Excelsior Orthopaedics

Sexual assault affects an estimated 0.5-12% of athletes and can seriously affect athlete health. Concerted efforts are needed to support survivors in receiving timely and appropriate care. Despite recognition from leading sports organisations about the need to prevent and respond effectively to sexual assault, many sports medicine physicians feel inadequately prepared to handle sexual assault disclosures. Emergency action plans (EAPs) offer a promising strategy to support adequate responses and ensure competent and consistent care. This modified Delphi study aimed to identify consensus-based components of a sexual assault EAP designed for sports medicine clinicians responding to sexual assault disclosures. A diverse panel of 24 individuals with lived and practical experience related to sexual violence in sport participated in one anonymous open-ended round and three anonymous voting rounds. The open-ended round generated important components in eight key domains: General Guidance; Mandatory Reporting, Confidentiality and Consent; Initial Evaluation; Follow-up Planning; Athlete Safety and Trauma-Informed Care; Legal Considerations; Established Contacts and Resources and Implementation. Overall, 90/130 proposed items (69%) achieved consensus (≥80% agreement for non-ranking items). The sexual assault EAP framework may improve clinician competency and support adequate responses, addressing common barriers such as low disclosure rates, personnel turnover and confidentiality concerns. Adoption of such plans has the potential to increase athlete trust in reporting mechanisms and foster more comprehensive care for athlete-survivors of sexual violence in sport. Example EAP templates are provided to assist sports organisations in implementing protocols that enhance self-efficacy among clinicians and support survivors throughout the reporting and recovery process.

Identify the effect size of mild and moderate levels of exertion on common sideline concussion assessment tool scores in healthy adolescent athletes. Three arm randomized controlled trial. High school training rooms. Forty-seven healthy adolescents who participate in school sports and have not had a concussion within the past month. Participants performed the Sport Concussion Assessment Tool 5 (SCAT5) and Vestibular Ocular Motor Screen (VOMS) at rest. Participants were randomized to perform No Exertion (n = 16, 15-minute seated rest), Mild Exertion [n = 16, 50%-55% of heart rate (HR) max for 15 minutes on a treadmill], or Moderate Exertion (n = 15, 70%-75% of HR max). Participants then repeated the SCAT5 and VOMS immediately after a 2-minute cool down. Effect size of change after exertion. Few differences were seen after mild and moderate levels of exertion. In the combined sample, there was a small increase in the number of modified balance error scoring system errors [d = -0.17 (-0.52, 0.19)], a medium degree of improvement in symptoms [d = 0.38 (0.01, 0.74)], and a small degree of improvement in cognitive scores [d = 0.20 (-0.16, 0.55)] after exercise. No differences on VOMS testing were observed. The SCAT5 and VOMS seem to be consistent measures even after mild and moderate levels of exertion (HR <75% of age-appropriate maximum). A future study should aim to identify the effect of maximal exertion.

Preparticipation cardiovascular screening, designed to identify cardiovascular pathology responsible for sudden unexpected death, is recommended by all major professional medical organizations overseeing the clinical care of competitive athletes. Data from several large, prospective, cohort studies indicate that cardiac imaging findings consistent with inflammatory heart disease following COVID-19 infection are more common than most forms of heart disease associated with sudden death during exercise. This call-to-action document is intended to provide recommendations about how routine preparticipation cardiovascular screening for young competitive athletes - which has the capacity to detect both COVID-19 cardiovascular complications and pathology unrelated to infection - should be altered to account for recent scientific advances.

The following office tip describes four patients that underwent primary total knee arthroplasty and developed posterolateral knee pain at a mean follow-up duration of 1.6 months postoperatively. The first patient in this series noted substantial pain lying in bed (in a lateral decubitus position with the operative leg up) while attempting to abduct her leg to adjust her sheet in bed. A thorough clinical and radiographic work-up was performed. This patient’s posturing in bed (and subsequent physical exam maneuver) led to a presumptive diagnosis of popliteal tendinopathy. The diagnosis was confirmed arthroscopically by identifying a frayed and inflamed popliteal tendon. After undergoing arthroscopic popliteal tendon release, the patient noted complete pain relief while retaining coronal stability in both flexion and extension. The following office tip defines a previously undescribed clinical diagnostic examination for popliteal tendinopathy that was identified based on a patient’s symptomatology and subsequently utilized to identify three additional cases of arthroscopically confirmed popliteal tendinopathy.