Defining Platelet-Rich Plasma Usage by Team Physicians in Elite Athletes

Background: The indications for the use of platelet-rich plasma (PRP) are vaguely defined despite the frequency of its use as a treatment for athletes. While select studies have advocated for its efficacy, the majority of orthopaedic research conducted on the topic has been equivocal. Purpose: To define the use of PRP in elite athletes by team physicians from professional sports leagues. Study Design: Cross-sectional study. Methods: A survey assessing treatment timing, usage patterns, indications, and complications was generated by fellowship-trained sports medicine orthopaedic surgeons. The survey was distributed to team physicians from the National Football League, National Basketball Association, Major League Baseball, National Hockey League, Major League Soccer, and the “Power 5” Division I conferences of the National Collegiate Athletic Association. From a compilation of publicly available email addresses and those available from professional team physician associations, 149 team physicians were sent this PRP assessment tool. Results: Of the 149 professional and collegiate team physicians contacted, 59 started the survey and 46 completed it, resulting in a 39.6% participation rate and a 30.9% completion rate. Approximately 93% of physicians stated that they use PRP in their practices, and 72% use ultrasonography for injection guidance. On average, collegiate team physicians and National Football League physicians treated the most players per season with PRP (69.4 and 60.4 players, respectively), while National Hockey League physicians treated the fewest (18.0 players). The majority of respondents reported no complications from PRP injections (70%), with pain being the most common complication reported (26%). There was no consensus on the most important aspect of PRP formulation, with the top 2 responses being platelet concentration (48%) and white blood cell concentration (39%). When grading the importance of indications to use PRP, physicians found athlete desire on average (7.5 ± 2.2 [SD]; out of 10) to be more important than reimbursement (2.2 ± 2.2) ( P < .001). Importantly, physicians stated that they moderately (5.4 ± 2.3) believed in the evidence behind PRP. Physicians listed hamstring injuries as the most common injury treated with PRP. Hamstring injuries were treated with a mean 3.14 PRP injections, as opposed to 2.19 injections for nonhamstring injuries. Conclusion: Professional and collegiate team physicians frequently use PRP despite a lack of consensus regarding the importance of the formulation of the product, the timing of treatment, and the conditions that would most benefit from PRP treatment.

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Sport-specific influences on respiratory patterns in elite athletes

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562015000000050 ◽

2015 ◽

Vol 41 (6) ◽

pp. 516-522 ◽

Cited By ~ 10

Author(s):

Tijana Durmic ◽

Biljana Lazovic ◽

Marina Djelic ◽

Jelena Suzic Lazic ◽

Dejan Zikic ◽

...

Keyword(s):

Reference Values ◽

Sports Medicine ◽

Elite Athletes ◽

Age Groups ◽

Cross Sectional Study ◽

Physiological Adaptation ◽

Basketball Players ◽

Cross Sectional ◽

Intensity Of Exercise ◽

Maximal Voluntary Ventilation

ABSTRACT OBJECTIVE: To examine differences in lung function among sports that are of a similar nature and to determine which anthropometric/demographic characteristics correlate with lung volumes and flows. METHODS: This was a cross-sectional study involving elite male athletes (N = 150; mean age, 21 4 years) engaging in one of four different sports, classified according to the type and intensity of exercise involved. All athletes underwent full anthropometric assessment and pulmonary function testing (spirometry). RESULTS: Across all age groups and sport types, the elite athletes showed spirometric values that were significantly higher than the reference values. We found that the values for FVC, FEV1, vital capacity, and maximal voluntary ventilation were higher in water polo players than in players of the other sports evaluated (p < 0.001). In addition, PEF was significantly higher in basketball players than in handball players (p < 0.001). Most anthropometric/demographic parameters correlated significantly with the spirometric parameters evaluated. We found that BMI correlated positively with all of the spirometric parameters evaluated (p < 0.001), the strongest of those correlations being between BMI and maximal voluntary ventilation (r = 0.46; p < 0.001). Conversely, the percentage of body fat correlated negatively with all of the spirometric parameters evaluated, correlating most significantly with FEV1 (r = −0.386; p < 0.001). CONCLUSIONS: Our results suggest that the type of sport played has a significant impact on the physiological adaptation of the respiratory system. That knowledge is particularly important when athletes present with respiratory symptoms such as dyspnea, cough, and wheezing. Because sports medicine physicians use predicted (reference) values for spirometric parameters, the risk that the severity of restrictive disease or airway obstruction will be underestimated might be greater for athletes.

