space Medicine Team, ESA HRE-OM, European Astronaut Centre (EAC) and KBR GmbH, Cologne, Germany; and Blue Abyss, Liverpool, United Kingdom. Abstract BACKGROUND: The Aerospace Medicine Systematic Review Group was set up in 2016 to facilitate high quality and transparent synthesis of primary data to enable evidence-based practice. The group identified many research methods specific to space medicine that need consideration for systematic review methods. The group has developed space medicine specific methods to address this and trialed usage of these methods across seven published systematic reviews. This paper outlines evolution of space medicine synthesis methods and discussion of their initial application. METHODS: Space medicine systematic review guidance has been developed for protocol planning, quantitative and qualitative synthesis, sourcing gray data, and assessing quality and transferability of space medicine human spaceflight simulation study environments. RESULTS: Decision algorithms for guidance and tool usage were created based on usage. Six reviews used quantitative methods in which no meta-analyses were possible due to lack of controlled trials or reporting issues. All reviews scored the quality and transferability of space simulation environments. One review was qualitative. Several research gaps were identified. CONCLUSION: Successful use of the developed methods demonstrates usability and initial validity. The current space medicine evidence base resulting in no meta-analyses being possible shows the need for standardized guidance on how to synthesize data in this field. It also provides evidence to call for increasing use of controlled trials, standardizing outcome measures, and improving minimum reporting standards. Space medicine is a unique field of medical research that requires specific systematic review methods.
Are contralateral pelvic drop, knee valgus and foot overpronation clinically relevant signs in injured runners?
Link to the presentation Amandine Bodson Biomechanics Master 2 - Université Claude Bernard Lyon 1Scientific Director: Prof Dr Jan Cabri (LIROMS)09-09-2021 Congratulations to Amandine Bodson who completed her Biomechanics Master's thesis. Amandine has performed an internship during 6 months at LIROMS. Background: The number of runners is increasing significantly each year and consequently also the number of overuse injuries. Previous research has demonstrated that kinematic parameters can be related to running injuries. Yet, we see three main kinematic parameters standing out from specific running related injuries: contralateral pelvic drop, knee valgus and foot overpronation. Objectives: To identify whether the three aforementioned kinematic variables are clinically relevant signs of possible structural injury. Secondly, to verify if differences in the kinematics between injured and non-injured legs are prevalent. Finally, to see if there is a correlation between the injury location and the three aforementioned kinematic parameters in the injured legs of runners tested.Design: Retrospective study Methods: Biomechanical treadmill running analyses were conducted on 50 injured and 13 non-injured runners using a 3-dimensional motion capture system (9 cameras Miqus System, Qualisys AB, Gothenburg, Sweden). Seven kinematic variables during the gait stance phase were compared between injured and healthy runners while controlling for speed. To eliminate redundancy and increase the power of our statistical model only three variables remained relevant: peak hip adduction angle, peak knee adduction angle and peak rearfoot eversion angle. Results: Results of the MANCOVA revealed no significant differences between the injured and non-injured runners' groups (p=0.164) for the variables controlling contralateral pelvic drop, knee valgus and foot overpronation with speed as covariate. However, significant differences between male and female participants for peak hip adduction (p=0.006) was found. Women demonstrate more hip adduction than men (mean=16.9°; SD 3.8 and 14°; SD 4.0 respectively). This difference can be explained by a larger pelvis width to femur length ratio in women than in men. In addition, running speed influenced several kinematic variables, i.e. peak hip adduction (p=0.002) and peak rearfoot eversion (p<0.001). A slower running speed was associated with reduced angle in peak hip adduction and peak rearfoot eversion The results of the paired sample T-test revealed that the injured and non-injured legs in the injured running population showed no significant differences with peak hip adduction (p=0.372), peak knee adduction (p=0.343) and peak rearfoot eversion (p=0.804) angles at mid-stance. As for the multiple logistic regression analysis, the relationship between the set of variables and injury location showed no significant relationship for foot (R2=0.043; p=0.535), lower leg (R2=0.190; p=0.017, knee (R2=0.038; p=0.465), or hip (R2=0.149; p=0.109). Conclusion: Contralateral pelvic drop, knee valgus and foot overpronation kinematic parameters are influenced by the population, running speed and injury location. For future research, a subclassification of the kinematic representation of each RRI could help clinician in their clinical reasoning process when evaluating runners and could target the intervention strategy development.
Side‐to‐side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL‐deficient knees
Link to the article Macchiarola L., Jacquet C., Dor J., Zaffagnini S., Mouton C., Seil R. Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees. Knee Surg Sports Traumatol Arthrosc. 2021 Aug 30. doi: 10.1007/s00167-021-06719-0. Epub ahead of print. PMID: 34459934. Abstract Purpose: To evaluate the influence of time from injury and meniscus tears on the side-to-side difference in anterior tibial translation (SSD-ATT) as measured on lateral monopodal weightbearing radiographs in both primary and secondary ACL deficiencies. Methods: Data from 69 patients (43 males/26 females, median age 27-percentile 25-75: 20-37), were retrospectively extracted from their medical records. All had a primary or secondary ACL deficiency as confirmed by MRI and clinical examination, with a bilateral weightbearing radiograph of the knees at 15°-20° flexion available. Meniscal status was assessed on MRI images by a radiologist and an independent orthopaedic surgeon. ATT and posterior tibial slope (PTS) were measured on the lateral monopodal weightbearing radiographs for both the affected and the contralateral healthy side. A paired t-test was used to compare affected/healthy knees. Independent t-tests were used to compare primary/secondary ACL deficiencies, time from injury (TFI) (≤ 4 years/ > 4 years) and meniscal versus no meniscal tear. Results: ATT of the affected side was significantly greater than the contralateral side (6.2 ± 4.4 mm vs 3.5 ± 2.8 mm; p < 0.01). There was moderate correlation between ATT and PTS in both the affected and healthy knees (r = 0.43, p < 0.01 and r = 0.41, p < 0.01). SSD-ATT was greater in secondary ACL deficiencies (4.7 ± 3.8 vs 1.9 ± 3.2 mm; p < 0.01), patients with a TFI greater than 4 years (4.2 ± 3.8 vs 2.0 ± 3.0 mm; p < 0.01) and with at least one meniscal tear (3.9 ± 3.8 vs 0.7 ± 2.2 mm; p < 0.01). Linear regression showed that, in primary ACL deficiencies, SSD-ATT was expected to increase (+ 2.7 mm) only if both a meniscal tear and a TFI > 4 years were present. In secondary ACL deficiencies, SSD-ATT was mainly influenced by the presence of meniscal tears regardless of the TFI. Conclusion: SSD-ATT was significantly greater in secondary ACL deficiencies, patients with a TFI greater than 4 years and with at least one meniscal tear. These results confirm that SSD-ATT is a time- and meniscal-dependent parameter, supporting the concept of gradual sagittal decompensation in ACL-deficient knees, and point out the importance of the menisci as secondary restraints of the anterior knee laxity. Monopodal weightbearing radiographs may offer an easy and objective method for the follow-up of ACL-injured patients to identify early signs of soft tissue decompensation under loading conditions.
The hypermobile and unstable lateral meniscus: a narrative review of the anatomy, biomechanics, diagnosis and treatment options
Link to the article Beel W, Macchiarola L, Mouton C, Laver L, Seil R. The hypermobile and unstable lateral meniscus: a narrative review of the anatomy, biomechanics, diagnosis and treatment options. Ann Joint 2021. https://dx.doi.org/10.21037/aoj-21-9 Objective: The purpose of this review is to improve the awareness of lateral meniscal hypermobility by describing its relevant anatomy, biomechanics, pathophysiology, imaging and arthroscopic findings as well as the treatment options. Background: The lateral meniscus is less stable than the medial meniscus. Its important posterior stabilizers are the popliteomeniscal fascicles, the posterior capsule, the meniscofemoral ligaments and the posterior meniscotibial ligament, which are divided by a bare area, the popliteal hiatus. Atraumatic insufficiency or rupture of one of these key structures may impact the mobility of the lateral meniscus and can lead to an unstable, hypermobile lateral meniscus. Lateral meniscus hypermobility can cause lateral knee pain and mechanical symptoms as locking. Ruptures of the popliteomeniscal fascicles are frequently associated with anterior cruciate ligament and posterolateral corner injuries. Their repair may be important to fully restore knee stability. Methods: This is a narrative overview of the literature synthesizing current knowledge about the hypermobile lateral meniscus. Anatomy, biomechanics, diagnosis and treatment of this entity was of particular interest for this review. Literature was retrieved from PubMed database, hand searches and cross-reference checking. Conclusions: Diagnosing lateral meniscus hypermobility is challenging since the magnetic resonance imaging are often unspecific and may show no structural alterations of the meniscus and its attachments. The only hint can be the patient’s history and clinical symptoms (e.g., locking). Ultimately, the diagnosis is confirmed during knee arthroscopy, when the lateral meniscus can be mobilized over 50% of the lateral tibial plateau or lateral femoral condyle while anterior probing or by using the aspiration function during arthroscopy. Treatment includes stabilizing the posterior lateral meniscus by repairing the injured structures. Therefore, a systematic arthroscopic evaluation of the lateral compartment is important to fully recognize the problem. Repair can be achieved arthroscopically with various suturing techniques used for meniscal repair with satisfactory results and low recurrence rates.
