2025 CASEM Podium Presentation Abstracts

Transitioning Out of Elite Sport: The Experience of Integrated Support Team Members P. Mazur, MSc,* J. Lopez Lamas, MA,* M. Wesner, MD,† McLaughlin, MEd,‡, T. Schubert, MCoach,* and A. Mosewich, PhD* Affiliations: *Faculty of Kinesiology, Sport, and Recreation, University of Alberta; †Glen Sather Sport Medicine Clinic, University of Alberta; and ‡Faculty of Education, University of Alberta. Objective: Integrated Support Teams (IST) are composed of multidisciplinary professionals dedicated to enhancing the performance of elite sport teams, and commonly include psychologists, athletic trainers, strength and conditioning coaches, physiotherapists, and physicians. IST membership is often perceived as the pinnacle of one's career, yet the opportunity also comes with substantial demands, drawbacks, and career-defining decisions. Therefore, understanding IST members' experiences is warranted, especially the culmination of their careers in elite sport. This study explored transitions out of an IST with an emphasis on barriers and facilitators to a successful transition. Study Design: The study was guided by an interpretive description (ID) framework. Participants completed one-on-one semi-structured interviews, and data were analysed following the 6 recursive phases for ID as outlined by Thorne (2016). Subjects: Six former IST members (4 physicians, 2 physiotherapists; 4 women, 2 men) who supported international-level teams and transitioned within the past 5 years. Intervention: Semi-structured interviews. Results: Data analysis resulted in 4 pre-transition themes (managing time demands, feeling undervalued/underappreciated, navigating evolving role expectations, preparing a transition plan), 4 during-transition themes (service continuity, variation in communication, lack of support, seeking mentorship), and 3 post-transition themes (managing identity, reconciling a hope to remain in sport, coping with post-transition emotions) and illustrated barriers and facilitators to successful transition. Key barriers included poor organizational oversight of ISTs, role instability, and members' ego-involvement, while key facilitators were social support, involvement in the transition, and continuation of meaningful work. Overall, the lack of organizational responsibility resulted in inconsistent processes and inadequate support for IST members transitioning from elite sport. Conclusions: Clarifying organizational responsibility, formalizing transition processes, providing support resources, and implementing mentoring schemes appear crucial in supporting IST transitions and service provision. An Evaluation of Self-Identified Amenorrhea, Oral Contraceptive Use and Sport-Related Injury in Female Varsity Endurance Athletes Annie Boyd, MSc Jenna Schulz, MPT, PhD and Jane Thornton, MD, PhD Affiliation: University of Western Ontario, Fowler Kennedy Sport Medicine, London, ON, Canada. Objective: Menstrual irregularities have been associated with decreased bone mineral density, but their relationship with musculoskeletal injuries in female athletes is unknown. The objective of this study is to explore self-identified amenorrhea, oral contraceptive use and sport-related injury in female varsity athletes. Study Design: Retrospective chart review. Subjects: Eighty female varsity athletes who completed a pre-participation evaluation (PPE) between June 1, 2016 and December 31, 2019 were identified. Eight athletes using intra-uterine devices (IUDs) were excluded, 72 athletes were included in final analysis, cross-country (n = 25) and rowing (n = 47). 35% (n = 25) of athletes reported using an oral contraceptive pill (OCP). Mean age at PPE completion was 19 ± 2 years. Observation Technique: Independent variables were self-identified amenorrhea (90 days or more without a menstrual period) in the past year and use of OCPs at the time of PPE completion. Outcome Measures: The primary outcome was the number of musculoskeletal sport-related injuries per varsity season. Results: Sixty-one injuries were reported among the 72 athletes, 48 (79%) in rowing and 13 (21%) in cross-country. The median injuries per season (interquartile range) was 0.5 (0.1). The median number of menstrual periods per year was 12 (10.75, 12) among athletes. The median menstrual cycle length was 28 (5, 30) days, and median number of days without a menstrual period in the past year among athletes was 34 (28, 51). The median number of sport-related injuries per season among athletes who self-reported amenorrhea was 0.5 (0.1) versus those who did not was 0.42 (0.1). Similarly, the median number of sport-related injuries per season in athletes who used OCPs was 0.5 (0.1) versus those who did not was 0.33 (0.1). Conclusions: There are a low number of sport-related injuries per season among endurance varsity female athletes regardless of self-identified amenorrhea and OCP use. Future research is needed to longitudinally evaluate sport-related injuries in a larger sample of athletes. Using Metabolic Biomarkers of Cartilage Degeneration for Diagnosing Osteoarthritis Earlier Than X-Ray Changes M.B.Y. Chohan, D. Bardana, S. Blennerhasset, A.A. Syed, and M. Blennerhasset Affiliation: Sports and Exercise Medicine, University of Ottawa. Objective: By the time