scholarly journals Staffing, Financial, and Administrative Oversight Models and Rates of Injury in Collegiate Athletes

2020 ◽  
Vol 55 (6) ◽  
pp. 580-586 ◽  
Author(s):  
Christine M. Baugh ◽  
William P. Meehan ◽  
Thomas G. McGuire ◽  
Laura A. Hatfield
Keyword(s):  
Health Care ◽  
Standard Deviation ◽  
Sports Medicine ◽  
Surveillance Program ◽  
Injury Incidence ◽  
Time Loss ◽  
Collegiate Sports ◽  
Medicine Department ◽  
Administrative Oversight ◽  
Athlete Injury

Context Structural features of health care environments are associated with patient health outcomes, but these relationships are not well understood in sports medicine. Objective To evaluate the association between athlete injury outcomes and structural measures of health care at universities: (1) clinicians per athlete, (2) financial model of the sports medicine department, and (3) administrative reporting structure of the sports medicine department. Design Descriptive epidemiology study. Setting Collegiate sports medicine programs. Patients or Other Participants Colleges that contribute data to the National Collegiate Athletic Association (NCAA) Injury Surveillance Program. Main Outcome Measure(s) We combined injury data from the NCAA Injury Surveillance Program, sports medicine staffing data from NCAA Research, athletic department characteristics from the United States Department of Education, and financial and administrative oversight model data from a previous survey. Rates of injury, reinjury, concussion, and time loss (days) in NCAA athletes. Results Compared with schools that had an average number of clinicians per athlete, schools 1 standard deviation above average had a 9.5% lower injury incidence (103.6 versus 93.7 per 10000 athlete-exposures [AEs]; incidence rate ratio [IRR] = 0.905, P < .001), 2.7% lower incidence of reinjury (10.6 versus 10.3 per 10000 AEs; IRR = 0.973, P = .004), and 6.7% lower incidence of concussion (6.1 versus 5.7 per 10000 AEs; IRR = 0.933, P < .001). Compared with the average, schools that had 1 standard deviation more clinicians per athlete had 16% greater injury time loss (5.0 days versus 4.2 days; IRR = 1.16, P < .001). At schools with sports medicine departments financed by or reporting to the athletics department (or both), athletes had higher injury incidences (31% and 9%, respectively). Conclusions The financial and reporting structures of collegiate sports medicine departments as well as the number of clinicians per athlete were associated with injury risk. Increasing the number of sports medicine clinicians on staff and structuring sports medicine departments such that they are financed by and report to a medical institution may reduce athlete injury incidence.

scholarly journals Epidemiology of Hand and Wrist Injuries in NCAA Men’s Football: 2009–2010 to 2013–2014

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983537 ◽  
Author(s):  
Douglas W. Bartels ◽  
Mario Hevesi ◽  
Cody Wyles ◽  
Jeffrey Macalena ◽  
Sanjeev Kakar ◽  
...  
Keyword(s):  
Epidemiological Study ◽  
National Collegiate Athletic Association ◽  
Injury Rate ◽  
Surveillance Program ◽  
Injury Incidence ◽  
Wrist Injuries ◽  
Time Loss ◽  
Expected Time ◽  
Common Activity ◽  
Injury Burden

Background: Participation in National Collegiate Athletic Association (NCAA) football is at an all-time high. This population of athletes experiences a substantial injury burden, with many injuries affecting the upper extremities. Purpose/Hypothesis: The purpose of this study was to describe the epidemiology of hand and wrist injuries in college football players from the academic years 2009–2010 to 2013–2014. We hypothesized that variables such as event type (practice vs game), mechanism of injury, and player position would have an effect on the injury incidence. Study Design: Descriptive epidemiological study. Methods: An epidemiological study utilizing the NCAA Injury Surveillance Program was performed to investigate rates and patterns of hand and wrist injuries in participating varsity football teams from 2009–2010 to 2013–2014. Results: A total of 725 hand and wrist injuries were captured in 899,225 athlete-exposures. The observed practice injury rate was 0.51 injuries per 1000 athlete-exposures, compared with a game injury rate of 3.60 ( P < .01). Player-on-player contact was the most common injury mechanism reported, with blocking being the most common activity at the time of injury. Offensive linemen were most likely to experience an injury. Of all injuries sustained, 71.4% resulted in no time loss from competition, whereas 9.8% of injuries resulted in longer than 7 days of time loss. A fracture resulted in the greatest time loss from competition (mean ± SD, 8.3 ± 24.0 days; median, 0 days [range, 0-148 days] for injuries sustained in a practice setting) (mean ± SD, 7.7 ± 15.8 days; median, 0 days [range, 0-87 days] for injuries sustained in a game setting). Conclusion: Hand and wrist injuries were found to be significantly more common in games when compared with practices. This study provides valuable prognostic data regarding expected time loss on a per-injury pattern basis. Further investigation on specific injury subtypes and expected time loss as a result of these injures would provide trainers, players, and coaches with useful information on an expected postinjury recovery and rehabilitation timeline.

