OBJECTIVES:Cardiac troponin (cTn) is a critical biomarker for diagnosing myocardial injury; however, intense physical activity can transiently elevate cTn concentrations, creating diagnostic challenges in athletic populations. High-sensitivity cardiac troponin assays (hs-cTn) further complicate discrimination between physiologic and pathologic elevations. METHODS:This study characterized baseline high-sensitivity cardiac troponin I (hs-cTnI) distributions in collegiate athletes and evaluated associations with sex, time since exercise, sport type, and creatine kinase-MB (CK-MB). We analyzed baseline hs-cTnI values from 173 elite collegiate athletes (98 women, 75 men) representing 21 sports. RESULTS:The median hs-cTnI concentration (<4 ng/L) was identical between sexes, but divergence emerged in the upper distribution tail, with hs-cTnI values exceeding population-derived 99th percentile upper reference limits occurring at lower percentiles in men than women (73rd vs 85th percentile), resulting in a higher prevalence of abnormal classifications in men (28% vs 17%, P < .01). Ninety-fifth percentile values were similar between sexes, whereas divergence was confined to the extreme upper tail (99th percentile). Abnormal hs-cTnI values were more frequent when samples were collected <48 hours after exercise compared with ≥48 hours (29% vs 16%, P = .04). No association was observed between hs-cTnI and CK-MB (P = .37). Significant differences emerged between sports (P = .02), with the highest proportions of abnormal hs-cTnI observed among cross-country (80%), sailing (44%), and rowing (35%) athletes. CONCLUSIONS:These findings support athlete-focused interpretation of hs-cTnI incorporating sex-specific thresholds, standardized postexercise sampling, and sport context. Such tailored approaches may reduce false-positive results and unnecessary evaluations while preserving diagnostic accuracy for true myocardial pathology.

PURPOSE:To systematically review the literature for studies using video analysis to evaluate acute lower extremity injury mechanisms in soccer players. METHODS:The study was preregistered on PROSPERO. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Three databases were searched for Level I to IV studies that quantified lower extremity injury mechanisms in soccer players using video analysis. Data recorded included study demographics, injury type, mechanisms, contact, phase of play, timing, and sagittal plane kinematics. Study methodological quality was analyzed using the Quality Appraisal for Sports Injury Video Analysis Studies scale. Forest plots of proportions were generated for injuries occurring in the first versus second half, defensive versus offensive phase, and contact versus noncontact injury. RESULTS:Nineteen articles (mean Quality Appraisal for Sports Injury Video Analysis Studies score 14.3 ± 1.9; all Level IV evidence, 1,652 videos, 17 professional males, 1 professional female, 1 both male/female) were included. Anterior cruciate ligament (ACL) tears (49% [42%-55%]), muscle strains (hamstring: 71% [47%-87%]), and Achilles tears (80%-83%) had a high percentage of noncontact (NC) injury mechanisms. Direct and indirect contact-predominant injuries include medial collateral ligament sprains (14% NC) and foot/ankle sprains (6% [4%-10%] NC). Most ACL injuries (68% [61%-75%]) occurred while defending, and quadriceps strains (81%-89%) occurred while attacking. CONCLUSIONS:In soccer, video analysis shows that a high proportion of acute ACL, Achilles, and muscle injuries occur through noncontact mechanisms, while medial collateral ligament and foot/ankle injuries usually happen with direct contact. ACL injuries are more likely to be sustained when defending, specifically when pressing/tackling, and muscle injuries result from sprinting, kicking, and lunging. Most noncontact-predominant injuries occurred at a higher percentage in the first half, whereas contact-predominant injuries occurred at a higher percentage in the second half. LEVEL OF EVIDENCE:Level IV, systematic review and meta-analysis of Level IV studies.

INTRODUCTION:We aimed to evaluate the efficacy of measuring transaminase levels to determine the resolution of splenomegaly in athletes diagnosed with infectious mononucleosis (IM). METHODS:We collected serial aspartate aminotransferase (AST) and alanine transaminase (ALT) levels and ultrasound-measured spleen sizes in university athletes who had been diagnosed with IM. Our study included seven university-aged athletes from a single institution. Patients received serial liver function tests (LFT) and splenic ultrasound testing until resolution of symptoms and full return to sport. The effects of AST, ALT, and days from symptom onset were analyzed using multivariable mixed-effects linear regression models. RESULTS:Levels of AST and ALT were significantly correlated with spleen size. For each 10-unit increase in AST and ALT values, spleen size increased by 0.1 cm (p = 0.007) and 0.09 cm (p = 0.008), respectively. Decreasing levels of ALT and AST correlated with a decrease in spleen size. Normalization of AST/ALT values correlated with return of spleen size to baseline. CONCLUSIONS:Liver function testing may be useful in the return-to-play decision-making process for athletes with IM.