Grade III pivot shift as an early sign of knee decompensation in chronic ACL‐injured knees with bimeniscal tears
Link to the article Magosch A, Jacquet C, Nührenbörger C, Mouton C, Seil R. Grade III pivot shift as an early sign of knee decompensation in chronic ACL-injured knees with bimeniscal tears. Knee Surg Sports Traumatol Arthrosc. 2021 Jul 23. doi: 10.1007/s00167-021-06673-x. Epub ahead of print. PMID: 34302192. Abstract Purpose: To analyse possible associations between the preoperative pivot shift (PS) test and both patient and injury characteristics in anterior cruciate ligament (ACL)-injured knees, considering previously neglected meniscal injuries such as ramp and root tears. The hypothesis was that a preoperative grade III PS was associated with the amount of intra-articular soft-tissue damage and chronicity of the injury. Methods: The cohort involved 376 patients who underwent primary ACL reconstruction (239 males/137 females; median age 26). Patients were examined under anesthesia before surgery, using the PS test. During arthroscopy, intra-articular soft-tissue damage of the injured knee was classified as: (1) partial ACL tear; (2) complete isolated ACL tear; (3) complete ACL tear with one meniscus tear; and (4) complete ACL and bimeniscal tears. Chi-square and Mann-Whitney U tests were used to evaluate whether sex, age, body mass index, sport at injury, mechanism of injury, time from injury and intra-articular damage (structural damage of ACL and menisci) were associated with a grade III PS. Intra-articular damage was further analyzed for two sub-cohorts: acute (time from injury ≤ 6 months) and chronic injuries (> 6 months). Results: A grade III PS test was observed in 26% of patients. A significant association with PS grading was shown for age, time from injury and intra-articular soft-tissue damage (p < 0.05). Further analyses showed that grade III PS was associated with intra-articular damage in chronic injuries only (p < 0.01). In complete ACL and bimeniscal tears, grade III PS was more frequent in chronic (53%) than in acute knee injuries (26%; p < 0.01). Patients with chronic complete ACL and bimeniscal tears had a grade III PS 3.3 [1.3-8.2] times more often than patients in the acute sub-cohort. Conclusion: In ACL-injured patients, a preoperative grade III PS was mainly associated with a higher amount of intra-articular soft-tissue damage and chronicity of the injury. Patients with complete chronic ACL injuries and bimeniscal tears were more likely to have a preoperative grade III PS than their acute counterparts. This suggests that grade III PS may be an early sign of knee decompensation of dynamic rotational knee laxity in chronic ACL-injured knees with bimeniscal lesions.
Technical note: rectangular femoral tunnel for anterior cruciate ligament reconstruction using a new ultrasonic device: a feasibility study
Link to the article Seil R., Mouton C., Jacquet C. Technical note: rectangular femoral tunnel for anterior cruciate ligament reconstruction using a new ultrasonic device: a feasibility study. J Exp Orthop. 2021 Jul 22;8(1):53. doi: 10.1186/s40634-021-00373-8. PMID: 34296367; PMCID: PMC8298747. Abstract Purpose: The goal of this preliminary report was to show the use of novel Ultrasound (US) technology for anterior cruciate ligament (ACL) reconstruction surgery and evaluate its feasibility for the creation of a rectangular femoral bone tunnel during an arthroscopic procedure in a human cadaver model. Methods: Two fresh frozen human cadaver knees were prepared for arthroscopic rectangular femoral tunnel completion using a prototype US device (OLYMPUS EUROPA SE & CO. KG). The desired rectangular femoral tunnel was intended to be located in the femoral anatomical ACL footprint. Its tunnel aperture was planned at 10 × 5 mm and a depth of 20 mm should be achieved. For one knee, the rectangular femoral tunnel was realized without a specific cutting guide and for the other with a 10 × 5 mm guide. One experienced orthopedic surgeon performed the two procedures consecutively. The time for femoral tunnel completion was evaluated. CT scans with subsequent three-dimensional image reconstructions were performed in order to evaluate tunnel placement and configuration. Results: In the two human cadaver models the two 10 × 5x20mm rectangular femoral tunnels were successfully completed and located in the femoral anatomical ACL footprint without adverse events. The time for femoral tunnel completion was 14 min 35 s for the procedure without the guide and 4 min 20 s with the guide. Conclusion: US technology can be used for the creation of a rectangular femoral bone tunnel during an arthroscopic ACL reconstruction procedure. The use of a specific cutting guide can reduce the time for femoral tunnel completion. Additional experience will further reduce the time of the procedure.
Machine learning methods in sport injury prediction and prevention: a systematic review
Link to the article Van Eetvelde, H., Mendonça, L.D., Ley, C., Seil R. and Tischer T. Machine learning methods in sport injury prediction and prevention: a systematic review. J EXP ORTOP 8, 27 (2021). https://doi.org/10.1186/s40634-021-00346-x The most downloaded JEO Journal article from July was an overview article on machine learning methods in athlete injury prediction and prevention.Read this interesting article on the fast-developing capabilities of machine learning in orthopaedics.
Functional Cortical Connectivity Related to Postural Control in Patients Six Weeks After Anterior Cruciate Ligament Reconstruction
Link to the article Lehmann T., Büchel D., Mouton C., Gokeler A., Seil R. and Baumeister J. (2021) Functional Cortical Connectivity Related to Postural Control in Patients Six Weeks After Anterior Cruciate Ligament Reconstruction. Front. Hum. Neurosci.15:655116. doi: 10.3389/fnhum.2021.655116 Introduction Injuries to the anterior cruciate ligament (ACL) substantially affect knee joint laxity and cause long-term consequences for injured athletes. The accompanying functional impairments of an ACL tear thereby appear to extend beyond biomechanical alterations, comprising a loss of mechanoreceptors which consequently lead to diminished afferent input to higher levels of the sensorimotor system (Courtney et al., 2005; Kapreli et al., 2009). Although ACL injuries have repeatedly been shown to cause deficits in knee function even after surgical anterior cruciate ligament reconstruction (ACLR), knowledge about associated mechanisms of the sensorimotor system for compensating these functional impairments is still lacking (Ageberg, 2002). A growing amount of evidence has begun identifying clinically meaningful neuroplastic changes in the sensorimotor system following ACL injury. Investigations utilizing transcranial magnetic stimulation, for instance, have detected enhanced motor thresholds in the ACL injured limb, whereas functional magnetic resonance imaging or electroencephalography (EEG) studies observed increased activations of the motor areas and lower activations of somatosensory areas in these patients (Neto et al., 2019). Along with altered somatosensory information from the ACL, decreased innervation to the primary sensory cortex (Valeriani et al., 1999), as well as different corticospinal and motor cortex excitability (Pietrosimone et al., 2015; Grooms et al., 2017; Lepley et al., 2020) have been observed in patients after ACL reconstruction. As a consequence of increased motor thresholds of the injured limb and decreased responsiveness of motor areas, greater cortico-cortical stimulation is required to evoke efferent neural signaling in the motor cortex for properly controlling motion and stability of the knee joint (Lepley et al., 2020). Thus, patients with ACL injury have been shown to recruit motor areas to a larger extent than healthy individuals, indicating that cortical adaptations may facilitate the restoration of lower limb motor functions by driving compensatory synergistic muscle patterns (Courtney et al., 2005). Whereas initial findings have identified compensatory cortical patterns in patients after ACLR during proprioceptive tasks (Baumeister et al., 2008, 2011), little is known about the cortical mechanisms behind the postural deficiencies in this population. After ACLR and the following rehabilitation, many patients exhibit significantly decreased static postural stability as implied by increased center of pressure (CoP) excursions and velocities while standing on their injured limb (Lehmann et al., 2017). Although comprehensive evidence in the early postsurgical period is missing, postural stability in patients after ACLR was reported to deviate from both the preoperative level (Gokalp et al., 2016) and healthy controls (Parus et al., 2015) after the 4th and 8th week of surgery. With respect to these functional deficiencies in patients after ACLR, postural control reflects multimodal interactions within the sensorimotor system (Shumway-Cook and Woollacott, 2012). Recent findings from neuroimaging studies suggested that active contributions from the cortex continuously maintain and restore postural equilibrium (Wittenberg et al., 2017). Collectively, these EEG investigations demonstrated variations in power spectral density of theta (4–7 Hz), alpha-1 (8–10 Hz), and alpha-2 (10–12 Hz) frequency oscillations in frontal, motor, parietal, and occipital regions of the cortex. While it is suggested that theta band oscillations reflect a general brain integrative mechanism related to short term storage and manipulation of multimodal information for a given operation, alpha oscillations are related to the active inhibition of non-essential