scholarly journals Sports Medicine Staffing Across National Collegiate Athletic Association Division I, II, and III Schools: Evidence for the Medical Model

2020 ◽  
Vol 55 (6) ◽  
pp. 573-579 ◽  
Author(s):  
Christine M. Baugh ◽  
Emily Kroshus ◽  
Bailey L. Lanser ◽  
Tory R. Lindley ◽  
William P. Meehan
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Health Care Providers ◽  
Sports Medicine ◽  
National Collegiate Athletic Association ◽  
Athletic Trainers ◽  
Full Time ◽  
Care Providers ◽  
Collegiate Sports ◽  
Financial Oversight

Context The ratio of clinicians to patients has been associated with health outcomes in many medical contexts but has not been explored in collegiate sports medicine. The relationship between administrative and financial oversight models and staffing is also unknown. Objective To (1) evaluate staffing patterns in National Collegiate Athletic Association sports medicine programs and (2) investigate whether staffing was associated with the division of competition, Power 5 conference status, administrative reporting structure (medical or athletic department), or financial structure (medical or athletic department). Design Cross-sectional study. Setting Collegiate sports medicine programs. Patients or Other Participants Representatives of 325 universities. Main Outcome Measure(s) A telephone survey was conducted during June and July 2015. Participants were asked questions regarding the presence and full-time equivalence of the health care providers on their sports medicine staff. The number of athletes per athletic trainer was determined. Results Responding sports medicine programs had 0.5 to 20 full-time equivalent staff athletic trainers (median = 4). Staff athletic trainers at participating schools cared for 21 to 525 athletes per clinician (median = 100). Both administrative and financial oversight from a medical department versus the athletics department was associated with improved staffing across multiple metrics. Staffing levels were associated with the division of competition; athletic trainers at Division I schools cared for fewer athletes than athletic trainers at Division II or III schools, on average. The support of graduate assistant and certified intern athletic trainers varied across the sample as did the contributions of nonphysician, nonathletic trainer health care providers. Conclusions In many health care settings, clinician : patient ratios are associated with patient health outcomes. We found systematic variations in clinician : patient ratios across National Collegiate Athletic Association divisions of competition and across medical versus athletics organizational models, raising the possibility that athletes' health outcomes vary across these contexts. Future researchers should evaluate the relationships between clinician : patient ratios and athletes' access to care, care provision, health care costs, health outcomes, and clinician job satisfaction.

scholarly journals Epidemiology of Injuries in National Collegiate Athletic Association Men's Football: 2014–2015 Through 2018–2019

2021 ◽  
Vol 56 (7) ◽  
pp. 643-650
Author(s):  
Avinash Chandran ◽  
Sarah N. Morris ◽  
Jacob R. Powell ◽  
Adrian J. Boltz ◽  
Hannah J. Robison ◽  
...  
Keyword(s):  
National Collegiate Athletic Association ◽  
Injury Rate ◽  
The United States ◽  
Lateral Ligament ◽  
Surveillance Program ◽  
Injury Incidence ◽  
Collegiate Sports ◽  
Injury Rates ◽  
Rate Ratios ◽  
Rules Changes