Objective Previous studies have shown the 5-word Standardized Assessment of Concussion (SAC) and modified-Balance Error Scoring System (mBESS) have poor diagnostic accuracy. The purpose of this study was to assess test-retest reliability, sensitivity/specificity, and AUC of the 10-word SAC and mBESS. Design Prospective, case-control. Setting Four NCAA Division I universities. Participants Concussed/matched-control varsity athletes. Interventions Athletes completed baseline testing including the 10-word SAC and mBESS. When an athlete presented with suspected concussion from February 2020 to April 2022 (sideline/within 24 hours), a battery of tests were performed. If a concussion was diagnosed, a control was identified to test, matched on comorbid conditions (attention deficit disorder, learning disability, headache disorder, mood disorder), gender, team, season, and baseline scores. Outcome Measures SAC scores and mBESS scores Main Results Baseline and post-injury data were collected on 85 concussed and 85 matched control athletes (n=66 SAC; n=85 mBESS). Athletes were predominantly male (n=112, 55%), with the largest sport distributions amongst football (n=78, 39%), volleyball (n=24, 12%), softball (n=22, 11%), and baseball (n=11, 6%). For the SAC, the test-retest reliability (ICC) was 0.26 (95% CI: 0.04–0.46); average of 286.6 days between assessments); sensitivity/specificity was 58%/76% (1-point decline), 55%/83% (2-point decline), 48%/85% (3-point decline); area under the curve (AUC) was 0.71 (0.52–0.77). For the mBESS, the ICC was 0.50 (95% CI: 0.32–0.64; average of 308.2 days between assessments); sensitivity/specificity was 44%/83% (3-point increase), 26%/94% (5-point increase), 11%/NA% (8-point increase); AUC was 0.66 (0.58–0.74). Conclusions The 10-word SAC and mBESS have poor diagnostic accuracy in isolation.

Background Splenomegaly is common in infectious mononucleosis (IM) and splenic rupture during the return-to-play process is a known complication.1 Because IM has a variable disease course, safe return-to-play guidelines vary.2 Although splenic ultrasound is the gold standard for determining splenomegaly, there is variability in baseline spleen sizes and serial ultrasounds are not feasible in all clinical settings. Effective monitoring of splenomegaly in athletes diagnosed with IM may reduce the risk of splenic rupture and its associated morbidity/mortality. Objective To evaluate the correlation of liver function testing (LFT) and spleen size in athletes diagnosed with IM. Design We prospectively collected serial aspartate aminotransferase (AST), alanine transaminase (ALT) levels, and ultrasound-measured spleen sizes over an average course of 24 days (range: 18–33 days) post symptom onset in university athletes who had been diagnosed with IM. The effects of AST, ALT, and days from symptom onset were analyzed using multivariable mixed-effects linear regression models. Setting University athletes at a single institution. Patients Seven university-aged athletes with laboratory confirmed diagnoses of IM. Interventions Patients received serial LFT and splenic ultrasound measurements until resolution of symptoms and full return to sport. Main Outcome Measurements AST/ALT values, spleen size Results Levels of AST and ALT were significantly correlated with spleen size. For each 10-unit increase in AST and ALT values, spleen size increased by 0.1cm (p=0.007) and 0.09cm (p = 0.008) respectively. Decreasing levels of ALT and AST correlated with a decrease in spleen size. Normalization of AST/ALT values correlated with return of spleen size to baseline. Conclusions Liver function testing provides sport physicians with a means to monitor splenomegaly in athletes who have been diagnosed with IM. This may be useful in guiding the return-to-play process for athletes who may otherwise be at risk for splenic rupture. References Sylvester JE, Buchanan BK, Silva TW. Infectious mononucleosis: rapid evidence review. Am Fam Physician 2023;107(1):71–78. Putukian M, McGrew CA, Benjamin HJ, Hammell MK, Hwang CE, Ray JW,... Wilson K. American medical society of sports medicine position statement: mononucleosis and athletic participation. Clinical Journal of Sport Medicine 2023;33(4):359–367.