Osteoarthritis (OA) is detected via radiology, irreversible cartilage damage has often occurred. This study hypothesizes that metabolic biomarkers, in conjunction with structural biomarkers, can identify the onset of OA inflammation, enabling earlier diagnosis and preventative treatment before X-ray-visible changes occur. Study Design: Cross sectional design with in-vitro/in-vivo approaches: In vitro: ATDC5 mouse chondrocytes and bovine chondrocytes were exposed to oxidative stress and pro-inflammatory cytokines (IL-1β and TNFα) under normoxic and hypoxic conditions. Biomarker expression including Enolase-1, HIF-1, COMP, Paraoxonase and Lamin were evaluated using qPCR. In vivo: Synovial fluid from 20 patients undergoing arthroscopy (minimal or no OA) or arthroplasty (advanced OA) was analyzed for metabolic and structural biomarkers using ELISA for Enolase-1, HIF-1, COMP and Paraoxonase. Correlations were drawn between biomarker levels and patient-reported outcomes (ICRS/IKDC scores). Subjects: Chondrocyte cultures were used for laboratory experiments. Synovial fluid was collected from 20 patients divided into minimal/absent and advanced OA groups based on clinical assessment. Outcome Measures: Primary outcomes included expression levels of metabolic and structural biomarkers, such as Enolase-1, HIF-1α, COMP, and Paraoxonase, in response to hypoxia and inflammation. Secondary measures included the correlation of these biomarkers with patient-reported outcomes and OA stage. Results: Under hypoxia, IL-1β and TNFα increased biomarker expression. Enolase-1 levels increased by 587% under IL-1β and by 266% under TNFα, indicating a metabolic shift. HIF-1α expression increased 70% under IL-1β. COMP levels, linked to cartilage degradation, and Paraoxonase, indicative of oxidative stress, were elevated under hypoxia. In in-vivo analysis, Enolase-1 levels were 810% higher in advanced OA compared to early OA, while Paraoxonase levels increased by 68%. HIF-1α showed moderate increases, with variability across samples. Biomarker levels correlated with patient outcomes, providing insight into OA progression. Conclusions: Enolase-1, Paraoxonase, COMP, and HIF-1α show potential for detecting OA earlier than X-ray-visible changes. The above study was a pilot project, and we are awaiting funding to strengthen the statistical relationships between biomarkers and patient outcomes to establish thresholds for interventions. Acknowledgments: M. Harrison, A. Campbell, L. Bradley. E-Consults to Sports and Exercise Medicine Specialists Improve Access and Modify Primary Care Provider Management and Referral Behaviour Setti Belhouari, MD,* David White, MSc, MD,† Clare Liddy, MSc, MD,* Erin Keely, MD,‡ and Erin Stone, MD* Affiliations: *Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; †Division of Sports and Exercise Medicine, University of Ottawa, Ottawa, ON, Canada; and ‡Department of Medicine, University of Ottawa, Ottawa, ON, Canada. Objective: To describe the impact of an electronic consult (eConsult) service on access to sports and exercise medicine specialists and the impact on primary care providers' (PCP) referral behaviour. Study Design: A cross-sectional study of eConsults submitted by PCPs to sports and exercise medicine specialists between January 2021 and December 2023. Subjects: All eConsults to sports and exercise medicine concerning 143 patients (56% female and 44% male). Intervention: Use of the Champlain BASE eConsult service by PCPs and a mandatory closeout survey completed by PCPs. Outcome Measures: We report patient demographics, PCP rurality, referral behaviour of PCPs, eConsult response times, clinical topics, and overall satisfaction of primary care physicians with eConsult services. Results: Seniors aged 65 years and over were the subject of 23.8% of all eConsults. PCPs serving patients in rural locations made up 15.7% of all eConsults. The median time for a PCP to receive a reply to an eConsult was 5 days. Approximately 52.4% of eConsults pertained to treatment recommendations. Leg, foot, and knee symptoms or complaints were most often discussed, representing 19.6%, 19.6%, and 17.5% of eConsults, respectively. PCPs received new or additional courses of action in 68.5% of submitted cases. Approximately 32.7% of in-person referrals contemplated by PCPs were deemed unnecessary and thus avoided. Approximately 93.7% of eConsults were rated highly useful by PCPs. Conclusions: The eConsult service provides PCPs with prompt and highly rated access to sports and exercise medicine specialists, which results in timely management of patient cases while reducing unnecessary in-person referrals. Analyzing the Risk of Avascular Necrosis Post Hip Intra-Articular Steroid Injection; A Systemic Review of the Literature Jesse Irvine, MD Affiliation: Division of Family Practice; Department of Sports Medicine, University of Alberta. Objective: This systematic review looked at the risks of AVN post intra-articular steroid injections into the hip. The quality of evidence was evaluated and used to make treatment recommendations. Data Sources: Information was gathered via 3 databases (Medline, Embase and sportsdiscus); looking for the risks of AVN post intra-articular hip injection of steroid. Special consideration was used for the osteoarthritis