Football Traumatology Current Concepts: from Prevention to Treatment Piero Volpi (Ed.)

Football Traumatology Current Concepts: from Prevention to Treatment

Foreword by: Neil P. Thomas Franco Carraro Sergio Campana Giacinto Facchetti

-Springer PIEROVOLPI Center for Sports Rehabilitation Galeazzi Orthopaedics Institute Milan, Italy

Library of Congress Control Number: 2005937087

ISBN 10 88-470-0418-7 Springer Milan Berlin Heidelberg New York ISBN 13 978-88-470-0418-4 Springer Milan Berlin Heidelberg New York

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Cover design: Simona Colombo, Milan, Italy Typesetting: Graphostudio, Milan, Italy Printing: Grafiche Porpora, Cernusco SIN (MI), Italy Foreword

This anthology of Football Traumatology edited by Dr. Piero Volpi comprises the collective experience of many of the leading surgeons in Europe whose practice includes footballers at all levels. By pooling this experience and clearly defining common problems and areas of current interest Professor Volpi has produced a very useful reference source for orthopaedic surgeons, sports physicians and physiotherapists. Future editions may expand on emerging areas in non-surgical fields such as dietary supplements and the effects of psychological factors on both injury itself as well as recovery. Topics in this first edition such as Epidemiology, Training Methods, Prevention, and Future Treatment are welcome adjuncts to the usual subjects and reflect recent areas of research.

Neil P. Thomas President ESSKA 2000 Winchester UK

With football becoming ever more relentless and intense, the role of the sports doctor has become in the last few years increasingly important in protecting footballers' health and their physical integrity. It is in this context that Dr. Volpi's in depth and wide ranging work must be viewed. His attention has focused specifically on two important aspects: the fight against doping and the preven- tion of sports traumas. Together with his scientific experience as a sports clini- cian and traumatologist, Dr. Volpi can also draw on his direct field experience as a football player, which adds considerable value to the editing of the current vol- ume, intended as a service to football. With the Football World Cup just round the corner, this book produced in collaboration with both Italian and foreign experts is particularly topical: I am convinced that the spread of medical-scien- tific knowledge and innovations is the most efficient way to safeguard the health of athletes and encourage the growth of a "better" football.

Franco Carraro President of the Italian Football Federation VI Foreword

This wide editorial initiative, conceived and realized by Dr. Piero Volpi, a pre- cious and not replaceable AIC consultant, brings an important scientific contri- bution to medical questions connected to football. It is noticeable in the work the importance of the Author's direct experiences, first as players and as sport and traumatic doctor then. AIC has always been strongly engaged in safeguarding the players' health, real protagonists of the sport event, and has, between his leading aims, the fight against doping and the traumas prevention. The information, the knowledge and the education are fundamental for play- ers who want to successfidly face the fight to defend their physical integrity and professional dignity. This praiseworthy editorial effort goes exactly in the direction wished by AIC and will be useful for all the football component to enrich their cultural heritage but especially to know how important is the work done by who acts in order to improve sport anyhow.

Sergio Campana President AIC Italian Footballers Association

As an F.C. Internazionale executive, and through dealing with the topic in UEFA and FIFA Commision meetings, I have been able to closely follow Piero Volpi's work in these past ten years. I have come to appreciate the preparation and ethics of a person who was "born" on the pitch and has since been through many experiences, first as footballer and later as a sports doctor. This interesting book is the result of an analysis of these two lives that run parallel, but which are not always necessarily linked in the professional world: theory is verified by practice, research addresses the demands and problems faced at the highest com- petitive levels. The knowledge and possibilities offered by sports medicine today are far superior to those in my generation of footballers. Piero Volpi's book is the most recent and vivid example that today's athlete has the moral and professional duty to consider his own health as one of the most important and decisive aspects of his career - at the very level and on each occasion, starting from the basis, from the decisive transition between playing for fun and playing competitively.

