Background:Achilles tendinopathy is a common condition, which can become chronic and interfere with athletic performance. The proteinase inhibitor aprotinin (as injection) has been found to improve recovery in patellar tendinopathy1 (evidence level 1b2) and Achilles tendinopathy.3 Internationally this therapy is being used based on this limited knowledge base.Aim:To evaluate whether aprotinin injections decrease time to recovery in Achilles tendinopathy.Method:A prospective, randomised, double blind, placebo controlled trial was performed comparing saline (0.9%) plus local anaesthetic injections and eccentric exercises with aprotinin (30 000 kIU) plus local anaesthetic injection and eccentric exercise. Three injections were given, each a week apart. In total, 26 patients, with 33 affected tendons, were enrolled for this study.Results:At no follow up point (2, 4, 12, or 52 weeks) was there any statistically significant difference between the treatment group and placebo. This included VISA-A scores4 and secondary outcome measures. However, a trend for improvement over placebo was noted.Conclusion:In this study on Achilles tendinopathy, aprotinin was not shown to offer any statistically significant benefit over placebo. Larger multicentre trials are needed to evaluate the efficacy of aprotinin in Achilles tendinopathy.

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The aim of this study was to determine the effectiveness of a tailored footwear programme on lower-limb comfort in professional rugby league players. The study was conducted over 30 weeks and involved two professional teams (n = 59 players) from the Australian National Rugby League competition. One team was assigned to a footwear programme (intervention), while players from the control group continued usual practices of self-selected footwear. The tailored footwear programme consisting of player education, prescription of footwear, and frequent rotation of footwear resulted in a lower incidence of injury and higher comfort ratings. The intervention group had fewer lower-limb injuries (P = 0.005; Cohen d = 0.72) and higher comfort ratings (P < 0.001, Cohen d = 1.24) than the control group. Specifically, the intervention group reported a lower incidence of poor comfort events (mean = 3.8, s = 2.7) than the control group (mean = 7.9, s = 3.7). Observations also included fewer time loss events in the intervention (mean = 6.3, s = 4.8) than the control group (mean = 11.0, s = 6.3) and reduced injuries per 1000 h in the intervention (24.79/1000) than the control group (30.76/1000). These findings should help medical advisers improve footwear comfort in sportspeople and so reduce the incidence of related injuries.

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Aims and ObjectivesThis study extends previous work in the field of injury awareness using a novel lower limb comfort index (LLCI), which was developed to assess comfort in professional football. Participants rated comfort for designated anatomical segments of the lower limb utilizing a seven point Likert scale. The aims of the study were (i) to assess the reliability of the LLCI in a competitive football environment (Australian Rules and Rugby League), and (ii) to assess whether LLCI measurements were responsive to changes in lower limb comfort over time.Methods and ResultsThe reliability of the LLCI was observed in two professional football environments: Training Week (mean difference 0.1 point, intra-class correlation coefficient, ICC 0.99) for n = 41 participants; and Match Day (mean difference 0.2 points, ICC 0.97) for n = 22 players. Measurements of lower limb comfort were responsive to changes in comfort over time. Within-player differences were not significant for periods 0–8 hrs (P > 0.05) but, generally, significant for time periods 0–24 hrs (P < 0.05), and significant between 24–96 hrs (P < 0.01). The results indicate that the LLCI was reliable when tested for repeated measures and indicated how the index measures lower limb comfort changes over time.ConclusionThis study shows that the use of a lower limb comfort index, when used in a competitive football environment, is both reliable and responsive to change during both a training week and under match day conditions.

The LLCI showed good trait construct to provide confidence to conduct a future study to investigate interrater consistency in a wider cohort of professional footballers under different conditions, such as match-day and training-week environments.