SummaryThis observational study assessed the frequency and risk factors of dental damage after classic direct laryngoscopy for tracheal intubation in 536 adult patients. The patients' sex, age, height, weight, dental condition, dental mobility, Mallampati class, interincisor gap, thyromental distance, neck circumference, and head and neck extension were recorded. From anaesthesia records, the difficulty of intubation, the number of attempts, type of neuromuscular blocking agent used and duration of anaesthesia were recorded. After anaesthesia, examination revealed that 134 patients (25.0%) had dental damage affecting 162 teeth (147 maxillary; 15 mandibular). Enamel fracture was the commonest injury. In tooth number 21, the interincisor gap (OR 2.5 (95% CI 1.0-5.9)) and in tooth number 22, the number of intubation attempts (OR 5.3 (95% CI 1.3-22.0)) were considered a risk factor for dental injury. Conventional direct laryngoscopy is associated with a strikingly high incidence of dental damage, although specific risk factors remain unclear.

Minor oral trauma is significantly more frequent after endotracheal intubation than after use of the laryngeal mask. This is true for injuries of the teeth, inferior lip and tongue. Further studies are needed to evaluate on a long-term basis the clinical relevance of the dental injuries we found.

Background High levels of the tumor necrosis factor alpha (TNF-α) induce apoptosis and pro-inflammatory effects for primary degeneration of tendon and development of tendinopathy. The aim of this study was to investigate the association between the TNF-α polymorphisms and tendinopathy in athletes. Methods Two hundred and seventy athletes (135 tendinopathy cases and 135 controls) were included and genotyped (TNF-α -1031T > C; -857 C > T; -308G > A) using TaqMan validated assays. The association of the polymorphisms with tendinopathy was evaluated by a multivariate logistic regression model, using odds ratios (OR) and 95 % confidence intervals (CI). Results The variant allele − 308 A was significantly associated with patellar (OR: 1.9; 95 % CI: 1.01–3.6) or Achilles tendinopathies (OR: 2.7; 95 % CI: 1.1–6.7). No significant differences were found in allele or genotype distributions of the − 1031T > C and − 857 C > T polymorphisms between cases and controls. TNF-α TCA haplotype was associated with increased tendinopathies risk, either considering all cases (OR: 2.6, 95 % CI: 1.3–5.3), patellar (OR: 3.3, 95 % CI: 1.5–7.3), rotator cuff (OR: 3.1, 95 % CI: 1.4–7.2) or Achilles tendinopathies (OR: 3.8, 95 % CI: 1.1–12.7). Conclusions These results suggest that the TNF-α polymorphisms could influence the susceptibility to developing tendinopathy among athletes. Knowledge of the TNF-α polymorphisms associated to tendinopathy in athletes can further understanding of the inflammatory role in the early stages of the disease and contribute for sports injury surveillance programmes, in which athletes with TNF-α TCA haplotype could be early subjected to cryotherapy after training and competition to avoid tendinopathy development.

Background and objectives: To evaluate the knowledge and sun protection habits of a group of Brazilian athletes. Sunburns are considered the main environmental risk factor for melanoma, especially before the age of 20. Most of professional athletes are young individuals intensively exposed to sunlight in their activities and leisure as well, being therefore susceptible to sunburns. Methods: During the XIV Pan-American Games, 115 Brazilian athletes answered to a questionnaire on sunburn during training and leisure; phototype; use of sunscreen (USS); importance of sun protection (ISP) and place of practice (indoors x outdoors). Results: The majority was outdoor (73%), and 59% had light phototype (I, II or III). Comparing the athletes by their practicing place, outdoors presented higher rates of sunburn episodes, ISP and USS during their training periods, while in leisure the groups did not show any difference. Grouped by phototypes, athletes with lighter skin complexion presented more sunburn episodes in both training and leisure. In multivariate analysis for sunburn risk, light phototypes and ISP were statistically significant. Conclusions: Outdoor sports modalities give origin to more sunburn in their athletes. However, during leisure, both outdoor and indoor athletes present similar sun habits, evidencing that in this moment they form a homogeneous group regarding sun light exposure. Athletes with lighter phototypes are more prone to sunburns in both leisure and training. The rates of sunscreen use are lower than the recommendation. Sun protection should be stimulated in both sports and leisure activities in Brazilian athletes.

BackgroundVolleyball can be considered one of the most popular sports. Prospective studies aimed at investigating the incidence and risk factors of volleyball injuries are scarce.ObjectiveTo investigate the incidence and risk factors for volleyball injuries among Brazilian elite volleyball players.Design20-week prospective cohort study.SettingBrazilian elite national league (2015–2016).Participants13 Brazilian elite volleyball teams (208 players): 7 male teams (116 players) and 6 female teams (92 players).Assessment of Risk FactorsVolleyball exposure (hours and sessions of training, strength training and number of matches) and injuries were recorded weekly by the medical team.Main Outcome MeasurementsInjury during the follow-up period.Results196 injuries were reported among 96 athletes. The overall injury incidence was 4.8 injuries/1000 hours of training and 18.6 injuries/1000 matches. Overuse injuries (65.3%, n=128) were more common than acute injuries (33.7%, n=66). Knee (28.5%, n=50) and shoulder (9.8%, n=19) were the body regions most affected by overuse injuries. Ankle (6.2%, n=12) and shoulder (5.6%, n=11) were the body regions most affected by acute injuries. Tendinopathy (23.7%, n=46) was the overuse injury type most observed, and ankle sprain (7.2%, n=12) was the acute injury type most observed. Female athletes (OR: 0.50, CI 95%: 0.31–0.80) and additional training sessions (OR: 0.74, CI 95%: 0.60–0.91) were associated with a lower risk of injury. Previous injury (OR: 2.18, CI 95%: 1.40–3.38), and an additional hour of training (OR: 1.18, CI 95%: 1.05–1.32) were associated with a higher risk of injury.ConclusionsThis study showed that male gender, an additional hour of training, and a history of previous injury were the most significant risk factors for developing a new injury. However, additional training session was associated with lower considered risk of injury.

