Philippe M. Tscholl

Abuse of medication during international football competition in 2010 – lesson not learned

Background The use of medication in professional football has previously been shown to defy clinical guidelines. Materials and methods Physicians of the teams who participated at the 2010 FIFA World Cup provided the list of medications used by each player within the 72 h preceding every match. Results During the tournament 71.7% of all players took medication, and 60.3% (444 of 736 players) took painkilling agents at least once. Over a third of players (39.0%) took a painkilling agent before every game. More medications were used during the finals than during the qualifying round of matches (pool games) (0.87±0.09 vs 0.77±0.03, p<0.01). Players from North and South America took almost twice the number of medications than did players from other continents (1.18±0.08 vs 0.64±0.03; p<0.01). Conclusion The use of medication reported by the team physicians in international football competition is increasing. Systematic use – medication for every match – appeared to be the norm in certain teams. This has implications for player health. These data encourage efforts to better understand, and to address, this potential disastrous practice in professional sports.

Radiological evaluation for conflict of the femoral tunnel entrance area prior to anterior cruciate ligament revision surgery.

PurposeAnterior cruciate ligament (ACL) revision surgery is a demanding procedure and requires meticulous pre-operative clinical and radiological assessment. In clinical practice the position of the femoral tunnel is identified mainly using plain radiographs (XR). Two-dimensional computed tomography (2D-CT) and magnetic resonance imaging (MRI) are not yet routine imaging methods and are only performed in specific clinical indications or in the scientific setting. Several measurement methods describe the femoral tunnel after ACL reconstruction and indicate ‘ideal or wrong’ placement to the surgeon. The aim of this study is to provide a reliable measurement method to predict potential conflict between the pre-existing and the planned femoral tunnel entrance area (FTEA).MethodsTen patients with primary ACL reconstruction served as a reference group to describe our desired FTEA. Their femoral tunnel positioning was measured on XR and 2D-CT according to published measurement methods. These results were compared to the FTEA measured with a new technique on 3-dimensionally reconstructed CT-images (3D-CT) based on intra-operative landmarks. Twenty patients requiring ACL revision surgery underwent identical radiological examination. The mean values of the reference group were compared to each measurement of the patients requiring revision surgery.Results3D-CT measurements found potential conflicts in nine out of 20 patients, which all proved to be true during arthroscopic revision surgery. Only one of these patients was identified in all XR and 2D-CT measurements. In 12 out of all 30 patients some measurements on XR or 2D-CT could not be recorded.Conclusion3D-CT reconstruction shows the most accuracy in depicting conflict of the pre-existing and desired femoral tunnel prior to ACL revision surgery. The desired FTEA must be defined for each surgeon and his individual technique. In contrast, precision of conventional measurement techniques on XR and 2D-CT is low and does not qualify for this purpose.

Osteotomies Around the Patellofemoral Joint

A normal patellofemoral gliding mechanism with perfect stability is guaranteed by the complex interaction of skeletal geometry, soft tissues, and neuromuscular control.10 During knee flexion, the patella moves from a medial to a lateral tilted positionas knee flexion approaches 90°.29,32,33,51,53Abnormal skeletal geometry – such as increased femoral anteversion, trochlear dysplasia, patella alta or infera, increased tibial external torsion, increased tibial tubercle lateralization, and variations of combined deformities – may lead to patellofemoral complaints.10 Altered vectors and forces acting on the patellofemoral joint (PFJ) can cause cartilage failure with secondary osteoarthritis instability and musculotendinous insufficiency. Osteotomy with soft tissue balancing might be the best treatment, depending on the underlying pathology. Surgery aimsto eliminate the present pathomorphology.