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Osteochondral lesions
Franck ACCADBLED
Friday, Sept. 22, 2017 · 8:11 a.m. · 23m 05s
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00:00:01
thank you good morning to all like first to uh and knowledge all the all the noises here and uh
00:00:08
congratulate them for this initiative i think it's a very great job and of course a
00:00:14
thank you to uh stefano and and always of course for having me today
00:00:18
gonna talk about also collisions uh so this talk would be the only
00:00:21
divided into parts first i'm gonna talk about the chronic injuries um
00:00:26
all the use as we like to say and uh the most typical one is also can right is this thickens
00:00:32
and then i will uh later talk about the acute injuries uh and also called fractures
00:00:38
so the definition is it a particle to ration of succumb rubble which can lead to instability and
00:00:43
separation of a bone fragment and i just sent article cartilage and then later also arthritis
00:00:50
um in terms of the terminology and we can find in the
00:00:55
um in the literature i mean textbooks the terms of
00:00:58
juvenile and adult form we should rather use now open files
00:01:01
is enclosed vices instead of distance which can be confusing
00:01:07
it became o. g. one uh uh on a thousand um
00:01:12
uh individuals mostly boast as you can say and it usually involves teens so
00:01:18
between ten and nineteen years old and this disease uh uh on
00:01:22
sets the ease in this a time frame us to come right is the second's thought that doesn't exist below the age of six
00:01:31
of course it involve mostly athletes at the new level but also and go
00:01:35
elbow or he joint for the description i'm gonna use the knee joint
00:01:41
um the middle combined is a predominantly affected then comes the lots
00:01:46
are compiled in the patel uh than the truck clear
00:01:49
but a few georgie and a more specifically is dodgy first is interesting studies
00:01:54
and describe a partial or complete classed as you can see here
00:01:59
separating the basil and fragments sites so there is a
00:02:03
pathology progression from the should control bone causes followed
00:02:07
by an equally phone absorption and then it is replaced
00:02:11
either by viable so control tragically all cartilage
00:02:15
so more or less just will behave like a fracture can heal or we can go to the non union
00:02:25
so the only a hypothesis which as a strong uh um
00:02:30
uh evidence based a demonstration is
00:02:34
an impeachment much alike uh the hip uh impeachment which we're gonna talk later on
00:02:41
uh with the next speaker it's engagement on the unfair to those fine
00:02:46
so different paper uh i'm all in favour of of these hypotheses
00:02:51
there is an increase poster we often media t. v. l.
00:02:53
slow in o. c. d. patients there is also a narrow uh in talk on the lawn arch and there's also larger
00:03:00
uh untouchables mine as we demonstrated at two years ago in in the paper in cases t. a.
00:03:07
interesting enough uh the team from boston also a a published about the
00:03:12
uh the mechanic all uh factors for these o. c. d. and
00:03:18
as you know uh the baseball is very popular in the us
00:03:22
and they relies that that uh the catches as represented here
00:03:26
have predominantly a a pasta relocation of a a c. d. of the middle combine
00:03:33
there is also a more peaceful implantation of the poster rocker sheet ligament
00:03:37
which is also in the same direction of uh an impeachment
00:03:42
and for those it is located in the last war combine such as
00:03:45
represented here they are strongly associated with this going is gets
00:03:51
although i quit is is well never confirmed
00:03:56
what is a clinical presentation three different modes it can be incidental which is the reason why this is very important
00:04:03
to um give a full comprehensive clinical examination uh
00:04:07
to danny because it can be related tools
00:04:10
which laptop for example and that this can be misdiagnosed as the o. c. d.