neuronal processing (Cheron et al., 2016), with alpha-1 reflecting global alertness of cortical areas and alpha-2 being associated with task-specific sensorimotor processing (Pfurtscheller and Lopes, 1999). Modulations of oscillatory activity during postural tasks therefore conceivably reflect direct or indirect interactions within complex transcortical and cortico-subcortical loops for detecting and counteracting postural instability (Wittenberg et al., 2017). The underlying functional relationships, as quantified by statistical interdependencies among distributed cortical regions, are referred to as functional connectivity (Friston, 2011). These connections show frequency-specific modulations within a fronto-parietal theta network and a parieto-occipital alpha network in response to postural instability and varying postural demands (Mierau et al., 2017; Varghese et al., 2019; Lehmann et al., 2020). In the light of injury-related increased postural sway (Lehmann et al., 2017), patients after ACLR may require stronger interactions of functionally interconnected sensorimotor areas for properly controlling postural stability (Rosen et al., 2019; Jiganti et al., 2020), as well as hip and knee movement (Criss et al., 2020) while standing on the injured limb. Investigations of structural white matter changes following ACLR further indicated that the hemisphere contralateral to the injured leg may be particularly affected by this neurostructural reorganization (Lepley et al., 2020). Therefore, the aim of the present case-control study is to explore leg dependent patterns of cortical connectivity related to postural control during single leg stances in patients 6 weeks following ACLR. It is hypothesized that patients after ACLR may show compensatory cortical mechanisms in terms of stronger functional connections within the theta and alpha networks compared to their matched controls. Furthermore, these cortical adaptations may specifically affect the stance on the injured limb. In this way, the current investigation may gain further insight into sensorimotor changes related to postural deficiencies after ACLR.
First Aggregation in Physiotherapy at the University of Porto
Prof. Dr Jan CABRI was part of the jury for the aggregation exam in Physiotherapy at the FADEUP (Faculty of Sport of the University of Porto). The curricular unit report is entitled “Clinical Exercise: Emerging Trends and Research Approaches” and the theme of the lesson/seminar is “Physical Exercise as a Non-Pharmacological Treatment of Arterial Hypertension”.”
Presentation from Dr. Luca Macchiarola (MD - Orthopaedic Surgeon)
Side-To-Side Anterior Tibial Translation on Monopodal Weightbearing Radiographs as a Sign of Knee Decompensation in ACL Deficient Knees Dr. Luca MACCHIAROLA (presenter), Dr. Christophe JACQUET, Dr Jeremie DOR, Prof. Stefano ZAFFAGNINI, Caroline MOUTON, Dr. Prof. Romain SEIL CHL EICH / LIROMS
Chief Scientific Expert nomination
Congratulations! to Prof. Dr. Jan CABRI who has been appointed Chief Scientific Expert for the Luxembourg Institute for High Performance in Sports (LIHPS). https://lihps.lu/who-we-are/team/
Mental Fatigue and Sport‐Specific Psychomotor Performance: A Systematic Review
Link to article Habay, J., Van Cutsem, J., Verschueren, J., De Bock, S., Proost, M., De Wachter, J., Tassignon, B., Meeusen, R., & Roelands, B. (2021). Mental Fatigue and Sport-Specific Psychomotor Performance: A Systematic Review. Sports medicine (Auckland, N.Z.), 51(7), 1527–1548. https://doi.org/10.1007/s40279-021-01429-6 Abstract Background Mental fatigue (MF) is a psychobiological state that impairs endurance performance in healthy athletes. Recently, multiple studies indicated that MF could also impair sport-specific psychomotor performance (SSPP). Neverthe- less, a systematic overview detailing the effects of MF on SSPP is currently lacking.Objective The objective of this study is to collate relevant literature and examine the effect of MF on SSPP. A secondary aim was to create an overview of the potential subjective and physiological factors underlying this MF effect. Methods PubMed (MEDLINE), Web of Science, PsycINFO and SPORTDiscus were searched (5th of November 2020). Studies were eligible when study outcomes encompassed any form of SSPP skill in a sport-specific context, the intervention was targeted to induce MF, and the population included healthy individuals. The presence of a manipulation check, to indicate the successful induction of MF, was obligatory for inclusion. Secondary outcomes were all outcomes (either physiological or psychological) that could explain the underlying mechanisms of the effect of MF on SSPP. Results In total, 21 papers were included. MF was successfully induced in all but two studies, which were excluded from further analysis. MF negatively impacts a myriad of SSPP outcomes, including decision-making, reaction time and accuracy outcomes. No changes in physiological outcomes, that could underlie the effect of MF, were reported. Subjectively, only ratings of perceived of exertion increased due to MF in some studies. Conclusions Overall, the selected papers indicated that MF negatively affects SSPP. Research that assesses brain function, while evaluating the effect of MF on SSPP is essential to create further insight.
Anti-Doping: New e-learning course for medical professionals
Link to the article Anti-Doping: New e-learning course for medical professionals Prof. Dr. med. Axel URHAUSEN is a member of the NADA Medicine Group, which participated to this project. The National Anti Doping Agency of Germany, NADA, a civil law foundation by form, is the key body for clean sports in Germany. NADA has become the center of competence for anti-doping activities in Germany. NADA’s tasks are diverse and cover doping controls, education and prevention, medical and legal advice as well as international cooperation. Thereby, NADA Germany significantly contributes to the preservation of values in sports. NADA tackles the problem of doping in sports, cooperatively, on the national and international level, and supports all athletes who compete clean. A comprehensive e-learning course designed by the World Anti-Doping Agency (WADA) and translated by the National Anti-Doping Agency (NADA) is available for athletes' medical personnel. It can be accessed under the title "ADEL for medical professionals" on WADA's Anti-Doping Education and Learning (ADEL) website: adel.wada-ama.org/learn/public/learning_plan/view/36/adel-fur-medizinisches-fachpersonal-german The course begins by addressing ethical and moral aspects that physicians are confronted with in the care of athletes. The course then focuses on practical case studies, which are used to explain the anti-doping regulations that are important for physicians, the World Anti-Doping Code and the National Anti-Doping Code, the Prohibited List and the Standard for Therapeutic Use Exemptions. In addition, it will be made clear how physicians can support the athletes under their care in complying with the anti-doping regulations. To this end, the course presents the basics of doping prevention and the doping control system as well as legal aspects. Each of the four thematic modules concludes with a review of the knowledge acquired. At the end of the entire course, participants can expect a final examination. If they pass, the participants receive a corresponding certificate.
Preliminary experience of an international orthopaedic registry: the ESSKA Paediatric Anterior Cruciate Ligament Initiative (PAMI) registry
Link to the article Mouton, C., Moksnes, H., Janssen, R., Fink C., Zaffagnini S., Monllau JC., Ekås G., Engebretsen L., Seil R. Preliminary experience of an international orthopaedic registry: the ESSKA Paediatric Anterior Cruciate Ligament Initiative (PAMI) registry. J EXP ORTOP 8, 45 (2021). https://doi.org/10.1186/s40634-021-00366-7 Abstract Paediatric and adolescent ACL injuries are an emerging health burden, increasing at a higher rate than in adults. They compromise quality of life, affect knee structure and function, lead to the early development of osteoarthritis and are a serious economic burden due to shortened professional careers and subsequent surgeries. Up to 35% of children and adolescents will experience a second ACL injury and this population particularly at high risk of secondary intraarticular soft tissue degeneration and growth abnormalities. However, there is still a lack of high-quality outcome studies on this specific population and many knowledge gaps persist in the current treatment guidelines. It is currently unknown whether ACL reconstruction in this young population decreases the risk of irreversible secondary intraarticular soft tissue degeneration. Furthermore, it is not known whether return to high or elite level sports after paediatric ACL injury or reconstruction should be recommended. The relatively low number of paediatric ACL injuries seen in each hospital makes it necessary to conduct international multi-centre studies to collect robust data to provide evidence-based guidelines for the treatment of these injuries. The Paediatric Anterior Cruciate Ligament Initiative (PAMI) was thus started by the European Society of Sports Traumatology, Knee Surgery & Arthroscopy and opened for patient inclusion in 2018. This comprehensive overview of the first 2 years of the PAMI registry shows that the project is now well consolidated and accepted by the European orthopaedic community. Future challenges include ensuring additional external funding to ascertain long term sustainability and continuous dissemination of the knowledge acquired in scientific journals.
