that the HAGOS may not be unidimensional in its measurementproperties. Further analysis suggests that, with modifications,this may be achieved although further validation is needed.

PP3 THE KNEE INJURY CLINIC: TRYING TO GET IT ‘RIGHTFIRST TIME’ FOR EMERGENCY DEPARTMENT SOFTTISSUE KNEE INJURIES

1R Smith, 2O Nafousi, 1S O’Leary. 1Department of Trauma and Orthopaedics, RoyalBerkshire NHS Foundation Trust, Reading, UK; 2Accident and Emergency Department,Royal Berkshire NHS Foundation Trust, Reading, UK

10.1136/bjsports-2014-094245.19

Open access specialist knee clinics are a proven method to dra-matically reduce the delay to diagnosis of soft tissue knee injuries(STKI). This service was introduced at the Royal Berkshire Hos-pital in 2011 taking referral from primary care and the emer-gency department (ED). The purpose of this audit was to (i)identify the incidence and diagnoses of STKIs in patientsreferred from the ED; (ii) evaluate the management of patients’referred from the ED to the acute knee injury clinic (AKIC) andimplement changes to improve this service. An initial retrospec-tive analysis of 150 consecutive ED referrals to the AKIC in2011/12 was undertaken. Paediatric patients were excluded asstreamed to a separate clinic. Time to first clinic appointment(FCA), diagnosis and surgical intervention was recorded. Follow-ing initial findings, recommendations were implemented toincrease ED staff education, a new patient leaflet was introducedand clinic frequency was increased to twice weekly. In 2012/13the audit loop was closed and a further 150 consecutive EDreferrals were reviewed. 222 of the 300 patients referred wereseen in the AKIC, 51 patients did not attend and 27 werestreamed to paediatric clinic. Anterior cruciate ligament rupture(ACL) was the most frequent injury referred to the AKIC (24%(54/222)), 78% were sustained through sporting activity. Meantime from ACL injury to ED presentation was three days. Auditinterventions led to a reduction in mean time from ED referralto FCA by 67%. Patient AKIC non-attendance rate decreased by49% and mean time from FCA to surgical intervention wasreduced from 97 to 75 days. 83 patients underwent surgery.Simple interventions led to a reduction in time to diagnosis withsuitable counselling and management, reducing socio-economiccost of knee injuries and helping to prevent secondary injuries.ACL rupture is common and presents early. Identifying the typeand frequency of STKIs presenting to AKIC will help to planfuture services.

PP4 JOURNEY TOWARDS EXCELLENCE IN ORIENTEERING:ANALYSIS OF ELITE ATHLETES’ LIFE STORIES

1T Celestino, 2J Leitão, 3,4H Sarmento, 5A Marques, 4A Pereira. 1University of Trás-Os-Montes E Alto Douro, Portugal; 2Research Center in Sports, Health Sciences and HumanDevelopment (CIDESD), University of Trás-Os-Montes E Alto Douro, Vila Real, Portugal;3Centre for the Study of Education, Technologies and Health (CI&DETS), PolytechnicInstitute of Viseu - School of Education, Viseu, Portugal; 4Department of Sport Sciencesand Physical Education - University Institute of Maia, Maia, Portugal; 5InterdisciplinaryCentre for the Study of Human Performance, Faculty of Human Kinetics, University ofLisbon, Portugal

10.1136/bjsports-2014-094245.20

The search for perfection and being excellent is a challenge thathas been following in every area of human realisation. This

development process has its genesis in childhood and is a conse-quence of a long-term investment. Considering this, it is neces-sary to understand excellence as a multidimensional andevolving process. Therefore, this study aimed at characterisingthe development path of a group of excellent athletes, in orderto identify the factors which influence and determine the devel-opment of excellence in orienteering. The study focused on agroup of 5 elite orienteering athletes, positioned among the top10 in the IOF 2013 world ranking. Data was collected via semi-structured interviews and the study was developed using life sto-ries methodology. Later the data was analysed using contentanalysis. Results have shown that being excellent implies devel-oping personal excellence, in which the performance excellenceis complemented by the development of a series of actions ofpersonal growth. Hence, this group of athletes shows a need tohave a set of characteristics such as professionalism and commit-ment towards the development of excellence. It was identifiedthat sport diversification is the base principle for all sport devel-opment processes with excellence and it is organised in threefundamental steps: initiation, which is characterised by a invest-ment in free and deliberate game; development, denoting a com-mitment to orienteering and structured training; improvement,highlighting the diversification of the locations to practice ascore aspects. These athletes have attributes special importance tothe context on which this process is developed, naming family,friends influence, as well as sociocultural dynamic of a countryor region. Lastly, a set of determinant factors of positive affec-tive-emotional nature were identified, were feelings of wellbeingand passion for the sport act as influence elements towards thedevelopment of excellence.

PP5 FACTORS RELATED TO COMPLETION ANDPERFORMANCE IN A 150 KM ARCTIC ULTRAMARATHON

GEA Graham, A Bamford, M Thompson. MDHU Derriford, Plymouth, UK

10.1136/bjsports-2014-094245.21

The term Ultramarathon is used to describe any foot race of adistance greater than 42.2 km. Races are run in a number ofenvironments including Jungle, Desert and Arctic. The Rova-niemi 150 is a 150 km ultramarathon run inside the ArcticCircle. Previous studies have examined factors predictive of com-pletion and performance in ultramarathons run in non-arcticconditions. There appears to be no research specific to ultramar-athons undertaken in an arctic environment. This study aims toidentify factors that are predictive of completion and perform-ance in a 150 km Arctic ultramarathon. All runners in the 2014Rovaniemi 150 Arctic Ultramarathon were asked to complete aquestionnaire and have basic demographic data gathered. 26runners started the race with a 73% response rate to the ques-tionnaire (n = 19). Runners who successfully finished the racehad a BMI 2.4 kg/m2 less than non-finishers (p = 0.01) and a2.1 cm greater mid-upper arm circumference (p = 0.05). Fin-ishers also had faster marathon PBs and had completed moreultramarathons, but these findings only approached statistical sig-nificance (p = 0.06). In runners who finished the race betterperformance was positively correlated with quicker marathon PB(0.56), greater training volume (�0.47), greater training fre-quency (�0.49) and longest run in training for the race (�0.59).There was no relationship with BMI (0.05), but a larger armmid-third circumference was correlated with better performance(�0.43). The authors think this is the first study examining

Poster presentations

British Journal of Sports Medicine 2014;48(Suppl 3):A1–A13 A7

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analysis of elite athletes' life storiesJourney towards excellence in orienteering: PP4

T Celestino, J Leitão, H Sarmento, A Marques and A Pereira

doi: 10.1136/bjsports-2014-094245.202014 48: A7 Br J Sports Med 

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