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Review Article| Volume 34, ISSUE 1, P135-163, February 2023

Orthobiologic Treatment of Ligament Injuries

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      References

        • Hauser R.A.
        • Dolan E.E.
        • Phillips H.J.
        • et al.
        Ligament injury and healing: a review of current clinical diagnostics and therapeutics.
        Open Rehabil J. 2013; 6: 1-20
        • Kunze K.N.
        • Pakanati M.S.
        • Vadhera B.S.
        • et al.
        The efficacy of platelet rich plasma for ligament injuries, A systematic review of basic science literature with protocol quality assessment.
        Orthop J Sports Med. 2022; 10: 1-25
        • Mautner K.
        • Malanga G.A.
        • Smith J.
        • et al.
        A call for a standard classification system for future biologic research: the rationale for new PRP nomenclature.
        Pm r. 2015; 7: S53-S59
        • Murray I.R.
        • Geeslin A.G.
        • Goudie E.B.
        • et al.
        Minimum information for studies evaluating biologics in orthopaedics (MIBO).
        J Bone Joint Surg. 2017; 99: 809-819
        • West R.V.
        • Fu F.H.
        Soft -tissue physiology and repair.
        in: Vaccaro A.R. Orthopedic knowledge update 8. American Academy of Orthopedic Surgeons, Rosemont, IL2005: 15-27 (Chapter 2)
        • Anitua E.
        • Andia I.
        • Ardanzanz B.
        • et al.
        Autologous platelets as a source of proteins for healing and tissue regeneration.
        Thronb Heamost. 2004; 91: 4-15
        • Monaco J.L.
        • Lawrence W.T.
        Acute wound healing an overview.
        Clin Plast Surg. 2003; 30: 1-12
        • Broughton 2nd, G.
        • Janis J.E.
        • Attinger C.E.
        The basic science of wound healing.
        Plast Reconstr Surg. 2006; 117: 12S-34S
        • Singer A.J.
        • Clark R.A.
        Cutaneous wound healing.
        N Engl J Med. 1999; 341: 738746
      1. Parrish WR, Roides B. Physiology of blood components in wound healing: an appreciation of cellular co-operativity in platelet rich plasma action. J Exec Sports Orthop.4(2):1-14. DOI:10.15226/2374-6904/4/2/00156.

        • Enoch S.
        • Leaper D.J.
        Basic science of wound healing.
        Surgery (Oxford). 2008; 26: 31-37
        • Santos M.T.
        • Valles J.
        • Aznar J.
        • et al.
        Role of red blood cells in the early stages of platelet activation by collagen.
        Thromb Haemost. 1986; 56: 376381
        • Whelihan M.F.
        • Zachary V.
        • Orfeo T.
        • et al.
        Prothrombin activation in blood coagulation: the erythrocyte contribution to thrombin generation.
        Blood. 2012; 120: 3837-3845
        • Wolberg A.S.
        Thrombin generation and fibrin clot structure.
        Blood Rev. 2007; 21: 131-142
        • Dohan Ehrenfest D.M.
        • Bielecki T.
        • Mishra A.
        • et al.
        In search of a consensus terminology in the field of platelet concentrates for surgical use: platelet-rich plasma (PRP), platelet-rich fibrin (PRF), fibrin gel polymerization and leukocytes.
        Curr Pharm Biotechnol. 2012; 13: 1131-1137
        • de Witt S.M.
        • Verdoold R.
        • Cosemans J.M.
        • et al.
        Insights into platelet-based control of coagulation.
        Thromb Res. 2014; 133: S139-S148
        • Blair P.
        • Flaumenhaft R.
        Platelet alpha-granules: basic biology and clinical correlates.
        Blood Rev. 2009; 23: 177-189
        • Rendu F.
        • Brohard-Bohn B.
        The platelet release reaction: granules' constituents, secretion, and functions.
        Platelets. 2001; 12: 261-273
        • Golebiewska E.M.
        • Poole A.W.
        Platelet secretion: From haemostasis to wound healing and beyond.
        Blood Rev. 2015; 29: 153-162
        • Italiano Jr., J.E.
        • Battinelli E.M.