Does practice of meniscus surgery change over time?
Link to the article Jacquet, C., Mouton, C., Becker, R., Koga H., Ollivier M., Verdonk P., Beaufils P., Seil R. Does practice of meniscus surgery change over time? A report of the 2021 ‘THE MENISCUS’ Webinar. J EXP ORTOP 8, 46 (2021). https://doi.org/10.1186/s40634-021-00365-8 Purpose. The aim of this paper was to report the results presented in the session “Does practice of meniscus surgery change over time?” of the 2021 MENISCUS webinar held online on January 30th 2021. Method. During the 2021 MENISCUS webinar, an evaluation of meniscus surgery practices was performed by analyzing: (1) The presentation of the results of a survey conducted among ESSKA members and assessing their current practices in the field of meniscus surgery, (2) Four reports by national experts analyzing the trends in Arthroscopic Partial Meniscectomy (APM) and meniscus repair procedures in their respective countries (France, Belgium, Germany and Japan). Results. (1) ESSKA Survey: Among the 461 respondents, 75% of surgeons claimed to perform more meniscus repairs and 85% less APM than 5 years ago. In ACL-associated meniscus injuries, a majority of surgeons (60%) indicated to perform a meniscal resection in less than 25% of cases. 25% declared to perform meniscus repair in ACL-associated meniscus injuries in less than 25% of cases and 37% in more than 50% of cases. Half of the respondents repair medial or lateral root tears in less than 25% of cases. Less than 20% of respondents were not familiar with the ESSKA consensus. (2) National trends: In France, between 2005 and 2017, the APM rate decreased by 21.4%, while the repair rate increased by 320%. In Belgium, between 2007 and 2017, the APM rate decreased by 28.6%. In Germany, between 2010 and 2017 the number of APM decreased by 30%, while the number of repair procedures increased by 55%. Finally, in Japan, between 2011 and 2016, the APM ratio (APM/meniscus procedures) decreased by 16% from 91 to 75% while the repair ratio increased from 9 to 25%. Conclusion. The 2021 ESSKA members' survey as well as statistics from 4 specifically examined countries (Belgium, France, Germany and Japan) suggest there has been a significant shift over the last years in the surgical management of meniscal lesions towards less APM and more conservative treatments.
Return to sports after COVID-19 infection
Video from the webinar held 16th June. Speakers: Dr S. Hein, Prof A. Urhausen, MD, PhD (CHL, Luxembourg) Organised by the Luxembourgish Academy for Sports Medicine, Sports Physiotherapy and Sports Science
Specific Sports Related Injuries - Handball
Link to the book Handball chapter - Landreau P., Laver L., Seil R., Popovic N. © ISAKOS 2021 S. Rocha Piedade et al. (eds.), Specific Sports-Related Injuries, https://doi.org/10.1007/978-3-030-66321-6_681 eBook ISBN978-3-030-66321-6 Hardcover ISBN978-3-030-66320-9 This book offers an overview of injury prevention and management for all most popular individual and team sports disciplines. Handball chapter (Landreau P., Laver L., Seil R., Popovic N.) Handball is one of the Olympic sports with the highest risk of injuries (13–17% of all athletes in Beijing, London, and Rio). In the 2012 Olympics, handball had the fourth highest injury score (22%) after taekwondo (39%), football (35%), and BMX (31%) and was ahead of other team sports like basketball (11%) and volleyball (6.9%). For some it would even be the highest risk ball sport. The risk of injuries is usually represented by the number of injuries occurring during a training or competitive match reported per 1000 exposure hours. The results in the literature are variable probably because some report only lesions caus- ing time-loss and others also include overuse.
Knee Arthroscopy: An Up-to-Date guide - Ramp lesions
Link to the book Ramp lesions chapter. Seil R., Mouton C. Knee Arthroscopy: An Up-to-date guide - © Springer Nature Singapore Pte Ltd. 2021J. G. Kim (ed.), Knee Arthroscopy, https://doi.org/10.1007/978-981-15-8191-5_18 eBook ISBN978-981-15-8191-5 Hardcover ISBN978-981-15-8190-8 This book provides detailed guidance on knee arthroscopy that reflects the very latest advances in this ever-changing field. Among the techniques covered are reconstruction of the anterior and posterior cruciate ligaments, meniscal repair and transplantation, cartilage repair by means of osteochondral allograft transplantation and autogenous osteochondral transfer, medial patellofemoral ligament reconstruction, and high tibial osteotomy. In each case, clear descriptions of technique are supported by a wealth of high-quality illustrations, with identification of potential pitfalls and how to avoid them. In addition, the latest knowledge is presented on anatomy and biomechanics. The book is written by recognized experts in sports injuries and knee disorders. It will serve as an up-to-date reference for the experienced knee surgeon and an ideal source of information for all who wish to broaden their knowledge of and improve their skills in knee arthroscopy, whether general orthopaedists, orthopaedic trainees, or sports medicine physicians. Ramp lesions chapter (Seil R., Mouton C.) Ramp lesions to the posterior horn of the medial meniscus have recently received increased attention due to their high preva- lence in patients undergoing an anterior cru- ciate ligament reconstruction. The diagnosis of these lesions is rarely possible with preop- erative imaging and quite limited with routine anterior arthroscopic inspection of the knee joint. Visual inspection of the posteromedial compartment of the knee joint should thus systematically be carried out via a trans-notch view and meniscocapsular structures directly probed with a needle or visualized via a pos- teromedial portal. While the clinical impact of ramp lesions is not yet well established, recent biomechanical studies have shown increased anteroposterior and rotational laxi- ties when a ramp lesion is present. The latter may thus be a cause for postoperative persis- tent laxity potentially leading to the failure of ACL reconstructions. To date, it remains unclear whether all ramp lesions should be repaired as only a few publications report long-term outcomes after ramp lesion repair. This article provides an overview of the cur- rent knowledge on ramp lesions including their diagnosis, classification, biomechanical relevance as well as treatment and outcomes.
Paperjam article - Medtech - 'CHL knee arthroscopy simulator receives €500,000'
Link to the article Title: 'Le simulateur d’arthroscopie du genou du CHL reçoit 500.000 euros' published in Paperjam on June 8th, 2021 How can surgeons be prepared for a meniscus operation? With a simulator, developed by the Swiss start-up Virtamed, for Professor Romain Seil of the Centre Hospitalier de Luxembourg. With the help of a young Luxembourger, Claude Hoeltgen, the project has just received a grant of 500,000 euros.
High Incidence of Anterior Cruciate Ligament Injuries Within the First 2 Months of the Season in Amateur Team Ball Sports
Link to the article Mouton, C., Gokeler, A., Urhausen, A., Nührenbörger, C., & Seil, R. (2021). High Incidence of Anterior Cruciate Ligament Injuries Within the First 2 Months of the Season in Amateur Team Ball Sports. Sports health, 19417381211014140. Advance online publication. https://doi.org/10.1177/19417381211014140 Background: The incidence of anterior cruciate ligament (ACL) injuries is commonly reported as an annual incidence rate. There is relatively little information about the seasonal aspects of these injuries. The aim of the current study was to analyze the distribution of ACL injuries during the season in nonprofessional soccer, handball, and basketball based on a retrospective analysis of a hospital-based registry.
Journée Kiné 2021 - Webinar June 2nd : Videos are now available!
