Saturday, December 20, 2014

ImPact testing, legislation changing how coaches, doctors detect concussions

By Nicholas Talbot

Stan Kotara stood in the middle of the room on one leg, holding his smartphone to his chest.
The concussion management director at Lubbock Sports Medicine was demonstrating the future of concussion testing. And for the most part, it seems alarmingly simple — the smart phone does most of the work as it measures a players’ balance.
But, there is far more to concussion testing than most people realize. 
The tests that athletes go through to be able to play again are more than reciting the alphabet backward or asking the time, date and location of the game. 
It has evolved into a scientific process. Currently, the most accepted form of testing across the NCAA and the University Interscholastic League is ImPACT testing.
“(ImPACT testing) does a couple of things for us. It helps us kind of confirm our suspicions that yes, a particular student athlete has had a concussion and it helps us track their recovery and then maybe as important as anything, it helps us determine when it’s safe for that student athlete to return to the field of play,” said Kotara, a certified ImPACT consultant.
Research cited by the American Association of Neurological Surgeons suggests that more than a third of college football players have had one concussion and 20 percent have had more than one.
The smartphone Kotara was holding in his hands was a technology that is currently under development. With the smart phone trainers are going to be able to measure a player’s balance and coordination after suffering from a possible concussive hit on the football field. 
“That is kind of new technology,” Kotara said. “So, we haven’t really quite implemented it just yet, but we are going to and that is measuring, a different area of our brain function. ... The ImPACT test measures our neurocognitive abilities, our attention to detail, our reaction time, your concentration ability, our working memory. This is more of the motor domain of our brain functions so that kind of incorporates our whole body.”
According to Kotara, it has also been proven that younger athletes are more susceptible to suffering from these types of injuries. 
“Younger kids, their symptoms of a concussion seem to linger on several more days than say a college player or certainly at the professional level,” he said. “Younger kids recover slower, we know that now.”
Still Kotara said he would not limit or ever recommend for parents to not let their children play sports. 
“Despite all of our latest evidence that we have now — and we’ve learned more about this injury in the last 10 to 12 years than the 50 years before that — There’s more about this injury that we don’t know, still,” Kotara said. 
There have been other technologies developed to help track and detect concussions and concussion-like symptoms, including devices in helmets and mouth guards that transmit signals back to a team’s training staff and coaches.
When a player gets hit the mouth guard or helmet sends a signal to a wireless receiver on the sideline in real-time so a trainer can be alerted by their laptop or smartphone.
However, Kotara said this has done little to curb the frequency of concussions. He believes legislation, combined with technology and knowledge will instead help diagnose and treat concussions. Part of that legislation requirement in the state of Texas is that every two years high school coaches must have documented training in the recognition of the signs and symptoms of a concussion. 
“Our treatment policies that are in place, that is required now by the state and it’s working,” Kotara said. “We’ve had several examples of some local high school coaches that have suspected something’s happened and … a kid’s pulled out and sure enough they’ve had a concussion. 
“So, it’s working.”

Lubbock Sports Medicine

Dr. Kevin Crawford, MD
4110 22nd Place Lubbock, TX 79409
(806) 792-4329

Microfracture of the Hip in Athletes

Most studies addressing treatment of chondral injuries have involved the knee. Various techniques have been used in the knee. Microfracture has shown excellent results in the knee. Chondral injuries of the hip are common in athletes with labral tears and femoroacetabular impingement. The microfracture technique is now being used in the hip joint. Indications include full-thickness cartilage loss or unstable flap on a weight-bearing surface. An important contraindication is the patients unwillingness to follow the postoperative protocol and rehabilitation plan. The microfracture technique in the hip is similar to that in the knee. Postoperatively, patients use a continuous passive motion and are flat foot (20 lbs.) weightbearing for 8 weeks. Early results following microfracture in the hip have been encouraging.


Lubbock Sports Medicine

Dr. Kevin Crawford, MD
4110 22nd Place Lubbock, TX 79409
(806) 792-4329

Thursday, December 4, 2014

Meniscus Injuries of the Knee

Reliability, Validity, and Responsiveness of the IKDC Score for Meniscus Injuries of the Knee

 Kevin Crawford, M.D., Karen K. Briggs, M.P.H., William G. Rodkey, D.V.M., and J. Richard Steadman, M.D. 

Arthroscopy Association of North America’s Research Essay Award Winner


Purpose: The purpose of this study was to determine the psychometric properties of the International Knee Documentation Committee (IKDC) score for meniscus injuries of the knee. Methods: Testretest reliability, content validity, construct validity, and responsiveness to change were determined for the IKDC score. Knees were excluded if they had ligament pathology or a chondral defect greater than Outerbridge grade 2. All patients had meniscus pathology requiring treatment. The study comprised 4 subsets of patients. Group A consisted of 31 patients who completed an IKDC form at least 2 years after surgery for meniscus pathology and were then retested within 4 weeks of the primary questionnaire. Group B contained 264 patients with preoperative IKDC scores that were used for construct and content validity. Group C contained 50 patients who had a preoperative IKDC score and completed a short form 12 survey. Group D contained 100 patients with preoperative and postoperative IKDC scores used to measure responsiveness. Results: The overall IKDC score showed acceptable test-retest reliability with an interclass correlation of 0.95. There were acceptable floor and ceiling effects. All constructs tested showed significant differences. These included lower IKDC score with the following: lower activity level, difficulty with activities of daily living, difficulty with sports, abnormal knee function, and complex/degenerative meniscus tears. Responsiveness to change showed a large effect size (2.11) and a large response mean (1.5) for the overall score. The SE of the measurement was 3.19, and the minimum detectable change was 8.8 points.

Conclusions:
The overall IKDC score showed overall acceptable psychometric performance for outcome measures of meniscus injuries of the knee. Level of Evidence: Level III, testing of previously developed diagnostic criteria in nonconsecutive patients.

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Lubbock Sports Medicine

Dr. Kevin Crawford, MD
4110 22nd Place Lubbock, TX 79409
(806) 792-4329