        Selective sorting of alpha-granule proteins.
        J Thromb Haemost. 2009; 7: 173-176
        • Zarbock A.
        • Polanowska-Grabowska R.K.
        • Ley K.
        Platelet-neutrophil-interactions: linking hemostasis and inflammation.
        Blood Rev. 2007; 21: 99-111
        • Cerletti C.
        • de G.G.
        • Lorenzet R.
        Platelet - leukocyte interactions: multiple links between inflammation, blood coagulation and vascular risk.
        Mediterr J Hematol Infect Dis. 2010; 2: e2010023
        • Weyrich A.S.
        • Zimmerman G.A.
        Platelets: signaling cells in the immune continuum.
        Trends Immunol. 2004; 25: 489-495
        • Nurden A.T.
        Platelets, inflammation, and tissue regeneration.
        Thromb Haemost. 2011; 105: S13-S33
        • Gear A.R.
        • Camerini D.
        Platelet chemokines and chemokine receptors: linking hemostasis, inflammation, and host defense.
        Microcirculation. 2003; 10: 335350
        • Demidova-Rice T.N.
        • Hamblin M.R.
        • Herman I.M.
        Acute and impaired wound healing: pathophysiology and current methods for drug delivery, part 1: normal and chronic wounds: biology, causes, and approaches to care.
        Adv Skin Wound Care. 2012; 25: 304-314
        • Strukova S.M.
        Thrombin as a regulator of inflammation and reparative processes in tissues.
        Biochemistry (Mosc). 2001; 66: 8-18
        • Suo Z.
        • Citron B.A.
        • Festoff B.W.
        Thrombin: a potential proinflammatory mediator in neurotrauma and neurodegenerative disorders.
        Curr Drug Targets Inflamm Allergy. 2004; 3: 105-114
        • Condliffe A.M.
        • Kitchen E.
        • Chilvers E.R.
        Neutrophil priming: pathophysiological consequences and underlying mechanisms.
        Clin Sci (Lond). 1998; 94: 461-471
        • Marcus A.J.
        Neutrophils inhibit platelet reactivity by multiple mechanisms: relevance to thromboregulation.
        J Lab Clin Med. 1990; 116: 138-139
        • Mocsai A.
        Diverse novel functions of neutrophils in immunity, inflammation, and beyond.
        J Exp Med. 2013; 210: 1283-1299
        • Bazzoni G.
        • Dejana E.
        • Del Maschio A.
        Platelet-neutrophil interactions. Possible relevance in the pathogenesis of thrombosis and inflammation.
        Haematologica. 1991; 76: 491-499
        • Hallett M.B.
        • Lloyds D.
        Neutrophil priming: the cellular signals that say 'amber' but not 'green.
        Immunol Today. 1995; 16: 264-268
        • Shen L.
        • Smith J.M.
        • Shen Z.
        • et al.
        Inhibition of human neutrophil degranulation by transforming growth factor-beta1.
        Clin Exp Immunol. 2007; 149: 155-161
        • Spisani S.
        • Giuliani A.L.
        • Cavalletti T.
        • et al.
        Modulation of neutrophil functions by activated platelet release factors.
        Inflammation. 1992; 16: 147-158
        • Del M.A.
        • Dejana E.
        • Bazzoni G.
        Bidirectional modulation of platelet and polymorphonuclear leukocyte activities.
        Ann Hematol. 1993; 67: 23-31
        • Della Corte A.
        • Maugeri N.
        • Pampuch A.
        • et al.
        Application of 2-dimensional difference gel electrophoresis (2D-DIGE) to the study of thrombin-activated human platelet secretome.
        Platelets. 2008; 19: 43-50
        • Rex S.
        • Beaulieu L.M.
        • Perlman D.H.
        • et al.
        Immune versus thrombotic stimulation of platelets differentially regulates signaling pathways, intracellular protein-protein interactions, and alpha-granule release.
        Thromb Haemost. 2009; 102: 97-110
        • Halpern B.C.
        • Chaudhury S.
        • Rodeo S.A.
        The role of platelet-rich plasma in inducing musculoskeletal tissue healing.