Context Football is among the most popular collegiate sports in the United States, and participation in National Collegiate Athletic Association (NCAA) football has risen in recent years. Background Continued monitoring of football injuries is important for capturing the evolving burden of injuries in NCAA football. The purpose of this study was to describe the epidemiology of football-related injuries among men's NCAA football players during the 2014–2015 through 2018–2019 academic years. Methods Exposure and injury data collected in the NCAA Injury Surveillance Program were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios were used to examine differential injury rates. Results The overall injury rate was 9.31 per 1000 athlete-exposures. Most injuries occurred during general play (17.5%), blocking (15.8%), and tackling (14.0%). Concussions (7.5%), lateral ligament complex tears (6.9%), and hamstring tears (4.7%) were the most commonly reported injuries. Conclusions Results of this study were generally consistent with previous findings, though changes over time in rates of commonly reported injuries warrant attention. Continued monitoring of injury incidence is needed to appraise the effectiveness of recently implemented rules changes.

scholarly journals Sports Medicine Staffing Patterns and Incidence of Injury in Collegiate Men's Ice Hockey

2020 ◽  
Vol 55 (6) ◽  
pp. 587-593 ◽  
Author(s):  
Christine M. Baugh ◽  
Zachary Y. Kerr ◽  
Emily Kroshus ◽  
Bailey L. Lanser ◽  
Tory R. Lindley ◽  
...  
Keyword(s):  
Health Care ◽  
Athletic Trainers ◽  
Ice Hockey ◽  
Injury Incidence ◽  
Graduate Assistant ◽  
Time Loss ◽  
Injury Rates ◽  
Hockey Players ◽  
Patient Load ◽  
Staffing Patterns

Context The relative availability of clinicians as well as the types and training of health care providers have been associated with morbidity and mortality in non-athletic health care settings. Whether staffing variations are associated with injury incidence in collegiate athletes is unknown. Objective To evaluate whether the institutional ratio of athletes to athletic trainers (patient load) or the ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers or both is associated with the incidence of injuries sustained by male ice hockey athletes at the school. Design Descriptive epidemiology study. Setting National Collegiate Athletic Association (NCAA) men's ice hockey teams. Patients or Other Participants Collegiate men's ice hockey athletes. Main Outcome Measure(s) The NCAA Injury Surveillance Program collected data from collegiate men's ice hockey athletes. Staffing patterns were obtained through telephone interviews. Injury counts, injury rates per 1000 athlete-exposures, and injury rate ratios with 95% confidence intervals were calculated and compared between the following groups: (1) schools with high (versus low) patient load and (2) schools with high (versus low) ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers. Results Both the patient load and relative number of staff athletic trainers were associated with variations in the incidences and types of diagnosed injuries in male ice hockey players. Specifically, fewer injuries were diagnosed by clinicians at institutions with high patient loads. The rates of injury overall and non–time-loss injuries were lower in the high patient-load group. Time-loss injury rates, severe injury rates, concussion rates, and overall rates of injury during competition were greater in the group with a higher proportion of staff athletic trainers, whereas non–time-loss injury rates were lower. Conclusions In this study of collegiate men's ice hockey players, athlete health outcomes were directly related to the number and types of clinicians available. Future researchers should evaluate whether this finding extends beyond men's ice hockey.

scholarly journals Epidemiological Patterns of Patellofemoral Injuries in Collegiate Athletes in the United States From 2009 to 2014

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711984071 ◽  
Author(s):  
Jeffrey D. Trojan ◽  
Joshua A. Treloar ◽  
Christopher M. Smith ◽  
Matthew J. Kraeutler ◽  
Mary K. Mulcahey
Keyword(s):  
Sports Medicine ◽  
National Collegiate Athletic Association ◽  
Female Athletes ◽  
Collegiate Athletes ◽  
The United States ◽  
Surveillance Program ◽  
Injury Incidence ◽  
Patellar Subluxation ◽  
Rate Ratios ◽  
Women's Volleyball

