João Espregueira-Mendes Editor-in-Chief C. Niek van Dijk · Philippe Neyret Moises Cohen · Stefano Della Villa Helder Pereira · J. Miguel Oliveira Editors Injuries and Health Problems in Football What Everyone Should Know Injuries and Health Problems in Football Editor-in-Chief João Espregueira-Mendes Editors C. Niek van Dijk • Philippe Neyret Moises Cohen • Stefano Della Villa Helder Pereira • J. Miguel Oliveira Injuries and Health Problems in Football What Everyone Should Know Editor-in-Chief Moises Cohen João Espregueira-Mendes Department of Orthopedics & Traumatology Clínica do Dragão, Espregueira-Mendes Federal University of São Paulo Sports Centre - FIFA Medical Centre of Vila Clementino - São Paulo Excellence Brazil Porto Portugal Stefano Della Villa Isokinetic Medical Group Dom Henrique Research Centre FIFA Medical Centre of Excellence Porto Bologna Portugal Italy 3B’s Research Group–Biomaterials, Biodegradables and Biomimetics, Helder Pereira University of Minho, Headquarters of the 3B’s Research Group–Biomaterials, European Institute of Excellence on Biodegradables and Biomimetics, Tissue Engineering and Regenerative University of Minho, Headquarters of the Medicine, AvePark, Parque de Ciência European Institute of Excellence on Tissue e Tecnologia, Zona Industrial da Gandra Engineering and Regenerative Medicine, Barco, Guimarães AvePark, Parque de Ciência e Tecnologia, Portugal Zona Industrial da Gandra Barco, Guimarães ICVS/3B’s–PT Government Associate Portugal Laboratory Braga/Guimarães ICVS/3B’s–PT Government Associate Portugal Laboratory Braga/Guimarães Orthopaedics Department of Minho Portugal University Minho J. Miguel Oliveira Portugal 3B’s Research Group–Biomaterials, Biodegradables and Biomimetics, Editors University of Minho, Headquarters of the C. Niek van Dijk European Institute of Excellence on Tissue Department of Orthopaedic Surgery Engineering and Regenerative Medicine, Academic Medical Centre AvePark, Parque de Ciência e Tecnologia, Amsterdam Zuidoost Zona Industrial da Gandra Noord-Holland Barco, Guimarães The Netherlands Portugal Philippe Neyret ICVS/3B’s–PT Government Associate Hopital de la Croix-Rousse Laboratory University of Lyon 1 Hopital de la Braga/Guimarães Croix-Rousse Portugal Lyon France ISBN 978-3-662-53923-1 ISBN 978-3-662-53924-8 (eBook) DOI 10.1007/978-3-662-53924-8 Library of Congress Control Number: 2017938163 © ISAKOS 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer-Verlag GmbH Germany The registered company address is: Heidelberger Platz 3, 14197 Berlin, Germany Foreword Not so long ago, the medical world was not interested in the world of sport, although there were some exceptions, like the well-known Galenus, who was also, besides his other duties, the doctor of the Roman gladiators. Sport medicine, related to football, was limited to one single question: “Can he play next Sunday?” Indeed, the relation between medicine and sport only concerned the treat- ment of lesions. Times changed: progressively, sports medicine received more attention, essentially due to the worldwide development of sport itself, becoming one of the most important social surroundings for young people. This resulted in general principles, valuable for the global world of sport. There was, however, no differentiation: the medical approach concerned, without specification, all sports disciplines. Later, times changed again: the specificity of each sport discipline resulted in sports-medical challenges, completely different from one discipline to another. Even in the same discipline, differences became evident and led to impor- tant medical repercussions. One of the most important specific approaches concerned football medi- cine: indeed, football, today, is played in every country of the world, and brings together, under the worldwide umbrella of FIFA, some 300 million football players. This gives us, football doctors, an important place in the contemporary society. It also gives us, however, an important responsibility. That is why I enthusiastically support the edition of this ISAKOS – book about injuries and health problems in football. This book is, naturally, essentially focused on locomotoric problems, but it also concerns other aspects of football medicine, essentially