Adam Weir

• Haaglanden Medisch Centrum

To develop a core outcome set for Achilles tendinopathy (COS-AT) for use in clinical trials we performed a five-step process including (1) a systematic review of available outcome measurement instruments, (2) an online survey on truth and feasibility of the available measurement instruments, (3) an assessment of the methodological quality of the se...

Background Cam morphology develops during skeletal growth, but its influence on cartilage and the labrum in high-impact athletes later in life is unknown. Purpose To (1) explore the association between the presence and duration of cam morphology during adolescence and the cartilage and labral status 7 to 12 years later and (2) report the prevalenc...

Hip and Groin Pain in Physically Active Adults A Formal ESSKA-EHPA-ESMA Consensus

Two recent randomized-controlled trials showed promising results of local corticosteroid injections combined with exercise therapy for Achilles tendinopathy and plantar fasciopathy. Should clinicians go back to using corticosteroid injections to treat tendinopathy? Are corticosteroids back (baby)? In this viewpoint we critically appraise the new ev...

Background: Ankle osteoarthritis is debilitating and usually affects relatively young people, often as a result of previous ankle traumas, frequently occurring in sports. Platelet-rich plasma (PRP) injections for ankle osteoarthritis have shown no evidence of benefit over the course of 26 weeks. Previous studies on PRP for knee osteoarthritis show...

Objectives: To determine whether baseline physical tests have a prognostic value on patient-reported outcomes in Achilles tendinopathy. Design: Prospective cohort study, secondary analysis of data from a randomized trial. Methods: Patients with chronic midportion Achilles tendinopathy performed a progressive calf muscle exercise program. At ba...

Objectives To evaluate the interexaminer reliability of abdominal palpation and resistance tests in athletes with longstanding groin pain, and to identify the prevalence of positive clinical tests in athletes classified with inguinal-related groin pain. Methods Male athletes (18–40 years) with longstanding groin pain were prospectively recruited b...

Patients with midportion Achilles tendinopathy (AT) are thought to experience a gradual symptomatic improvement over time. The aim of this study was to prospectively investigate if patients with midportion AT have symptoms at 10-year follow-up. Patients withmidportion AT were invited to complete an online questionnaire 10 years after inclusion in a...

The Doha agreement classification is used to classify groin pain in athletes. We evaluated the inter-examiner reliability of this classification system. We prospectively recruited 48 male athletes (66 symptomatic sides) with groin pain between 10-2017 and 03-2020 at a sports medicine hospital in Qatar. Two examiners (23 and 10 years of clinical exp...

Background: Adductor-related groin pain (ARGP) is the most common groin injury in athletes. If conservative treatment fails, then adductor tenotomy to relieve tension can be considered. The use of botulinum toxin A (BoNT-A) has shown good results in other musculoskeletal pathologies. Objective: Assess the effectiveness of BoNT-A injections in AR...

Groin pain is common in athletes, but remains a challenge to diagnose. Self-reported pain quality distribution may facilitate differential diagnoses. We included 167 athletes with groin pain (≥ 4 weeks). All athletes received a standardized clinical examination. Athletes could choose multiple quality descriptors and intensity, and drew these on a d...

Groin pain is common in athletes, but remains a challenge to diagnose. Self-reported pain quality distribution may facilitate differential diagnoses. We included 167 athletes with groin pain (≥ 4 weeks). All athletes received a standardized clinical examination. Athletes could choose multiple quality descriptors and intensity, and drew these on a d...

Objective: To investigate the relationship between training/match play duration and time-loss groin injury in professional male soccer players and determine if previously identified intrinsic risk factors influenced this relationship. Design: Prospective cohort study. Methods: A total of 590 professional male soccer players were prospectively...

Introduction Pubic-related groin pain can affect young athletes and pubic apophysitis is a potential cause of pain. We aimed to describe the maturation of the pubic symphysis in adolescent football players on x-ray. Materials and Methods 105 anteroposterior radiographs of healthy adolescent male football players between 12 and 24 years old were us...

Introduction There is a lack of effective non-surgical interventions for ankle osteoarthritis. Platelet-rich plasma (PRP) injections are widely used and reported to be beneficial for knee osteoarthritis. We evaluated the efficacy of PRP injections in the management of ankle osteoarthritis. Materials and Methods In this six-center stratified, block...