BACKGROUND: Large-scale data on incidental premature ventricular contraction (PVC) prevalence and morphologies have been lacking, leaving many providers without guidance on further cardiac testing for patients with incidental PVCs on ECG. Athletes offer an intriguing cohort to understand the clinical significance, prevalence, and common morphologies of incidental PVCs because they often undergo ECG screening during preparticipation exams. METHODS: Digital ECGs were obtained from 10 728 screened athletes aged 14 to 35 years during mass screenings in schools and professional sports teams between 2014 and 2021. A retrospective analysis of ECGs with PVCs was performed using the simultaneous display of frontal (limb) and horizontal (precordial) plane leads. PVCs were coded for morphology and categorized as benign or nonbenign using recommended criteria. RESULTS: Twenty-six athletes (0.24%) were found to have at least 1 PVC. Among these, 50% were female, 65% were White, 8% were Asian, 4% were Hispanic, and 23% were Black. Nineteen of the 26 (73%) ECGs had PVCs with a left bundle branch block pattern compared with 7 (27%) with a right bundle branch block pattern. Twenty-four ECGs (96%) had PVCs with benign patterns, including 18 with right ventricular outflow tract, 5 with left anterior fascicle, and 2 with left posterior fascicle morphology. CONCLUSIONS: There is a low prevalence of PVCs on routine ECG screening of young athletes, and most PVCs are of benign morphology in this population. This study highlights the value of using digital ECG recorders with simultaneous lead display to guide decision-making about further cardiac testing and referrals in young athletes with PVCs. Using our results and review of the literature, we propose methods and algorithms of PVC evaluation on screening ECGs to help guide many providers with risk stratification and decision-making about further cardiac testing and electrophysiology referrals in young athletes with PVCs.

Importance:The Sports Concussion Assessment Tool-5 (SCAT5) has been recommended for concussion evaluation and utilizes both a subjective reported symptom grading scale and objective measures of concussion including a cognitive evaluation: the Standardized Assessment of Concussion (SAC). The SAC includes testing for orientation, immediate memory, concentration, and delayed recall; a 10-word list is used to assess immediate memory and delayed recall. Objective:To determine the diagnostic accuracy of components of the SCAT5 and to provide a framework for clinical interpretation. Design, Setting, and Participants:This prospective case-control study of National Collegiate Athletic Association Division I athletes from any sport was conducted from July 2020 to December 2022 at 4 universities. Athletes completed baseline SCAT5 testing using the 10-word list. When an athlete presented acutely with suspected concussion (sideline or within 2 days), the tests were repeated. If a concussion was diagnosed, a control athlete underwent the same tests. Controls were identified and matched on comorbid conditions, sex and gender, sport, season, and baseline scores. Data analysis was conducted from August to October 2023. Main Outcomes and Measures:The primary outcomes were area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive value, and test-retest reliability of the symptom score; symptom severity score; the total SAC score; and the orientation, immediate memory, concentration, and delayed memory subcomponent scores on the SCAT5 compared with clinical diagnosis of concussion. Results:Baseline and postinjury data were collected on 92 athletes with concussion and 92 matched control athletes (96 men [52%] and 88 women [48%]; 110 who played a sport other than football [59%]). Diagnostic utility was considered excellent for symptom score (AUC, 0.93; 95% CI, 0.89-0.96) and symptom severity score (AUC, 0.94; 95% CI, 0.90-0.97). An increase of 2 points on the symptom score was associated with a sensitivity of 86% (95% CI, 78%-92%), specificity of 80% (95% CI, 70%-87I%), and positive predictive value of 81% (95% CI, 72%-88%). The total SAC score had poor to fair diagnostic utility (AUC, 0.70; 95% CI, 0.63-0.77); however, 41 athletes with concussion (45%) had a total SAC score at or above their baseline score (ie, within normal limits). The diagnostic utility was poor to fair for immediate memory (AUC, 0.68, 95%CI, 0.61-0.75) and delayed recall (AUC, 0.69; 95% CI, 0.62-0.77) and not useful for orientation (AUC, 0.49; 95% CI, 0.43-0.56) and concentration (AUC, 0.52 95% CI, 0.44-0.61). Test-retest reliability was fair for total SAC and poor for immediate memory and delayed recall, orientation, and concentration. Conclusions and Relevance:In this case-control study of the diagnostic accuracy of reported symptoms and the SAC, reported symptoms were the most accurate indicator of concussion while the 10-word SAC had limited sensitivity. These findings suggest that understanding the properties of the SAC is important when making the diagnosis of concussion.

