ECSS Paris 2023: OP-MH31
INTRODUCTION: Despite a high surgical success rate, total knee arthroplasty often results in a profound and debilitating decline in physical function. Although lower-limb muscle strength is a strong predictor of physical function in patients with advanced knee osteoarthritis prior to surgery, its prognostic value for postoperative function following total knee arthroplasty remains unclear. METHODS: Hierarchical linear regression analyses were conducted to examine the predictive value of pre-operative leg press maximal strength relative to body weight for post-operative physical function in 40 total knee arthroplasty patients (age: 66 ± 7 years; 17 males and 23 females; and BMI: 29 ± 5 kg/m²). Outcome variables were postoperative performance-based physical function tasks, including 10-step stair climbing, 30 s sit-to-stand, 40 m fast-paced walking, and unipedal stance tests at 3 weeks postoperatively. Sit-to-stand and stair climbing were also assessed at the 1-year follow-up, and separate regression models were conducted for each time point. For each variable, age, sex, and post-operative pain assessed at the corresponding follow-up time point were entered in the first block as covariates, and maximal strength was added in the second block as the predictor. RESULTS: The model with covariates was only associated with balance at 3 weeks and only stair climbing at the 1-year follow-up. The addition of maximal strength significantly improved prediction of function. At 3 weeks postoperatively, maximal strength was a strong predictor of sit-to-stand (p < 0.001), stair climbing (p < 0.001), and balance performance (p = 0.004), accounting for 40%, 36%, and 18% of the variance, respectively. Maximal strength was not significantly associated with fast-paced walking. The predictive ability of maximal strength for sit-to-stand (p = 0.002; 26%) and stair climbing (p = 0.012; 11%) persisted at 1 year. CONCLUSION: Preoperative maximal strength is a powerful predictor of physical function at early- and mid-term follow-up after total knee arthroplasty, particularly for force-driven tasks such as sit-to-stand and stair climbing. It provides prognostic information and may help identify patients at risk of poorer early- and mid-term postoperative physical function, supporting optimized interventions to target preoperative lower limb maximal strength.
Read CV Mani IzadiECSS Paris 2023: OP-MH31
INTRODUCTION: Bone Stress Injuries (BSIs) are one of the main health problems among elite athletes causing loss of a large number of training days and even the end of the competition season. BSI occur as a result of an imbalance between the mechanical load placed on the bone that leads to abnormal remodelling. Numerous risk factors have been postulated for their development, including training load, type of sport, individual anatomical and biomechanical characteristics, nutritional status, and general health factors. Identifying such determinants could enable the creation of effective screening tools and targeted preventive programs to reduce injury risk among athletes. The aim of the study was to provide information about the prevalence, and selected characteristics associated with BSIs among professional Polish athletes. METHODS: The study included elite Polish athletes representing Olympic sport disciplines who completed a questionnaire during routine medical examinations regarding lifetime history of BSIs and training-related factors. RESULTS: 64 of 956 active athletes (6,7%) reported BSI in their medical history. The prevalence of BSI was higher in women than in men and differed significantly across sport categories, with the highest proportion among endurance athletes. Within the BSI group, 76.6% of athletes reported a subjective relationship between the occurrence of the injury and a significant change in their training regimen. The most frequently mentioned training-related changes included increased intensity (43.8%) and training volume (21.9%), as well as early sport specialization (51.6%). CONCLUSION: The number of BSI reported in our group is comparable with the results of other studies which range from 4-5% annually among runners to 8.3%-52% in endurance runners and track and field athletes. The main findings of our study indicate significant associations between incidence of BSI and sex (female athletes), as well as the type of training, with a higher prevalence observed in endurance sports. Factors that have been proposed to explain higher incidence of BSIs among female athletes can be divided into two categories - those related to the constitutional structure of the female body and those related to behaviours that influence the hormonal balance. It appears that the specific nature of endurance sports appears to have a substantial influence on disrupting bone remodelling. Early specialization was significantly more prevalent in athletes with a history of BSI in mixed sports compared with endurance sports. A plausible explanation is that mixed training - combining high load in terms of volume and intensity - can cause excessive loading that disrupts bone remodelling in the developing skeletal system. Conclusion: BSIs represent a relevant health issue among professional athletes, particularly among women and endurance athletes. Early specialization and increases in training volume were commonly reported characteristics among athletes with a history of BSI.
Read CV Jaroslaw KrzywanskiECSS Paris 2023: OP-MH31
INTRODUCTION: Vitamin D deficiency is common in athletic populations and has been implicated in musculoskeletal health. While its role in bone injury is well known, the association between vitamin D deficiency and soft-tissue injury remains unclear. This study aimed to systematically review and meta-analyse the association between vitamin D deficiency and the prevalence of soft-tissue injuries in athletes. METHODS: A systematic review was conducted in MEDLINE (OVID) and the Cochrane Library using predefined search terms related to vitamin D, athletes, and musculoskeletal injury. Observational studies comparing the prevalence of soft-tissue injuries between vitamin D-deficient and vitamin D-sufficient athletes were included. Study quality was assessed using the Newcastle–Ottawa Scale. A random-effects meta-analysis was performed using inverse-variance weighting with DerSimonian–Laird estimation to calculate pooled odds ratios (ORs) in the SPSS program. Statistical heterogeneity was assessed using the I-squared and tau-squared statistics. Publication bias was evaluated through funnel plot inspection and Egger’s, Harbord’s, and Peters’ regression tests. RESULTS: Six studies met the inclusion criteria and were included in the meta-analysis. Vitamin D deficiency (serum 25-hydroxyvitamin D <30 ng/ml) was not significantly associated with the prevalence of soft-tissue injury when compared with vitamin D sufficiency (pooled OR = 2.63, 95% CI 0.38–18.01; p = 0.32). Substantial heterogeneity was observed across studies (I squared = 93%; tau squared = 2.63). Although most included studies reported effect estimates suggestive of increased injury prevalence among vitamin D-deficient athletes, confidence intervals were wide and inconsistent. No evidence of publication bias was identified on visual inspection or through regression-based testing. CONCLUSION: This meta-analysis found no statistically significant association between vitamin D deficiency and the prevalence of soft-tissue injuries in athletes. Despite a tendency toward higher injury prevalence in vitamin D-deficient groups within individual studies, the pooled findings were inconclusive and characterised by marked heterogeneity. These results conflict with aspects of the existing literature suggesting a potential relationship between low vitamin D status and musculoskeletal injury risk. The current evidence base remains limited and inconsistent, underscoring the need for larger, well-designed prospective studies to more definitively clarify the role of vitamin D status in soft-tissue injury risk among athletic populations.
Read CV Srisiddharth YadatiECSS Paris 2023: OP-MH31