00:04:16
second incidental but most uh most often uh the presentation isn't many mechanical pain
00:04:21
especially for those athletes uh involved in in fact uh sports
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this can be also in near constant pain with nice willing and looking sensation and this is usually
00:04:32
uh associated with uh in stable form of o. c. d. we're gonna talk about later on
00:04:38
pay attention to the mechanic a lexus or c. d. of the media can lies usually uh when the the um
00:04:44
the linux isn't virus as opposed to do artwork online which is a associated with about this uh access
00:04:52
i get this is called the subjective like t. v. c. is interesting the least
00:04:56
affected university than any all the new condition so the symptoms i usually mild
00:05:03
it is a good examination there's nothing really specific of what should be alive too but
00:05:09
they become the loss of face at various faction degrees and these uh it
00:05:14
this way you can find a tenderness uh at the o. c. d.'s bought the wilson test is a classic
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so you bring penny at turn ninety degrees flexion um you
00:05:26
turn the foot internally and then you extend any and
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does usually triggered the pain the pain which is recognised by the patients is exactly the painting complains about
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and then you do exactly the same another by applying
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external rotation instead of internal and the pain disappears
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if so this is a positive recent past and this is clearly in favour of on a c. d. of the medial combine
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imaging of course right graph or stuff with the right graph we
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get pressure we uh we get some referrals from a patient
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come straight to us with an enter i i'm all right graph always start with
00:06:03
the red a graph to simple nomads radiation eighty and not at all
00:06:08
i like to do with bilateral uh it straight because uh remember that fifteen percent
00:06:13
i've got a bilateral involvement and right again i should not be sit systematic
00:06:21
not every patient been issued from an initial in the right indication is a lot solution
00:06:28
ration with schools freezes and they go about the age of eleven a boy above the age of
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thirteen and of course in case of persisting symptoms after conservative treatment of three to six months
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typical image yeah t. one with a low signal
00:06:48
here is that you told you wanted to you can see the the ipod signalling to to fight set with
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the yeah the bone uh the bone a daemon you can see here but the cottage is not interrupted
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in this case here governor view i hear the cutting edge the cutting edge is interrupted you can see
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this with yeah going into the legion so this is an unstable full you gonna talk about later
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differential this is not a c. d. you can tell that from the the thickness here all the cottage
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uh which is it if it's all got to which is not only articulate calculate you can you
00:07:26
can tell that is a very young individual actually this was a six year old boy
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this image yeah can be misdiagnosed as o. c. d. it's not this is
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just a variant of normal of the your regular suffocation of the conduct
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instability uh out his rather clear now uh at least in other teen videos
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they are very clear criteria for instability according to the and the right
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the court standoff remains offers complete you can tell that the l. c. d. is and stable
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one inspection because the calculate is a a discontinued all the fragments
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is palatable when you push on it with the pro
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so this is the ghost and all but in the youngest individuals with open she sees it
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appears to be very sensitive but the specificity is very cool so there was a problem
00:08:18
in fact uh different papers coming uh in a few years later uh brought
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some secondary creature yeah which are the high signal in to to uh
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creates a surrounding ream which has to be the same signal as the signal goes you know go through it
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so running this there is a second dream of rules signal activity but intensity sorry represented here
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don't multiple breaks in the state control bone and they also
00:08:48
round insist which could be which can be multiple all
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larger some five really matter when you use lucia gonna retire yes
00:08:57
the specificity it back is back to one hundred percent
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so this finding that uh at enter like retire for instability
00:09:09
as a very pulls a specificity in in the youngest individual was buzzing me
00:09:14
so in fact i think my hypothesis behind this is rather clear in fact the and the right
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shows the only of the instability in this case for example is it was rather criteria there is uh is
00:09:27
there is uh to to uh intense signal here but on apple's copy there is just to show though
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as you can see here with the arrows and there was no uh there was no movement of the fragments so
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according to the goats then down which is a office copy this was not an unstable fragment but in fact
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as you can see on the on the very young the child the it's right the thickness
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of the article or story of your t. v.'s or cottage is a very important so
00:09:58
it takes time true actually see on up with could be that the fragment as mobility
00:10:05
so i think this is the reason why i am right was a considered as non specific
00:10:13
what is the natural history it can heal uh fortunately but to confound meeting it has to
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be can you call and also read what you call it can also progress sadly
00:10:25
then it gives trenchant a mechanical pain sometimes yes later it can
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be a kiss on for years and this is very important
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and again the turning point even stability when i was he becomes unstable is
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never gonna he'll spontaneously than the fragment is released an yes after
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the patient will have osteoarthritis to the need as represented here with lose fragment yet
00:10:49
kinda separate you could talk about and you can see that you're still fight the station was eighteen at the time
00:10:57
almost this fact all the good fact also open files is of course and also
00:11:01
