The 2013 sisk awards.

Each spring, the editors of Sports Health have the pleasure of selecting the winning manuscripts for the annual T. David Sisk Awards. These awards commemorate the life of Dr T. David Sisk, our colleague and mentor, who chaired the American Orthopaedic Society for Sports Medicine (AOSSM) Medical Publishing Board during the development of Sports Health. Dr Sisk enthusiastically fostered the development of the journal because he believed in the multidisciplinary approach to sports medicine. He was a team physician at Memphis, where he practiced this team approach in the care of athletes. Dr Sisk grew up in a very humble environment, excelling in sports and later in sports medicine. He taught us a lot about teamwork—in good times and in others. He really was a team player! So it’s a special opportunity to award these 3 groups of investigators that have contributed to the success of Sports Health.

Evangelos Pappas, PhD, authored a systematic review with meta-analysis on the prospective predictors of patellofemoral pain syndrome (PFPS).[3] The meta-analysis included age, weight, height, sample size, patient type (military vs civilian), follow-up, diagnostic methods, and criteria. Not surprising, lower knee extensor strength was the only variable that was predictive of PFPS (P ≤ 0.01). Anthropometric variables were not associated with PFPS. For musculoskeletal clinicians who frequently treat this malady, confirmation of this factor is instructive. Not surprisingly, many painful adolescent knees do get better with exercise. Screening for these strength deficits, especially in young athletes, before the symptoms develop is well worth the effort, knowing how difficult it can be to reverse this painful process once it begins. This work was recognized at the 2013 AOSSM Annual Meeting with the T. David Sisk Award for the Best Clinical Review.

In the International category, Stephano Della Villa, MD, reported on the clinical outcomes in return to sports participation for 50 soccer players after anterior cruciate ligament (ACL) reconstruction utilizing a sports-specific rehabilitation protocol.[2] The assessment of these players included the Knee Outcome Survey-Sports Activity Scale as well as isokinetic and aerobic fitness tests. The mean start of the on-field rehabilitation process was 90 ± 26 days from surgery, and the mean time for return to competition was 185 ± 52 days. The addition of the on-field rehabilitation component appears to have completed the functional rehabilitation process, allowing transition from surgical recovery to competitive sports participation. Especially for soccer players, who are highly susceptible to ACL injuries, this functional progression program offers much insight into the process and timing of returning this high-risk group of athletes to sports competition. The first part of this program resembled classic rehabilitation in a gym with the emphasis on full knee motion and strength acquisition. The second part moved onto the soccer field for sport-specific “re-education” after patients demonstrated a less than 20% deficit in isokinetic maximal peak torque for knee flexion and extension. Furthermore, to begin the on-field rehabilitation, patients had to run on a treadmill at a pace of 8 km per hour for 10 minutes without pain, swelling, or decreased range of motion, emphasizing the need for stepwise functional progression. Eliminating motion and strength deficits before sports-specific training began was critical.

In the Original Research category, Christian Coyle, PhD, headed a group of investigators from the University of Pittsburgh that demonstrated that serum CTXii (a biochemical biomarker of collagen type II degradation) correlates with articular cartilage degeneration after ACL transection or arthrotomy in rats when followed by exercise.[1] This research addresses a critical need for biomarkers that can signal the status of articular cartilage after injury, providing a target for interventions. ACL injury places articular cartilage at risk. Separating the negative consequences of this injury, surgical or nonsurgical treatment, and vigorous rehabilitation would be beneficial for our patients to help individualize the best course for each one. Currently, if a patient had an ACL tear in the past and was asymptomatic, we have only a few options for monitoring articular cartilage degeneration. Most studies have relied on radiographic parameters (eg, joint space narrowing), which are actually only a crude indicator, if at all, of the early stages of degenerative disease. Assessing joint space accurately on radiograph is difficult at best. It requires a meticulous approach to yield useful measurements. A recent MRI follow-up study suggested that all ACL injuries incur articular cartilage thinning over time.[4] No doubt these early stages usually will not be detectable with routine imaging. To advance this science and improve clinical care, clinicians and researchers need better tools to monitor degenerative disease. The strong correlations between histological scores and CTXii levels in ACL-transected rats suggest the potential for biomarker monitoring. Clinical trials of early intervention efforts will become possible when reliable biomarkers for degenerative disease are available.

All of these investigators have made significant contributions to the clinical care of athletes and the science of sports medicine. These studies address current, widespread clinical dilemmas that we face daily. Thanks to their work, we have a few more answers for our patients and, hopefully, we’re advancing the science of sports medicine!