Background: As many as 30% of patients with knee pain seen in sports medicine clinics have complaints related to the patellofemoral joint. There is a paucity of research available regarding patellofemoral injuries, mechanism of injury, and playing time lost in collegiate athletes. Purpose: To describe the rates, mechanisms, severity, and potential sex-based differences of patellofemoral injuries in collegiate athletes across 25 National Collegiate Athletic Association (NCAA) sports. Study Design: Descriptive epidemiology study. Methods: Data from the 2009-2010 through the 2013-2014 academic years were obtained from the NCAA Injury Surveillance Program and were analyzed to calculate patellofemoral injury rates, mechanisms of injury, time lost, and need for surgery. Rate ratios and injury proportion ratios were used to quantify discernible differences between sex-comparable sports and timing of injury (ie, practice vs competition), respectively. Results: The overall patellofemoral injury incidence rate was 16.10 per 100,000 athlete-exposures (AEs). Women’s volleyball had the highest incidence of all sports (39.57 per 100,000 AEs). Injuries were 66% more likely to occur in competition than during practice. Female athletes experienced significantly more patellofemoral injuries than males in similar sports. Patellar tendinitis accounted for 49.2% of all patellofemoral injuries and was the most common injury in 20 of 25 studied sports. Patellar subluxation accounted for the most total days missed, and patellar dislocation had the highest mean days missed per injury (11.42 days). Patella fracture was the most likely injury to require surgery (80%). Conclusion: Patellofemoral injuries were most common in sports that require jumping and quick changes of direction, specifically women’s volleyball, men’s and women’s basketball, and women’s soccer. The majority of patellofemoral injuries in this cohort were classified as patellar tendinitis caused by overuse. Most injuries resulted in no competition or practice time lost. This information may contribute to the development of prevention programs aimed at addressing the most prevalent types and mechanisms of injury in each sport to reduce the incidence of patellofemoral injury in these athletes.

scholarly journals Pressure on Sports Medicine Clinicians to Prematurely Return Collegiate Athletes to Play After Concussion

2015 ◽  
Vol 50 (9) ◽  
pp. 944-951 ◽  
Author(s):  
Emily Kroshus ◽  
Christine M. Baugh ◽  
Daniel H. Daneshvar ◽  
Julie M. Stamm ◽  
R. Mark Laursen ◽  
...  
Keyword(s):  
Sports Medicine ◽  
Athletic Trainers ◽  
Collegiate Athletes ◽  
Cross Sectional Study ◽  
Athletic Department ◽  
Collegiate Sports ◽  
Cross Sectional ◽  
Web Based ◽  
Medicine Department ◽  
Concussion Recovery

Context  Anecdotal and qualitative evidence has suggested that some clinicians face pressure from coaches and other personnel in the athletic environment to prematurely return athletes to participation after a concussion. This type of pressure potentially can result in compromised patient care. Objective  To quantify the extent to which clinicians in the collegiate sports medicine environment experience pressure when caring for concussed athletes and whether this pressure varies by the supervisory structure of the institution's sports medicine department, the clinician's sex, and other factors. Design  Cross-sectional study. Setting  Web-based survey of National College Athletic Association member institutions. Patients or Other Participants  A total of 789 athletic trainers and 111 team physicians from 530 institutions. Main Outcome Measure(s)  We asked participants whether they had experienced pressure from 3 stakeholder populations (other clinicians, coaches, athletes) to prematurely return athletes to participation after a concussion. Modifying variables that we assessed were the position (athletic trainer, physician) and sex of the clinicians, the supervisory structure of their institutions' sports medicine departments, and the division of competition in which their institutions participate. Results  We observed that 64.4% (n = 580) of responding clinicians reported having experienced pressure from athletes to prematurely clear them to return to participation after a concussion, and 53.7% (n = 483) reported having experienced this pressure from coaches. Only 6.6% (n = 59) reported having experienced pressure from other clinicians to prematurely clear an athlete to return to participation after a concussion. Clinicians reported greater pressure from coaches when their departments were under the supervisory purview of the athletic department rather than a medical institution. Female clinicians reported greater pressure from coaches than male clinicians did. Conclusions  Most clinicians reported experiencing pressure to prematurely return athletes to participation after a concussion. Identifying factors that are associated with variability in pressure on clinicians during concussion recovery can inform potential future strategies to reduce these pressures.

scholarly journals Epidemiology of Elbow Ulnar Collateral Ligament Injuries in Throwing Versus Contact Athletes of the National Collegiate Athletic Association: Analysis of the 2009-2010 to 2013-2014 Seasons