cardiologic, nutritional and respiratory aspects. It follows the different steps in the medical guidance of football medicine, from prevention to diagnosis, conservative and surgical therapy, rehabilita- tion and, finally, “return to play”. This is not the end of the story. Like so many other aspects in our human society, the medicine of football will be influenced, and directed tomorrow, by the “BINC” revolution: Biophysiology, Biotechnology, Informatics and artificial Intelligence, Nanotechnology and Cognitive sciences. v vi Foreword The techniques of diagnosis and therapy will change. What must remain is our constant care for the health and the physical condition of the young foot- ball players. Football doctors must never forget that football is a game before being a product, that football is a sport before being a market, that football is a spectacle before being a business. Baron Dr Michel D’Hooghe Chairman of the Medical Commission of FIFA and UEFA Preface Medical education is a noble mission, where basic sciences together with medical skills, innovations, and applied technology compete to improve the quality of life and performance of sports practitioners. Football is the world’s number one sport, played by 300 million men and women, including referees and officials. It is interesting that 69.6% of regis- tered female and 54.7% of registered male players are young, which shows that FIFA and its member associations are on track toward enhancing the popularity of this sport further in the future. This new publication on football medicine is dedicated to all those who love football and presents insights into the most frequent problems in the sport and some of the hot topics in a friendly, clear, and practical way. In injuries and health problems in football – what everyone should know, we sought to provide an update on the state of the art. To achieve this goal, we gathered valuable contributions from some of renowned experts in the field, selected from FIFA, UEFA, ISAKOS, and ESSKA. We used our experience to put together a team that could contribute to the leverage of education in this field, providing knowledge of high- performance skills, offering guidance on the current rules for best practice, and ensuring high standards in football medicine with regard to prevention, diagnosis, con- servative and surgical treatment, complications, time and criteria for return to sports, and prognosis. We are now entering the era of biologics, tissue engi- neering, and a molecular understanding of healing, and starting to leave the gray area of experimental therapies behind in favor of evidence-b ased treatments. In the subsequent pages of this book, the reader will become acquainted with a generous amount of cognitive knowledge, conveying a comprehensive resource for understanding the most frequent problems in football medicine. Talented and passionate authors in sports medicine bring science to you. We hope you will join us on this priceless mission. “I hear and I forget. I see and I remember. I do and I understand” Confucius, 551–479 BC. Thank you so much to all the contributors. It is an honor, a privilege, and a great pleasure to share with you this exciting challenge. João Espregueira-Mendes vii Contents Part I The Athlete in the Field 1 The Relevance of Medicine in Football . . . . . . . . . . . . . . . . . . . . . . 3 José Ferraz, José Pereira, Jacques Menetrey, and Paulo Lobo 2 Epidemiology: The Most Frequent Lesions . . . . . . . . . . . . . . . . . . 5 Henrique Jones, Pedro Cantista, and Matteo Denti 3 Teamwork in Football/Bringing Science to the Pitch . . . . . . . . . 13 José Neto 4 The Field Case . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Rodolfo Moura 5 How to Examine an Athlete on the Field: What You Should Not Miss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Frederico Varandas, Nuno Oliveira, João Pedro Araújo, Paulo Beckert, and Paco Biosca 6 Principles of Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 João Pedro Araújo, Isabel Lopes, Filipe Guimarães, and Vítor Moreira Part II Anatomy, Biomechanics and Imaging 7 Basics on Knee (dys)Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Rogério Pereira, Ricardo Vidal, Ana Leal, and Maria Amélia Ferreira 8 Biomechanics of Lower Limb Injuries . . . . . . . . . . . . . . . . . . . . . 