Domhnall MacAuley on sports medicine’s top ten

Domhnall MacauleySports medicine’s top ten. The keynote speaker had to drop out – could I give a talk about the top papers in 2010 at the UK sports and exercise medicine meeting (UKSEM) …this is a selection of papers that caught my eye with some additional  suggestions  from colleagues. See what you think:

Just bubbling under my top ten were some  topical and interesting papers.  There was a good piece of work by Nic Maffulli’s group on genetics and sport; I enjoyed the session on exercise and cancer at the American College of Sports Medicine and some of the content is summarised in their journal and the Lancet published an excellent review article on injection therapy this week. As the winter sports season draws closer, I was also fascinated by an audit of illness and  injury at the recent winter Olympics.

The Top Ten
Autologus chondrocyte implantation was highlighted at a recent research meeting, and this is the latest systematic review from the Journal of Bone and Joint Surgery – the technique certainly has potential.

9. Functional fitness will allow us to cope with the normal tasks of daily living as we age.  The Jan 25th issue of Annals of Internal Medicine, included a number of papers on physical activity and ageing. Clearly exercise and physical activity are now mainstream medicine so I was excited by a BMJ paper showing reduced mortality associated with four measures of functional fitness.

8. Childhood obesity is another big public health story. There is a wealth of research showing the benefit of physical activity in preventing childhood obesity but, it is easy to blame inactivity and more difficult to tell parents that the problem is their child’s diet. Although it is a relatively small cohort study, I liked the message in this paper from Archives of Diseases in Childhood showing that fatness lead to inactivity but that inactivity did not lead to fatness.

7. The highest profile sports medicine issue in 2010 was “Bloodgate”. It transfixed the UK media and was even reported in the New York Times where they said “Doctors are not Gods but God help us if we cannot trust them.” This unfortunate story highlighted the pressures facing sports medicine doctors and how a wrong decision may have huge professional implications. For this reason we must include the UK FSEM professional code as one of the most important publications of the year.

6. Sudden death in sport is always tragic. There are often calls that something must be done to prevent these untimely deaths, a sentiment supported by grieving relatives and well meaning charitable bodies.  The lack of evidence always concerned me but opinions are polarised so the question, if electrocardiograph screening  could prevent sudden death in athletes, was a great topic to address in a BMJ Head to Head. Decide for yourself.

5. A miracle cure – “Exercise may beat the common cold” screamed one headline.  A paper, published three weeks ago in the British Journal of Sports Medicine, suggesting that exercise could cure the common cold went viral. It was a reanalysis of a study of 1002 adults who recorded respiratory tract infections over 12 weeks. The study has limitations but it attained worldwide publicity.

4. Platelet rich plasma (PRP) injection is the latest treatment to take sports medicine by storm but, does it work? A double blind RCT in JAMA comparing eccentric exercises (usual care) with either a PRP injection (PRP group) or saline injection (placebo group)  in Achilles tendon injury found no significant difference in the  primary outcomes, pain and function, nor in the secondary outcomes, patient satisfaction or return to sport,  up to 24 weeks.  We also picked it up in BMJ Short cuts. The evidence doesn’t support its use. Listen to Robert Jan de Vos and Adam Weir discuss their research in a BJSM podcast.

3.  And, I hope you will forgive me for suggesting that that the best sports medicine research paper from the UK was a randomised controlled trial of accelerated rehabilitation on function after ankle sprain by my colleagues. Chris Bleakley lead a team that found  an  accelerated exercise protocol during the first week after ankle sprain improved ankle function; patients were   more active during that week than the group receiving standard care. A subsequent BMJ review article summarised the benefits of additional supervised exercises compared to conventional treatment in ankle sprain.

  The research team of the year must be the Oslo Sports Trauma Centre. While no individual paper stands out, their body of work is impressive and, in particular, their work on soccer in 2010. One might argue that a single comprehensive paper might have been of more value than the series  of papers dealing with different sites of injury, but it is impressive nevertheless.

Together with some innovative work by Hideyuki Koga on the aetiology of non contact anterior cruciate injury and Torbjorn Soligard’s work showing that skilled soccer players were more prone to injury, no one could compete with this group.

1. The outstanding international research paper of the year…..It is incredible that a piece of tissue just a few centimetres long has attracted such a volume of research over the years. There are few definitive papers. But, a RCT published in the New England Journal of Medicine showing that rehabilitation plus early ACL reconstruction was not superior to a rehabilitation plus optional delayed ACL reconstruction, was arguably the research paper of the year. It has considerable potential to change orthopaedic management.

Domhnall Macauley is primary care editor, BMJ