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983642 ◽  
Author(s):  
Neill Y. Li ◽  
Avi D. Goodman ◽  
Nicholas J. Lemme ◽  
Brett D. Owens
Keyword(s):  
National Collegiate Athletic Association ◽  
Injury Rate ◽  
Ulnar Collateral Ligament ◽  
Surveillance Program ◽  
Collateral Ligament ◽  
Time Loss ◽  
Collegiate Sports ◽  
Severe Injuries ◽  
Injury Rates ◽  
Varsity Sports

Background: The management and outcomes of elbow ulnar collateral ligament (UCL) injuries in throwing athletes have been well investigated. However, less is known regarding the management, severity, and outcomes of such injuries in contact athletes. Purpose: To compare the incidence, severity, and outcomes of elbow UCL injuries between throwing and contact athletes in collegiate sports. Study Design: Descriptive epidemiology study. Methods: Elbow UCL injuries were queried from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program between the seasons of 2009-2010 and 2013-2014 in 25 varsity sports. The rates and distribution of injuries by mechanism, participation restriction time, and outcomes (eg, season-ending injury, surgery) were examined. A severe injury was defined as loss of ≥21 days from participation, a season-ending injury, or requiring a surgical intervention. The injury frequency, incidence per 10,000 athlete-exposures (AEs), and injury proportion ratio comparing throwing and contact athletes were calculated with 95% CIs. Results: Over the course of 5 seasons, 109 UCL injuries were recorded, for an overall injury rate of 0.29 per 10,000 AEs. Of these injuries, 83 (76.1%) were a result of contact and 26 (23.9%) from throwing. Men’s wrestling (1.78 per 10,000 AEs) and men’s baseball (1.12 per 10,000 AEs) sustained the highest injury rates. A larger proportion of throwing (n = 8; 36.4%) compared with contact (n = –7; 9.1%) ( P < 0.01) injuries results in >21 days of time loss. Additionally, more throwing-related UCL injuries required surgery (n = 2; 11.1%) compared with contact-related injuries (n = 1; 1.3%) ( P < 0.01). As a result, throwing athletes demonstrated a significantly higher proportion of severe injuries than contact athletes (injury proportion ratio, 4.62 [95% CI, 1.72-12.40]). Conclusion: The evaluation of athletes in 25 collegiate varsity sports across 5 seasons found over 3 times more elbow UCL injuries in contact versus throwing athletes. However, the number of severe injuries in throwing athletes was significantly higher than in contact athletes. These findings demonstrate that although elbow UCL injuries are prone to occur in both contact and throwing athletes, their prevention, management, and outcomes must be framed on a sport-by-sport basis.

scholarly journals Epidemiology of Injuries in National Collegiate Athletic Association Women's Basketball: 2014–2015 Through 2018–2019

2021 ◽  
Vol 56 (7) ◽  
pp. 674-680
Author(s):  
Landon B. Lempke ◽  
Avinash Chandran ◽  
Adrian J. Boltz ◽  
Hannah J. Robison ◽  
Christy L. Collins ◽  
...  
Keyword(s):  
Sports Medicine ◽  
National Collegiate Athletic Association ◽  
Cruciate Ligament ◽  
Injury Rate ◽  
Surveillance Program ◽  
Injury Incidence ◽  
Ankle Sprains ◽  
Contributing Factors ◽  
Injury Rates ◽  
Women's Basketball

Context Frequent inspection of sports-related injury epidemiology among National Collegiate Athletic Association (NCAA) women's basketball student-athletes is valuable for identifying injury-related patterns. Background Emerging patterns in epidemiology of NCAA women's basketball injuries are unknown though general sports medicine practices, and playing rules and regulations have evolved in recent years. Methods Athlete exposures (AEs) and injury incidence data were reported to the NCAA Injury Surveillance Program between 2014–2015 and 2018–2019. Injury counts, rates, and proportions were used to examine injury characteristics, and injury rate ratios (IRRs) were used to assess injury rate differences. Results Practice and competition injury rates were 5.93 and 10.35 per 1000 AEs, respectively. Preseason injury rates were higher than regular (IRR = 1.41; 95% CI = 1.31, 1.53) and postseason (IRR = 3.12; 95% CI = 2.39, 4.07). Ankle sprains (14.3%), concussions (7.5%), and anterior cruciate ligament tears (2.5%) were the most commonly reported injuries. Summary Higher rates of practice and competition injuries, as well as ankle sprains, were observed relative to previous reports; continuous monitoring is necessary to identify potential contributing factors to these trends.