population. A sole reviewer conducted searches of titles, abstracts and articles in the aforementioned databases. Inclusion and exclusion criteria were applied, and information was complied. Main Results: Through 3 database searches, 26 articles were identified post duplicate removal and abstract review. The vast majority had AVN as their primary outcome, measured via either XR or MRI. Compiling of the literature revealed mixed results, with both case studies and reviews studies presenting both an association of steroid injection with AVN and others rejecting it. Deeper review of this nuanced literature pointed away from this association, but literature on both sides of the argument were of lower power, retrospective and failed to control for confounding variables. The mean study quality can be considered fair. The overall quality of the literature used in this review would be consider low in relation to GRADE guidelines. Conclusions: The following review demonstrates the limitations of the current state of literature regarding hip AVN post intra-articular cortisone injection(s). Given the limited evidence of its association and the large potential benefits of the injection, shared decision making is recommended for next steps. Caution should be taken on both sides and definitive recommendations are limited. Clinical and Radiographic Characteristics of Patients With Knee Osteoarthritis With and Without a Previous Knee Injury: A Cross-Sectional Study Richard E. Magony, MSc, Jeffrey S. Brooks, PhD, Derek Pamukoff, PhD, and Jane Thornton, MD, PhD Affiliation: Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada. Objective: To compare clinical and radiographic characteristics and physical activity levels of patients with mild to moderate knee osteoarthritis (OA) with and without previous knee injuries associated with post-traumatic osteoarthritis (PTOA) presenting to a sport medicine clinic. Study Design: Cross-sectional study. Subjects: A total of 262 patients (147 females) over 40 years of age who were diagnosed with mild-to-moderate knee OA using clinical and radiographic criteria. Comparison: Patients were categorized into 2 groups: 1) previous knee injury associated with PTOA (PTOA), or 2) no previous knee injury associated with PTOA (NTOA). Main Outcome Measures: Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales (primary), Kellgren-Lawrence (KL) radiographic OA scores, functional tests (40-metre fast-paced walk, 30-second chair stand), physical activity levels (daily steps), general patient characteristics including comorbidities and anthropometrics, Intermittent and Constant Osteoarthritis Pain (ICOAP) questionnaire, Arthritis Self-efficacy (ASE) questionnaire, Patient Global Assessment of Health Status (PGAHS), and Center for the Epidemiological Studies—Depression Scale (CESD-R). Results: While the PTOA group (n = 67) was 4.1 years younger on average than the NTOA group (n = 195, P < 0.001), there were no differences in sex distribution, body mass index, comorbidities, or KL radiographic OA scores. The PTOA group had higher scores on the KOOS Pain (63.6 ± 15.3 vs 58.3 ± 18.0, P < 0.05) and Activities of Daily Living subscales (73.6 ± 15.3 vs 65.7 ± 20.1, P < 0.01), PGAHS (62.5 ± 20.5 vs 53.5 ± 22.7, P < 0.001), and ASE (62.5 ± 21.8 vs 54.2 ± 21.1, P < 0.01) and lower scores on the ICOAP (32.8 ± 23.8 vs 40.3 ± 26.7, P < 0.005) and CESD-R questionnaires (17.4 ± 6.6 vs 19.3 ± 18.0, P < 0.05). They also had superior physical function with higher daily steps (5944 ± 443 vs 4312 ± 265, P < 0.01), faster 40-metre fast-paced walk speeds (23.6 ± 4.3 vs 27.2 ± 6.5, P < 0.001) and more 30-second chair-stand repetitions (14.4 ± 5.6 vs 12.1 ± 5.6, P < 0.05). Conclusions: This was the first study to compare clinical and radiographic characteristics between knee OA patients with and without a previous PTOA-associated knee injury. Despite having similar radiographic scores, patients with PTOA-associated injuries demonstrated better physical and psychological Therefore, NTOA patients to and physical activity levels, than PTOA This study also a between clinical and research is Risk and With a among Elite P. MD, David and MD, Affiliations: *Department of Clinical of Medicine, University of Canada; Canada; Sport Canada; London, ON, Canada; of Kinesiology, Sport Medicine University of Canada; Canada; for Canada; Canada; and Sport Canada; and ON, Canada. Objective: To the of and its between associated with a Study Design: study Subjects: elite and age and athletes to and control groups respectively. Intervention: The completed a their while their The and performance psychological and performance and Outcome Measures: and the season was for was used to for differences between and for vs and was used to compare the average time to between the and and to identify potential Results: athletes were diagnosed with a 1, in the were to be at lower of compared to those in = P = Previous of was a of increased = time in was not between days, athletes days, and higher of days, were of time < 0.05). Conclusions: for and results of this study completion of a the of by for elite compared with those who did from did not between age and a higher time Acknowledgments: the athletes, study and into the Knee Injury A Knee Injury PhD PhD Jane