Background Adolescent athletes have different injury patterns to those of adults, and their growing bones are susceptible to overuse injuries. Evidence of growth-related injuries in relation to growth and maturation in youth elite soccer players remains sparse. Objective 1) to investigate lower-limb apophyseal injuries (LL-AI) and 2) their relatio...

Importance Approximately 3.4% of adults have ankle (tibiotalar) osteoarthritis and, among younger patients, ankle osteoarthritis is more common than knee and hip osteoarthritis. Few effective nonsurgical interventions exist, but platelet-rich plasma (PRP) injections are widely used, with some evidence of efficacy in knee osteoarthritis. Objective...

Introduction Physeal injuries have been overlooked in epidemiological research in youth sports. Our prospective study investigated the incidence, severity, and burden of physeal injuries in a youth elite football academy. Methods 551 youth male football players from Under-9 to Under-19 were included and observed over four consecutive seasons. Inju...

Poor reporting of medical and healthcare systematic reviews is a problem from which the sports and exercise medicine, musculoskeletal rehabilitation, and sports science fields are not immune. Transparent, accurate and comprehensive systematic review reporting helps researchers replicate methods, readers understand what was done and why, and clinici...

Background Cam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging conce...

Objectives Evaluate the adoption of and opinions on the Doha agreement meeting classification in groin pain in athletes. Design Delphi survey and e-survey. Methods A 2-round Delphi survey among the Doha agreement meeting expert group, and a separate international e-survey among clinicians who regularly assess athletes with groin pain. Clinical ca...

Objective To provide a comprehensive, evidence-based overview of the risk factors, prevention, diagnosis, imaging, treatment and prognosis for Achilles tendinopathy. To make clinical recommendations for healthcare practitioners and patients. Design Comprehensive multidisciplinary guideline process funded by the Quality Foundation of the Dutch Fede...

Background Complete avulsions of the adductor longus tendon are serious injuries, yet we have few data to inform clinical decisions on management. Previous studies are limited by a lack of detailed follow-up. Purpose To describe detailed clinical and imaging measures 1 year after complete proximal adductor longus avulsion injuries in athletes who...

Background The association between injury risk and skeletal maturity in youth soccer has received little attention. Purpose To prospectively investigate injury patterns and incidence in relation to skeletal maturity in elite youth academy soccer players and to determine the injury risks associated with the skeletal maturity status, both overall an...

Purpose To develop a specified radiographic scoring system for the pubic symphysis and adjacent bones, and to examine the intra- and inter-rater reproducibility of this system. Method Development of the scoring protocol was performed in three stages using AP pelvis radiographs of 102 male adult athletes. The final protocol included 5 overall scori...

Objective Investigate the incidence and burden of injuries by age group in youth football (soccer) academy players during four consecutive seasons. Methods All injuries that caused time-loss or required medical attention (as per consensus definitions) were prospectively recorded in 551 youth football players from under 9 years to under 19 years. I...

Objectives To investigate the association between clinical assessment and MRI measures of oedema and MRI grading in male athletes with acute adductor injuries. Design Cross-sectional study. Methods We included 81 consecutive athletes with acute adductor injuries. All athletes received a standardized clinical assessment and magnetic resonance imag...

Objective: To investigate the relationship between repeated clinical measures and the progression of rehabilitation of male athletes with acute adductor injuries. Design: Prospective observational cohort study. Methods: Male athletes with acute adductor injuries received a standardized criteria-based rehabilitation program with four repeated c...

Abstract Objective To investigate the comparative effectiveness of all treatments for patellofemoral pain (PFP). Design Living systematic review with network meta-analysis (NMA). Data sources Sensitive search in seven databases, three grey literature resources and four trial registers. Eligibility criteria Randomised controlled trials evaluating...

Objectives To determine normal values for hip strength and range of motion (ROM) of elite, sub-elite and amateur male field hockey players and to examine the effect of age, leg dominance, playing position, playing level and non-time-loss groin pain on hip strength and ROM. Design Cross-sectional study. Setting Physical testing took place at field...

Background Clinical decision-making around intramuscular tendon injuries of the hamstrings is a controversial topic in sports medicine. For this injury, MRI at return to play (RTP) might improve RTP decision-making; however, no studies have investigated this. Objective Our objectives were to describe MRI characteristics at RTP, to evaluate healing...