the age below twelve the bad problems is fractal lots of face and ceased
00:11:07
and multiple and a a larger than one point three meters on or why the americans they
00:11:12
try to uh establish normal grams two of the predictive a school for spontaneous eating
00:11:20
treatment fast it is conservative of course if or c. d. is an incidental finding no
00:11:26
treatment just observe until rather graphic eating in case of symptoms an open vices
00:11:35
i usually restrict activities especially when i features involving
00:11:39
by voting and repeat it back sports
00:11:43
i'm a musician has never been proved to be beneficial so low cost has been no grace
00:11:49
this provides nearly a a hundred percent of using without socially in these age range
00:11:57
in case of a persistent pain after six months then this is an indication for parity of treatment
00:12:04
so actually you should always start with offers could be even thought you've you need to do a a formal off
00:12:10
after to me later on it does to start with and of course copy to evaluate uh the lesion
00:12:17
so there is a pretty good classification from the rock through the group in the us
00:12:22
from cue ball to shot was we as we discussed before wrinkle in the rack looked goal which
00:12:28
is clearly an unstable asian drop door and then across down the fragment has been released
00:12:33
and this should be combine because i modified the specification with about patient as you
00:12:38
can see here there is an overlap of stable and unstable asian for example
00:12:42
the shadow can be associated with a bottle double fragment or
00:12:46
not so important to combine inspection and also probing
00:12:52
perforation is indicated in in case of a stable c. d. resisting to conservative treatment
00:12:58
so basically we create shah nails through the bone to promote request relation
00:13:04
technically it can be read twelve to could last that such as represented here all present
00:13:08
to cool concert ticket off is much simpler and and clearly clearly as my preference
00:13:15
it doesn't need a image intensify as you get you have direct control of the situation uh
00:13:21
the only problem is that should go with the wire through a completely normal cottage
00:13:28
but in my experience and also according to the literature just provide
00:13:32
very good results and no damage to the optical surveys
00:13:37
fixation is indicated in case the fragment is unstable
00:13:42
you can use metallic implants such as represented here you can use up little bubble implants
00:13:48
you can also use biological fixation using outlook useless to convert plugs such as
00:13:54
in the old almost like plastic technique and this is clearly my preference
00:13:58
here is a uh an intro purity view of such
00:14:01
a technique combining perforation is an a biological fixation
00:14:06
you can also use hybrid fixation combining biological and one of those techniques such as
00:14:13
described by the uh the team from there so yeah in a in in paris
00:14:17
here is a uh um a follow up and the right
00:14:20
six month showing uh the gradual integration of the product
00:14:28
so fixation is indicated in case of instability but in case there is an inch calculation is flat
00:14:35
way if a second route bone loss because remember this disease affect both the bone and cartilage
00:14:42
and there is a crap that then you need to combine uh uh we the consumers bone graft
00:14:48
in such a situation you just need to extend the instrumental pop star
00:14:52
down and you can uh a harvest some uh consumes bone from the proximity yeah
00:14:57
and uh a graft uh the the defect and is also provide good results
00:15:07
on all the off a situation in case of a ross
00:15:10
of substance all and then sort of archibald fragments
00:15:14
first again using the office copy the m. right you need to
00:15:18
evaluate the location surveys and also the depth of the lesion
00:15:25
and write an awful i would fall asleep isn't it yeah offers complete it's very important
00:15:30
to use the probe which we know is three minute along and you can
00:15:35
shift progressively the problem and you can then evaluate the surface of the lesion because then
00:15:42
the treatment and the technique you're gonna use depends on these uh primary evaluation
00:15:49
simple lose but you remove all it's too long term also authorities to the it's very simple and wanted me to
00:15:56
therefore you need to favour of cartilage and bone reconstruction the
00:16:01
indication were clearly described by uh the french uh
00:16:05
uh offers to pull a society you know twenty eleven many techniques available are
00:16:11
we don't need a describe most like plastic which is my preference
00:16:15
for these which is rather simple it's just the ones that treatment
00:16:20
and you can uh address quite a large range of the fact that two to three to four square centimetre
00:16:27
you can almost cylindrical plugs from the peripheral program
00:16:32
this can be don't oppose completely and if you're not comfortable with of course could be we don't offer to me
00:16:37
the limits of course is the mobility of the donor sites will not too many plugs
00:16:43
and also the concrete you of the plug into the joint which is a bit tricky to uh adjust and to accommodate
00:16:52
make out is a salvage prosody on not gonna talk wrong on this
00:16:57
autographed of course you don't have the the the little site uh mobility
00:17:01
micro factoring is very popular because it's very simple the problem with this is simple yes
00:17:08
it provides various not satisfactory shortened outcome but soon it deteriorates for this reason
00:17:13
uh uh i i yeah i'm use this technique only for the nonwhite
00:17:17
bearings on a source to see the the battle for more joint
00:17:23
i mean it is a is a variant on micro factoring using a membrane on top of it
00:17:28
provide very good results as well control side could show of course this is very interesting the
00:17:34
long term result this paper was really this year in uh americans on all sorts mission
00:17:40
it speaks for itself about two hundred and a twenty one patient operating
00:17:45
all them what operating most of them with fragment removal simple remover
00:17:51
uh that's seventy eight plus uh of them with the formation of fixation
00:17:55
and very few of them were construction you can see here
00:17:59
little body remove or seventy percent or stop watches after thirty years
00:18:05
the formation of fixation minus twenty five percent it goes down to forty five percent
00:18:12
this is the office but after press to write simple lose but you remove or fifty five
00:18:18
percent of me put all of course after pressed the off of thought yes the formation
00:18:24
forty percent of this only fifteen percent of course for construction the the the the series
00:18:30
was too short to over a conclusion so this is my proposed algorithm for treatment
00:18:38
a symptomatic so incidental finding just observe symptomatic in
00:18:42
the young individual sports restriction for three months
00:18:46
if pain persists then this is an indication for i'm right i also get on them right in
00:18:52
the older individual voice uh about the age of fifteen goals below the age of eleven
00:18:59
she doesn't heal uh sorry if if the famine is stable spots restriction for another three months it doesn't heal
00:19:06
then i would do the formations for unstable fragments remember this is the twenty point
00:19:12
office copy and then you need to accommodate the the technique to the uh opposed
00:19:17
to get findings uh during the abolition a few words about the fractures
00:19:22
and then you have or they are usually associated with a bottle from all this
00:19:27
location or the first episode when there is a a dramatic a situation
00:19:32
it's it's represents fifty percent of the cases of a part of the modifications is a very
00:19:38
high rate for this reason we recommend to use either on an arrival cities can
00:19:43
uh within three weeks after the trauma remember that the volume is underestimated by a c. t.