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Influence of Cognitive Performance on Musculoskeletal Injury Risk: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546521998081 ◽

2021 ◽

pp. 036354652199808

Author(s):

Jason M. Avedesian ◽

Warren Forbes ◽

Tracey Covassin ◽

Janet S. Dufek

Keyword(s):

Systematic Review ◽

Cognitive Performance ◽

Sports Medicine ◽

Injury Risk ◽

Assessment Tool ◽

Meta Analysis ◽

Cross Sectional ◽

Athletic Population ◽

Injury Occurrence ◽

Injured Athletes

Background: While a large number of studies have investigated the anatomic, hormonal, and biomechanical risk factors related to musculoskeletal (MSK) injury risk, there is growing evidence to suggest that cognition is an important injury contributor in the athletic population. A systematic review of the available evidence regarding the influence of cognitive performance on MSK injury risk has yet to be published in the sports medicine literature. Purpose/Hypothesis: The purpose was to determine the effects of cognition on (1) MSK biomechanics during sports-specific tasks and (2) MSK injury occurrence in the athletic population. It was hypothesized that athletes with lower cognitive performance would demonstrate biomechanical patterns suggestive of MSK injury risk and that injured athletes would perform worse on baseline measures of cognition as compared with their noninjured counterparts. Study Design: Systematic review. Methods: PubMed and SPORTDiscus were searched from January 2000 to January 2020. Manual searches were performed on the reference lists of the included studies. A search of the literature was performed for studies published in English that reported MSK biomechanics as a function of cognitive performance and MSK injury occurrence after baseline measures of cognition. Two independent reviewers extracted pertinent study data in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 guidelines and assessed study quality using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies from the National Institutes of Health. A meta-analysis was not performed, owing to the heterogeneous nature of the study designs. Results: Ten studies met inclusion criteria: 4 cognition–MSK biomechanics studies and 6 cognition–MSK injury studies. All 4 cognition–MSK biomechanics studies demonstrated that worse performance on measures of cognition was associated with lower extremity MSK biomechanical patterns suggestive of greater risk for MSK injury. The majority of the cognition–MSK injury studies demonstrated that injured athletes significantly differed on baseline cognition measures versus matched controls or that cognitive performance was a significant predictor for subsequent MSK injury. Conclusion: Although the literature exploring cognitive contributions to MSK injury risk is still in its infancy, it is suggested that sports medicine personnel conduct baseline assessments of cognition—in particular, reaction time and working memory—to identify which athletes may be at elevated risk for future MSK injury.

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Hamstring Injury Trends in Major and Minor League Baseball: Epidemiological Findings From the Major League Baseball Health and Injury Tracking System

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119861064 ◽

2019 ◽

Vol 7 (7) ◽

pp. 232596711986106

Author(s):

Kelechi R. Okoroha ◽

Stan Conte ◽

Eric C. Makhni ◽

Vincent A. Lizzio ◽

Christopher L. Camp ◽

...

Keyword(s):