Força muscular é uma variável comprovadamente importante de ser avaliada não somente para obter bom desempenho na prática de esportes, como também para identificar indivíduos que possam estar em um grupo de risco para lesões musculoesqueléticas. Poucos estudos descrevem valores de força para diferentes articulações em atletas de elite do futebol feminino. O objetivo deste estudo é descrever esses valores. Para isso, 23 atletas da seleção brasileira de futebol feminino, em preparação para as Olimpíadas de 2004, foram avaliadas nos movimentos de flexo-extensão de tronco, rotação interno-externa do quadril e flexo-extensão dos joelhos no dinamômetro isocinético Cybex 6000 (Lumex Inc. Ronkonkoma, NY). Foram encontrados os valores médios de torque máximo, expressos em Nm: rotação interna do quadril: 23,1; rotação externa do quadril: 25,6; flexão de tronco: 213,2; extensão de tronco: 267,7; extensão de joelho: 181,4; flexão de joelho: 102,0. Os valores encontrados devem ser considerados quando o indivíduo testado equivaler ao grupo estudado.

Background/Aims Cross‐country mountain biking and field hockey are two Olympic sports that pose a potential risk for dentofacial trauma. However, mouthguard use is not mandatory in either of these sports and knowledge about tooth rescue among athletes is often neglected. The aim of this cross‐sectional epidemiological survey was to evaluate the prevalence of sports‐related dentofacial injuries, mouthguard use, and attitudes regarding tooth rescue among cross‐country mountain biking and field hockey athletes participating at pre‐Olympic competitions held in Rio de Janeiro, Brazil. Materials and Methods A convenience sample of 217 athletes from 33 countries participating in cross‐country mountain biking (n = 82; mean age = 30.96 ± 8.52 years) and field hockey (n = 135; mean age = 19.72 ± 2.46 years) pre‐Olympic competitions were examined clinically, and they answered a questionnaire regarding previous history of sports‐related dentofacial injuries, attitudes toward mouthguard use, and tooth rescue. Results There were 120 (55.30%) males and 97 (44.70%) females who participated in the study. The prevalence of facial trauma was higher in mountain biking (54.88%) than in field hockey (26.66%, P < .001). Fracture was the most prevalent facial injury in mountain biking (80%), while laceration was the most prevalent in field hockey (30.55%). Extensive dental injuries occurred more often in mountain biking (47.37%) than in hockey (12.50%). The teeth most often affected were the maxillary central incisors in both mountain biking (57.89%) and field hockey (93.75%). Mouthguard use was more frequent among field hockey athletes (41.48%) than in mountain biking (1.22%, P < .001). The overall knowledge about tooth rescue was low, and most of the athletes in both sports did not know what to do in case of an avulsed tooth. Conclusions Prevalence of dentofacial injuries among XCO‐MTB and field hockey athletes participating at this pre‐Olympic event was high. The majority of the athletes in this study did not use mouthguards and were unaware of recommendations in the case of an avulsed tooth.

The anterior cruciate ligament (ACL) tear represents more than half of all knee injuries in sports that involve body rotations and sudden changes of direction. Discharging the athlete for return to play (RTP) post-ACL reconstruction (ACLR) is a difficult task with multidisciplinary responsibility. For many years, a six-month period post-ACLR was adopted as the only criterion for RTP. However, it is now suggested that RTP should not be exclusively time-based, but to clinical data and systematic assessments. Despite the importance of post-ACLR factors for RTP, pre- and peri-ACLR factors must also be considered. Historically, ACLR is performed with the hamstring or autologous patellar tendons, although the choice of graft is still an open and constantly evolving theme. Anterolateral ligament reconstruction and repair of meniscal ramp tear associated with ACLR have recently been suggested as strategies for improving knee joint stability. Subjective questionnaires are easy to apply, and help identify physical or psychological factors that can hamper RTP. Functional tests, such as hop tests and strength assessment by means of isokinetic dynamometers, are fundamental tools for decision making when associated with clinical evaluation and magnetic resonance imaging. Recently, the capacity to generate force explosively has been incorporated into the muscle strength assessment. This is quantified through the rate of torque development (RTD). Due to characteristics inherent to the practice of sport, there is an extremely short time available for produce strength. Thus, RTD seems to better represent athletic demands than the maximum strength assessment alone. This review investigates the pre-, peri- and post-ACLR factors established in the literature, and shares our clinical practice, which we consider to be best practice for RTP. Level of evidence V; Specialist opinion.