and PhD* Affiliations: University, of University, of University, of and Objective: To describe and from first of the knee injury study. Study Design: study. Subjects: of age with an knee injury that to Observation Technique: questionnaires at and Outcome Measures: data knee physical activity quality of from to and current and knee on Scale = no data collected in this of decision to or Global physical activity quality of and knee Results: The first with data were ± years female and representing of the and The most reported injuries are (n = and (n = and (n = number of injury is 3 = and of had for their injury. The median Scale in the year before injury was levels of and knee are ± ± and ± respectively. Sixty-one of to be and a moderate the who the have completed their Conclusions: to and that treatment and outcomes, including This study can as a to evaluate care for knee injuries in an for an injury to be that both and which is a of knee injury that on The Use of in Medicine in the S. MD,* MD,† David MD,† T. Campbell, MSc,* and Affiliations: of Medicine and Department of Clinical University of of Medicine, Canada; of Family Medicine, University of of Medicine, Canada; University of Canada; and of and Pain Medicine, University of of Medicine, Canada. Objective: To describe the use of within sports Study Design: study using an Subjects: physicians for the who are in Observation Technique: Team physicians completed on the season. Outcome Measures: of the use of among physicians, including time of of and time Results: A total of 28 were were completed within of injury were completed more than 48 within 6 to and between and 48 The majority of the the were completed in the by the and the was used for lower injuries by and the lower the or the knee or and the injuries were injuries and was most often used to a diagnosis as a of the to patient understanding and to out a diagnosis were for the injury were and were of were for additional = to with = for Conclusions: In this group of sports medicine physicians, was used to a of injuries in athletes. was most and to the injury. Overall, clinical decision making and time to We would to the for their A in on and Previous MD, J. and PhD* Affiliations: Canada; and Injury of University of Canada. and Objective: The of on the and management of sport-related results in evolving clinical recommendations that a for The objective of this study was to evaluate the impact of a as a in of and successful completion of the A in was to support the of the recommendations from the on in June 2023. The included on the following to management of symptoms and for The was to for in the of completion and were the primary and was using a composed of that were also in the evaluation of of these be based on recommendations that the and recommendations that following the Results: the that the at and completed the Participants physiotherapists, care groups The average and scores from to on the 5 by compared to to for the recommendations that following the Conclusions: results that a is and has a impact on The results also that the most recommendations had a in scores than recommendations that were from the previous the use of a in as a for is of data is to new recommendations are in sports of MSc,* MSc,* MD,† David Affiliations: of Medicine, University of ON, Canada; Medicine and University, ON, Canada; of Department of Medicine, University of ON, Canada; for Health ON, Canada; Medicine and Medicine, University of Canada; of Medicine and Department of Medicine, University of ON, Canada; Western University Health Canada; ON, Canada; University Health ON, Canada; and and Health ON, Canada. Objective: is to care research is within This review to explore of in using a The to the of an Data Sources: databases (Medline, of were for studies on and in The completed in identified to studies from the past years be based on their with and on care in Using a review to the criteria and on The data analysis to on between 3 and to identify between Main Results: themes include the of shared and for teams to guided analysis revealed such as role and which impact of We also identified for to these as for into Conclusions: is by between study results evidence and for an care which and of a to as for in Patients or With Knee OA MD, MD, MD, J. MD, M. MD, and M. PhD Affiliation: University of Western Ontario, London, ON, Canada. Objective: To evaluate the is a for activity in patients with knee osteoarthritis (OA) and by between activity and self-reported Study Design: study. Subjects: with OA age ± and at age ± Technique: Participants their daily to activity for 4 and the for the Participants were to their not by their Outcome Measures: Participants reported their daily for 4 self-reported which were to metabolic of per The their the the patients completed a Scale to their activity over the past To the association between activity we and used for were as < < < < Results: the OA the association between and was = = the was = = The association between and was = = for the OA group and = = 0.01) for the Conclusions: The demonstrated with for both groups but was for OA to limited to their scores showed a association with better activity The be more for OA while measures better highly

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