Background:Previous studies have shown that most professional head and orthopaedic team physicians are men, and most orthopaedic team physicians are fellowship-trained. It is unknown whether this holds true for primary care team physicians. Purpose:To evaluate the residency and fellowship training background as well as the demographic characteristics of primary care team physicians in professional sports. Study Design:Cross-sectional study. Methods:Publicly available information was used to determine the lead and supporting primary care team physicians for every US-based team in Major League Baseball, Major League Soccer, National Basketball Association, National Football League, National Hockey League, National Women's Soccer League, and Women's National Basketball Association. Data regarding training background and sex were obtained using internet-based sources. Results:We identified 310 primary care team physicians from all 165 US-based teams in the 7 leagues included in the study. Female physicians comprised 11.5% (19/165) of the lead primary care team physicians and 14.2% (44/310) of all primary care team physicians. Overall, 66.7% (110/165) of lead primary care team physicians and 75.5% (234/310) of all primary care team physicians were sports medicine fellowship-trained. There was a higher proportion of female (37.5%) and fellowship-trained (93.8%) physicians in women's professional sports leagues. Most primary care team physicians (244/310 [78.7%]) were trained in family medicine or internal medicine. Conclusion:Women constituted a small minority of primary care team physicians in professional sports. Most primary care team physicians were residency trained in family medicine or internal medicine and were sports medicine fellowship-trained. The proportion of female and fellowship-trained primary care team physicians was highest in the National Women's Soccer League and the Women's National Basketball Association.

Background: Although objective outcomes assessing knee function are essential measurements for return to sport, psychological factors have become increasingly recognized as equally important parameters for determining an athlete’s ability to return to sport after surgery. Purpose: To systematically review the literature to determine whether patients who returned to sport after anterior cruciate ligament (ACL) reconstruction had improved psychological scores (as measured with validated questionnaires) compared with patients who did not return to sport. Study Design: Systematic review and meta-analysis; Level of evidence, 3. Methods: A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was preregistered on PROSPERO. Four databases were searched for level 1 to 3 studies that compared at least 1 psychological outcome measured by a validated questionnaire for patients who did and did not return to sport after primary ACL reconstruction. The following data were recorded: study and patient characteristics; psychological metrics (ACL–Return to Sport Injury [ACL-RSI] scale, Knee Self-Efficacy Scale [K-SES], and Tampa Scale of Kinesiophobia [TSK/TSK-11]); International Knee Documentation Committee (IKDC) score; and clinical metrics. Study methodological quality was analyzed using the methodological index for non-randomized studies (MINORS), and the mean difference (MD) and 95% CI were calculated for each psychological outcome score using the inverse variance method. Results: We included and analyzed 16 articles (3744 patients; 38.9% female; mean age range, 17-28.7 years; mean MINORS score, 19.9 ± 1.4). Overall, 61.8% of athletes returned to sport (66.8% of male patients; 55.4% of female patients). Patients who returned scored significantly higher on the ACL-RSI scale (MD, 20.8; 95% CI, 15.9 to 25.7; P < .001), significantly higher on the K-SES (MD, 1.3; 95% CI, 0.2 to 2.3; P = .036), and significantly lower on the TSK/TSK-11 (MD, 10.1%; 95% CI, −12.1% to −8.2%; P = .004). Those returning to sport did not exceed the minimal clinically important difference for IKDC score versus those not returning to sport. Conclusion: Patients who returned to sport after primary ACL reconstruction had significantly higher psychological readiness, higher self-efficacy, and lower kinesiophobia compared with those who did not return to sport, despite having clinically similar knee function scores. Evaluation of psychological readiness, in combination with other objective measurements, is a critical component of return-to-sport evaluation in athletes after primary ACL reconstruction. Registration: CRD42021284735 (PROSPERO).