Major League Baseball ◽

Platelet Rich Plasma ◽

Tracking System ◽

Hamstring Injury ◽

Professional Baseball ◽

Baseball Players ◽

Minor League Baseball ◽

Hamstring Injuries ◽

Minor League ◽

Major League

Background: Hamstring strains are the most common injury for professional baseball players and can result in significant time on the disabled list. To date, no study has reported the current trends in hamstring strains in professional baseball. Hypothesis: Professional baseball players would have an increased incidence of hamstring strains from 2011 through 2016. Study Design: Descriptive epidemiology study. Methods: Injury data were prospectively collected from 2011 through 2016 for every Major League Baseball (MLB) and Minor League Baseball (MiLB) team and was recorded in the MLB Health and Injury Tracking System. Data collected for this study included date of injury, activity during injury, time lost, primary injury or reinjury status, and imaging findings as well as player demographic information related to level of play, age, and position for all hamstring injury events. Injury rates were reported as hamstring injuries per number of games. Results: From 2011 to 2016, there were 2633 hamstring strains in professional baseball players. The rate of hamstring strains increased in MLB from a low of 1 injury every 39 games in 2011 to a high of 1 injury every 30 games in 2016. In MiLB, there were 2192 hamstring strains, with 1 injury every 35 games in 2011 compared with 1 injury every 30 games in 2016. The majority of injuries occurred in the infielder positions (37.5%) and resulted from base running (>50%), most commonly from home to first base. The most common hamstring injury was a grade 2 injury to the distal biceps femoris. The mean time missed after a hamstring injury was 14.5 days. Grade 3 and grade 2 hamstring strains resulted in significantly more days missed compared with grade 1 injuries ( P = .005 and P = .002, respectively). The rate of recurrent hamstring injuries was 16.3% for MLB and 14.2% for MiLB. Recurrent hamstring injuries resulted in more time lost than primary injuries (mean, 16.4 vs 14.5 days, respectively; P = .02). A total of 42 injuries were treated with platelet-rich plasma, and 19 were treated with surgery. The number of injuries treated with platelet-rich plasma increased in successive years. Conclusion: The rate of hamstring strains in professional baseball players has increased over the past 6 years and has resulted in a significant loss of playing time. Study results indicated that these injuries are affected by injury characteristics, position played, running to first base, seasonal timing, and history of hamstring injuries.

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Cardiovascular Screening Practices and Attitudes From the NCAA Autonomous “Power” 5 Conferences

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738118775039 ◽

2018 ◽

Vol 10 (6) ◽

pp. 547-551 ◽

Cited By ~ 7

Author(s):

Christopher W. Miars ◽

Andreas Stamatis ◽

Grant B. Morgan ◽

Jonathan A. Drezner

Keyword(s):

Sports Medicine ◽

Student Athletes ◽

National Collegiate Athletic Association ◽

Physician Attitudes ◽

Level Of Evidence ◽

Cross Sectional ◽

Men's Basketball ◽

Screening Practices ◽

Cardiovascular Screening ◽

Screening Protocol

Background: The development of athlete-specific electrocardiogram (ECG) interpretation standards, along with recent rates of sudden cardiac death (SCD) in athletes being higher than previously estimated, has heightened the debate in the sports medicine community regarding cardiovascular screening of the college athlete, including whether certain high-risk subsets, such as male basketball athletes, should undergo more intensive screening. Hypothesis: ECG and/or echocardiography screening in National Collegiate Athletic Association Autonomous 5 Division I (A5DI) schools will be more common than previous reports, and there will be more frequent use of noninvasive cardiac screening for men’s basketball players than the general athlete population. Study Design: Cross-sectional, quantitative study. Level of Evidence: Level 4. Methods: The head team physician for each of the 65 schools in the A5DI conferences was contacted to complete an anonymous survey regarding cardiovascular screening practices at their institution. The survey inquired about current screening protocols, whether SCD epidemiology (SCD-E) was considered in establishing those practices, and whether awareness of present epidemiology altered physician attitudes toward screening. Results: A total of 45 of the 65 team physicians (69%) responded. All schools reported performing history and a physical evaluation. While 17 (38%) perform only history and physical, 26 (58%) also include an ECG, and 12 (27%) include echocardiography for all student-athletes. Specifically for male basketball athletes, 10 (22%) schools perform only history and physical, 32 (71%) include ECG, and 20 (45%) include echocardiography. Additionally, 64% reported using SCD-E in developing their screening protocol. Those that had not considered SCD-E indicated they were unlikely to change their screening protocol when presented with current SCD-E. Conclusion: The majority (62%) of A5DI institutions include ECG and/or echocardiography as part of their cardiovascular screening of all athletes, increasing to 78% when specifically analyzing male basketball athletes. Clinical Relevance: A5DI institutions, presumably with greater resources, have largely implemented more intensive cardiovascular screening than just history and physical for all student-athletes and specifically for men’s basketball—the athlete group at greatest risk.