53 Manuel Vieira da Silva and Bruno Pereira 9 Imaging in Football Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Sérgio Rodrigues-Gomes, José Carlos Vasconcelos, Pedro Portugal, Rui Aguiar, Abdalla Skaf, and Nuno Sousa Part III Ankle and Foot Injuries 10 Injury of Ankle Ligaments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Renato Andrade, Hélder Pereira, João Paulo Vilas- Boas, João Espregueira-Mendes, and C. Niek van Dijk ix x Contents 11 Osteochondral Ankle Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Ricardo Telles Freitas, Hélder Pereira, John Kennedy, and C. Niek Van Dijk 12 Ankle and Foot Fractures and Dislocations . . . . . . . . . . . . . . . . 113 Marta Massada, Gino Kerkoffs, and Paulo Amado 13 Football Ankle Fractures and Return to Sport: A Review on the Arthroscopic Approach . . . . . . . . . . . . . . . . . . 129 Pieter d’Hooghe, Hélder Pereira, and Stefano Zaffagnini Part IV Knee Injuries 14 Meniscal Lesions: From Basic Science to Clinical Management in Footballers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Ibrahim Fatih Cengiz, Hélder Pereira, Joana Silva- Correia, Pedro L. Ripoll, João Espregueira- Mendes, Rodrigo Kaz, J. Miguel Oliveira, and Rui Luís Reis 15 Injury of Knee Ligaments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Frantzeska Zampeli, Anastasios Georgoulis, Freddie Fu, Romain Seil, Jim-Dimitris Georgoulis, and João Espregueira-Mendes 16 Patellofemoral Pain and Instability . . . . . . . . . . . . . . . . . . . . . . . 177 Ana Leal, Paulo Flores, Filipe Silva, Elizabeth Arendt, Philippe Neyret, and João Espregueira-Mendes 17 Osteochondritis Dissecans of the Knee in Football Players . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Alberto Gobbi, João Espregueira-Mendes, Mustafa Karahan, Moisés Cohen, and Graeme P. Whyte 18 Knee and Tibial Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Luís Silva, Ricardo Varatojo, Camila Cohen, and Philippe Neyret Part V Hip, Groin and Tigh Injuries 19 Groin Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 Nuno Loureiro, João Pedro Araújo, Luís Simões, and Marco Fonseca 20 Femoroacetabular Impingement . . . . . . . . . . . . . . . . . . . . . . . . . 227 André Sarmento, J. Cruz de Melo, Alberto Monteiro, and Pieter D’Hooghe 21 Femur Fractures � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 243 Eurico Bandeira-Rodrigues, Sebastiano Vasta, José Carlos Leitão, and Joan Carles Monllau Contents xi Part VI Spine and Head Conditions 22 First Aid and Cares in Spine Trauma . . . . . . . . . . . . . . . . . . . . . 259 Luís Silva, J.M. Pinto de Freitas, and Jorge Mineiro 23 Low Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Rui Rocha, Ana Margarida Fernandes, and António Oliveira 24 Brain Concussion in Football . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 Basil Ribeiro and Bruno Carvalho 25 Face Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 Rui Pratas and Victor Hugo 26 Ophthalmic Lesions in Football . . . . . . . . . . . . . . . . . . . . . . . . . . 299 Luís Torrão 27 ColorADD: Color Identification System for Color-Blind People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303 Miguel Neiva Part VII Upper Limb Injuries 28 Acute Fractures of the Upper Limb . . . . . . . . . . . . . . . . . . . . . . 317 Carina Cohen, Horácio Sousa, Nuno Sevivas, and Guillermo Arce 29 Traumatic Lesions of the Elbow and Wrist . . . . . . . . . . . . . . . . 329 Ricardo Bastos, Miguel Trigueiros, Nuno Sevivas, and Luigi Pederzini 30 Shoulder Instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335 Nuno Gomes, Nuno Sevivas, Pietro Randelli, and Marc Safran 31 Overuse Injuries of the Goalkeeper . . . . . . . . . . . . . . . . . . . . . . 353 Nuno Sevivas, Mustafa Karahan, Carlos Vilela, and António Cartucho Part VIII Muscle Injuries in the Lower Limb 32 Epidemiology, Risk Factors, and Prevention . . . . . . . . . . . . . . . 365 Paulo Barreira, João Pedro Araújo, Ruben Ferreira, and Nuno Loureiro 33 Muscle Injury Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375 Xavier Valle, Johannes L. Tol, Bruce Hamilton, and Ricard Pruna 34 Diagnosis and Management of Muscle Injuries . . . . . . . . . . . . . 381 Ricard Pruna and Matilda Lundblad