        HSS J. 2012; 8: 137-145
        • Schaffer C.J.
        • Nanney L.B.
        Cell biology of wound healing.
        Int Rev Cytol. 1996; 169: 151-181
        • Bielecki T.
        • Dohan Ehrenfest D.M.
        • Everts P.A.
        • et al.
        The role of leukocytes from L-PRP/L-PRF in wound healing and immune defense: new perspectives.
        Curr Pharm Biotechnol. 2012; 13: 1153-1162
        • Ekpenyong A.E.
        • Toepfner N.
        • Chilvers E.R.
        • et al.
        Mechanotransduction in neutrophil activation and deactivation.
        Biochim Biophys Acta. 2015; 1853: 3105-3116
        • Singh N.R.
        • Johnson A.
        • Peters A.M.
        • et al.
        Acute lung injury results from failure of neutrophil de-priming: a new hypothesis.
        Eur J Clin Invest. 2012; 42: 1342-1349
        • Aquino E.N.
        • Neves A.C.
        • Santos K.C.
        • et al.
        Proteomic Analysis of Neutrophil Priming by PAF.
        Protein Pept Lett. 2016; 23: 142-151
        • Mariani E.
        • Canella V.
        • Cattini L.
        • et al.
        Leukocyte-Rich Platelet-Rich Plasma Injections Do Not Up-Modulate Intra-Articular Pro-Inflammatory Cytokines in the Osteoarthritic Knee.
        PLoS One. 2016; 11: e0156137
        • Serhan C.N.
        • Savill J.
        Resolution of inflammation: the beginning programs the end.
        Nat Immunol. 2005; 6: 1191-1197
        • Serhan C.N.
        Novel omega -- 3-derived local mediators in anti-inflammation and resolution.
        Pharmacol Ther. 2005; 105: 7-21
        • Xing L.
        • Remick D.G.
        Neutrophils as firemen, production of anti-inflammatory mediators by neutrophils in a mixed cell environment.
        Cell Immunol. 2004; 231: 126-132
        • Sugimoto M.A.
        • Sousa L.P.
        • Pinho V.
        • et al.
        Resolution of Inflammation: What Controls Its Onset?.
        Front Immunol. 2016; 7: 160
        • Soehnlein O.
        • Lindbom L.
        Phagocyte partnership during the onset and resolution of inflammation.
        Nat Rev Immunol. 2010; 10: 427-439
        • Ortega-Gomez A.
        • Perretti M.
        • Soehnlein O.
        Resolution of inflammation: an integrated view.
        EMBO Mol Med. 2013; 5: 661-674
        • Gilroy D.
        • De Maeyer R.
        New insights into the resolution of inflammation.
        Semin Immunol. 2015; 27: 161-168
        • Andia I.
        • Sanchez M.
        • Maffulli N.
        Tendon healing and platelet-rich plasma therapies.
        Expert Opin Biol Ther. 2010; 10: 1415-1426
      2. Dean R, DePhillipo N, LaPrade R. Ligament Lesions: Cell Therapy. In G. Filardo et al. (eds.), Orthobiologics, Chap 20, 245-255, https://doi.org.org/10.1007/978-3-084744-9_20.

        • Nguyen D.
        • Ramwadhdoebe T.
        • et al.
        Intrinsic healing response of the human anterior cruciate ligament: a historical study of reattached ACL remnants.
        J Orthop Res. 2014; 132: 296-301
        • Li J.
        • Chen J.
        • Kirsner R.
        Pathophysiology of acute wound healing.
        Clin Dermatol. 2007; 25: 9-18
        • Thackham J.A.
        • McElwain D.L.
        • Long R.J.
        The use of hyperbaric oxygen therapy to treat chronic wounds: a review.
        Wound Repair Regen. 2008; 16: 321-330
        • Ariel A.
        • Timor O.
        Hanging in the balance: endogenous anti-inflammatory mechanisms in tissue repair and fibrosis.
        J Pathol. 2013; 229: 250-263
        • Darby I.A.
        • Laverdet B.
        • Bonte F.
        • et al.
        Fibroblasts and myofibroblasts in wound healing.
