What's new in sports medicine (primary care)

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

Exercise in children and adolescents with depression (February 2023)

Prescribing exercise for depression in adults is supported by multiple trials. Physical activity also appears to benefit children and adolescents with depression. In a meta-analysis of 21 studies of more than 2400 youths (mostly randomized trials), a variety of aerobic exercise programs (generally prescribed as monotherapy) were associated with moderately improved depressive symptoms compared with usual care or no treatment [1]. However, after a mean follow-up of 21 weeks, improvement of depressive symptoms in the two groups was comparable. For children and adolescents with unipolar major depression, we suggest physical exercise as an adjunct treatment along with pharmacotherapy and/or psychotherapy. (See "Overview of prevention and treatment for pediatric depression", section on 'Adjunctive exercise'.)

MANAGEMENT AND REHABILITATION OF MUSCULOSKELETAL INJURIES

Success rates for meniscus repair (October 2022)

Little high-quality evidence is available about surgical repair of a torn meniscus. A newly published meta-analysis of 27 studies (primarily small case series) involving 1630 meniscal repairs reported an overall success rate of 80.5 percent at five years when modern surgical techniques were employed [2]. The study noted that success rates were higher for lateral versus medial meniscus repair (87.4 versus 76.1 percent) and that concomitant anterior cruciate ligament reconstruction did not affect the success of meniscal repair. (See "Meniscal injury of the knee", section on 'Arthroscopic or open surgery'.)

MEDICAL ISSUES RELATED TO SPORTS AND EXERCISE

Undiagnosed concussion and long-term sequelae (November 2022)

Few studies have assessed the long-term risks associated with an undiagnosed sports-related concussion (SRC). In an observational study performed by the Concussion Assessment, Research, and Education (CARE) Consortium involving nearly 30,000 collegiate athletes and military personnel, individuals who described having sustained one or more undiagnosed concussions performed significantly worse on multiple neurocognitive assessments at subsequent baseline evaluations compared with those whose previous concussions were diagnosed [3]. These findings suggest possible long-term harm when SRC is not diagnosed promptly and managed appropriately. (See "Clinic-based evaluation of sports-related concussion in older adolescents and adults", section on 'Intrinsic risk factors'.

OTHER PRIMARY CARE SPORTS MEDICINE

Mask wearing during exercise (March 2023)

The effects of wearing a mask while exercising are debated. In a recent systematic review and meta-analysis of 45 studies (1264 healthy participants), masks were found to have a modest negative impact on pulmonary function and gas exchange during exercise, but regularly produced subjective feelings of discomfort (eg, dyspnea, increased exertion, fatigue) [4]. This is consistent with findings from other studies and reviews. While preventative measures such as mask wearing remain important during periods of high infection, at other times we believe it is reasonable to engage in shared decision-making with athletes about the relative risks and benefits of wearing a mask during exercise. (See "COVID-19: Return to sport or strenuous activity following infection", section on 'Wearing a mask during exercise'.)

Hamstring injury rates unchanged (February 2023)

Hamstring muscle injuries continue to be a common problem among athletes. In a meta-analysis of 63 prospective studies encompassing nearly 6,000 injuries sustained over more than seven million  hours of exposure to field-based team sports (eg, soccer, rugby), hamstring injury incidence was 0.81 per 1000 participation hours, comprising 10 percent of all injuries sustained [5]. Despite advances in prevention and rehabilitation, the incidence remains unchanged over the past 30 years. Sensible training practices and regular performance of eccentric strength exercises can reduce the risk of injury. (See "Hamstring muscle and tendon injuries", section on 'Epidemiology'.)

Athletic benefit of caffeine supplementation does not diminish with habitual caffeine intake (October 2022)

Research suggests that caffeine supplementation, when taken in appropriate doses, can improve exercise capacity and power in some athletes. Whether habitual caffeine intake diminishes such effects has not been well studied. In a systematic review and meta-analysis of 60 studies (over 1100 athletes) that reported the effects of habitual and supplemental caffeine intake on performance, researchers found that habitual, dietary consumption of caffeine (eg, daily coffee) does not appear to diminish its ergogenic effects when taken as a supplement to improve athletic performance [6]. Consistent with other studies, the review found no added benefit from high doses (6 mg/kg). (See "Nutritional and non-medication supplements permitted for performance enhancement", section on 'Caffeine'.)