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November 2019 - Volume 29 - Issue 6

  • Christopher Hughes, MBBS, MSc
  • 1050-642X
  • 1536-3724
  • 6 issues / year
  • Orthopedics 21/76
    Sport Sciences 22/83
    Physiology 32/81
  • 2.702

It's hard to believe we have reached November again, and here we are with our last Issue of the Clinical Journal of Sport Medicine in 2019. 

I'm pleased to say that November's CJSM is crammed with a veritable smorgasbord of clinically-relevant research. 

Amidst the controversies which continue to surround the hot topic of the association of sports-related concussion with the development chronic traumatic encephalopathy, we bring you our headline Original Research article this month by Barber Foss and colleagues which is a pilot cohort study determining pre-season to post-season changes in brain white matter integrity from repetitive head impacts for youth football players compared with high school football players during a competitive football season. 

Many clinicians and researchers believe that youth athletes are more susceptible to white matter degradation resulting from head impact exposure than older athletes. The Authors of this study hypothesised that youth footballers would exhibit significant reductions in white matter integrity over a competitive season, with a greater degree of reduction to be observed in younger footballers when compared with their high school counterparts. 

Pre-season and post-season neuroimaging MRI scans were performed in both groups with head impact exposure being measured using helmet-mounted accelerometers, and tract-based spatial statistics were used to evaluate several different diffusion tensor imaging variables. 

Interestingly, the results of the study showed that the high school footballers exhibited significant reductions in all three tensor imaging variables compared with a significant reduction in only one variable seen in the youth footballers group, adjusting for head impact exposure (greater amongst the high school group). 

The Authors concluded that their study did not confirm a greater deleterious effect of repetitive head impacts amongst younger children compared with their high school counterparts, although they did point out limitations of their Study due to the relatively small sample size of the younger athletes and an increased number of days between last impact exposure and post-season scan for the younger athletes compared with the hih school group. 

It would be interesting in the future to see if these observations could be generalized to a larger group in a prospective observational study.

Interested readers should also check out Deputy Editor James MacDonald's blog post this month concerning the association of repetitive heading and neurodegenerative diseases amongst soccer players, and don't forget to leave your thoughts on the topic in the comments section of the blog. 

Issues related to return to sport following surgery are often discussed prior to undertaking procedures, and we bring you three Original Research articles this Issue concerning return to sport after surgery. Ortmaier and Colleagues report on return to sport short-stem following total hip arthroplasty. D'Ambrosi and Colleagues report on return to sport following arthroscopic autologous matrix-induced chondrogenesis for patients with osteochondral talus lesions, and van der Ven and Colleagues report on return to activity for cyclists undergoing anteroinferior plate fixation of clavicle fractures. 

Clavicle fractures are also a painful hazard for many NFL athletes, and Vora and Colleagues report on return to play and performance ratings amongst NFL players following these injuries both when treated conservatively and surgically. 

Gondolini and Colleagues report on the outcome of mini-open surgical decompression for chronic exertional compartment syndrome of the forearm amongst professional motorcycle riders, reporting good results at 5-year follow-up with few recurrences. 

Our Systematic Review article this Issue by Rosen and Colleagues concerns the question as to how reliable functional performance tests are in identifying individuals with chronic ankle instability. This Systematic Review, which included twenty nine studies, indicated that the side-hop, timed-hopping, multiple-hop and foot-lift tests seemed to be the best in evaluating those with chronic ankle instability. 

Following the problems seen with Zika Virus risk to competitors and visitors to Rio for the 2016 Olympic Games, Hamilton and Colleagues offer a Practical Management article on this topic based on the approach of the New Zealand Medical Team during the Olympics.

We also bring you four different Case Reports, and Letters to the Editor and their responses on our e-media web pages. 

Don't forget to keep up to speed with events on our blog with James MacDonald and contributors, the CJSM twitter account on @CJSMonline and our Facebook account. 

Also, another reminder for those of you seeking CME to check out our CME articles on the CME Lippincott CME Connection website

Here's wishing you a great last couple of months for 2019, until we meet again in 2020. 

Best Wishes, 



Christopher Hughes MBBS MSc


Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football: A Pilot Comparison of Youth Versus High School Football

Barber Foss, Kim D.; Yuan, Weihong; Diekfuss, Jed A.; More

Clinical Journal of Sport Medicine. 29(6):442-450, November 2019.

Relative Head Impact Exposure and Brain White Matter Alterations After a Single Season of Competitive Football : A Pilot Comparison of Youth Versus High School Football

Ability of Functional Performance Tests to Identify Individuals With Chronic Ankle Instability: A Systematic Review With Meta-Analysis

Rosen, Adam B.; Needle, Alan R.; Ko, Jupil

Clinical Journal of Sport Medicine. 29(6):509-522, November 2019.

Ability of Functional Performance Tests to Identify Individuals with Chronic Ankle Instability : A Systematic Review with Meta-Analysis