Do Hyaluronic Acid Injections Reduce Biomarkers of Collagen Degradation?

Early decrease of serum biomarkers of type II collagen degradation (Coll2-1) and joint inflammation (Coll2-1 NO2 ) by hyaluronic acid intra-articular injections in patients with knee osteoarthritis: A research study part of the Biovisco study

Henrotin Y, Chevalier X, Deberg M, Balblanc JC, Richette P, Mulleman D, Maillet B, Rannou F, Piroth C, Mathieu P, Conrozier T; Osteoarthritis Group of the French Society of Rheumatology.  J Orthop Res. 2013 Jun;31(6):901-7. doi: 10.1002/jor.22297. Epub 2013 Feb 19.

http://www.ncbi.nlm.nih.gov/pubmed/23423846

Take Home Message:  Hyaluronic acid injections decrease factors related to collagen degradation. Some blood tests may differentiate responders and nonresponders to these injections.  

Knee osteoarthritis, one of the leading causes of disability, has no cure and current treatments commonly involve medications to decrease inflammation and pain.  Hyaluronic acid (HA) injections have become a popular form of treatment for knee osteoarthritis.  However, the mechanism of action has yet to be determined.  Therefore, the authors examined serum biomarkers of collagen breakdown (Coll2-1 and Coll2-1 NO₂) in 45 patients with various stages of knee osteoarthritis before (-15 days), at the time of injection, and following treatment (30 and 90 days) with HA injections.

Fitness Level and Baseline Concussion Symptoms

Does an Individual’s Fitness Level Affect Baseline Concussion Symptoms?

Mrazik, M; Naidu, D; Lebrun, C; Game, A; Matthews-White, J. Journal of Athletic Training In-Press. doi: 10.4085/1062-6050-48.3.19

http://natajournals.org/doi/abs/10.4085/1062-6050-48.3.19

Take Home Message: Fitness level may influence baseline concussion symptom reporting with fitter individuals reporting fewer concussion symptoms.  Athletes also appear to report more concussion symptoms when reporting after exercise.

Baseline testing in concussion management, including graded symptom assessment, has become commonplace in multiple sports on almost every level of competition.  Different assessment tools (e.g., Sideline Concussion Assessment Tool [SCAT3], Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT]) establish a baseline for many nonspecific symptoms so that post-injury symptoms may be compared to baseline results.   Previous research has shown that multiple factors, including physical-activity level, can result in reports of more neurological symptoms. Therefore, Mrazik, et al sought to evaluate if an individual’s fitness level correlated with report of concussion symptoms at baseline. They hypothesized that after exertion, athletes with higher fitness levels would report fewer symptoms at baseline.

Elite Soccer Players Have High Rates of OA

Knee and Ankle Osteoarthritis in Former Elite Soccer Players: A Systematic Review of the Recent Literature

Kujit MK, Inklaar H, Gouttebarge V, & Frings-Dresen MHW. Journal of Science and Medicine in Sport. 2012 15: 480 - 487.

http://www.jsams.org/article/S1440-2440(12)00063-1/abstract

Take Home Message: Elite soccer athletes may be at an increased risk for knee and ankle osteoarthritis compared with the general population.  This group should be identified as high risk and preventative measures should be taken.

While participation in elite-level sports is often viewed as a good thing, there is an established increased risk of short-term injuries (e.g., sprains, strains).  This increased injury risk may leave athletes at an increased risk for long-term disability (e.g., osteoarthritis [OA]).  The purpose of this systematic review was to investigate the prevalence of knee and ankle OA among former elite-level soccer players.

High-Tech Tools Do Not Always Create a Better Test

Comparison of the balance accelerometer measure and balance error scoring system in adolescent concussions in sports

Furman G.T., Lin C-C., Ballanca, J.L., Marchetti G.F., Collins M.W., Whitney S.L. The American Journal of Sports Medicine. 2013; ahead of print.

http://www.ncbi.nlm.nih.gov/pubmed/23585486

Take Home Message: The balance error scoring system (BESS) test is more effective in assessing high school age students’ concussions compared to the Balance Accelerometer Measure (BAM) assessment. The tandem leg stances on firm and foam surface of the BESS test are the most sensitive and specific positions for the detection of a concussion.