Giacinto Facchetti President, EC. Internazionale Milano Preface

Every child has a dream: to play football and become a famous footballer. When I was 10 years old, my father was used to bring me to San Siro stadium on sunday afternoons to watch the Inter team playing. The great Inter was grow- ing up. Sarti, Burnich, Facchetti.. . it was an absolute and sudden love. Twenty years later I was climbing that prestigious stadium through the stairs from the locker rooms wearing the shirt of Como team to play a football match of the first league Italian championship against Inter. Fifteen years later, I was sitting as a chief physician on the bench of the Moratti's Inter team, Ronaldo, Baggio, etc. Sometimes dreams come true. With the present book I accomplish today another wish. To enrich the won- derful world of football with scientific and specialistic contributions on football traumatology, a branch that has undergone important hits and progresses. Football has constant need of medical, diagnostic, clinical, therapeutic knowl- edge to counteract the increased number of traumas occurring during sport per- formance in order to defend the integrity of its players, beeing them profession- als, amateurs, young or women. Thanks to my father, to him my dearest memory, thanks for bringing me to the stadium when I was a child. Thanks to everybody that I met in the football world: players, team compan- ions and competitors, trainers, managers, physicians, physiotherapists, press reporters, fans; I learned from everyone as in a real "gym of lifeyy. Thanks to the Authors of this book, for their participation and for the high scientific level reached in their chapters. Thanks to Springer who has been recipient of this idea and was able with great skill to make it real.

Piero Volpi Contents

Section I General concepts Epidemiologyand Risk Factor P. VOLPI ......

Aspects of Biomechanics G. CERULLI,A. CARAFFA,G. ZAMARRA,F. FANTASIA, M. LORENZINI,D. CHECCARELLI...... 1 1

Training Methods C.BORDON ...... 23

Evaluation of Whole Physical Condition F. PIGOZZI,A.GUIMBINI, F. FAGNANI,~.DI SALVO...... 33

Biochemical and HaematologicalParameters in Football Players G.BANFI...... 43

Prevention of Football Injuries I.BERKES,A. KYNSBURG, G. PANICS...... 53

Organisation of a ProfessionalTeam's Medical Staff and the Physician's Role P.VOLPI ...... 67

Injuries in Women's Football L. ENGEBRETSEN,K. STEFFEN ...... 75

Referee Lesions J. ESPREIGUERA-MENDES,C. ARCE ...... 89 X Contents

Future treatmentsfor Football lnjuries M.FERRETTI,B.A.ZELLE,F.H.FU...... 101

Section II: Specific lnjuries Maxillo-Facial Traumatology R. BRUSATI,F. BIGLIOLI...... 1 13

Upper Extremity lnjuries P.VOLPI,R. POZZONI,M. GALLI,C. BAIT...... 123

Shoulder Dislocation R.ZINI ...... 127

Back Problems E. ROLLAND,G. SAILLANT...... 143

Muscle lnjuries D. TORNESE,G. MELEGATI,P.VOLPI ...... 153

Tendon lnjuries M.K. SAYANA,N. MAFFULLI...... 165

Groin Pain A. FERRETTI,A. DE CARLI,E. MONACO...... 183

Meniscal Lesions M.DENTI,D.LOVETERE...... 197

Anterior Cruciate Ligament lnjuries P. AGLIETTI,F. GIRON, P. CUOMO...... 205

Anteromedial Knee Instability M. MARCACCI,S. ZAFFAGNINI ...... 2 17

Medial Side Injury of the Knee P. ADRAVANTI,A. AMPOLLINI ...... 231

Posterior Cruciate Ligament lnjuries P.P. MARIANI,F. MARGHERITINI...... 245 Contents XI

Articular Cartilage Lesions in Football Players L. PETERSON,C. ERNEST...... 255

Patellofemoral Problems A. SCHIAVONEPANNI, M. TARTARONE,A.PATRICOLA, D. SANTAITI ...... 263

Footballer's Arthritic Knee S. LUSTIG,T. AIT SI SELMI,E. SERVIEN,G. TROTTA,P. NEYRET...... 275