        Clin Cosmet Investig Dermatol. 2014; 7: 301-311
        • Desmouliere A.
        • Chaponnier C.
        • Gabbiani G.
        Tissue repair, contraction, and the myofibroblast.
        Wound Repair Regen. 2005; 13: 7-12
        • Hinz B.
        Formation and function of the myofibroblast during tissue repair.
        J Invest Dermatol. 2007; 127: 526-537
        • Xue M.
        • Le N.T.
        • Jackson C.J.
        Targeting matrix metalloproteases to improve cutaneous wound healing.
        Expert Opin Ther Targets. 2006; 10: 143-155
        • McCawley L.J.
        • Matrisian L.M.
        Matrix metalloproteinases: they're not just for matrix anymore.
        Curr Opin Cell Biol. 2001; 13: 534-540
        • Hardy M.A.
        The biology of scar formation.
        Phys Ther. 1989; 69: 1014-1024
        • Bray R.C.
        • Leonard C.A.
        • Salo P.T.
        Vascular Physiology and long-term healing of partial ligament tears.
        J Orthop Res. 2002; 20: 984-989
        • Murray M.M.
        • Fleming B.C.
        Biology of anterior cruciate ligament injury and repair: kappa delta anndoner vaughn award paper 2013.
        J Orthop Res. 2013; 31: 1509 -6
        • Murray M.M.
        • Spindler K.P.
        • Ballard P.
        • et al.
        Enhanced histologic repair in a central wound of the anterior cruciate ligament with a collagen-platelet-rich plasma scaffold.
        J Orthop Res. 2007; 25: 1007-1017
        • Murray M.M.
        • Martin S.D.
        • Martin T.L.
        • et al.
        Histological changes in the human anterior cruciate ligament after rupture.
        J Bone Jt Surg Am. 2000; 82: 1387-1397
        • Dines J.
        • Williams P.
        • ElAttrache N.
        • et al.
        Platelet-rich plasma can be used to successfully treat elbow ulnar collateral ligament insufficiency in high-level throwers.
        Am J Orthop. 2016; 45: 296-300
        • Keller R.A.
        • Steffes M.J.
        • Zhuo D.
        • et al.
        The effects of medial ulnar collateral ligament reconstruction on Major League pitching performance.
        J Shoulder Elbow Surg. 2014; 23: 1591-1598
        • Deal J.
        • Smith E.
        • Heard W.
        • et al.
        Platelet-rich plasma for primary treatment of partial ulnar collateral ligament tears: MRI correlation with results.
        Orthop J Sports Med. 2017; 5 (6D 2325967117738238): 1
        • Azar F.M.
        • Andrews J.R.
        • Wilk K.E.
        • et al.
        Operative treatment of ulnar collateral ligament injuries of the elbow in athletes.
        Am J Sports Med. 2000; 28: 16-23
        • Cain Jr., E.L.
        • Andrews J.R.
        • Dugas J.R.
        • et al.
        Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: results in 743 athletes with minimum 2-year follow-up.
        Am J Sports Med. 2010; 38: 2426-2434
        • Vitale M.A.
        • Ahmad C.S.
        The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review.
        Am J Sports Med. 2008; 36: 1193-1205
        • Jobe F.W.
        • Stark H.
        • Lombardo S.J.
        Reconstruction of the ulnar collateral ligament in athletes.
        J Bone Joint Surg Am. 1986; 68: 1158-1163
        • Savoie III, F.H.
        • Morgan C.
        • Yaste J.
        • et al.
        Medial ulnar collateral ligament reconstruction using hamstring allograft in overhead throwing athletes.
        J Bone Joint Surg Am. 2013; 95: 1062-1066
        • Savoie III, F.H.
        • Trenhaile S.W.
        • Roberts J.
        • et al.
        Primary repair of ulnar collateral ligament injuries of the elbow in young athletes: a case series of injuries to the proximal and distal ends of the ligament.
        Am J Sports Med. 2008; 36: 1066-1072
        • Chahla J.
        • Kennedy M.
        • Aman Z.
        the prod R. Orthobiologics for ligament repair and reconstruction.
        Clin Sports Med. 2019; 38: 97-107
        • Erickson B.J.
