Sports related injuries account for 30 to 40 percent of all unintentional injuries, and sports accidents are the leading cause of injury in young adults. With approximately 30 million children and adolescents participating in sports activities according to the U.S. Centers for Disease Control, the prevalence of sports injury is on the rise. Nearly 40 percent of sports injuries occur in children aged 5 to 14 years, and the severity of the injuries increase with age. High school aged individuals account for 2 million injuries that result in over 500,000 doctor visits and 30,000 hospitalizations in the United States. The prevalence is higher amongst the younger age groups as a result of immature bones, insufficient training, and overuse injuries. Sports injuries have lifelong effects on young individuals as fractures of a growth plate can interfere with skeletal growth and cause them to be unable to participate in physical activity. Sports injuries have also proven to increase the risk of fractures, arthritis, and joint degeneration in later life. In regards to research, there is need for additional research due to the lack of data on the long term effects of these injuries and the increasing prevalence of sports injuries.
Femoroacetabular impingement (FAI) is a recently described condition that causes hip pain in the young adult. It occurs as a result of a size and shape mismatch between the femoral head and the acetabulum. With FAI, the femoral head (ball) and acetabular rim (socket) of the hip joint collide during hip flexion and rotation. This collision results in an impingement of the femur and acetabulum, and patients experience hip pain. The development of hip pain in this manner serves as an indicator for early hip damage and is often the presenting symptom. In addition, this pain can be a precursor to early hip damage such as cartilage delamination and labral tears of the hip. As the condition progresses, the resulting hip damage may lead to osteoarthritis (OA) of the hip.
The diagnosis and treatment of FAI have become one of the most popular clinical scenarios in orthopaedic surgery. The indications for surgery are increasingly being refined and include both paediatric and adult patients. Some estimates suggest that the rate of hip arthroscopy procedures will double over a 5 year span (2008-2013) and a large number of these procedures will relate to treating FAI. One can assume a significant increase in health care costs associated with this increase in treatment.
The current evidence for the management of FAI is limited to retrospective reviews or case series. Recent systematic reviews of the English literature have highlighted that the lack of level I or II evidence continues to limit the progression of FAI management. To date, no prospective randomised controlled trial (RCT) has been conducted to evaluate the treatment effect of surgical intervention for FAI.
Given the rarity of sports medicine surgeons who evaluate and treat FAI, we are moving to establish the first international FAI collaborative to allow for larger, more generalizable, and high quality studies to be conducted on a global scale. We held the first FAI Symposium at McMaster University in May 2013. This meeting brought together the foremost experts in sports medicine treating FAI. The meeting fostered important preliminary discussion regarding current practices and challenges with a focus on future research initiatives and establishing a collaborative. This collaborative is the first of its kind and will further McMaster’s reputation as a leader in clinical research.
Anterior Cruciate Ligament Reconstruction
The aim of anterior cruciate ligament (ACL) reconstruction is to regain functional stability of the knee following ACL injury, allowing patients to return to their pre-injury level of activity. The reconstruction procedure has evolved significantly since the early 1900’s, when the first ACL reconstruction was performed. Although the techniques have changed, the goal of the surgery remains the same. A large volume of literature has been published examining the results of ACL reconstruction. Most of these are case series, some including the results of ACL reconstructions with long term follow up (up to 15 years), which have reported satisfactory results. However, a more detailed analysis of much of the reported literature reveals several issues.
The goal of providing a rotationally stable knee following ACL reconstruction remains difficult to achieve. It is hypothesized that poor rotational control, and hence a positive pivot shift, may predispose to future graft failure and need for revision surgery. This is particularly problematic in young patients returning to pivoting sport, who have been shown to be at a much higher risk of early graft failure. A surgical procedure which addresses rotational control is therefore of utmost importance when treating the ACL deficient knee.
The specific objectives of the orthopaedic sports medicine theme are:
- To establish the first international collaborative in the field of orthopaedic sports medicine.
- To conduct comprehensive systematic reviews concerning FAI, other sports-related hip problems, and arthroscopic techniques to summarize the available evidence and inform future studies.
- To determine the efficacy of surgical treatment for FAI.
- To investigate optimal surgical mehtods for ACL reconstruction.