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    <recommendedItem id="20100101_19_264"
                     title="AAP Releases Tips on Preventing Soccer Injuries (CME/CE)"
                     score="0.002"
                     href="http://www.medpagetoday.com/Orthopedics/Orthopedics/tb/18098?impressionId=1265780720319"
                     
      &lt;p&gt;Coaches, parents, doctors and soccer officials can help prevent soccer-related injuries as the popularity of the sport grows, according to a report from the American Academy of Pediatrics.&lt;/p&gt;
&lt;p&gt;Although soccer is an effective way for children and teens to increase their physical activity, injury rates are higher than in many other contact sports, including field hockey, rugby, basketball, and football, according to Chris Koutures, MD, a pediatrician in Anaheim Hills, Calif., and Andrew Gregory, MD, of Vanderbilt University.&lt;/p&gt;
&lt;p&gt;Both are members of the AAP&apos;s Council on Sports Medicine and Fitness, which released the report in the February issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Risk of injury goes up when dirty play enters the game. In one study, 11.9% of girls&apos; soccer injuries and 11.4% of boys&apos; were attributed to illegal actions.&lt;/p&gt;
&lt;p&gt;&quot;There is consensus that proper rule enforcement and limitation of violent contact can reduce the risk of injury,&quot; Koutures and Gregory noted.&lt;/p&gt;
&lt;p&gt;&quot;Officials controlling the physicality of the game and emphasis on safe play with respect for one&apos;s opponents can both play significant roles in reducing contact injuries in soccer.&quot;&lt;/p&gt;
&lt;p&gt;The U.S. Consumer Product Safety Commission (CPSC) estimated that there were 186,544 soccer-related injuries in 2006, with 80% occurring in athletes younger than 24. About 44% occurred in children and teens younger than 15, who have a higher risk of injury than their older counterparts.&lt;/p&gt;
&lt;p&gt;Most injuries are to the lower extremities, with ankle injuries accounting for up to 29% and knee injuries accounting for up to 36% of the total.&lt;/p&gt;
&lt;p&gt;Girls have a greater risk of knee injury and rupture of the anterior cruciate ligament, mostly from hyperextension of the knee when landing, cutting, or turning.&lt;/p&gt;
&lt;p&gt;Certain exercise programs focused on neuromuscular training have been shown effective for preventing knee injuries among adolescent girls. (See &lt;a href=&quot;http://www.medpagetoday.com/Orthopedics/Orthopedics/17887&quot; mce_href=&quot;http://www.medpagetoday.com/Orthopedics/Orthopedics/17887&quot; target=&quot;_blank&quot;&gt;Program Cuts Knee Injuries in Soccer&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;&quot;Pediatricians are encouraged to familiarize themselves with these programs and inform their patients on the availability and potential benefits,&quot; Koutures and Gregory wrote.&lt;/p&gt;
&lt;p&gt;Upper extremity injuries are much less common, accounting for 3% to 12% of the total.&lt;/p&gt;
&lt;p&gt;Soccer-related fatalities are rare and usually involve impact with the goalposts. According to the CPSC, there have been 28 deaths resulting from falling goalposts since 1979.&lt;/p&gt;
&lt;p&gt;Koutures and Gregory noted that guidelines have been developed by manufacturers and the CPSC on properly securing goalposts.&lt;/p&gt;
&lt;p&gt;Concussions occur at a rate similar to that seen in ice hockey and football players. Only about 3% of the total injuries are concussions, but the authors said there might be some under-reporting.&lt;/p&gt;
&lt;p&gt;About half of concussions (47%) are caused by a collision with another player, with the rest coming from contact with the ball (24%), the ground or goalpost (17%), or a combination of objects (10%).&lt;/p&gt;
&lt;p&gt;Koutures and Gregory noted that evidence does not support any adverse short- or long-term neurological consequences from heading the ball on purpose.&lt;/p&gt;
&lt;p&gt;&quot;However,&quot; they wrote, &quot;the AAP encourages heading of the ball only be taught when the child is willing to learn proper technique and has developed coordinated use of his or her head, neck, and trunk to properly contract the neck muscles and contact the ball with the forehead.&quot;&lt;/p&gt;
&lt;p&gt;The risk of eye and other facial injuries is considered low to moderate, according to the authors.&lt;/p&gt;
&lt;p&gt;Nevertheless, they wrote, &quot;protective eyewear is recommended for all participants in soccer ... and should be mandatory for athletes with only one functional eye or those with a past history of major eye surgery or trauma.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors did not make any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_636"
                     title="AOSSM: Elbow Surgery for Baseball Players Does Not Hurt Chance at the Big Leagues"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AdditionalMeetings/tb/13090?impressionId=1265780720319"
                     
      LAS VEGAS, March 2 -- Baseball players who have elbow ligaments reconstructed before going pro have just as good a chance at career success as their counterparts who don&apos;t undergo surgery, a case-control study showed.