Abstract Objective To provide a consistently updated overview of the comparative effectiveness of treatments for Achilles tendinopathy. Design Living systematic review and network meta-analysis. Data sources Multiple databases including grey literature sources were searched up to February 2019. Study eligibility criteria Randomised controlled trial...

Background Time to return-to-sport (RTS) after acute adductor injuries varies among athletes, yet we know little about which factors determine this variance. Purpose To investigate the association between initial clinical and imaging examination findings and time to RTS in male athletes with acute adductor injuries. Study Design Cohort study (Pro...

Background Despite being one of the most common sports injuries, there are no criteria-based rehabilitation programs published for acute adductor injuries. Purpose To evaluate return-to-sport (RTS) outcomes and reinjuries after criteria-based rehabilitation for athletes with acute adductor injuries. Study Design Cohort study; Level of evidence, 2...

There is no agreement on how to classify, define or diagnose hip-related pain—a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how t...

Using the Downs and Black checklist, the majority of included RCTs (8/11) were judged to be high-quality trials. Kosik et al interpreted study quality assessment findings to provide moderate-quality to high-quality evidence for therapeutic interventions improving patient-reported function in individuals with CAI. Using ROB2 on the same sample of RC...

In this editorial, we introduced risk of bias as the perceived risk that the results of a research study may underestimate or overestimate the truth. Systematic review authors should perform a domain-based risk of bias assessment that reflects risk of bias instead of assessing study quality. If a research study reports multiple outcome measures, se...

IntroductionDiagnosing groin pain in athletes is challenging due to the close proximity of multiple anatomic structures, the lack of a golden reference standard, and the widespread use of different terminology for similar conditions. These issues were highlighted in a previous Delphi study whereby 23 groin pain experts had poor inter-rater agreemen...

Introduction Platelet-rich plasma (PRP) is a potentially efficacious treatment for ankle osteoarthritis (OA), but its use has not been examined in high-quality studies. Systematic reviews show that PRP injections significantly decrease pain and improve function in patients with knee OA. Ankle OA is more common than hip or knee OA in the young activ...

Objective To investigate the effects of compression shorts on pain and performance in football players with groin pain. Study design Double blinded randomized controlled trial. Setting Soccer pitch. Participants Thirty-four male football players with groin pain. Main outcome measures The effect of wearing zoned high compression shorts (ZHC-shor...

Introduction Patellofemoral pain (PFP) affects 1 in every 14 adults. Many treatments for PFP have been evaluated, but the comparative effectiveness of all available treatments has never been examined. Network meta-analysis is the only design to study the comparative effectiveness of all available treatments in one synthesis. This protocol describes...

ABSTRACT Objectives: To study the clinical course including return to sport success rates of football players with adductor-related groin pain (ARGP) after manual therapy of the adductor muscles. Design: Prospective case series. Methods: Thirty-four football players with ARGP with median pre-injury Tegner scores of 9 (IQR 25–75: 9–9) were treated...

Samenvatting Het doel van dit onderzoek was (1) inzicht te krijgen in de ernst van heup- en liesblessures (HLB) in het voorseizoen 2015- 2016 en de relatie met (2) eerdere HLB en (3) eerdere blessures op andere locaties dan de heup/lies bij amateurvoetbalsters. In het voorseizoen van 2015-2016 completeerden 434 speelsters een online blessure-vragen...

Background Change of direction and kicking have been described as the main actions resulting in adductor longus injury. Video descriptions of inciting events are lacking. Objective Perform a standardised visual video analysis of a series of acute adductor longus injuries in football. Study design Cross-sectional. Methods Video footage was review...

Purpose: Hip and groin injuries in football are problematic due to their high incidence and risk of chronicity and recurrence. The use of only time-loss injury definitions may underestimate the burden of hip and groin injuries. Little is known about hip and groin injury epidemiology in female football. The first aim of this study was to examine th...

Study Design Cohort study with prospective and retrospective elements. Background Groin injury and symptoms are common in soccer players. Their relationship with reduced hip range of motion (ROM) and previous injury is unclear. Objectives To conduct a retrospective assessment of associations between previous injury and pre-season hip ROM and pre-...

Background Acute hamstring injury that includes intramuscular tendon injury has been suggested to be associated with increased reinjury risk. These observations were based on a relatively small number of retrospectively analysed cases. Objective To determine whether intramuscular tendon injury is associated with higher reinjury rates in acute hams...

