Gelenkzentrum Zürich

Handball is associated with a high risk of knee injury. This study investigated whether an injury prevention program is effective in reducing acute, severe and overuse knee injuries in handball athletes. Sixty-nine men's and women's handball teams (U-15, U-17, U-19 and senior athletes) were cluster-randomised into an intervention and control group for one season. Players in the intervention group regularly completed the Knee-ABC 2 injury prevention program. Acute, severe and overuse knee injuries and handball exposure were documented every 8 weeks for both groups using an online questionnaire. The primary outcome parameter was the incidence of acute, severe knee injury. Secondary outcome parameters were prevalence and intensity of overuse knee injuries measured by the Oslo Trauma Research Centre (OSTRC) questionnaire and the Victorian Institute of Sport Assessment - Patellar Tendinopathy (VISA-P) score. The study included 32 teams (260 players) in the intervention group and 33 teams (215 players) as controls. Acute, severe knee injuries occurred significantly less often in the intervention group (0.059/1000 h) than in the control group (0.348/1000 h). The incidence rate ratio was 0.170 (95% confidence interval [CI] 0.031-0.619), p = 0.002). Players in the intervention group (51.5%) reported less often an OSTRC score >0 than controls (63.8%, p = 0.028) and had lower intensity scores (med 3, interquartile range [IQR] 0-15 vs. med 6 IQR: 0-19, p = 0.046). There were no differences in the VISA-P score between the two groups. Frequent use of the Knee-ABC 2 program prevents acute, severe and overuse knee injuries in adolescent and senior handball players and should therefore be included in the practical routine and in the education of team managers. Level Ib.

Ligamentous Lisfranc injuries present a significant challenge in both diagnosis and treatment due to the inherent diagnostic gaps associated with these types of injuries. Recent biomechanical research conducted on 16 human cadaveric lower limbs has shed light on the critical role of the plantar ligament in enhancing the understanding of ligamentous Lisfranc injuries.The study highlighted the following several important aspects.Role of the Plantar Ligament: The plantar ligament has been identified as a crucial component in both the diagnosis and treatment of ligamentous Lisfranc injuries. Its integrity is vital for maintaining the stability of the midfoot and any compromise can lead to significant functional impairment.Improved Diagnostic Algorithms: By understanding the biomechanical properties and functions of the plantar ligament, clinicians can refine their diagnostic algorithms. This improvement allows for more accurate identification of Lisfranc injuries, which is essential for effective treatment planning.Surgical Treatment Considerations: The findings also emphasize the need for a more defined approach to surgical intervention. With a clearer understanding of the role of the plantar ligament, surgeons can better assess when surgical treatment is necessary, potentially leading to improved patient outcomes.Clinical Implications: The insights gained from this study are invaluable for orthopedic practitioners. By integrating these findings into clinical practice, healthcare providers can enhance their diagnostic accuracy and treatment strategies for patients with ligamentous Lisfranc injuries.In conclusion, the study underscores the importance of the plantar ligament in the context of ligamentous Lisfranc injuries, paving the way for advancements in both diagnosis and surgical treatment. As research continues to evolve, it is crucial for clinicians to stay informed about these developments to provide the best possible care for their patients.

To determine whether a six-months technology-based gait training results in relevant changes of ambulatory function in a chronic stage after a neurological event. Further, changes in quality of life will be assessed as well as the willingness to pay for technology-based gait training. Single-center, longitudinal cohort study. One outpatient center specialized in neurological rehabilitation. Adults with a chronic neurological diagnosis resulting in residual gait impairments. Six month of technology-based gait training (with Lokomat, Andago, or C-Mill) with a minimal number of trainings of 10 per month. Walking performance assessed with the 10-meter walk test, 6-minute walk test and functional ambulation category; quality of life assessed with the EQ-5D-3L and WHODAS 2.0; predicted market share and willingness to pay assessed with a choice-based conjoint analysis survey and direct question. 27 participants completed three months while 20 completed six months of training. Comparing variables at baseline (BL) and after three (M3) and six (M6) months of training, both the walking speed in the 10-meter walk test (BL: 0.46m/s, M3: 0.54 m/s M6: 0.57 m/s) and the distance covered in the 6-minute walk test (BL: 149m, M3: 155m, M6: 159m) showed improvements that were below the clinically relevant change. The quality of life did not indicate a change. The direct willingness to pay was at CHF 80 which resulted in an estimated market share of 55% based on the conjoint analysis. The observed, small changes in ambulatory function in patients with chronic, neurological impairments and the willingness to pay indicates the need to provide technology-based gait training in an outpatient setting.