              &lt;p&gt; 
              &lt;p&gt;The research involved ulnar collateral ligament reconstruction -- known as  &quot;Tommy John surgery&quot; after the star pitcher who credited the operation with extending a 26-year career with the Yankees, Indians, Dodgers, and other teams.
              &lt;p&gt; 
              &lt;p&gt;Young players who had the surgery before being drafted were equally likely to progress through the ranks to reach the major leagues, Gregory Carolan, M.D., of St. Luke&apos;s Hospital in Bethlehem, Pa., reported here at the American Orthopaedic Society for Sports Medicine Specialty Day.
              &lt;p&gt; 
              &lt;p&gt;They also had similar rates of being placed on the disabled list at any level, and similar performances statistically once they reached the highest level of play.
              &lt;p&gt; 
              &lt;p&gt;&quot;With the increase in ulnar collateral ligament reconstructions being performed,&quot; Dr. Carolan said, &quot;it is heartening to see that the procedure can be successful in allowing future professional athletes to the reach the highest level of competition on par with their peers.&quot;
              &lt;p&gt; 
              &lt;p&gt;Surgery to repair or reconstruct the ulnar collateral ligament, the primary component of valgus stability in the elbow, has become increasingly common, particularly in younger pitchers most -- likely because of increased injury due to inadequate rest throughout the year. (See: &lt;a href=&quot;http://www.medpagetoday.com/Orthopedics/Orthopedics/10573&quot; target=&quot;blank&quot;&gt;Use of Tommy John Surgery for Young Elbows on the Rise&lt;/a&gt;)
              &lt;p&gt; 
              &lt;p&gt;Rehabilitation and time off are the first options in treating injuries to the ligament, but for some, surgery to replace the ligament with a tendon from another part of the body is required.
              &lt;p&gt; 
              &lt;p&gt;The surgery has a high level of success, returning up to 90% of recipients to their prior skill level, Dr. Carolan said.
              &lt;p&gt; 
              &lt;p&gt;However, he said, a longer-term outlook had not been established. So he and colleagues identified all 30 players, including 27 pitchers, who had ulnar collateral ligament repair or reconstruction and were drafted by major league teams from 1999 through 2003.
              &lt;p&gt; 
              &lt;p&gt;Each player was matched to three controls -- who had not undergone surgery -- by age, draft class, round selected, and position played. The mean age of the players was 20.7, and they were drafted, on average, in the middle of the tenth round.
              &lt;p&gt; 
              &lt;p&gt;Through a minimum follow-up period of three years, the controls were just as likely to suffer an injury to their dominant elbow as those who had undergone surgery were to injure their reconstructed elbow (26.7% of the surgery group versus 28.9% of the controls).
              &lt;p&gt; 
              &lt;p&gt;There were similar rates of placement on the disabled list (60% of the surgery group versus 61% of the controls) and of placement on the disabled list more than twice (26.7% of the surgery group versus 25.5% of the controls).
              &lt;p&gt; 
              &lt;p&gt;After a minimum follow-up of three years, there was no difference in the professional level achieved: 10% of the surgery group and 13.3% of the control group made it to the major leagues (&lt;em&gt;P&lt;/em&gt;=0.54).
              &lt;p&gt; 
              &lt;p&gt;All players who reached the highest level were pitchers. Although there were trends toward better numbers for the controls, there were no statistically significant differences between the two groups for earned run average, the ratio of walks to hits per inning pitched, or total innings pitched (&lt;em&gt;P&lt;/em&gt;=0.663 for all).
              &lt;p&gt; 
              &lt;p&gt;&quot;While the statistics employed in the study demonstrated that there was no significant difference between the two groups, we have to caution against drawing firm conclusions regarding absolute equivalence between the two groups,&quot; Dr. Carolan said.
              &lt;p&gt; 
              &lt;p&gt;&quot;Our study design provided us with sufficient power to identify a large difference between the two groups but significantly less power for smaller differences,&quot; he said.
              &lt;p&gt; 
              &lt;p&gt;He and his colleagues update their database with each new draft class, which will strengthen the results over time, he said.
              &lt;p&gt; 
              &lt;p&gt;Dr. Carolan also cautioned that placement on the disabled list may not be an ideal surrogate for injury because each player reports injury differently and each team has a different threshold for placing a player on the list.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Carolan made no financial disclosures.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_6_54"
                     title="SPECIAL REPORT: Use of Tommy John Surgery for Young Elbows on the Rise"
                     score="-0.006"
                     href="