Many people want to be part of Sports Medicine so it will be a challenge to keep up the quality and use of evidence-based medicine. Some may try to take shortcuts to fame. I believe that dedication to hard work, good education and involvement in research will be the main tenets that determine how well Sports Medicine will develop as a discipline.
There is still a lack of resources going to the sports medical service and research today. Available financial resources in the dominant sports are mainly allocated to attract good athletes. It is a fact that an athlete with an injury cannot fully compete and is then not very valuable. The smart coaches of today understand this and support Sports Medicine service of highest quality.
Effective treatment of an injury must be evidence-based, or if the evidence is not there at least be based on long-term experience. The largest problem in most team sports is an ACL injury, with a substantial risk for re-injury, complications, and/or osteoarthritis, especially if the athlete’s return to sport is too early. Top level sport in itself is a risk factor. Today there are indications for sustained healing of knee articular cartilage for as long as 1–2 years after an ACL injury. This is a new challenge for both the surgeon and the rehabilitation team, and will affect the rehabilitation and time to return to sport. The good news is that ACL programs can be effective. Pooled estimates suggest a substantial beneficial effect of ACL injury prevention programs, with a risk reduction of 52 % in female athletes and 85 % in male athletes. The individual coaching of the player by the team physiotherapist and compliance with the training program by the player are key factors in the rehabilitation.
Tendinopathy in Achilles, patellar and rotator cuff tendons remain to be major challenges in sports as they are difficult to manage and take a long time to return to sport. New techniques addressing tendon management such as tissue engineering and tissue regeneration seem promising. These methods include molecular approaches by which genetically modified cells, including stem cells, synthesize growth factors or other mediators needed for progression of failed healing. However, molecular procedures are not yet ready for routine clinical use. Novel mini-invasive procedures that target underlying pathology, such as abnormal neoinnervation, are being developed and while initially promising, still necessitate high quality randomized controlled trials before management of tendinopathy can be recommended.