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Platelet-rich plasma (PRP) Shortens Return to Play in National Football League (NFL) Players with Acute Hamstring Injuries

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00425 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0042

Author(s):

Justin W. Arner ◽

Tracye J. Lawyer ◽

Craig Stephen Mauro ◽

James P. Bradley

Keyword(s):

Operative Treatment ◽

National Football League ◽

Platelet Rich Plasma ◽

Financial Impact ◽

Return To Play ◽

Professional Athletes ◽

Hamstring Injury ◽

Hamstring Injuries ◽

Injection Treatment ◽

Musculoskeletal Radiologist

Objectives: Hamstring injuries are common in professional athletes and subsequent delays in healing are common, costly, and even career ending. The efficacy of platelet-rich plasma (PRP) for augmentation of non-operative treatment of partial musculotendinous hamstring injuries has not yet been established. Methods: NFL players from a single team who sustained acute grade 2 hamstring injuries as diagnosed on MRI by a musculoskeletal radiologist from 2009 to 2017 were retrospectively reviewed. Average days, practices, and games missed were recorded. Players that did and did not receive PRP injections were compared. Those who received PRP did so within 24 to 48 hours after injury. Results: Ninety-four NFL players had MRI evidence of a hamstring injury, while 61 athletes sustained grade 2 injuries. Thirty-one were treated with PRP injections and 30 were not. Average time missed in those treated with PRP injections was 22.4 days, 18.5 practices, and 1.7 games. In those who did not receive PRP injections, time missed was 25.8 days (p = 0.81), 22.2 practices (p = 0.68), and 2.7 games (p < 0.05). Conclusion: PRP injection treatment for acute grade 2 hamstring injuries in NFL players allows for faster return to play with a 1 game overall difference. Due to the possible large financial impact of return to play 1 game sooner, PRP injections for treatment of grade 2 hamstring injuries may be advantageous in professional athletes. Additional evaluation of PRP treatment of acute hamstring injuries in a larger cohort is necessary.

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The Fractured Messaging of the National Collegiate Athletic Association and Its Members in Response to COVID-19

International Journal of Sport Communication ◽

10.1123/ijsc.2020-0249 ◽

2020 ◽

Vol 13 (3) ◽

pp. 324-334

Author(s):

Timothy Mirabito ◽

Robin Hardin ◽

Joshua R. Pate

Keyword(s):

National Football League ◽

National Collegiate Athletic Association ◽

Youth Sports ◽

Governance Structure ◽

National Basketball Association ◽

Division I ◽

National Hockey League ◽

The Public ◽

Women's Basketball ◽

Ladies Professional Golf Association

The sports world’s near universal moratorium in response to the COVID-19 pandemic was abrupt and unprecedented. From professional leagues to youth sports, doors were closed to competitions and events to help stop the spread of the coronavirus. The hiatus began at one of the busiest times on the calendar for sport, with the National Basketball Association and National Hockey League seasons concluding; the Women's National Basketball Association and National Football League drafts taking place; Major League Baseball's spring training nearing its conclusion; the Professional Golf Association and Ladies Professional Golf Association Tours starting their seasons; and the National Collegiate Athletic Association's marquee events, the Division-I men’s and women’s basketball tournaments, set to begin. The suddenness of the interruption was met with a need by the various sport entities to engage their public with information about their respective responses. The statements that emerged on or after March 12—“the day the sports world stopped”—were not all the same. Many of the statements, in fact, were quite different. That was especially the case with the National Collegiate Athletic Association, whose governance structure and messaging practices hindered their ability to have a uniform response. The purpose of this essay was to examine the public messaging of sport leagues and organizations and to discuss the effectiveness (or ineffectiveness) of those public statements.

