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Komeil Dashti Rostami and Abbey Thomas

The influence of fatigue on landing biomechanics in anterior cruciate ligament deficient (ACLD) patients is poorly understood. The purpose of this study was to examine the effect of fatigue on hip and knee joint biomechanics in deficient patients. Twelve ACLD males and 12 healthy control subjects participated in the study. The ACLD patients landed with increased peak knee flexion angle (F = 15.71, p < .01) and decreased peak knee flexion moment (F = 9.13, p < .01) after fatigue. Furthermore, ACLD patients experienced lower vertical ground reaction forces compared with controls regardless of fatigue state (F = 9.75, p < .01). It seems that ACLD patients use protective strategy in response to fatigue in order to prevent further injury in knee point.

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Alexis Peters, Julliana Tapia, and Stephanie H. Clines

Focused Clinical Question: Does the implementation of a psychoeducational program increase mental health knowledge among collegiate student-athletes? Clinical Bottom Line: There is consistent, limited-quality patient-oriented evidence to suggest that implementation of a psychoeducational program is effective in increasing mental health knowledge in collegiate student-athletes based on the guidelines of the strength of recommendation taxonomy.

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Katherine Newsham

Patients and clinicians have expressed frustration when learning or teaching intrinsic foot muscle exercises. However, there is limited information on how patients perceive the workload of an exercise. This study evaluates participants’ perceptions of workload while learning intrinsic foot muscle exercises with or without neuromuscular electric stimulation. Twenty-six individuals completed a 4-week supervised intrinsic foot muscle training program. Thirteen participants utilized neuromuscular electric stimulation during the initial 2 weeks of training. Participant perceptions of workload, measured by the National Aeronautics and Space Administration Task Load Index, revealed decreasing load over 2 weeks and minimal load at 4 weeks. Inclusion of neuromuscular electric stimulation did not affect perception of load of skill acquisition.

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Ioanna K. Bolia, Jennifer A. Bell, Hyunwoo P. Kang, Aryan Haratian, Laith K. Hasan, Michael B. Eppler, Russ Romano, James E. Tibone, Seth C. Gamradt, and Alexander E. Weber

Context: It is important to examine hip injury characteristics in baseball athletes in order to develop injury-specific prevention protocols. There is currently a lack of literature regarding collegiate baseball athletes. Objective: To report the hip injury characteristics and time missed from sport participation in National Collegiate Athletic Association Division I baseball players over a period of 5 years. Results: Forty-seven hip–groin injuries were recorded in 30 National Collegiate Athletic Association Division I baseball players. Pitchers had the highest number of hip–groin injuries (24/47, 51%), and outfielders had the longest time missed from baseball participation (33 days on average). The two most common types of hip–groin injuries were femoroacetabular impingement syndrome (14/47, 30%) and hip adductor strain (14/47, 30%). Days missed from baseball participation was 4.5 days (range: 4–7) for short-term injuries and 90 days (range: 46–131) for long-term injuries. Interpretations: Femoroacetabular impingement syndrome and adductor muscle strain were the predominant diagnoses in National Collegiate Athletic Association Division I baseball players with hip–groin injury; short-term injuries resulted in ∼5 days missed but recovery from a long-term injury took ∼3 months. Pitchers had the highest number of injuries (including adductor strain and femoroacetabular impingement syndrome).

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Alyson Hansbarger, Ryan Thomson, Jamie L. Mansell, and Ryan T. Tierney

Clinical Scenario: Sport-related concussions are common injuries during sport-related activities. Evaluations of these injuries involve symptom reporting. Unfortunately, concussion symptoms are widely underreported by athletes, and can lead to longer recovery times. Concussion education programs were created to encourage reporting of symptoms by athletes. Clinical Question: Does concussion education impact injury disclosure in high school athletes? Summary of Key Findings: Three studies were included in this appraisal. Two studies utilized an educational lecture, and one study utilized an informational video providing the concussion education. All three studies found significant increases in injury history disclosure from pre-education to immediate post-education. Clinical Bottom Line: There is moderate evidence to support the idea that education has a positive impact on concussion reporting behaviors. These studies found positive results immediately following concussion education therefore it may be beneficial to provide concussion education several times a year. Strength of Recommendation: There is Level B evidence to support the idea that implementing concussion education will impact concussion reporting behaviors as it pertains to injury history disclosure.

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Hyunjae Jeon, Sean Krysak, Steven J. Pfeiffer, and Abbey C. Thomas

Second anterior cruciate ligament (ACL) injury has similar biomechanical risk factors as primary injury. Standard of care rehabilitation does not adequately mitigate these biomechanical risks. This study examined the effectiveness of a 4-week plyometric intervention on biomechanical risk factors of second ACL injury versus no intervention in patients with a history of ACL reconstruction. Thirty adults post-ACL reconstruction received 12 sessions of plyometric (age: 19.9 ± 1.62 years; body mass index: 23.9 ± 2.6 kg/m2; months postoperative: 35.7 ± 24.2) or no (age: 21.3 ± 3.5 years; body mass index: 27.7 ± 4.8 kg/m2; months postoperative: 45.3 ± 25.4) exercise intervention. Hip and knee biomechanics were quantified during a jump-landing task before and after the intervention. Individual response to the intervention was evaluated via minimal detectable change. Hip flexion angle had the greatest response to plyometric training. Overall, focused plyometric intervention did not adequately mitigate biomechanical risk factors of second ACL injury; thus, development of interventions capable of modifying biomechanics known to contribute to ACL injury risk remains necessary.

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Matthew P. Brancaleone and René R. Shingles

Athletes who are deaf or hard of hearing (D/HoH) participate at all levels of athletic competition, but no evidence exists regarding their knowledge of and attitudes toward concussion. The purpose of our study was to explore the knowledge of and attitudes toward concussion in athletes who are D/HoH using the Rosenbaum Concussion Knowledge and Attitudes Survey. The Rosenbaum Concussion Knowledge and Attitudes Survey consists of two subscales, the Concussion Knowledge Index (range 0–25) and the Concussion Attitudes Index (15–75). Athletes who are D/HoH had a Concussion Knowledge Index score of 16.25 ± 3.83 and Concussion Knowledge Index score of 58.04 ± 6.44. There were differences between races for Concussion Knowledge Index scores (p < .01). Findings may allow health care professionals to better target educational interventions for athletes who are D/HoH.

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Leslie Tufano, Jon Hochstetler, Timothy Seminerio, and Rebecca M. Lopez

Clinical Question: During bouts of exercises in a hypohydrated state, do patients with sickle cell trait compared with patients without sickle cell trait demonstrate higher blood viscosity? Clinical Bottom Line: There is evidence that there is a difference in hematocrit levels in patients with sickle cell trait and patients without sickle cell trait both pre- and postexercise with suboptimal hydration status. Moreover, the effects on hematocrit levels increase over baseline levels in the recovery stages postexercise in patients with sickle cell trait.