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The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.
ADOLESCENT AND PEDIATRIC SPORTS MEDICINE
Prevention of concussion in children playing hockey (April 2017)
Evidence is limited regarding specific interventions to prevent sport-related concussion. In a prospective study of the effect of a Canadian rule change on age eligibility for body checking in youth hockey, the rate of concussions decreased by 64 percent among 11- and 12-year-old hockey players after the eligible age for checking was raised to 13 years . Thus, limiting types of contact until an older age appears to be an effective strategy to reduce the risk of concussion in younger players, although prior studies suggest that the risk of injuries other than concussion may be increased when players are introduced to body checking in subsequent seasons. (See "Concussion in children and adolescents: Management", section on 'Prevention'.)
MANAGEMENT AND REHABILITATION OF MUSCULOSKELETAL INJURIES
Supervised or home exercise therapy following ankle sprain (February 2017)
Early exercise therapy improves outcomes following acute ankle sprain, and some trials of supervised physical therapy have shown benefit. However, a randomized trial involving 503 patients with Grade I and II acute ankle sprains compared usual care (including written instructions about standard interventions and graduated weight bearing activities) with usual care plus supervised physical therapy and found no improved outcome, functional or subjective, at one, three, or six months with the addition of supervised physical therapy . Nevertheless, supervised rehabilitation may be advantageous for patients for whom a faster return to work or sport is especially important. (See "Ankle sprain", section on 'Approach and exercises'.)
PREVENTION AND BIOMECHANICS OF MUSCULOSKELETAL INJURIES
Minimalist running shoes and injury risk (June 2017)
Although running shoes with minimal padding (minimalist shoes) have gained popularity in recent years, few studies of the effects of training in such shoes have been performed. In a recent randomized trial, 61 trained runners with a habitual rearfoot strike were randomly assigned to minimalist or standard running shoes, and then gradually increased the time spent running in the designated shoes over 26 weeks . Of 27 injuries sustained by participants, 16 occurred in runners using minimalist shoes and 11 in runners using conventional running shoes. The risk of injury was increased twofold among runners with increased body mass using minimalist shoes. We suggest that runners over 85 kg (187 pounds) not use minimalist shoes, and that other runners avoid excessive training in such shoes. (See "Overview of running injuries of the lower extremity", section on 'Running barefoot or with minimalist shoes'.)
Running shoe heel-to-toe drop and injury risk (February 2017)
The role of running shoes in preventing or causing injury remains controversial. In a trial of over 500 recreational runners randomly assigned to use identical running shoes that differed only in drop (the change in height from heel to forefoot) and followed for six months, the overall injury rate did not differ by group . However, in a stratified analysis based on running frequency, the risk of injury was higher in regular runners using low rather than high drop shoes. This finding suggests that some recreational runners may benefit from the reduced impact associated with a larger drop, but further study is needed to confirm this finding. (See "Overview of running injuries of the lower extremity".)
Anticoagulant thromboprophylaxis not warranted in nonmajor lower limb orthopedic surgery (January 2017)
Whether anticoagulation thromboprophylaxis is indicated for patients with lower leg immobilization from below knee casting or undergoing arthroscopy was evaluated in a randomized trial . The rate of symptomatic venous thromboembolism (VTE) was low (<2 percent) and not affected by the administration of anticoagulant prophylaxis. Risk factors in addition to the surgery itself were present among the few patients who did develop thrombus. This trial supports the current recommendation that, for patients with lower leg immobilization due to below knee casting or arthroscopy who do not have additional risk factors for VTE, anticoagulant prophylaxis is not warranted. (See "Prevention of venous thromboembolic disease in surgical patients", section on 'Orthopedic surgery'.)
OTHER PRIMARY CARE SPORTS MEDICINE
Structured exercise program and mobility disability in older adults (January 2017)
The randomized multicenter LIFE study, comparing a structured exercise program with a health information program among sedentary adults aged 70 to 89 years without major mobility disability at baseline, had previously reported that exercise decreased the incidence of major mobility disorder (MMD) and risk for permanent MMD. In a new report, the structured exercise also increased the likelihood of transition from MMD, if it occurred, to no MMD . Preserving mobility is essential for maintaining independence and quality of life among older adults. These findings indicate that exercise both prevents initial mobility disability and promotes restored mobility in those who become disabled. (See "Physical activity and exercise in older adults", section on 'Benefits of physical activity'.)
- Black AM, Hagel BE, Palacios-Derflingher L, et al. The risk of injury associated with body checking among Pee Wee ice hockey players: an evaluation of Hockey Canada's national body checking policy change. Br J Sports Med 2017.
- Brison RJ, Day AG, Pelland L, et al. Effect of early supervised physiotherapy on recovery from acute ankle sprain: randomised controlled trial. BMJ 2016; 355:i5650.
- Fuller JT, Thewlis D, Buckley JD, et al. Body Mass and Weekly Training Distance Influence the Pain and Injuries Experienced by Runners Using Minimalist Shoes: A Randomized Controlled Trial. Am J Sports Med 2017; 45:1162.
- Malisoux L, Chambon N, Urhausen A, Theisen D. Influence of the Heel-to-Toe Drop of Standard Cushioned Running Shoes on Injury Risk in Leisure-Time Runners: A Randomized Controlled Trial With 6-Month Follow-up. Am J Sports Med 2016; 44:2933.
- van Adrichem RA, Nemeth B, Algra A, et al. Thromboprophylaxis after Knee Arthroscopy and Lower-Leg Casting. N Engl J Med 2017; 376:515.
- Gill TM, Guralnik JM, Pahor M, et al. Effect of Structured Physical Activity on Overall Burden and Transitions Between States of Major Mobility Disability in Older Persons: Secondary Analysis of a Randomized Trial. Ann Intern Med 2016; 165:833.