Injury incidence and characteristics for elite, male, artistic USA gymnastics competitions from 2008 to 2018

2020 ◽  
pp. bjsports-2019-101297
Author(s):  
David William Kruse ◽  
Andrew Seiji Nobe ◽  
John Billimek
Keyword(s):  
Athletic Trainers ◽  
Common Type ◽  
Injury Incidence ◽  
Muscle Strain ◽  
Time Loss ◽  
Certified Athletic Trainers ◽  
Injury Site ◽  
The Usa ◽  
Location Type ◽  
Type Of Injury

ObjectivesTo determine the injury incidence and characteristics for elite, male, artistic USA gymnasts during gymnastics competitions, held in the USA, from 2008 to 2018.MethodsInjury documentation performed by lead physician and certified athletic trainers at elite junior and senior USA Gymnastics competitions from 2008 to 2018 were reviewed and compiled into an excel database. Injury incidence was computed per 1000 registered gymnasts by competition setting as well as injury location, type, cause, severity, and setting.ResultsFrom 2008 to 2018, 180 injuries were reported in a total of 2102 gymnasts with injury incidence of 85.6 per 1000 gymnasts (95% CI 73.4 to 97.8). The most common injury site was at the ankle (16.7 per 1000 gymnasts, 95% CI 10.9 to 22.4), and muscle strain/rupture/tear was the most common type of injury (28.5 per 1000 gymnasts, 95% CI 21.2 to 35.9). The most common cause was contact with surface (56.1 per 1000 gymnasts, 95% CI 46.1 to 66.2), and the event where most injuries were sustained was the vault (21.9 per 1000 gymnasts, 95% CI 15.4 to 28.4). Incidence of time loss injuries was 38.5 per 1000 gymnasts (95% CI 30.1 to 47.0). Injury incidence was higher during competition (58.5 per 1000 gymnasts, 95% CI 48.2 to 68.8) than during training (27.1 per 1000 RG, 95% CI 19.9 to 34.3; RR 2.16, 95% CI 1.59 to 2.94, p<0.001); injury incidence was greater at Olympic Trials (RR 3.23, 95% CI 1.24 to 8.47, p=0.017) than at National Qualifier meets. We report concussion incidence in gymnastics (5.7 per 1000 gymnasts, 95% CI 2.3 to 9.2).ConclusionsThis is the largest injury study to date for male artistic gymnasts (180 injuries, 2102 gymnasts, 11 years).

Sports Medicine and Artificial Intelligence: A Primer

2021 ◽  
pp. 036354652110086
Author(s):  
Prem N. Ramkumar ◽  
Bryan C. Luu ◽  
Heather S. Haeberle ◽  
Jaret M. Karnuta ◽  
Benedict U. Nwachukwu ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Sports Medicine ◽  
Injury Risk ◽  
Industrial Revolution ◽  
Improve Patient Care ◽  
Great Promise ◽  
Patient Reported ◽  
Athlete Injury ◽  
Improve Patient ◽  
Applications Of Ai

Artificial intelligence (AI) represents the fourth industrial revolution and the next frontier in medicine poised to transform the field of orthopaedics and sports medicine, though widespread understanding of the fundamental principles and adoption of applications remain nascent. Recent research efforts into implementation of AI in the field of orthopaedic surgery and sports medicine have demonstrated great promise in predicting athlete injury risk, interpreting advanced imaging, evaluating patient-reported outcomes, reporting value-based metrics, and augmenting the patient experience. Not unlike the recent emphasis thrust upon physicians to understand the business of medicine, the future practice of sports medicine specialists will require a fundamental working knowledge of the strengths, limitations, and applications of AI-based tools. With appreciation, caution, and experience applying AI to sports medicine, the potential to automate tasks and improve data-driven insights may be realized to fundamentally improve patient care. In this Current Concepts review, we discuss the definitions, strengths, limitations, and applications of AI from the current literature as it relates to orthopaedic sports medicine.

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