        • Gupta A.K.
        • Harris J.D.
        • et al.
        Rate of return to pitching and performance after Tommy John surgery in Major League Baseball pitchers.
        Am J Sports Med. 2014; 42: 536-543
        • Makhni E.C.
        • Lee R.W.
        • Morrow Z.S.
        • et al.
        Performance, return to competition, and reinjury after Tommy John surgery in major league baseball pitchers: a review of 147 cases.
        Am J Sports Med. 2014; 42: 1323-1332
        • Osbahr D.C.
        • Cain Jr., E.L.
        • Raines B.T.
        • et al.
        Long-term outcomes after ulnar collateral ligament reconstruction in competitive baseball players: minimum 10-year follow-up.
        Am J Sports Med. 2014; 42: 1333-1342
        • Park J.Y.
        • Oh K.S.
        • Bahng S.C.
        • et al.
        Does well-maintained graft provide consistent return to play after medial ulnar collateral ligament reconstruction of the elbow joint in elite baseball players?.
        Clin Orthop Surg. 2014; 6: 190-195
        • Rohrbough J.T.
        • Altchek D.W.
        • Hyman J.
        • et al.
        Medial collateral ligament reconstruction of the elbow using the docking technique.
        Am J Sports Med. 2002; 30: 541-548
        • Conway J.E.
        • Jobe F.W.
        • Glousman R.E.
        • et al.
        Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral lig10(2), ament.
        J Bone Joint Surg Am. 1992; 74: 67-83
        • Dodson C.C.
        • Thomas A.
        • Dines J.S.
        • et al.
        Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes.
        Am J Sports Med. 2006; 34: 1926-1932
        • Podesta L.
        • Crow S.A.
        • Volkmer D.
        • et al.
        Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma.
        Am J Sports Med. 2013; 41: 1689-1694
        • Rettig A.C.
        • Sherrill C.
        • Snead D.S.
        • et al.
        Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes.
        Am J Sports Med. 2001; 29: 15-17
        • Chen X.
        • Jones I.A.
        • Park C.
        • et al.
        The efficacy of platelet-rich plasma on tendon and ligament healing: a systematic review and meta- analysis with bias assessment.
        Am J Sports Med. 2018; 46: 2020-2032
        • Filardo G.
        • Di Matteo B.
        • Kon E.
        • et al.
        Platelet-rich plasma in tendon-related disorders: results and indications.
        Knee Surg Sports Traumatol Arthrosc. 2018; 26: 1984-1999
        • Del Torto M.
        • Enea D.
        • Panfoli N.
        • et al.
        Hamstrings anterior cruciate ligament reconstruction with and without platelet rich fibrin matrix.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 3614-3622
        • Boswell S.G.
        • Cole B.J.
        • Sundman E.A.
        • et al.
        Platelet-rich plasma: a milieu of bioactive factors.
        Arthroscopy. 2012; 28 (2019;100(2):336-349): 429-439
        • Magnussen R.A.
        • Flanigan D.C.
        • Pedroza A.D.
        • et al.
        Platelet-rich plasma use in allograft ACL reconstructions: two-year clinical results of a MOON cohort study.
        Knee. 2013; 20: 277-280
        • Mirzatolooei F.
        • Alamdari M.T.
        • Khalkhali H.R.
        The impact of platelet-rich plasma on the prevention of tunnel widening in anterior cruciate ligament reconstruction using quadrupled autologous hamstring tendon: a randomised clinical trial.
        Bone Joint J. 2013; 95: 65-69
        • Valenti Azcarate A.
        • Lamo-Espinosa J.
        • Aquerreta Beola J.D.
        • et al.
        Comparison between two different platelet-rich plasma preparations and control applied during anterior cruciate ligament reconstruction: is there any evidence to support their use?.
        Injury. 2014; 45: S36-S41
        • Buckely P.
        • Morris E.
        • Robbins C.
        • et al.
        Variations in blood supply from proximal to distal in the ulnar collateral ligament of the elbow: a qualitative descriptive cadaveric study.
        Am J Sports Med. 2019; 47: 1117-1123
        • Frangiamore S.J.
        • Lynch T.S.