IMPORTANCE The US Centers for Disease Control and Prevention shortened the recommended isolation period for SARS-CoV-2 infection from 10 days to 5 days in December 2021. It is unknown whether an individual with the infection may still have a positive result to a rapid antigen test and potentially be contagious at the end of this shortened isolation period. OBJECTIVE To estimate the proportion of individuals with SARS-CoV-2 infection whose rapid antigen test is still positive starting 7 days postdiagnosis. DESIGN, SETTING, AND PARTICIPANTS This case series analyzed student athletes at a National Collegiate Athletic Association Division I university campus who tested positive for SARS-CoV-2 between January 3 and May 6, 2022. Individuals underwent rapid antigen testing starting 7 days postdiagnosis to determine whether they could end their isolation period. EXPOSURES Rapid antigen testing 7 days after testing positive for SARS-CoV-2. MAIN OUTCOMES AND MEASURES Rapid antigen test results, symptom status, and SARS-CoV-2 variant identification via campus wastewater analysis. RESULTS A total of 264 student athletes (140 [53%] female; mean [SD] age, 20.1 [1.2] years; range, 18-25 years) representing 268 infections (177 [66%] symptomatic, 91 [34%] asymptomatic) were included in the study. Of the 248 infections in individuals who did a day 7 test, 67 (27%; 95% CI, 21%-33%) tests were still positive. Patients with symptomatic infections were significantly more likely to test positive on day 7 vs those who were asymptomatic (35%; 95% CI, 28%-43% vs 11%; 95% CI, 5%-18%; P < .001). Patients with the BA.2 variant were also significantly more likely to test positive on day 7 compared with those with the BA.1 variant (40%; 95% CI, 29%-51% vs 21%; 95% CI, 15%-27%; P = .007). CONCLUSIONS AND RELEVANCE In this case series, rapid antigen tests remained positive in 27% of the individuals after 7 days of isolation, suggesting that the Centers for Disease Control and Prevention-recommended 5-day isolation period may be insufficient in preventing ongoing spread of disease. Further studies are needed to determine whether these findings are present in a more heterogeneous population and in subsequent variants.

This case series evaluates the performance of rapid antigen tests in detecting SARS-CoV-2 infection in college athletes during prevalence of a dominant Omicron variant.

BACKGROUND:Prognosticating recovery times for individual athletes with a concussion remains a challenge for health care providers. Several preinjury and postinjury factors have been proposed to be predictive of prolonged return-to-play (RTP) times, but the data in this area are still sparse.PURPOSES:This study aimed to identify risk factors associated with prolonged recovery times and determine which are most predictive of prolonged recovery times in a head-to-head comparison.STUDY DESIGN:Case-control study; Level of evidence, 3.METHODS:All concussions occurring between September 2017 and August 2020 at a single National Collegiate Athletic Association Division I institution were reviewed and included in this study. Preinjury modifiers including age, sex, sport, concussion history, and past medical problems were collected from the electronic medical records. Postinjury modifiers analyzed included initial and follow-up Sport Concussion Assessment Tool 5th Edition scores, vestibular evaluation findings, and eye tracking results.RESULTS:A total of 159 athletes and 187 concussion cases were included. Preinjury factors that were correlated with prolonged RTP times included a history of concussions (P = .015), a history of migraines (P = .013), and whether an athlete participated in an individual sport (P = .009). Postinjury factors correlated with prolonged RTP times included the total number (P = .020) and severity (P = .023) of symptoms as well as abnormal Vestibular Ocular Motor Screening findings (P = .002). Overall, 6 different symptoms (balance problems, difficulty concentrating, light sensitivity, drowsiness, fatigue/low energy, and difficulty remembering) were significantly correlated with prolonged RTP times. The study also found that the number and severity of symptoms were additive in a dose-dependent fashion. On multivariable analysis of all these factors, a history of concussions was found to be the most predictive of prolonged RTP times, while participation in an individual sport had the largest effect on recovery times.CONCLUSION:Several preinjury and postinjury risk factors were identified as being correlated with prolonged recovery times. Many of these risk factors were also found to be additive in nature. This information provides clinicians with a valuable tool in prognosticating and estimating recovery times for athletes. The study also revealed that athletes participating in individual sports had longer RTP times compared with athletes in team sports, which is a novel finding that requires further research.