Background: Musculoskeletal hip/groin screening tests are commonly performed to detect at-risk individuals. Bony hip morphology is considered a potential intrinsic risk factor but has not been examined prospectively. Purpose: To evaluate the association between intrinsic risk factors identified from musculoskeletal and radiographic screening tes...

Study Design Cross-sectional cohort study. Objectives To investigate the relationship between musculoskeletal screening findings and bony hip morphology in asymptomatic male soccer players. Background Athletes with femoroacetabular impingement (FAI) syndrome have cam and/or pincer morphology, pain on orthopaedic testing, and often reduced hip ran...

Synopsis Groin pain is common in athletes who participate in multidirectional sports and has traditionally been considered a difficult problem to understand, diagnose, and manage. This may be due to sparse historical focus on this complex region in sports medicine. Until recently, there has been little agreement regarding terminology, definitions,...

Four previous reviews1–4 found lower hip range of motion (ROM) to be a risk factor for the development of groin pain in athletes, but two reviews5 6 did not. A systematic review with meta-analysis by Mosler et al. 7 found lower hip ROM to be associated with groin pain. No published prevention or treatment programs for groin pain in athletes focus...

Background Involvement of the intramuscular (central) tendon in acute hamstring injuries, as detected on magnetic resonance imaging (MRI), may prolong recovery times. To date, it is unclear whether hamstring injuries exhibiting intramuscular tendon involvement can be identified though routine clinical examinations that assess flexibility and streng...

Background/Aim Groin injury epidemiology has not previously been examined in an entire professional football league. We recorded and characterised time loss groin injuries sustained in the Qatar Stars League. Methods Male players were observed prospectively from July 2013 to June 2015. Time loss injuries, individual training and match play exposur...

Acute adductor injuries account for the majority of acute groin injuries; however, little is known about specific injury characteristics, which could be important for the understanding of etiology and management of these injuries. The study aim was to describe acute adductor injuries in athletes using magnetic resonance imaging (MRI). Male athletes...

Hip flexor injuries account for one third of acute groin injuries; however, little is known about specific injury characteristics. The aims of this study was to describe acute hip flexor injuries using magnetic resonance imaging (MRI) in athletes with acute groin pain, and to compare specific muscle injuries with reported injury situations. Male at...

Objective: To examine the prevalence of different causes of groin pain in athletes using the recent Doha consensus classification of terminology and definitions of groin pain in athletes. Design: Descriptive epidemiological study. Setting: Multidisciplinary sports groin pain clinic at Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qata...

ABSTRACT Background Whether hip range of motion (ROM) is a risk factor for groin pain in athletes is not known. Objectives To systematically review the relationship between hip ROM and groin pain in athletes in cross- sectional/case–control and prospective studies. Study design Systematic review, prospectively registered (PROSPERO) according to PRI...

Background A challenge for sports physicians is to estimate the risk of a hamstring re-injury, but the current evidence for MRI variables as a risk factor is unknown. Objective To systematically review the literature on the prognostic value of MRI findings at index injury and/or return to play for acute hamstring re-injuries. Data sources Databas...

ABSTRACT Background The majority of sporting injuries are clinically diagnosed using history and physical examination as the cornerstone. There are no studies supporting the reliability of making a clinical diagnosis of medial tibial stress syndrome (MTSS). Aim Our aim was to assess if MTSS can be diagnosed reliably, using history and physical exam...

Background Clinicians and athletes do not always agree when return to play (RTP) is advisable. A better understanding of how RTP decisions are made could help prevent re injury. Objective To describe and compare risk assessments from sport medicine physicians, physiotherapists and athletes during routine care of injured athletes, and to elicit if...

Background: Diagnosing femoroacetabular impingement/acetabular labral tear (FAI/ALT) and subsequently making a decision regarding surgery are based primarily on diagnostic imaging and intra-articular hip joint injection techniques of unknown accuracy. Purpose: Summarize and evaluate the diagnostic accuracy and clinical utility of various imaging...

Twee jaar geleden is er in Nederland een grootschalig onderzoek naar liesblessures bij profvoetballers gestart: de GRoin Injury Prevention (GRIP)-studie. Deze prospectieve studie richt zich op risicofactoren voor het ontstaan van een liesblessure én behandelingen na het oplopen van een dergelijke blessure. Tijdens GRIP zijn de aanbevelingen uit het...