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The Effect of NFL and NCAA Football Games on the Spread of COVID-19 in the United States: An Empirical Analysis

10.1101/2021.02.15.21251745 ◽

2021 ◽

Author(s):

Asmae Toumi ◽

Haoruo Zhao ◽

Jagpreet Chhatwal ◽

Benjamin P. Linas ◽

Turgay Ayer

Keyword(s):

Time Series ◽

National Football League ◽

National Collegiate Athletic Association ◽

The United States ◽

Cross Sectional Study ◽

County Level ◽

Sectional Study ◽

Difference In Differences ◽

Cross Sectional ◽

The Impact

ABSTRACTImportanceIn 2020 and early 2021, the National Football League (NFL) and National Collegiate Athletic Association (NCAA) had opted to host games in stadiums across the country. The in-person attendance of games has varied with time and from county to county. There is currently no evidence on whether limited in-person attendance of games has caused a substantial increase in coronavirus disease 2019 (COVID-19) cases.ObjectiveTo assess whether NFL and NCAA football games with limited in-person attendance have contributed to a substantial increase in COVID-19 cases in the counties they were held.DesignIn this time-series cross-sectional study, we matched every county hosting game(s) with in-person attendance (treated) in 2020 and 2021 with a county that has an identical game history for up to 14 days (control). We employed a standard matching method to further refine this matched set so that the treated and matched control counties have similar population size, non-pharmaceutical intervention(s) in place, and COVID-19 trends. We assessed the effect of hosting games with in-person attendance using a difference-in-difference estimator.SettingU.S. counties.ParticipantsU.S. counties hosting NFL and/or NCAA games.ExposureHosting NFL and/or NCAA games.Main outcomes and measuresEstimating the impact of NFL and NCAA games with in-person attendance on new, reported COVID-19 cases per 100,000 residents at the county-level up to 14 days post-game.ResultsThe matching algorithm returned 361 matching sets of counties. The effect of in-person attendance at NFL and NCAA games on community COVID-19 spread is not significant as it did not surpass 5 new daily cases of COVID-19 per 100,000 residents on average.Conclusions and relevanceThis time-series, cross-sectional matching study with a difference-in-differences design did not find an increase in COVID-19 cases per 100,000 residents in the counties where NFL and NCAA games were held with in-person attendance. Our study suggests that NFL and NCAA football games hosted with limited in-person attendance do not cause a significant increase in local COVID-19 cases.Key pointsQuestionDid NFL and NCAA football games with limited in-person attendance cause a substantia increase in coronavirus disease 2019 (COVID-19) cases in the U.S. counties where the games were held?FindingsThis time-series, cross-sectional study of U.S. counties with NFL and NCAA football games used matching and difference-in-differences design to estimate the effect of games with limited in-person attendance on county-level COVID-19 spread. Our study does not find an increase in county-level COVID-19 cases per 100,000 residents due to NFL and NCAA football games held with limited in-person attendance.MeaningThis study suggests that NFL and NCAA games held with limited in-person attendance do not cause an increase in COVID-19 cases in the counties they are held.

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Blood-Derived Products for Tissue Repair/Regeneration

International Journal of Molecular Sciences ◽

10.3390/ijms20184581 ◽

2019 ◽

Vol 20 (18) ◽

pp. 4581 ◽

Cited By ~ 3

Author(s):

Isabel Andia ◽

Nicola Maffulli

Keyword(s):

Sports Medicine ◽

Tissue Repair ◽

Chronic Wounds ◽

Platelet Rich Plasma ◽

Elite Athletes ◽

Medical Interest

Medical interest in “blood-derived products for tissue repair/regeneration” has old roots, starting with chronic wounds in the 1980s, and boosted by sports medicine at the beginning of the millennium, when elite athletes treated with platelet rich plasma (PRP) resumed competition earlier than expected [...]

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Platelet-Rich Plasma Shortens Return to Play in National Football League Players With Acute Hamstring Injuries

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120911731 ◽

2020 ◽

Vol 8 (4) ◽

pp. 232596712091173 ◽

Cited By ~ 1

Author(s):

James P. Bradley ◽

Tracye J. Lawyer ◽

Sonia Ruef ◽

Jeffrey D. Towers ◽

Justin W. Arner

Keyword(s):