Videos from the Webinar June 2nd 2021. ACL CLINICAL PATHWAY: TRANSLATED EVIDENCE INTO CLINICAL PRACTICE Modérateurs: Romain SEIL, Prof. Dr. med, CHL. Danièle SCHAACK, PT; CHL. Topics presented: 1. Introduction - Jean-Paul Weydert 2. New developments in the management of severe knee injuries - Romain Seil, Prof. Dr. med 3. ACL clinical pathway - the CHL sports clinic model - Caroline Mouton, PhD 4. The importance of pre-habilitation of the injured athlete and the immediate post-operative care (Part 1) - Anne Frisch, PT, PhD 5. The importance of pre-habilitation of the injured athlete and the immediate post-operative care (Part 2) - Lisa Kirsch, PT 6. From the crutches back to functional activities - Louis Wennig 7. The return to training and performance (Part 1) - Nina Goedert PT 8. The return to training and performance (Part 2) - Jérôme Pauls, PT
Primary prevention of sports injuries and overuse
Link to the article. Tischer T., Besenius E., Lutter C., Seil R. Primärprävention von Sportverletzungen und -schäden. Sports Orthop. Traumatol. 37, 4–9 (2021) https://doi.org/10.1016/j.orthtr.2021.01.011 Sport is an important part of our society and has far-reaching positive effects on our health. Unfortunately, some of these positive effects are lost again due to sports injuries. In the meantime, the evidence of prevention programs to avoid sports injuries in knee, hip, ankle and shoulder is well documented. The data is greatest for the knee joint, where up to 67% of anterior cruciate ligament injuries can be avoided in adolescents and young female adults. The shoulder is still the least studied area, where there are only a few randomized studies, but which could also show a significant reduction in injuries. Thus, the main challenge is to implement prevention programs in the daily training of athletes, while at the same time improving the registration of sports injuries and the training of all players. In the future, new technologies (sensors, artificial intelligence) will certainly play an important role.
Influence of physical activity and sports training on obesity
Link to the article. Thünenkötter T., Urhausen A. Einfluss von körperlicher Aktivität und sportlichem Training auf ÜbergewichtSports Orthop. Traumatol. 37, 18–25 (2021) https://doi.org/10.1016/j.orthtr.2020.11.009 For years, the prevalence of overweight and obesity has been increasing worldwide. Due to a variety of associated comorbidities, this represents a central challenge for the health care systems. The majority of the daily energy consumption of humans can be influenced by physical training. Endurance and strength training is recommended for weight reduction. This is one of the main focus of integrative treatment programs, along with the modification of nutrition and behavior. In an adipogenic environment, however, it is very difficult for most overweight and obese people to lose weight. Exercise, even without weight normalization, can help prevent overweight-associated diseases and thus reduce mortality. Physical activity, as a cost-effective intervention, has such a positive effect on health as hardly any other measure. For this reason, therapeutic efforts in overweight and obesity should not be aimed exclusively at weight reduction, but also and especially at increasing cardiorespiratory fitness.
Prevention of sports injuries in childhood and adolescence
Link to the article. Nührenbörger C., Mouton C., Engelhardt M. Sports Orthop. Traumatol. 37, 10–17 (2021) Prävention von Sportverletzungen im Kindes- und Jugendalter. https://doi.org/10.1016/j.orthtr.2021.01.005 Sport in childhood and adolescence has many positive effects on a physical, psychological and social level as well as negative consequences such as sport injuries. There is a clear increase in acute and overuse injuries, with some serious long-term consequences on later life. In order to minimize the risk of injury, various preventive measures such as special exercise programs, age-appropriate training and competition loads, protective equipment, preventive sports medical examinations and competition support as well as rule changes have been introduced. The majority of them show positive results with a reduction in the number of injuries by 30 to 80%. However, there are still difficulties, in particular with the implementation of the prevention exercises, which in the future must be carried out with the cooperation of all structures that support sports at club, federation and school sports level as well as in sports and health policy. It is important that all supervising persons are convinced of the proven benefits of the early application of prevention exercises on health and performance in children and youth sports and that sports medicine science focuses even more on the evidence on prevention.
Webinar: What's new in orthopaedic surgery?
Link to the video What's new in orthopaedic surgery? Languages: French and German Program: - Introduction - Prof. Dr Romain Seil- Introduction to the department - Dr Caroline Mouton- Foot tendinopathies - Dr Nicolien VanGiffen- Ankle and shoulder instability: current developments - Dr Pietro Spennacchio- Ligamentous injuries of the knee - Prof.. Dr Romain Seil- Degenerative meniscus damage - Dr Christophe Jacquet- Misalignment of the legs - Prof. Dr Dietrich Pape- Minimally invasive prosthetic surgery - Dr Victor David- Surgery for infections and prosthesis revisions - Dr Alexander Hoffman- General discussion
Paperjam article : 'The stride analysed by 3D analysis'
Link to the article Title: La foulée décortiquée par une analyse 3D by Prof. Dr. Jan Cabri in Paperjam on May 20th 2021 For the past year, the CHL has offered a laboratory for the analysis of movement in 3 dimensions. A godsend for runners, who are sometimes unaware of the source of the injuries that too often bring them to stop running. In running, chronic or overload injuries are frequent. And without seeing the patient in action, it is sometimes difficult for a doctor to determine the cause. Often, it is linked to the way of running or to a malformation, which can be benign but disabling in the long run. To overcome this problem, the Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science (LIROMS) has set up the Human Motion Laboratory. "This laboratory has existed for about ten years," explains Professor Jan Cabri, Scientific Director at LIROMS. "But in the last year we have equipped it with three-dimensional motion analysis technology to analyse walking and running."
High incidence of previously neglected meniscus lesions influencing knee biomechanics in association with ACL injuries - Virtual 19th ESSKA Congress
Video from the Virtual 19th ESSKA Congress 11-15 May 2021 CHL / LIROMS / LIH Caroline MOUTON, Amanda MAGOSCH, Christian NÜHRENBÖRGER, Romain SEIL
High number of ACL injuries after the summer break in team ball sports - Virtual 19th ESSKA Congress
Presentation at the Star paper session of the Virtual 19th ESSKA Congress. This presentation was selected amongst the 5 best abstracts from 2000 abstract submissions at the ESSKA Congress. CHL / LIROMS / LIH C.Mouton, A. Gokeler, A. Urhausen, C. Nührenbörger, R. Seil
Incidence and risk factors for residual high-grade pivot shift after ACL reconstruction with or without a lateral extra-articular tenodesis
Link to the article Jacquet, C., Pioger, C., Seil, R., Khakha, R., Parratte, S., Steltzlen, C., Argenson, J.-N., Pujol, N., & Ollivier, M. (2021). Incidence and Risk Factors for Residual High-Grade Pivot Shift After ACL Reconstruction With or Without a Lateral Extra-articular Tenodesis. Orthopaedic Journal of Sports Medicine. https://doi.org/10.1177/23259671211003590 Background: Residual rotatory knee laxity at midterm follow-up after isolated anterior cruciate ligament reconstruction (ACLR) versus ACLR with lateral extra-articular tenodesis (LET) remains an issue. Purpose/Hypothesis: To evaluate the outcomes of ACLR with or without additional LET at a minimum 2-year follow-up in patients with preoperative high-grade pivot shift (PS). Our hypothesis was that the addition of LET would decrease the risk of secondary meniscal injury and the presence of residual high-grade PS at follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis performed at 3 sports medicine centers identified 266 study patients; all had a high-grade PS (grade 2 or 3) preoperatively and underwent isolated ACLR with or without LET. Four different ACLR techniques were used: single-strand quadrupled semitendinosus (ST4) ACLR without LET (ST4 group; n = 55), ST4 with anatomic LET (ST4+LET group; n = 77), bone–patellar tendon and modified Lemaire LET (BTB+LET group; n = 43), and quadriceps tendon and modified Lemaire LET (QT+LET group; n = 91). At follow-up, we evaluated for the presence of high-grade (grade ≥2) PS. Preoperative meniscal tears and their treatment were recorded. Results: Overall, 185 (69.5%) patients had at least 1 meniscal tear at index surgery. The mean follow-up period was 44.3 months; 47 (17.7%) patients had a new meniscal tear and 64 (24%) patients had a high-grade PS at follow-up. Compared with meniscal repair, significant predictors for high-grade PS at follow-up were meniscectomy (odds ratio [OR] = 2.65 [95% CI, 1.19-5.63]; P = .02) and nonrepair of preoperative meniscal tear (OR = 3.26 [95% CI, 1.27-9.43]; P = .007). The appearance of a new symptomatic meniscal tear was the strongest significant predictor of high-grade PS at follow-up (OR = 4.31 [95% CI, 2.31-8.06]; P < .001). No significant correlation was observed between the addition of LET and the presence of high-grade PS at follow-up. Conclusion: In the current study, 1 in 4 patients with high-grade PS before ACLR with or without LET was at risk of residual rotatory knee laxity at mean 44-month follow-up, regardless of the technique used. Repairing a pre-existing meniscal lesion was more effective than performing LET to decrease the presence of a high-grade PS at follow-up.