Leg Fractures KARLP.BENEDETTO...... 287

Malleolar Fractures F. CASTOLDI,R. ROSSI,A. MARMOTTI,R. DELDIN, P. ROSSI ...... 297

Ankle Ligament Injuries A.VENTURA,A.LANZETTA...... 307

Osteochondral Ankle Defects M.ZENGERINK,N.VANDUK...... 319

Chronic Footballer's Ankle E. GIZA,B. MANDELBAUM...... 333

Foot Problems S. GIANNINI,A.FERRUZZI, M. MOSCA,C. BIAGINI...... 353

Stress Fractures F. BENAZZO,M. MOSCONI,G. ZANON...... 365

Rehabilitationafter Football Injuries S.WERNER...... 375

Return to Play A. CACCHIO,G. MELEGATI,P.VOLPI ...... 389

Protective Equipment D.T. KIRKENDALL...... 401

Subject Index ...... 417 Contributors

ADRAVANTIPAOLO Galeazzi Orthopaedics Institute Casa di Cura "Citti di Parma" Milan, Italy Parma, Italy BANFIGIUSEPPE AGLIETTIPAOLO Facolti di Scienze Motorie First Orthopaedic Clinic Universitl di Milano University of Florence Istituto Ortopedico Galeazzi Florence, Italy Milano, Italy BENAZZOFRANCESCO AITSI SELMITARIK Orthopaedics and Trauma Centre Livet Department, University of Pavia Service Professeur Philippe Neyret Policlinico San Matteo Caluire, France Pavia, Italy

AMPOLLINIALDO BENEDETTOKARL P. Casa di Cura "Citti di Parma" Trauma Surgery and Sports Medicine Parma, Italy Academic Hospital Feldkirch Austria ARCECARLOS Orthopaedics and Sports Trauma BERKESISTVAN Department Department of Sports Orthopaedic Pedro Hispano Hospital Medicine and Rehabilitation Matosinhos, Portugal Faculty of Physical Education and Sports Science, Semmelweis University ARCHILLETTIANTONIO Budapest, Hungary Laboratory of Clinical Biomechanics "Let People Move" BIAGINICHIARA Perugia, Italy Orthopaedics Department University of Bologna BAITCORRADO Rizzoli Orthopaedic Institute Center for Sports Rehabilitation Bologna, Italy XIV Contributors

BIGLIOLIFEDERICO Department Maxillo-Facial Surgery Unit R. Silvestrini Hospital Ospedale San Paolo Laboratory of Clinical Milan, Italy Biomechanics "Let People Move" Perugia, Italy BORDONCLAUDIO U.S. Citth di Palermo CHECCARELLIDANIELE Palermo, Italy University of Perugia Orthopaedics and Traumatology BRUSATIROBERTO Department Maxillo-Facial Surgery, R. Silvestrini Hospital University of Milan, Italy Perugia, Italy Maxillo-Facial Surgical Unit Ospedale San Paolo Cuo~oPIERLUIGI Milan, Italy First Orthopaedic Clinic University of Florence CARAFFAAURO Florence, Italy University of Perugia Orthopaedics and Traumatology DE CARLIANGELO Department Orthopaedic Unit and Kirk Kilgour R. Silvestrini Hospital Sports Injury Center Laboratory of Clinical San Andrea Hospital Biomechanics University "La Sapienza" "Let People Move" Rome, Italy Perugia, Italy DELDIN RAINERO CACCHIOANGELO Third Department of Orthopaedics Dipartimento di Neuroscienze and Traumatology Unith Operativa di Medicina University of Turin Medical School Fisica e Riabilitazione "Umberto I" Hospital, Turin, Italy Ospedale San Salvatore L'Aquila, Italy DENTIMATTEO Sports Traumatology and Arthroscopic CASTOLDIFILIPPO Surgery Unit University of Turin Medical School Galeazzi Orthopaedics Institute "Umberto I" Hospital Milan, Italy Turin, Italy DI SALVOVALTER CERULLIGIULIANO University Institute of University of Perugia Movement Sciences Orthopaedics and Traumatology Rome, Italy Contributors XV