Objective: The risk of myocardial damage after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been controversial. The purpose of this study is to report the incidence of abnormal cardiovascular findings in National Collegiate Athletic Association (NCAA) Division I student-athletes with a history of SARS-CoV-2 infection. Design: This is a case series of student-athletes with SARS-CoV-2 infection and their subsequent cardiac work-up, including troponin level, electrocardiogram, and echocardiogram. Additional testing was ordered as clinically indicated. Setting: This study was conducted at a single NCAA Division I institution. Participants: Student-athletes were included if they tested positive for SARS-CoV-2 by PCR or antibody testing [immunoglobulin G (IgG)] from April 15, 2020 to October 31, 2020. Intervention: Cardiac testing was conducted as part of postinfection screening. Main Outcome Measures: This study was designed to quantify abnormal cardiovascular screening results and cardiac diagnoses after SARS-CoV-2 infection in Division I collegiate athletes. Results: Fifty-five student-athletes tested positive for SARS-CoV-2. Of these, 14 (26%) had a positive IgG and 41 (74%) had a positive PCR test. Eight abnormal cardiovascular screening evaluations necessitated further testing including cardiac magnetic resonance imaging (cMRI). Two athletes received new cardiac diagnoses, one probable early cardiomyopathy and one pericarditis, whereas the remaining 6 had normal cMRIs. Conclusions: These data support recent publications which recommend the de-escalation of cardiovascular testing such as cardiac MRI or echocardiogram for athletes who have recovered from asymptomatic or mildly symptomatic SARS-CoV-2 infection. Continued follow-up of these athletes for sequelae of SARS-CoV-2 is critical.

Background:Both natural grass (NG) and artificial turf (AT) are popular playing surfaces for soccer. Biomechanical studies have found increased frictional forces on AT that may lead to anterior cruciate ligament (ACL) injury. The increased risk of ACL injury during soccer in female participants may amplify this effect. Purpose:To systematically review the literature for studies comparing ACL injury risk in soccer players on AT versus NG and to specifically determine whether there were differences in injury risk in male versus female players when considering the playing surface. Study Design:Systematic review; Level of evidence, 3. Methods:A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Three databases were searched for studies with evidence level 1 to 3 that compared the incidence of ACL injuries on AT versus NG in soccer players. Data recorded included study characteristics, sex, competition level, exposure setting (games or practices), turf type, and ACL injury information. Study methodological quality was analyzed using the methodological index for non-randomized studies (MINORS) score, and incidence rate ratios (IRRs) were calculated. Results:Included were 7 articles (3 studying professional soccer, 3 collegiate soccer, 1 youth-level soccer; 4 male cohorts, 2 female cohorts, and 1 male and female cohort; mean MINORS score, 20 ± 0.8). Pooled ACL injury IRRs demonstrated no significant differences in overall ACL injury risk when playing soccer on AT compared with NG (IRR = 0.57 [95% CI, 0.21-1.53]; P = .31). A significantly increased risk of ACL injury in games played on AT compared with NG was detected for female (IRR = 1.18 [95% CI, 1.05-1.31]; P = .004) but not for male players (IRR = 1.18 [95% CI, 0.97-1.42]; P = .09). Subgroup analyses showed no significant differences in injury risk for games (IRR = 1.07 [95% CI, 0.97-1.18]; P = .20) or practices (IRR = 0.21 [95% CI, 0.04-1.23]; P = .09). Conclusion:Findings indicated that female soccer players had a significantly higher risk of ACL injury when playing games on AT versus NG, whereas no significant difference was seen in male players. No differences were found for the combined male/female cohort or for soccer games or training sessions played on AT compared with NG.

ABSTRACT Purpose This study aimed to assess the associations between serious injury (≥3-month time loss) and level of specialization among high-level female soccer players and to compare the specialization and college commitment ages of female youth soccer players to Division I college and professional soccer athletes. Methods Youth, college, and professional female soccer players in the United States playing in the top league at each level were recruited to complete an anonymous online survey. The survey collected information about player demographics, soccer specialization and training patterns, history of serious injuries from soccer, and perceptions surrounding soccer specialization. Comparisons between groups were performed using two-sample t -tests, χ 2 analyses, and multiple logistic regression models controlling for differences in age. A P value of less than 0.05 was set as significant. Results A total of 1,018 (767 youth, 251 college/professional) athletes completed the survey. Serious injuries affected 23.6% of youth and 51.4% of college/professional athletes. Anterior cruciate ligament tears were more prevalent in college/professional players compared with youth athletes (18.3% vs 4.0%; P < 0.001). Highly specialized youth athletes (66.5%) were more likely to have sustained a serious injury from soccer compared with athletes with low specialization (odds ratio, 2.28 (1.38–3.92); P = 0.008) but not moderate specialization (odds ratio, 1.37 (0.83–2.27); P = 0.43). A higher proportion of youth athletes specialized at a young age (≤10 yr) compared with college/professional players (44.2% vs 25.9%; P < 0.001). Conclusions High specialization in female youth soccer players is associated with an increased likelihood of sustaining a serious injury. Current youth soccer players are specializing earlier and committing to play college soccer at a younger age compared with when current college and professional players did.