Assessing balance after a concussion provides useful information not only for diagnosis and prognosis but also during the athlete’s return to play progression. Many clinicians evaluate balance with the balance error scoring system (BESS), which may be imprecise and susceptible to inter-rater error; however, it was specifically designed to assess concussion injuries. In contrast, the Balance Accelerometer Measure (BAM), which is assessed by the patient wearing small sensors, provides accurate balance assessments but was not designed to assess concussed athletes. Therefore, the purpose of this study was to compare the BAM test with the BESS test regarding the ability to detect differences in postural differences between 43 high school students with concussions compared to 27 age-matched controls.

Wii Balance Boards for Testing Postural Control During Single-Leg Stance Tests

Comparison of a laboratory grade force platform with a Nintendo Wii Balance Board on measurement of postural control in single-leg stance balance tasks.

Huurnink A, Fransz DP, Kingma I, and van Dieen JH. J Biomech. 2013; 46:1392-1395.

http://www.ncbi.nlm.nih.gov/pubmed/23528845

           

Take Home Message: The Wii Balance Board is an acceptable substitute for measuring the center of pressure during single leg stance balance tests.

While a laboratory grade force plate is the gold standard for both testing and training balance, these force plates are limited to research laboratories. Due to the importance of balance testing and training during the rehabilitation process, a cost effective, widely available and portable force plate is desirable. Therefore, Huurnink and colleagues compared a laboratory grade, in-floor force plate to the Wii Balance Board (WBB).

Problematic Patterns of Nonsteroidal Anti-Inflammatory Drug Use

Nonsteroidal Anti-inflammatory Drug Use in Collegiate Football Players

Holmes N, Cronholm PF, Duffy AJ, Webner D. Clin J Sport Med. 2013. Epub ahead of print

http://www.ncbi.nlm.nih.gov/pubmed/23528841

Take Home Message: NSAIDs are a common treatment method for musculoskeletal injuries; however, over-the-counter availability, overuse, self-medication, and trends of initial use in high school may interfere with appropriate consumption among college athletes.

Nonsteroidal anti-inflammatory drugs (NSAIDs), a common treatment for athletic injuries, are generally safe medications when used short-term but can become problematic when used long-term and without oversight from a medical professional. There is a discrepancy between the amount of NSAIDs used in athletics and the number of studies that address their safety in athletics. In this cross-sectional study, Holmes et al. surveyed 211 collegiate football players at two institutions on two occasions (beginning of 2006 and 2009 seasons) regarding their NSAID use during the respective seasons.

The Role of Genetics in Achilles Tendon Pathology

Polymorphic Variation within the ADAMTS2, ADAMTS14, ADAMTS5, ADAM12, and TIMP2 Genes and the Risk of Achilles Tendon Pathology: A Genetic Association Study

El Khoury L, Posthumus M, Collins M, Handley CJ, Cook J, Raleigh SM. J Sci Med Sport. 2013 Mar 11

http://www.ncbi.nlm.nih.gov/pubmed/23491141

Take Home Message: Achilles tendon pathology is associated with variation within a gene (TIMP2) responsible for inhibiting enzymes responsible for collagen degradation. Genetic pre-screening of at-risk individuals may help guide individualized treatment strategies.

Genetic risk factors have recently been identified for Achilles tendon pathology, which may allow for genetic screening and identification of at-risk patients and could help guide clinical management of this injury. Specifically, previous studies reviewed by SMR have shown that variants within genes that encode for structural and regulatory proteins (such as Col5a1 and TNC) are associated with risk of Achilles tendon pathology.  However, additional genes encoding for enzymes that breakdown the extracellular matrix and their inhibitors (such as the ADAM, ADAMTS, and TIMP family of proteins) have not yet been evaluated.  Therefore, the purpose of this study was to determine if variations within these genes are associated with Achilles tendon pathology.