00:19:49
m. right above because the uh cartilage news components is very high in the an individual
00:19:54
they killing potential is very high even when there is little all nobody
00:19:59
component at all uh as it was demonstrated in this paper
00:20:03
here is an example dissipation other trauma ten months before
00:20:07
playing rugby was still complaining of until only pain
00:20:11
m. irvine demonstrated a lose body in the poster of compartment and
00:20:15
a defect on the and a lot of on a combine
00:20:19
here on the actual to in fact it was an undiagnosed traumatic but they're not this location so that's i was focused on the
00:20:25
rugby game does not even real life that's the other part are dislocation so this is the office computer showing the defect
00:20:32
the fragment was actually reach read uh using a portable media access only portal
00:20:37
was much bigger than initially because the cottages i drove you take
00:20:41
the frogman was reshaped the defect was uh a fresh and
00:20:45
and you was reposition fix with two wires and then
00:20:48
a candidate it screws and this is the second look aspect than ten month after four screws remove all
00:20:55
me and tell instability function tell that told you about this uh this is a
00:20:59
typical example of a fourteen all the uh go on an athlete playing volleyball
00:21:04
she uh sustain an a. c. l. injury it conservative treatment and two
00:21:09
months after that she felt well she went back to volleyball game
00:21:13
sure the uh just uh another trauma what factor was not
00:21:16
a troll my was an instability accident giving way
00:21:19
but then she enjoyed both uh middle a mini skirts and
00:21:24
a cottage we can see here that there is a share a injury of of the media going down
00:21:31
so this is the office group view you can see this is quite terrible uh the crap that
00:21:37
you have of the the cartilage unused effect and to lose body a floating around in
00:21:42
so she was treated with base your reconstruction menace 'cause repair and uh uh
00:21:47
two plugs uh of old with a good outcome of that much
00:21:52
more difficult uh surgery so yes i will join a front yeah is there are no in delay of
00:21:58
treatment yes there is considering the competition is just time
00:22:02
is uh uh but prognosis after three months
00:22:06
take a message considering wasn't it is like automatic remember
00:22:11
a a bear in mind the signs of instability
00:22:14
for both patient with open files is sport restriction provide a very good outcome
00:22:20
if not operation is indicated don't forget to observe them until it's healed on the x. ray
00:22:28
for acute was talking or injury is fifty percent of too much about the
00:22:31
law dislocation is such associated with cottage in is a fractures so
00:22:36
this patient benefit from an right within three weeks after the injury
00:22:40
always consider fixation because presentation of the great ailing potential
00:22:45
oh this is a very a comprehensive and this is my favourite technique
00:22:50
and again i will emphasise uh what uh the previous because said ace
Conference Program
Opening address
Boris GOJANOVIC
Sept. 21, 2017 · 1:22 p.m.
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Biological Maturation and the Path to Success: Before and After the Fact
Manuel COELHO-E-SILVA, Biological Maturation and the Path to Success: Before and After the Fact
Sept. 21, 2017 · 1:31 p.m.
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Designing pathways to success – part kaleidoscope, part microscope
Jason GULBIN, Designing pathways to success – part kaleidoscope, part microscope
Sept. 21, 2017 · 1:53 p.m.
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Talent ID and Development: Why doing the “right thing” is not always the “best thing
Ross TUCKER , Talent ID and Development: Why doing the “right thing” is not always the “best thing
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BIOLOGICAL DEVELOPMENT AND PATHWAYS TO SUCCESS - Q&A
Panel
Sept. 21, 2017 · 2:41 p.m.