The knee in elite sport
Keynote lecture during the German Sports, Medicine and Health Summit 2021 about the knee in elite sport by Prof. Dr. Romain Seil.
Paperjam article: 'Orthopaedic insoles: the last chance'
Link to the article Title: LE BON GESTE: Semelles orthopédiques: le dernier recours By Prof Dr Jan Cabri in Paperjam on 8 April 2021 More and more runners are using orthopaedic insoles to correct their movement. But the debate about their effectiveness is still ongoing. For Professor Jan Cabri (Liroms), their effectiveness is often unproven.
The future of meniscus science: international expert consensus
Link to article DePhillipo N.N., LaPrade R.F., Zaffagnini S., Mouton C., Seil R., Beaufils P. . The future of meniscus science: international expert consensus. J EXP ORTOP 8, 24 (2021). https://doi.org/10.1186/s40634-021-00345-y Purpose. The purpose of this study was to evaluate the main focus areas for research and development for furthering the state of meniscus science in 2021. Methods. An electronic survey including 10 questions was sent in a blind fashion to the faculty members of the 5th International Conference on Meniscus Science and Surgery. These faculty served as an expert consensus on the future of research and development areas of meniscus science. Survey responses were analyzed using descriptive statistics and ranking weighted averages were calculated to score survey questions. Results. Of the 82 faculty, 76 (93%) from 18 different countries completed the survey (84% male, 16% female). The highest ranked future research and development focus areas were meniscus repair, biologics, osteotomy procedures, addressing meniscus extrusion, and the development of new therapies for the prevention of posttraumatic osteoarthritis. Currently, the most ‘valuable’ type of biologic reported for meniscus treatment was platelet-rich plasma. The main reported global research limitation was a lack of long-term clinical outcomes data. The most promising emerging medical technologies for improving meniscus science were 3-D printing, personalized medicine, and artificial implants. Conclusions. This survey suggests that the future of meniscus science should be focused on meniscal preservation techniques through meniscus repair, addressing meniscal extrusion, and the use of orthobiologics. The lack of long-term clinical outcomes was the main reported research limitation globally for meniscus treatment. Future product development utilizing emerging medical technologies suggest the use of 3-D printing for meniscal transplants/scaffolds, personalized treatment, and bioengineering for artificial implants.
Machine learning methods in sport injury prediction and prevention: a systematic review
Link to the article Van Eetvelde, H., Mendonça, L.D., Ley, C.,Seil R.and Tischer T. Machine learning methods in sport injury prediction and prevention: a systematic review. J EXP ORTOP 8, 27 (2021). https://doi.org/10.1186/s40634-021-00346-x Injuries are common in sports and can have significant physical, psychological and financial consequences. Machine learning (ML) methods could be used to improve injury prediction and allow proper approaches to injury prevention. The aim of our study was therefore to perform a systematic review of ML methods in sport injury prediction and prevention. Methods: A search of the PubMed database was performed on March 24th 2020. Eligible articles included original studies investigating the role of ML for sport injury prediction and prevention. Two independent reviewers screened articles, assessed eligibility, risk of bias and extracted data. Methodological quality and risk of bias were determined by the Newcastle–Ottawa Scale. Study quality was evaluated using the GRADE working group methodology. Results: Eleven out of 249 studies met inclusion/exclusion criteria. Different ML methods were used (tree-based ensemble methods (n = 9), Support Vector Machines (n = 4), Artificial Neural Networks (n = 2)). The classification methods were facilitated by preprocessing steps (n = 5) and optimized using over- and undersampling methods (n = 6), hyperparameter tuning (n = 4), feature selection (n = 3) and dimensionality reduction (n = 1). Injury predictive performance ranged from poor (Accuracy = 52%, AUC = 0.52) to strong (AUC = 0.87, f1-score = 85%). Conclusions: Current ML methods can be used to identify athletes at high injury risk and be helpful to detect the most important injury risk factors. Methodological quality of the analyses was sufficient in general, but could be further improved. More effort should be put in the interpretation of the ML models.
Paperjam article: 'And suddenly it's a cramp!'
Link to the article Title: LE BON GESTE: Et soudain, c’est la crampe! By Prof Dr Jan Cabri in Paperjam on 14 January 2021 We may be well prepared, but a cramp can spoil a performance in competition. Can it be prevented and avoided?
Winner of the Best Original Article Award in the JISAKOS Best Article competition.
Link to the award winning article Ardern CL, Ekås G, Grindem H, et al. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuriesJournal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 2018;3:66-82. Hearty congratulations to the authors for being honoured as the winner of the Best Original Article Award in the JISAKOS Best Article competition selected by the Journal of ISAKOS (JISAKOS) Editorial Board and the ISAKOS Board of Directors. The article was entitled '2018 International Olympic Committee Consensus Statement on Prevention, Diagnosis and Management of Paediatric Anterior Cruciate Ligament (ACL) Injuries'. The Best Article competition was conducted as part of the celebration of ISAKOS 25th Anniversary and the JISAKOS 5th Anniversary. The authors have been invited to join at the 13th Biennial Congress in Cape Town, South Africa where the article will be recognized during the session titled 'How to get Published in The Journal of ISAKOS: Editor's Tips for Maximizing Your Journal Submissions' on Monday, November 29, 2021 at 10:30-11:15 am. Authors who attend the session also will receive a certificate of recognition as well as a cash award from the Journal of ISAKOS.
Diagnosing instability of ligamentous syndesmotic injuries: A biomechanical perspective. Review published in Clinical Biomechanics
Link to the article Spennacchio P., Seil R., Gathen M., Cucchi D. Diagnosing instability of ligamentous syndesmotic injuries: A biomechanical perspective, Clinical Biomechanics, Volume 84, 2021, 105312, ISSN 0268-0033, https://doi.org/10.1016/j.clinbiomech.2021.105312. Highlights Different experimental setups available to investigate syndesmotic stability.. Ex vivo models: significant kinematic role of anterior inferior tibiofibular ligament.. Isolated anterior inferior tibiofibular ligament lesion can cause dynamic instability.. Suspected syndesmotic instability: 2nd level diagnostics, minimize risk for sequelae.. Computed tomography can improve the diagnosis of syndesmotic instability.. Abstract Background: High ankle sprains are insidious injuries associated with a long recovery period, functional impairment and long-term sequelae if mistreated. This systematic review investigates the biomechanical knowledge on the kinematic consequences of sequential syndesmotic ligamentous injuries, aiming to furnish an updated and objective contribution for the critical appraisal and further elaboration of current diagnostic algorithms for high ankle sprains. Methods: A systematic review was performed to identify human biomechanical studies evaluating the stabilizing role of the syndesmotic ligaments. Special attention was paid to identify the smallest lesion within the progressive simulated injuries able to provoke statistically significant changes of the syndesmotic kinematic on the specimen, the mechanical solicitation that provoked it, and the measurement methodology. Findings: Fourteen studies were included. In eight articles already an isolated injury to the anterior inferior tibiofibular ligament provoked significant changes of the syndesmotic kinematic, which was always depicted under an external rotation torque. In three articles an isolated deltoid ligament injury provoked significant changes of the syndesmotic kinematic. Four articles described a direct measure of the bony movements, whereas seven collected data through conventional radiography or CT-scan imaging and three via a 3D motion analysis tracking system. Interpretation: An isolated lesion of the anterior inferior tibiofibular ligament can provoke significant kinematic modifications in ex vivo syndesmotic models and may be responsible of subtle patterns of dynamic instability, regardless of further syndesmotic ligamentous injuries. The data observed support efforts to define reliable CT imaging parameters to improve non-invasive diagnostic of subtle forms of syndesmotic instability.