OBJECTIVE:To determine the utility of monospot testing in the diagnosis of mononucleosis in the collegiate student-athlete clinical setting. DESIGN:Retrospective cohort study. SETTING:National Collegiate Athletic Association Division I sports medicine clinic. PATIENTS:All varsity student athletes who had a monospot test and Epstein-Barr virus (EBV) titers obtained from January 1, 2016, through March 31, 2020, (n = 199) were included. INDEPENDENT VARIABLES:Monospot, EBV antibody titers, and liver transaminase results. MAIN OUTCOME MEASURES:Using EBV titers indicating acute or recent infection as the gold standard for diagnosing infectious mononucleosis (IM), the reliability of a positive monospot test and elevated liver transaminases for the diagnosis of IM were examined. RESULTS:The monospot test had a sensitivity and specificity of 80.0% and 90.6%, respectively, with a positive predictive value of 36.4% and a negative predictive value of 98.5% in this cohort. All athletes diagnosed with IM also had elevated liver transaminases. CONCLUSIONS:The specificity of the monospot test is lower than previously reported in the literature, and a positive test is not sufficient to diagnose mononucleosis in this clinical setting. Positive monospot results should be confirmed with EBV antibody testing. Elevated transaminase levels are highly correlated with acute IM and could play a supporting role in the diagnosis.

Introduction Infectious mononucleosis (IM) is a common self-limiting illness most often caused by the Epstein-Barr virus (EBV) and characterized by the classic triad of fever, pharyngitis, and cervical lymphadenopathy (1–3). Splenomegaly is commonly found in those with IM and can lead to the infrequent, but feared, complication of splenic rupture, which has an incidence of 0.1% to 0.5% in IM (4,5). Physical activity is thought to be a risk factor for splenic rupture, and this limits how quickly an IM-infected athlete can safely return to sport (4–6). IM is relatively common in the general population. More than 90% of individuals older than 35 years are seropositive for EBV antibodies, and these antibodies are thought toprovide immunity against future infection (2). This unique case report features aNational Collegiate Athletic Association Division I athlete with a history of remote IM infection (EBV viral capsid antigen [VCA] (+) IgG), which developed a new symptomatic IM infection with subsequent splenomegaly.

Decades of studies have shown that eliminating circadian rhythms of mammals does not compromise their health or longevity in the laboratory in any obvious way. These observations have raised questions about the functional significance of the mammalian circadian system, but have been difficult to address for lack of an appropriate animal model. Surgical ablation of the suprachiasmatic nucleus (SCN) and clock gene knockouts eliminate rhythms, but also damage adjacent brain regions or cause developmental effects that may impair cognitive or other physiological functions. We developed a method that avoids these problems and eliminates rhythms by noninvasive means in Siberian hamsters (Phodopus sungorus). The present study evaluated cognitive function in arrhythmic animals by using a hippocampal-dependent learning task. Control hamsters exhibited normal circadian modulation of performance in a delayed novel-object recognition task. By contrast, arrhythmic animals could not discriminate a novel object from a familiar one only 20 or 60 min after training. Memory performance was not related to prior sleep history as sleep manipulations had no effect on performance. The GABA antagonist pentylenetetrazol restored learning without restoring circadian rhythms. We conclude that the circadian system is involved in memory function in a manner that is independent of sleep. Circadian influence on learning may be exerted via cyclic GABA output from the SCN to target sites involved in learning. Arrhythmic hamsters may have failed to perform this task because of chronic inhibitory signaling from the SCN that interfered with the plastic mechanisms that encode learning in the hippocampus.