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Resistance training during long-term athlete development
Urs GRANACHER
Sept. 21, 2017 · 2:52 p.m.
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The development of aerobic power in young athletes
Grégoire MILLET
Sept. 21, 2017 · 3:15 p.m.
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Fueling the young athlete
Asker JEUKENDRUP
Sept. 21, 2017 · 3:36 p.m.
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Training young athletes: challenges and opportunities
Marco CARDINALE
Sept. 21, 2017 · 4:01 p.m.
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TRAINING THE YOUNG ATHLETE - Q&A
Panel
Sept. 21, 2017 · 4:33 p.m.
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Coaching from junior to the top of the world (Lara Gut)
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Sept. 21, 2017 · 5:20 p.m.
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Keep your athletes close and their parents closer: Working effectively with parents
Olivier SCHMID
Sept. 21, 2017 · 5:52 p.m.
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Combine sport and studies, are the schools doing enough ?
Florian ETTER
Sept. 21, 2017 · 6:11 p.m.
219 views
COACHING, PARENTING AND DEVELOPMENT - Q&A
Panel
Sept. 21, 2017 · 6:28 p.m.
DÉBAT PUBLIC (IN FRENCH) : Children and competitive sport, for the best or the worst ?
Panel
Sept. 21, 2017 · 8:07 p.m.
238 views
Knee ligament injuries in immature athletes
Franck CHOTEL
Sept. 22, 2017 · 7:48 a.m.
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Osteochondral lesions
Franck ACCADBLED
Sept. 22, 2017 · 8:11 a.m.
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The influence of athletic activities during growth on hip development
Rintje AGRICOLA
Sept. 22, 2017 · 8:35 a.m.
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INJURIES WITH THE ORTHOPEDISTS - Q&A
Panel
Sept. 22, 2017 · 8:54 a.m.
Back pain in young athletes
Liba SHEERAN
Sept. 22, 2017 · 9:34 a.m.
215 views
Injuries and illnesses amongst young elite athletes – so healthy it hurts?
Christine HOLM MOSEID
Sept. 22, 2017 · 9:57 a.m.
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Long term sequelae of youth overuse injuries
Mark BATT
Sept. 22, 2017 · 10:19 a.m.
OVERUSE INJURIES - Q&A
Panel
Sept. 22, 2017 · 10:40 a.m.
Concussions in young athletes : myths and reality
Christopher NEWMAN
Sept. 22, 2017 · 10:52 a.m.
Screening for heart disease in sports – nonsense or necessary?
Matthias WILHELM
Sept. 22, 2017 · 11:16 a.m.
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Energy deficiency in young athletes – prevalence, consequences and screening
Anna MELIN
Sept. 22, 2017 · 11:39 a.m.
723 views
Competitive Sport & Health: hidden issues
Gordon MATHESON
Sept. 22, 2017 · 12:04 p.m.
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THE COMPLEX MEDICAL PROBLEMS - Q&A
Sept. 22, 2017 · 12:33 p.m.
Injury prevention in youth : What is learned in the cradle is carried in the tomb ?
Evert VERHAGEN
Sept. 22, 2017 · 1:46 p.m.
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Injury prevention programs : The 11+ Kids Project
Mario BIZZINI
Sept. 22, 2017 · 2:12 p.m.
185 views
Sports specialized training: what are the true effects and is it really all bad ?
Neeru JAYANTHI
Sept. 22, 2017 · 2:29 p.m.
141 views
What is “load” and how does it impact athletes’s risk of injury ?
Torbjorn SOLIGARD
Sept. 22, 2017 · 2:49 p.m.
344 views
Instituting a unique public health approach to ACL injury risk management
Joseph Janoski
Sept. 22, 2017 · 3:47 p.m.
Instituting a unique public health approach to ACL injury risk management - Q&A
Joseph Janoski
Sept. 22, 2017 · 3:54 p.m.
Parents’ Knowledge of Sport Psychology and Nutrition
Dr Camilla J. Knight
Sept. 22, 2017 · 3:57 p.m.
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Injuries and injury risk factors in youth alpine ski racing: A two-season prospective study
Lisa, Müller
Sept. 22, 2017 · 4:09 p.m.
FREE COMMUNICATION AND BEST ABSTRACT PRESENTATION - Q&A
Panel
Sept. 22, 2017 · 4:21 p.m.
610 views
Closing Address
Frederic Koehn, President Young Athletes Forum Foundation
Sept. 22, 2017 · 6:04 p.m.
140 views