Video recording of the lecture: 'Return to sport after Covid 19' by Prof Urhausen
The conference/webinar on 'The Management of Post Covid 19 Patients' was held on Wednesday, March 3, 2021, online and in person. It was organized by the CHL in collaboration with the Society of Medical Sciences of the Grand Duchy of Luxembourg. Prof Dr Axel Urhausen was invited to present his lecture on 'Return to sport after Covid 19' . The overall programme can be assessed at https://www.chl.lu/fr/actualites/videos-conference-prise-en-charge-des-patients-post-covid-19 The video recording of the conference can be assessed at https://vimeo.com/showcase/8211358/video/519810335
Ramp lesions are six times more likely to be observed in the presence of a posterior medial tibial bone bruise in ACL‑injured patients: Publication in KSSTA
Link to the publication Beel W, Mouton C, Tradati D, Nührenbörger C, Seil R. Ramp lesions are six times more likely to be observed in the presence of a posterior medial tibial bone bruise in ACL-injured patients. Knee Surg Sports Traumatol Arthrosc. 2021 Mar 4. doi: 10.1007/s00167-021-06520-z. Epub ahead of print. PMID: 33661324. Abstract Purpose: The aim of this study was to determine whether posterior tibial slope (PTS), meniscal slope (MS), and bone bruise pattern (BBP), as observed on magnetic resonance imaging (MRI), differed between patients with or without medial meniscus ramp lesions at the time of anterior cruciate ligament reconstruction (ACLR). The hypothesis was that patients with a ramp lesion had a higher PTS and MS, with a different BBP than patients without a ramp lesion. Methods: Fifty-six patients undergoing ACLR were selected from an in-house registry and separated into 2 groups: (1) the RAMP group included patients with a primary ACLR and a medial meniscus ramp lesion diagnosed intraoperatively; (2) the CONTROL group included patients with a primary ACLR without ramp lesion after arthroscopic exploration of the posteromedial knee area. The two groups were matched for age, sex and type of concomitant meniscal lesions. The medial/lateral-PTS/MS and BBP were subjected to blinded evaluation on the preoperative MRI of the reconstructed knee. Results: Twenty eight patients (21 males; 7 females) were included in each group. No significant difference could be observed between groups in terms of demographical characteristics, PTS, and MS. A posteromedial tibial plateau (PMTP) bone bruise was more often observed in the RAMP group (n = 23/28) compared to the CONTROL group (n = 12/28) (p < 0.01). The RAMP group was 6.1 (95%CI [1.8; 20.8]) times more likely to present a PMTP bone bruise. The likelihood of having a bone bruise in both the medial and lateral compartments was 4.5 (95%CI [1.2; 16.5]) times higher in the RAMP group. However, a BBP only involving the lateral tibiofemoral compartment was more likely to be observed in the CONTROL group (n = 10/28) compared to the RAMP group (n = 3/28, p < 0.05 - odds ratio 4.6 (95%CI [1.1; 19.2]). Conclusion: Ramp lesions were 6.1 and 4.5 times more likely to be observed in the presence of a posteromedial tibia plateau bone bruise or a combined bone bruise respectively in both the medial and lateral tibiofemoral compartment in patients undergoing ACLR. The tibial and meniscal slopes did not differ between patients with or without ramp lesions undergoing ACLR. Level of evidence: Level III. Keywords: ACL reconstruction; Bone bruise; Meniscal slope; Posterior tibial slope; Ramp lesion.
The aspiration test: an arthroscopic sign of lateral meniscus posterior horn instability. Publication in JEO
Link to the publication Jacquet, C., Magosch, A., Mouton, C. et al. The aspiration test: an arthroscopic sign of lateral meniscus posterior horn instability. J EXP ORTOP 8, 17 (2021). https://doi.org/10.1186/s40634-021-00327-0 The suspensory mechanism of the posterior part of the lateral meniscus is an anatomically complex structure which allows its mobility, essential to the kinematics of the knee. Damage to this structure (either through knee trauma or congenital abnormalities) can result in an instability of the lateral meniscus that may lead to lateral knee pain, locking sensations or lack of rotational control of the knee. Currently, there are no reliable clinical or imaging tests to identify this pathology and the diagnosis of lateral meniscus instability is often delayed or missed The authors of this study propose a novel method for a quick and easy arthroscopic screening test (called the aspiration test) to help surgeons to identify this instability of the lateral meniscus The description of this test is important in order to improve its diagnosis and to allow for complete anatomical repair when indicated.
Best young researcher award at ReFORM- won by Amanda Magosch
ReFORM Amanda Magosch from LIROMS won the award for the best young researcher in an online conference organized by ReFORM, the French consortium for sports health research recognized by the International Olympic Committee along with another researcher. This consortium includes the National Sports Institute of Montreal, the University of Liège, the University of Geneva, INSEP in Paris and us. The centres had selected their 11 best researchers, for the occasion. The title of Amanda's presentation was: "On the road to knee rotary instability". Her work involved a clinical examination called "pivot shift" that we routinely perform under general anesthesia before any surgery for the anterior cruciate ligament of the knee. In more than 300 patients, she was able to identify 3 variables associated with the degree of rotary instability, namely age at the time of injury, accident-surgery interval and extent of associated meniscal lesions. This is the first time these associations have been described in the literature. They are important to refine our understanding of the extent of lesions and the therapeutic approach in these patients and to improve their long-term prognosis, including physical activity and the development of osteoarthritis of the knee. The results are currently being published. The fact that Ms. Magosch was awarded this award is a testament not only to the importance of the results to the international scientific community, but also to an excellent talent in a young medical student and the right entourage by our various clinical and scientific teams. We wish her the very best in her endeavours.
ReFORM PhD days scientific contribution
Two of our PhD-students were invited to represent LIROMS at the first "Young Researcher Day“ organized by ReFORM. Anouk Urhausen described her ongoing project on the 10-year follow-up of the Delaware-Oslo ACL Cohort Study. Amanda Magosch presented the results of a study on factors associated with the Pivot Shift signs, a clinical test for rotational instability in the ACL-insufficient knee Joint. The findings that age at injury, time from injury to surgery and amount of meniscus damage were are associated with rotational laxity are new, especially with respect to the meniscus damage. In the end, Amanda was awarded for the best presentation along with one other presenter.
Video recording of the webinar: Biomechanical analysis of running performance
On 20 January 2021, a sports medical webinar on "Biomechanical assessment of running performance" by P. Gette, R. Krecké, and Prof J. Cabri, PhD (LIROMS/CHL/LIH, Luxembourg) was held virtually over Zoom attended by 100 participants. A video recording of the talk is now available.
Influence of physical activity and sports training on obesity: Review/ Special Issue in Sports Orthopaedics and Traumatology
Link to the article Summary For years, the prevalence of overweight and obesity has been increasing worldwide. Due to a variety of associated comorbidities, this represents a central challenge for the health care systems. The majority of the daily energy consumption of humans can be influenced by physical training. Endurance and strength training is recommended for weight reduction. This is one of the main focus of integrative treatment programs, along with the modification of nutrition and behavior. In an adipogenic environment, however, it is very difficult for most overweight and obese people to lose weight. Exercise, even without weight normalization, can help prevent overweight-associated diseases and thus reduce mortality. Physical activity, as a cost-effective intervention, has such a positive effect on health as hardly any other measure. For this reason, therapeutic efforts in overweight and obesity should not be aimed exclusively at weight reduction, but also and especially at increasing cardiorespiratory fitness. Keywords Fitness, Overweight, Obesity, SportsTraining, Cardiorespiratory fitness Thomas Thünenkötter, Axel Urhausen (2021) Einfluss von körperlicher Aktivität und sportlichem Training auf Übergewicht, Sports Orthopaedics and Traumatology, 2021, ISSN 0949-328X, https://doi.org/10.1016/j.orthtr.2020.11.009.
2020 update of Medial Meniscus ramp lessions: published in ESSKA Newsletter
In the December 2020 ESSKA Newsletter, an article co-authored by LIROMS President Prof Dr Romain Seil has been published. Titled as "2020 update of Medial Meniscus ramp lessions, difficult to diagnose but vital to repair". Link to the article here.
Exclusive Interview of LIROMS President Prof Dr Romain Seil: "Pillars of ESSKA"
ESSKA likes to honour individuals who they consider to be the "pillars" of the society. In the December 2020 quarterly online newsletter of ESSKA, an exclusive interview of LIROMS President, Prof Dr Romain Seil has been presented. Interviewed by Jaun Carlos Monllau. Read the interview here to catch a glimpse of Prof Seil's inspring career as well as his personal journey along the way!
ESSKA Newsletter Dec 2020
Read the latest news from ESSKA in the December issue of their quarterly newsletter. View it in a user-friendly online version as well as the traditional PDF version which can be downloaded to read offline. In this issue, there are a number of interesting articles, including: 3. ESSKA President Jacques Menetrey’s Editorial: News from the Society4. 19th ESSKA Congress GOES VIRTUAL - 11-15 May 202110. Tips and Tricks for Young Reviewers14. Pillar of ESSKA: Romain Seil18. ESSKA Sections looking forward to 202127. ESSKA Speciality Days - 3-4 September 2021 in Warsaw, Poland35. ESSKA Webinars scheduled for 2021-202248. 2020 update of Medial meniscus ramp lesions; difficult to diagnose but vital to repair50. 3D Navigation Model for Diagnosis and Treatment of the Elbow Bony Impingement ...and much more!