        • Vaughn M.D.
        • et al.
        Magnetic resonance imaging predictors of failure in the nonoperative management of ulnar collateral ligament injuries in professional baseball pitchers.
        Am J Sports Med. 2017; 45: 1783-1789
      3. Podesta L. Orthobiologics and the UCL: Treatment or delaying surgical treatment: The Overhead Athlete, Annual Assembly of the American Academy of Physical Medicine and Rehabilitation 2019, San Antonio, TX, November 14, 2019.

      4. Podesta L. Ulnar Collateral Ligament (UCL) Treatment with PRP & BMC in the Throwing Athlete, TOBI Virtual, 11th Annual Orthobiologics Symposium, June 13, 2020.

      5. Podesta L. Orthobiologics and the UCL: Treatment or delaying surgical intervention? 34th Annual Kerlan-Jobe Alumni Research Conference, July 8, 2020.

        • Lopez-Vidriero E.
        • Goulding K.A.
        • Simon D.A.
        • et al.
        The use of platelet-rich plasma in arthroscopy and sports medicine: optimizing the healing environment.
        Arthroscopy. 2010; 26: 269-278
        • Gobbi A.
        • Karnatzikos G.
        • Sankineani S.R.
        • et al.
        Biological augmentation of ACL re-fixation in partial lesions in a group of athletes: results at the 5-year follow-up.
        Tech Orthop. 2013; 28: 180-184
        • Centeno C.J.
        • Pitts J.
        • Al-Sayegh H.
        • et al.
        Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: A case series.
        J Pain Res. 2015; 8: 437-447
        • Centeno C.
        • Markle J.
        • Dodson E.
        • et al.
        Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study.
        J Transl Med. 2018; 16: 246
        • Figueroa D.
        • Figueroa F.
        • Calvo R.
        • et al.
        Platelet-rich plasma used in anterior cruciate ligament surgery: Systematic review of the literature.
        Art Ther. 2015; 31: 981-988
        • Vogrin M.
        • Rupreht M.
        • Crnjac A.
        • et al.
        The effect of platelet-derived growth factors on the stability after anterior cruciate ligament reconstruction: a prospective randomized clinical study.
        Wien Klin Wochenschr. 2010; 122: 91-95
        • Dallo I.
        • Chahla J.
        • Mithchel J.
        • et al.
        Biologic approaches for the treatment of partial tears of the anterior cruciate ligament: a current concepts review.
        Orthop J Sports Med. 2017; 5: 1-9
        • Seijas R.
        • Ares O.
        • Cusco X.
        • et al.
        Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors.
        World J Orthop. 2014; 5: 373-378
      6. Figueroa D, Guiloff R, Figueroa F. Ligament lesions: biologics. In Filardo G. et al. (eds.), Orthobiologics, Chap 21, 257-263, doi.org.org/10.1007/978-3-030-84744-9_21

        • Centeno C.
        • Matthew L.
        • Stemper I.
        • et al.
        Image-guided injection of anterior cruciate ligament tears with autologous bone marrow concentrate and platelets: mid-term analysis from a randomized controlled trial.
        Ortho J. 2022; 3 (2): e7-e20
        • da Costa E.L.
        • Teixeira L.E.M.
        • Padua B.J.
        • et al.
        Biomechanical study of the effect of platelet-rich plasma on the treatment of medial collateral ligament injuries in rabbits.
        Acta Cir Bras. 2017; 32: 827-835
        • Yoshioka T.
        • Kanamori A.
        • Washio T.
        • et al.
        The effects of plasma rich in growth factors (PRGF-Endoret) on healing of medial collateral ligament of the knee.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 1763-1769
        • Zou G.
        • Zheng M.
        • Chen W.
        • et al.
        Autologous platelet-rich plasma therapy for refractory pain after low-grade medial collateral ligament injury.
        J Int Med Res. 2020; 48: 1-7
        • Eirale C.
        • Mauri E.
        • Hamilton B.
        Use of platelet rich plasma in an isolated complete medial collateral ligament lesion in a professional football (soccer) player: a case report.
        Asian J Sports Med 2013. 2006; 4: 158-162