National Football League ◽

Platelet Rich Plasma ◽

Nonoperative Treatment ◽

Return To Play ◽

Professional Athletes ◽

Hamstring Injury ◽

Level Of Evidence ◽

Hamstring Injuries ◽

Recurrent Injury ◽

Significant Difference

Background: Hamstring injuries are prevalent in professional athletes and can lead to significant time loss, with recurrent injury being common. The efficacy of platelet-rich plasma (PRP) for augmentation of nonoperative treatment of partial musculotendinous hamstring injuries is not well established. Hypothesis: The addition of PRP injections to nonoperative treatment for acute partial musculotendinous hamstring injuries will lead to a shortened return to play in National Football League (NFL) players. Study Design: Cohort study; Level of evidence, 3. Methods: NFL players from a single team who sustained acute grade 2 hamstring injuries, as diagnosed on magnetic resonance imaging (MRI) by a musculoskeletal radiologist from 2009 to 2018, were retrospectively reviewed. Average days, practices, and games missed were recorded. Players who did and did not receive PRP (leukocyte-poor) injections were compared. Those who received PRP did so within 24 to 48 hours after injury. Results: A total of 108 NFL players had MRI evidence of a hamstring injury, and of those, 69 athletes sustained grade 2 injuries. Thirty players received augmented treatment with PRP injections and 39 players underwent nonoperative treatment alone. Average time missed in those treated with PRP injections was 22.5 days, 18.2 practices, and 1.3 games. In those who did not receive PRP injections, time missed was 25.7 days ( P = .81), 22.8 practices ( P = .68), and 2.9 games ( P < .05). Conclusion: Augmentation with PRP injections for acute grade 2 hamstring injuries in NFL players showed no significant difference in days missed or time to return to practice but did allow for faster return to play, with a 1 game overall difference. Owing to the possible large financial impact of returning to play 1 game sooner, PRP injections for treatment of grade 2 hamstring injuries may be advantageous in professional athletes.

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International Olympic Committee (IOC) Sport Mental Health Assessment Tool 1 (SMHAT-1) and Sport Mental Health Recognition Tool 1 (SMHRT-1): towards better support of athletes’ mental health

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-102411 ◽

2020 ◽

Vol 55 (1) ◽

pp. 30-37

Author(s):

Vincent Gouttebarge ◽

Abhinav Bindra ◽

Cheri Blauwet ◽

Niccolo Campriani ◽

Alan Currie ◽

...

Keyword(s):

Mental Health ◽

Sports Medicine ◽

Assessment Tool ◽

Elite Athletes ◽

Health Assessment ◽

International Olympic Committee ◽

Mental Health Symptoms ◽

Health Symptoms ◽

Mental Health Assessment ◽

Former Elite Athletes

ObjectivesTo develop an assessment and recognition tool to identify elite athletes at risk for mental health symptoms and disorders.MethodsWe conducted narrative and systematic reviews about mental health symptoms and disorders in active and former elite athletes. The views of active and former elite athletes (N=360) on mental health symptoms in elite sports were retrieved through an electronic questionnaire. Our group identified the objective(s), target group(s) and approach of the mental health tools. For the assessment tool, we undertook a modified Delphi consensus process and used existing validated screening instruments. Both tools were compiled during two 2-day meeting. We also explored the appropriateness and preliminary reliability and validity of the assessment tool.Sport Mental Health Assessment Tool 1 and Sport Mental Health Recognition Tool 1The International Olympic Committee Sport Mental Health Assessment Tool 1 (SMHAT-1) was developed for sports medicine physicians and other licensed/registered health professionals to assess elite athletes (defined as professional, Olympic, Paralympic or collegiate level; aged 16 years and older) potentially at risk for or already experiencing mental health symptoms and disorders. The SMHAT-1 consists of: (i) triage with an athlete-specific screening tool, (ii) six subsequent disorder-specific screening tools and (iii) a clinical assessment (and related management) by a sports medicine physician or licensed/registered mental health professional (eg, psychiatrist and psychologist). The International Olympic Committee Sport Mental Health Recognition Tool 1 (SMHRT-1) was developed for athletes and their entourage (eg, friends, fellow athletes, family and coaches).ConclusionThe SMHAT-1 and SMHRT-1 enable that mental health symptoms and disorders in elite athletes are recognised earlier than they otherwise would. These tools should facilitate the timely referral of those athletes in need for appropriate support and treatment.

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