Liesblessures bij sporters komen vaak voor en kunnen langdurig bestaan. Vooral bij voetballers worden liesblessures veel gezien. Ongeveer 4 tot 19% van de voetballers ontwikkelt gedurende een seizoen liesklachten waarvoor medische behandeling noodzakelijk is. 1 Desondanks is het stellen van een diagnose vaak moeilijk, maar waarom? De liesregio kenm...

Background: There is no valid and reliable instrument that evaluates injury severity and treatment effects for medial tibial stress syndrome (MTSS) patients. Objective: The aim was to generate items for the MTSS score, a new patient-reported outcome measure for patients with MTSS. Methods: The authors consulted experts in the field of MTSS to gener...

‘How can I treat my patient best?’ is a question clinicians ask themselves on a daily basis. For clinical inquiries, systematic reviews (SRs) deliver the highest level of evidence in medical sciences.1 They can cover a variety of domains, including treatment and diagnostics. Presenting a full overview of the literature and delivering an unbiased es...

Objectives: Different individuals may make different return to play (RTP) decisions due to different risk assessments or risk tolerances. Our objectives were to determine the feasibility of eliciting reinjury risk assessments with Bayesian methods, and risk tolerance with questionnaires, from clinicians and athletes in a real-world RTP setting. D...

Background Little is known about the value of clinical examination in relation to diagnostic imaging for acute groin injuries in athletes. Primary aim: to investigate whether clinical examination tests predict a positive or negative MRI result (MRI±). Secondary aim: to assess accuracy of clinical tests to localise injury in MRI+ cases. Methods We...

Background: Participation in high-impact athletic activities has recently been associated with a higher prevalence of cam deformity. Bony hip morphology has also emerged as an important factor in the development of hip osteoarthritis. However, it is unknown whether bony morphology differs between ethnicities in athletes participating in high-impac...

Objectives: To determine the normal profiles for hip strength and range of motion (ROM) in a professional football league in Qatar, and examine the effect of leg dominance, age, past history of injury, and ethnicity on these profiles. Design: Cross-sectional cohort study. Methods: Participants included 394 asymptomatic, male professional footb...

Abstract: Objective: The aim of this study was to develop a test to measure sport specific range of motion (SSROM) of the lower limb, evaluate its reliability and describe findings in non-injured and injured football players. Design: Case-controlled. Setting: 6 elite, 6 amateur clubs, sports medicine practice. Participants: 103 elite, 83 amateur an...

Objectives To describe a multi-dimensional MRI assessment approach with a focus on acute musculotendinous groin lesions, and to evaluate scoring reproducibility. Methods Male athletes who participated in competitive sports and presented within 7 days of an acute onset of sports-related groin pain were included. All athletes underwent MRI (1.5 T) ac...

Study Design Cohort study, repeated measures. Background Although hamstring strength measurements are used for assessing prognosis and monitoring recovery after hamstring injury, their actual clinical relevance has not been established. Handheld dynamometry (HHD) is a commonly used method of measuring muscle strength. The reliability of HHD has no...

Background: Soccer (football) players often have hip and groin symptoms (HGS), and a previous groin injury is a risk factor for a relapse. Decreased hip range of motion (HROM) has been related to both hip and groin pain and the presence of a cam deformity. How these factors interact is unknown. Purpose: The first aim was to study whether HGS are...

Background At present, there is no validated patient-reported outcome measure (PROM) for patients with medial tibial stress syndrome (MTSS). Aim Our aim was to select and validate previously generated items and create a valid, reliable and responsive PROM for patients with MTSS: the MTSS score. Methods A prospective cohort study was performed in...

Background: Tendinopathy is characterized by alterations in the tendon structure, but there are conflicting results on the potential of tendon structure normalization and no large studies on the quantified, ultrasonographic tendon structure and its association with symptoms. Purpose: To determine whether the tendon structure returns to values of...

Abstract Background Our 2012 review on therapeutic interventions for acute hamstring injuries found a lack of high-quality studies. The publication of new studies warranted an update. Objectives To update and reanalyse the efficacy of conservative treatments for hamstring injury. Data sources PubMed, EMBASE, Web of Science, Cochrane library, CINAHL...

Hip and groin injuries are common in many sports. Understanding the factors differentiating athletes with hip/groin pain from those without these injuries could facilitate management and prevention. Conduct a systematic review and meta-analysis of the literature on factors differentiating athletes with and without hip/groin pain. The review was reg...