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What's new in sports medicine (primary care)

What's new in sports medicine (primary care)
Authors:
Jonathan Grayzel, MD, FAAEM
James F Wiley, II, MD, MPH
Literature review current through: Feb 2022. | This topic last updated: Feb 18, 2022.

The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.

ADOLESCENT AND PEDIATRIC SPORTS MEDICINE

Return to play following COVID illness (November 2021)

The American Academy of Pediatrics (AAP) has updated its interim guidance for clinicians managing children and adolescents who are returning to sport after recovering from COVID-19 illness [1]. According to the AAP, younger children recovering from mild illness may return to activity as tolerated. Children and adolescents 12 years and older recovering from mild illness should return to play in a graduated manner over a minimum of seven days. Before doing so, the child or adolescent must be free of any cardiorespiratory symptoms when performing normal activities of daily living. A more detailed evaluation and longer protocol for return to activity is needed following severe illness. We concur with the guidance and schedule outlined for a return to full play. (See "COVID-19: Return to play or strenuous activity following infection", section on 'Children and adolescents'.)

MANAGEMENT AND REHABILITATION OF MUSCULOSKELETAL INJURIES

Platelet-rich plasma ineffective for lateral elbow tendinopathy (January 2022)

Platelet-rich plasma (PRP) and other so-called biologic injection therapies continue to be used for a variety of soft tissue injuries, but there is little evidence supporting their effectiveness. In a systematic review of randomized and quasi-randomized trials of such therapies for the treatment of lateral elbow tendinopathy (lateral epicondylitis), 25 of which involved PRP, the authors concluded that PRP injections likely provide little or no clinically important benefit for pain or function at three months [2]. We continue to recommend well-designed physical therapy programs that include progressive eccentric strengthening as primary treatment for elbow tendinopathy. (See "Elbow tendinopathy (tennis and golf elbow)", section on 'Platelet-rich plasma and other biologic injections'.)

Lack of benefit for platelet-rich plasma injections for ankle osteoarthritis (November 2021)

Injection of intra-articular platelet-rich plasma (PRP) has been a therapeutic agent of interest for the management of osteoarthritis (OA), although most studies have evaluated knee OA symptoms. The first randomized trial to evaluate its use in ankle OA included 100 patients and found that intra-articular PRP injections, compared with placebo injections, did not improve a composite score of pain and function during the 26-week follow-up period [3]. These findings do not support the use of PRP injections for patients with ankle OA. (See "Investigational approaches to the management of osteoarthritis", section on 'Platelet-rich plasma'.)

MEDICAL ISSUES RELATED TO SPORTS AND EXERCISE

Myocarditis in athletes recovering from COVID-19 (October 2021)

Despite initial concerns about possible myocarditis in older adolescent and young adult athletes recovering from COVID-19, recent studies suggest that the risk of cardiac injury is low. In a prospective, multi-center cohort of over 3,000 US collegiate athletes diagnosed with COVID-19 and undergoing cardiac evaluation, possible cardiac injury was noted in 21 (0.7 percent), including 15 of 119 individuals who underwent cardiac magnetic resonance (CMR) imaging based on preliminary test findings (ECG, cardiac troponin, and/or echocardiography) and 6 of 198 individuals who underwent primary CMR screening [4]. During subsequent surveillance, only one adverse cardiac event occurred, most likely unrelated to COVID-19. These findings may not reflect the frequency of myocarditis after SARS-CoV-2 infection caused by subsequent variants such as the Delta variant. Nevertheless, they provide support for the current approach to cardiac evaluation and return to play in this population (algorithm 1). (See "COVID-19: Return to play or strenuous activity following infection", section on 'Cardiovascular complications in athletes'.)

Topic 101594 Version 10977.0

References

1 : https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/ (Accessed on March 01, 2022).

2 : Autologous blood and platelet-rich plasma injection therapy for lateral elbow pain.

3 : Effect of Platelet-Rich Plasma Injections vs Placebo on Ankle Symptoms and Function in Patients With Ankle Osteoarthritis: A Randomized Clinical Trial.

4 : SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes.