Presidential address of the American Orthopaedic Society for Sports Medicine. Sports medicine: past, present, and future.
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Sports medicine is a profession pertaining to primary health care of sport population (competitors, coaches, referees, participants in sports recreation). It embraces the physical and mental health protection and promotion of participants in relation to a particular sport activity and sport environment, directing athletes to a sport and adapting them to sport and the sport to them. Sports medicine takes part in selection procedure, training process planning and programming, and cares for epidemiological, hygienic, nutritional and other problems in sport. The Republic of Croatia belongs to those world states in which the field of sports medicine is regulated neither by a law or by profession. A consequence is that wide circle of physicians and paramedics work in clubs and various medical units without any legal or/and professional control not being adequately educated nor having licence for it. This review is an appeal to the Croatian Medical Chamber and the Ministry of Health to make efforts to promote the education and medical profession in sports medicine.
Sports Medicine as an apparent sub-class of medicine has developed apace over the past 30 years. Its recent trajectory has been evidenced by the emergence of specialist international research journals, standard texts, annual conferences, academic appointments and postgraduate courses. Although this field of enquiry and practice lays claim to the title 'sports medicine' this paper queries the legitimacy of that claim. Depending upon how 'sports medicine' and 'medicine' are defined, a plausible-sounding case can be made to show that sports medicine is not in fact a branch of medicine. Rather, it is sometimes closer to practices such as non-therapeutic cosmetic surgery. The argument of the paper is as follows. It begins with a brief statement concerning methodology. We then identify and subscribe to a plausible defining goal of medicine taken from a recognised authority in the field. Then two representative, authoritative, definitions of sports medicine are discussed. It is then shown that acceptance of these definitions of sports medicine generates a problem in that if they are accepted, no necessary commitment to the defining goal of medicine is present within sports medicine. It seems to follow that sports medicine is not medicine. In the final part of the paper a critical response to that conclusion is presented and rebutted. The response is one which rejects the identification of the defining goal of medicine upon which our argument rests.
Sports medicine is one of the most rapidly growing subspecialties in orthopedics. Magnetic resonance (MR) imaging in sports medicine includes depiction of normal anatomy and pathologic conditions in almost every joint in the body, but the MR examinations most frequently requested are of the knee and shoulder. The reported high accuracy of MR imaging in the knee has resulted in MR imaging being preferred to diagnostic arthroscopy by most leading orthopedic surgeons. MR imaging is particularly helpful for sports medicine surgeons in evaluating menisci to determine if they are repairable, in posterolateral corner syndrome, and in evaluating the hyaline articular cartilage. In evaluating the shoulder, MR arthrography is becoming the preoperative imaging procedure of choice for many sports medicine surgeons. Shoulder MR imaging is particularly important in helping identify abnormalities that may mimic rotator cuff or labral abnormalities at clinical examination, thus preventing unnecessary surgery in some patients. These abnormalities include Parsonage-Turner syndrome and quadrilateral space syndrome, each of which has a distinctive MR imaging appearance. As the field of sports medicine expands, radiologists will continue to see increased requests for MR imaging, because sports medicine and high-quality imaging are inextricably linked.
Sports medicine physicians are not exempt from the ethical challenges of medical practice merely because their patients are robust and healthy. In fact, precisely because the patients with sports injuries are so healthy the moral issues remain subtle. Many ethical issues in sports medicine come about because the traditional relationship between doctor and patient is altered or absent. In the current review, several routine topics in biomedical ethics, including doctor and patient confidentiality, informed consent, the care of minors, medical advertising and use of innovative treatments, will be studied from the sports medicine perspective. Hypothetical case histories will be presented, along with an analysis of the underlying ethical issues. The goal of this analysis is not to offer answers to these moral questions, but to increase awareness and promote contemplation of the correct course of action.
OBJECTIVE: The consensus of opinion suggests that when assessing measurement agreement, the most appropriate statistic to report is the "95% limits of agreement". The precise form that this interval takes depends on whether a positive relation exists between the differences in measurement methods (errors) and the size of the measurements--that is, heteroscedastic errors. If a positive and significant relation exists, the recommended procedure is to report "the ratio limits of agreement" using log transformed measurements. This study assessed the prevalence of heteroscedastic errors when investigating measurement agreement of variables recorded on a ratio scale in sports medicine and sports science. METHODS: Measurement agreement (or repeatability) was assessed in 13 studies (providing 23 examples) conducted in the Centre for Sport and Exercise Sciences at Liverpool John Moores University over the past five years. RESULTS: The correlation between the absolute differences and the mean was positive in all 23 examples (median r = 0.37), eight being significant (P < 0.05). In 21 of 23 examples analysed, the correlation was greater than the equivalent correlation using log transformed measurements (median r = 0.01). Based on a simple meta-analysis, the assumption that no relation exists between the measurement differences and the size of measurement must be rejected (P < 0.001). CONCLUSIONS: When assessing measurement agreement of variables recorded on a ratio scale in sports medicine and sports science, this study (23 examples) provides strong evidence that heteroscedastic errors are the norm. If the correlation between the absolute measurement differences and the means is positive (but not necessarily significant) and greater than the equivalent correlation using log transformed measurements, the authors recommend reporting the "ratio limits of agreement".
Sports injuries usually involve tissues that display a limited capacity for healing. The treatment of sports injuries has improved over the past 10 to 20 years through sophisticated rehabilitation programs, novel operative techniques, and advances in the field of biomechanical research. Despite this considerable progress, no optimal solution has been found for treatment of various sports-related injuries, including muscle injuries, ligament and tendon ruptures, central meniscal tears, cartilage lesions, and delayed bone fracture healing. New biological approaches focus on the treatment of these injuries with growth factors to stimulate and hasten the healing process. Gene therapy using the transfer of defined genes encoding therapeutic proteins represents a promising way to efficiently deliver suitable growth factors into the injured tissue. Tissue engineering, which may eventually be combined with gene therapy, may potentially result in the creation of tissues or scaffolds for regeneration of tissue defects following trauma. In this article we will discuss why gene therapy and tissue engineering are becoming increasingly important in modern orthopaedic sports medicine practice. We then will review recent research achievements in the area of gene therapy and tissue engineering for sports-related injuries, and highlight the potential clinical applications of this technology in the treatment of patients with musculoskeletal problems following sports-related injuries.
This self-directed learning module highlights new advances in this topic area. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses physiatric duties as a team physician, preparticipation physical examinations, ergogenic aids, heat-related illness, pediatric sports injuries, female sports injuries, and sports medicine topics pertinent to geriatric and physically or mentally challenged athletes. New advances covered in this section include use of creatine, guidelines for the preparticipation examination, sudden cardiac athletic death, pediatric and female anterior cruciate ligament injuries, the female athlete triad, spine screening in Down syndrome athletes, and "boosting" in athletes with spinal cord injury.
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Sports injuries frequently involve tissues that have limited healing capabilities. In order to improve the healing process and thus prevent the serious consequences of injury, it is necessary to understand the molecular and cellular biology of healing. Several growth factors and other cytokines have been identified as important mediators of a successful healing process. Such molecules have promise as novel agents for the treatment of sporting injuries, but there is presently no clinically useful way to deliver them. Gene transfer may be used to serve this purpose. In this role, gene therapy functions as a type of local biological drug delivery system. Recent studies have shown the feasibility of transferring marker genes to synovium, chondrocytes, meniscal fibrochondrocytes, tenocytes and ligamental fibroblasts, prompting optimism about the eventual success of this approach.
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