Updates on PAMI: published in ESSKA newsletter Dec 2020
Latest news from Pediatric ACL Monitoring Inititiative (PAMI), co/authored by LIROMS President Prof Dr Romain Seil and LIROMS scientific collaborator Dr Caroline Mouton, published in ESSKA December 2020 newsletter. Link to the article here.
Surgical treatment of complex meniscus tear and disease: state of the art review
Link to the publication Ozeki, N., Seil, R., Krych, A., & Koga, H. (2020, September 17). Surgical treatment of complex meniscus tear and disease: State of the art. Retrieved November 27, 2020, from https://jisakos.bmj.com/content/early/2020/09/17/jisakos-2019-000380 In collaboration with Tokyo Medical University, Japan, Mayo Clinic, USA and CHL, LIH and LIROMS, Luxembourg, a recent publication published in BMJ journals highlights the most modern and advanced techniques of meniscus preservation surgery (instead of resection). Dr Megha Agrawal was acknowldged in the manuscript for English editing.
Editorial in BJSM: The mission of ReFORM
Link to the article Martens G, Edouard P, Tscholl P, et alDocument, create and translate knowledge: the mission of ReFORM, the Francophone IOC Research Centre for Prevention of Injury and Protection of Athlete HealthBritish Journal of Sports Medicine Published Online First: 12 November 2020. doi: 10.1136/bjsports-2020-103087 The International Olympic Committee (IOC) has supported athletes’ health protection by funding research centres dedicated to the prevention and treatment of sports-related injuries and illnesses. After establishing four centres in 2009, the IOC research centres network expanded to 9 institutions in 2014 and the 2019 round recognised 11 centres. In this editorial, the mission of ReFORM—an international French-speaking network of five institutions is discussed along with the focus areas, expertise and what makes ReFORM unique.
A warm-up before jogging: useful or not? Prof Dr Jan Cabri discusses
Publication: Medial meniscus ramp and lateral meniscus posterior root lesions are present in more than a third of primary and revision ACL reconstructions
Link to the article This study identified concomitant meniscal lesions in two thirds of all ACL reconstructions. Fifty in ACL-injured knees and an improved understanding of ACL injury mechanisms. 50 percent of them involved the biomechanically relevant, but previously often undiagnosed lesions of the medial meniscus ramp or the lateral meniscus posterior root. These findings highlight the need for a thorough and systematic inspection of the menisci. Magosch, A., Mouton, C., Nührenbörger, C. et al. Medial meniscus ramp and lateral meniscus posterior root lesions are present in more than a third of primary and revision ACL reconstructions. Knee Surg Sports Traumatol Arthrosc (2020). https://doi.org/10.1007/s00167-020-06352-3
KSSTA Editorial Published, ‘From Meniscal resection to meniscal repair: a journey of the last decade’
Authors: Roland Becker, Sebastian Kopf, Romain Seil, Michael T. Hirschmann, Philippe Beaufils, Jon Karlsson The last decade has shed some light on the darkness surrounding the treatment of meniscal injuries. A significant amount of work has been done in order to provide a more scientific approach to the treatment of the injured meniscus. Degenerative meniscal lesions and traumatic meniscal tears differ in terms of aetiology and pathology and require differentiated diagnostic algorithms and treatments. A new terminology has, therefore, been defined by the ESSKA meniscus concensus project. A traumatic meniscal tear is caused by an acute and sufficiently serious trauma to the knee. In contrast, a degenerative meniscal lesion occurs due to repetitive minor injuries and lacks a sufficiently serious single trauma. This editorial shows that the scope of the meniscus repair is greater than before and there is still a need for both more basic scince and clinical research in order to identify the best practice when treating different meniscal pathologies. Link: https://link.springer.com/article/10.1007/s00167-020-06316-7
The Meniscus Congress postponed to January 12th-15th 2022
Unfortunately, the pandemic forced us to revise our plans for THE MENISCUS congress which was scheduled from January 27th – 30th 2021 in Luxembourg..
Release of the book on ‘Primary prevention of sports injuries’ after the success of GOTS Expert meeting 2019 in Luxembourg
In close collaboration with LIROMS, the German-speaking Orthopaedic and Traumatologic Society of Sports Medicine (GOTS) has continued the successful tradition of its expert meetings, which started in 2010.. At the 6th edition of GOTS expert meeting from 19-22 September 2019, in Canach (Luxembourg), organized under the direction of GOTS president Prof. Romain Seil, a group of 30 specialists from Austria, Belgium, Germany, Luxembourg, Norway, Switzerland, and The Netherlands, discussed the current status of primary prevention of sports injuries and illnesses. The majority of the experts were orthopaedic surgeons, but also sports scientists and physiotherapists, as well as German health insurance companies, were involved.
LIROMS recognized by the International Olympic Committee as one of the five partners of the French-speaking Sports Medicine Research
We are proud to announce that LIROMS has been recognized by the International Olympic Committee as one of the five partners of the French-speaking Sports Medicine Research Network. ReFORM: Réseau Francophone Olympique de la Recherche de Médecine du sport (formerly known as FReNAHP2).
The 1st virtual Qualisys User Group Meeting took place on October 8th, 2020.
Qualisys users across Central Europe gathered at the virtual “Hopin” venue to share their work and experience on the topic ”Using motion capture to benefit researchers, clinicians and coaches – today and in the future”. LIROMS representatives were amongst invited speakers for the session entitled “Functional Assessment”. Presentations covered the state of play in scientific and field-based motion capture approaches for athletes, coaches and medical teams working with them to assess athlete’s health and performance status. The panel discussion fostered in-deep conversations amongst peers, pinpointing current challenges and future opportunities of available and rising technologies. The LIROMS contribution was rewarded with positive echo and a burst of recurrent exchanges throughout the rest of the day in the event’s chat rooms. Honored by the invitation, the LIROMS team thanks the event organizers and attendees for this outstanding session. Link: https://www.qualisys.com/events/qualisys-virtual-user-group-meeting-dach/
The first annual workshop for the Pediatric Anterior Cruciate Ligament Initiative (PAMI), 2nd Oct 2020, organized by ESSKA.
The aim of the workshop was to gather PAMI partners as well as interested institutions to discuss the organisational aspects and the future perspectives of the initiative. The PAMI aims to collect and analyse data from orthopaedic surgeons who are treating children and adolescents with anterior cruciate ligament (ACL) injury using an international data collection system. Through this initiative, the goal is to improve diagnosis, treatment options, surgical techniques and rehabilitation of pediatric ACL injuries. Presented during the ESSKA conference in Glasgow in May 2018, the ESSKA leadership has placed PAMI under the lead of its Basic Science Committee chaired by Caroline Mouton since May 2020. Currently, 6 partner institutions from Austria, Italy, Luxembourg, Netherlands Norway, and Spain are actively enrolling patients. Since the first inclusion in October 2018, 68 children have been recruited with a continuous increase of inclusion within the last months. The first data shows that the chronological age at injury for this population was in average 12 years of age (from 6 to 17 years of age). Most injuries occurred while playing football (38%). At the time of the analysis, 69% were indicated for surgery. While several developments were made in the last months to enhance data quality and user’s experience with the PAMI web portal, the preliminary analyses allowed the PAMI steering committee to highlight some technical issues in data consistency, accuracy and completeness. These issues will be specifically targeted within the next months to consolidate the database and provides efficient guidelines to PAMI partners. In 2021, the PAMI managers will also start to provide yearly feedbacks to partner institutions on their data in order to ensure the quality of data and to officially publish the first results of the PAMI. Next years will be critical for the PAMI. A request to extend the ethical approval of the project as well as financial supports is foreseen, which also gives the opportunity to evaluate and strengthen the current initiative. During the workshop, inclusion/exclusion criteria were discussed again as well as the possibility to extend the content of data gathered within the project. Please be aware that we are still looking for interested partner institutions to join us. If you are an orthopaedic surgeon or a medical doctor treating children and adolescents with ACL injury and are interesting in the PAMI, please contact us at firstname.lastname@example.org. We will keep you aware of our next workshop and symposium that we hope to be able to organise during the next ESSKA congress in Milano. Detailed information on how to become a PAMI partner is available online on the ESSKA platform; https://www.esska.org/general/custom.asp?page=PAMI Thanks to the following partners: Smith and Nephew, International Olympic Committee, Luxemburgish Olympic committee, Luxembourg Institute of Health