ENGEBRETSENLARS Fu FREDDIEH. Orthopaedic Center University of Pittsburgh Ulleval University Hospital School of Medicine Oslo, Norway Department of Orthopaedic Surgery Kaufmann Building ERNESTCHRISTIAN Pittsburgh, USA Gothenburg Medical Center Wstra Frolunda, Sweden GALLIMARCO Sports Traumatology and ESPREGUEIRA-MENDESJOAO Arthroscopic Surgery Unit Orthopaedic and Sports Trauma Galeazzi Orthopaedics Institute Department Milan, Italy Minho University and Porto University Porto, Portugal GIANNINISANDRO Orthopaedics Department FAGNANIFEDERICA University of Bologna University Institute of Rizzoli Orthopaedic Institute Movement Sciences Bologna, Italy Rome, Italy GIOMBINIARRIGO FANTASIAFABIANO University Institute of University of Perugia Movement Sciences Orthopaedics and Traumatology Rome, Italy Department R. Silvestrini Hospital GIRONFRANCESCO Perugia, Italy First Orthopaedic Clinic University of Florence FERRETTIANDREA Florence, Italy Orthopaedic Unit and Kirk Kilgour Sports Injury Center GIZAERIC San Andrea Hospital Santa Monica Orthopaedic Sports University "La Sapienza" Rome, Italy Medicine and Research Foundation Santa Monica, USA FERRETTIMARIO University of Pittsburgh KIRKENDALLDONALD T. School of Medicine Department of Exercise and Department of Orthopaedic Surgery Sport Sciences Kaufmann Building University of North Carolina Pittsburgh, USA Chapel Hill, USA XVI Contributors

KRISHNASAYANA, MURALI MAFFULLINICOLA Department of Trauma and Department of Trauma and Orthopaedics Orthopaedics University Hospital of University Hospital of North Staffordshire North Staffordshire Post Graduate Medicine Post Graduate Medicine Keele Medical School Keele Medical School Stoke-on-Trent, United Kingdom Stoke-on-Trent United Kingdom KYNSBURGAKOS Department of Sports Orthopaedic MANDELBAUMBERT Medicine and Rehabilitation Santa Monica Orthopaedic Sports Faculty of Physical Education and Medicine and Research Foundation Sports Science, Semmelweis University Santa Monica, USA Budapest, Hungary MARCACCIMAURIZIO LANZETTAALBINO Rizzoli Orthopaedic Institute 1st Division, Traumatology Sports Traumatology and Sport Centre Orthopaedics Division Orthopaedic Institute Gaetano Pini Biomechanics Laboratory Milan, Italy Bologna, Italy Lo VETEREDARIO MARGHERITINIFABRIZIO Sports Traumatology and University of Motor Sciences Arthroscopic Surgery Unit Unit of Sports Traumatology Galeazzi Orthopaedics Institute Rome, Italy Milan, Italy MARIANIPIER PAOLO L~RENZINIMICHELA University of Motor Sciences University of Perugia Unit of Sports Traumatology Orthopaedics and Traumatology Department Rome, Italy R. Silvestrini Hospital Perugia, Italy MARMOTTIANTONGIULIO Third Department of Orthopaedics LUSTIGSBBASTIEN and Traumatology Centre Livet University of Turin Service Professeur Medical School Mauriziano Philippe Neyret "Umberto I" Hospital Caluire, France Turin, Italy Contributors XVII

MELEGATIGIANLUCA PATRICOLAALESSANDRO ANTONIO Center for Sports Rehabilitation ISpeO Galeazzi Orthopaedics Institute Istituto Specialistico Ortopedico Milan, Italy Casa di Cura "San Giuseppe" Rome, Italy MONACOEDOARDO Orthopaedic Unit and Kirk Kilgour PETERSONLARS Sports Injury Center Gothenburg Medical Center St. Andrea Hospital Vastra Friilunda, Sweden University "La Sapienzayy Rome, Italy PIGOZZIFABIO University Institute Mosc~MASSIMILIANO of Movement Sciences Orthopaedics Department Rome, Italy University of Bologna Rizzoli Orthopaedic Institute Pozzo~~ROBERTO Bologna, Italy Sports Traumatology and Arthroscopic Surgery Unit MOSCONIMARIO Galeazzi Orthopaedics Institute Clinica Ortopedica e Traumatologia Milan, Italy dell'universitl degli Studi di Pavia Centro Studi e Ricerche in Medicina e ROLLANDERIC Traumatologia dello Sport Orthopaedic Surgery Service Policlinico San Matteo PitiC SalpEtriCre Hospital Pavia, Italy Paris, France

NEYRETPHILIPPE ROSSIPAOLO Centre Livet 3rd Department of Orthopaedics and Service Professeur Traumatology Phiippe Neyret University of Turin Medical School Caluire, France "Umberto I" Hospital Turin, Italy PANICSGERGELY Department of Sports Orthopaedic Ross1 ROBERTO Medicine and Rehabilitation Orthopaedics and Traumatology Faculty of Physical Education and University of Turin Sports Science Medical School Semmelweis University "Umberto I" Hospital Budapest, Hungary Turin, Italy XVIII Conttibutors

SAILLANTG~RARD TROTTAGIUSEPPE Orthopaedic Surgery Service Centre Livet Piti6 Salp&tri&reHospital Service Professeur Paris, France Philippe Neyret Caluire, France SANTAITIDANIELE ISpeO VAN DIJKC. NIEK Istituto Specialistico Ortopedico Department of Orthopaedic Surgery Casa di Cura "San Giuseppe" Academic Medical Centre Rome, Italy University of Amsterdam Amsterdam, The Netherlands SCHIAVONEPANNI ALFREDO ISpeO VENTURAALBERTO Istituto Specialistico Ortopedico 1st Division, Traumatology Casa di Cura "San Giuseppe" Sport Centre Rome, Italy Orthopaedic Institute Gaetano Pini Milan, Italy SERVIENELVIRE Centre Livet VERCILLOFABIO Service Professeur University of Perugia Philippe Neyret Orthopaedics and Traumatology Caluire, France Department R. Silvestrini Hospital STEFFENKATHRIN Perugia, Italy Oslo Sports Trauma Research Center VOLPIPIERO Norwegian School of Center for Sports Rehabilitation Sport Sciences Galeazzi Orthopaedics Institute Oslo, Norway Milan, Italy

TARTARONEMARIO WERNERSUZANNE ISpeO Section of Sports Medicine Istituto Specialistico Ortopedico Division of Molecular Casa di Cura "San Giuseppe" Medicine and Surgery Rome, Italy Karolinska Institutet Stockholm, Sweden TORNESEDAVIDE Center for Sports Rehabilitation ZAFFAGNINISTEFANO Galeazzi Orthopaedics Institute Rizzoli Orthopaedic Institute Milan, Italy Sports Traumatology and Conttibutoa XIX

Orthopaedics Division ZELLEBORIS A. Biomechanics Laboratory University of Pittsburgh Bologna, Italy School of Medicine Department of Orthopaedic Surgery ZAMARRAGIOVANNI Pittsburgh, USA University of Perugia Orthopaedics and Traumatology ZENGERINKMAARTJE Department of Perugia Department of Orthopaedic Surgery R. Silvestrini Hospital Academic Medical Centre Perugia, Italy University of Amsterdam Amsterdam ZANONGIACOMO The Netherlands Clinica Ortopedica e Traumatologia dell'Universit8 degli Studi di Pavia ZINIRAUL Centro Studi e Ricerche in Medicina e U.O. Ortopedia Traumatologia dello Sport Azienda Ospedaliera Policlinico San Matteo San Salvatore Pavia, Italy Pesaro, Italy