The King-Devick test for sideline concussion screening in collegiate football

PURPOSE

Sports-related concussion has received increasing attention as a result of neurologic sequelae seen among athletes, highlighting the need for a validated, rapid screening tool. The King-Devick (K-D) test requires vision, eye movements, language function and attention in order to perform and has been proposed as a promising tool for assessment of concussion. We investigated the K-D test as a sideline screening tool in a collegiate cohort to determine the effect of concussion.

METHODS

Athletes (n=127, mean age 19.6±1.2 years) from the Wheaton College football and men's and women's basketball teams underwent baseline K-D testing at pre-season physicals for the 2012-2013 season. K-D testing was administered immediately on the sidelines for football players with suspected head injury during regular games and changes compared to baseline were determined. Post-season testing was also performed to compare non-concussed athletes' test performance.

RESULTS

Concussed athletes (n=11) displayed sideline K-D scores that were significantly higher (worse) than baseline (36.5±5.6s vs. 31.3±4.5s, p<0.005, Wilcoxon signed-rank test). Post-season testing demonstrated improvement of scores and was consistent with known learning effects (35.1±5.2s vs. 34.4±5.0s, p<0.05, Wilcoxon signed-rank test). Test-retest reliability was analyzed between baseline and post-season administrations of the K-D test resulting in high levels of test-retest reliability (intraclass correlation coefficient (ICC)=0.95 [95% Confidence Interval 0.85-1.05]).

CONCLUSIONS

The data show worsening of K-D test scores following concussion further supporting utility of the K-D test as an objective, reliable and effective sideline visual screening tool to help identify athletes with concussion.

High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: is PFP itself a predictor for subsequent ACL injury?

BACKGROUND

Identifying risk factors for knee pain and anterior cruciate ligament (ACL) injury can be an important step in the injury prevention cycle.

OBJECTIVE

We evaluated two unique prospective cohorts with similar populations and methodologies to compare the incidence rates and risk factors associated with patellofemoral pain (PFP) and ACL injury.

METHODS

The 'PFP cohort' consisted of 240 middle and high school female athletes. They were evaluated by a physician and underwent anthropometric assessment, strength testing and three-dimensional landing biomechanical analyses prior to their basketball season. 145 of these athletes met inclusion for surveillance of incident (new) PFP by certified athletic trainers during their competitive season. The 'ACL cohort' included 205 high school female volleyball, soccer and basketball athletes who underwent the same anthropometric, strength and biomechanical assessment prior to their competitive season and were subsequently followed up for incidence of ACL injury. A one-way analysis of variance was used to evaluate potential group (incident PFP vs ACL injured) differences in anthropometrics, strength and landing biomechanics. Knee abduction moment (KAM) cut-scores that provided the maximal sensitivity and specificity for prediction of PFP or ACL injury risk were also compared between the cohorts.

RESULTS

KAM during landing above 15.4 Nm was associated with a 6.8% risk to develop PFP compared to a 2.9% risk if below the PFP risk threshold in our sample. Likewise, a KAM above 25.3 Nm was associated with a 6.8% risk for subsequent ACL injury compared to a 0.4% risk if below the established ACL risk threshold. The ACL-injured athletes initiated landing with a greater knee abduction angle and a reduced hamstrings-to-quadriceps strength ratio relative to the incident PFP group. Also, when comparing across cohorts, the athletes who suffered ACL injury also had lower hamstring/quadriceps ratio than the players in the PFP sample (p<0.05).

CONCLUSIONS

In adolescent girls aged 13.3 years, >15 Nm of knee abduction load during landing is associated with greater likelihood of developing PFP. Also, in girls aged 16.1 years who land with >25 Nm of knee abduction load during landing are at increased risk for both PFP and ACL injury.

Postural stability does not differ among female sports with high risk of anterior cruciate ligament injury

Dancers have a lower incidence of anterior cruciate ligament (ACL) injury compared to athletes in sports that involve cutting and landing motions. Balance can impact ACL injury risk and is related to neuromuscular control during movement. The purpose of this study was to investigate whether balance differences exist among female dancers and female soccer and basketball athletes. Fifty-eight female dancers, soccer, and basketball athletes (16.5 ± 1.6 yrs, 1.6 ± 0.2 m, 60.2 ± 14.1 kg) completed the Stability Evaluation Test (SET) on the NeuroCom VSR Sport (NeuroCom International, Clackamas, OR) to measure sway velocity. Video records of the SET test were used for Balance Error Scoring System (BESS) test scoring. A oneway ANCOVA compared composite sway velocity and BESS scores among sports. There was no statistically significant difference for sway velocity or BESS among sports (sway velocity soccer 2.3 ± 0.4, dance 2.2 ± 0.4, and basketball 2.4 ± 0.4; BESS soccer 13.6 ± 5.0, dance 11.9 ± 5.5, and basketball 14.9 ± 5.1, p>0.05). Balance was similar among athletes participating in different sports (dance, basketball, and soccer). Quasi-static balance may not play a significant role in neuromuscular control during movement and not be a significant risk factor to explain the disparity in ACL injury incidence among sports. Future research should examine the effects of dynamic balance and limb asymmetries among sports to elucidate on the existing differences on ACL injury incidence rates.

Common overuse injuries in the young athlete

Pediatric overuse injury is a common complaint presenting to pediatricians. Overuse injury can affect the soft tissues or bone, and results from an imbalance between training and load to the tissues and recovery time. In the skeletally immature athlete, physeal and apophyseal tissue is particularly vulnerable to overuse resulting in different patterns of injury compared to adults. Awareness of age-dependent patterns of overuse is necessary for proper recognition, treatment, and prevention of injury. This article reviews the most common pediatric overuse injuries with emphasis on risk factors, diagnosis, and treatment. Guidelines for prevention are included, as this is the key component for successful management of overuse injury in pediatric athletes.

Acute fibular sesamoid fracture: one part of the spectrum of sesamoid pathologies

A 35-year-old male athlete presented with acute pain plantar to the hallux metatarsophalangeal joint following jumping to catch a basketball.

Trends in primary and revision anterior cruciate ligament reconstruction among National Basketball Association team physicians

Anterior cruciate ligament (ACL) tears are common in athletes. Techniques and methods of treatment for these injuries continue to vary among surgeons. Thirty National Basketball Association (NBA) team physicians were surveyed during the NBA Pre-Draft Combine. Survey questions involved current and previous practice methods of primary and revision ACL reconstruction, including technique, graft choice, rehabilitation, and treatment of combined ACL and medial collateral ligament injuries. Descriptive parametric statistics, Fisher exact test, and logistic regression were used, and significance was set at α = 0.05. All 30 team physicians completed the survey. Eighty-seven percent indicated they use autograft (81% bone-patellar tendon-bone) for primary ACL reconstruction in NBA athletes, and 43% indicated they use autograft for revision cases. Fourteen surgeons (47%) indicated they use an anteromedial portal (AMP) for femoral tunnel drilling, whereas 5 years earlier only 4 (13%) used this technique. There was a significant (P = .009) positive correlation between fewer years in practice and AMP use. NBA team physicians' use of an AMP for femoral tunnel drilling has increased over the past 5 years.

Growth plate alteration precedes cam-type deformity in elite basketball players

BACKGROUND

Vigorous sporting activity during the growth years is associated with an increased risk of having a cam-type deformity develop. The underlying cause of this osseous deformity is unclear. One may speculate whether this is caused by reactive bone apposition in the region of the anterosuperior head-neck junction or whether sports activity alters the shape of and growth in the growth plate. If the latter is true, then one would expect athletes to show an abnormal shape of the capital growth plate (specifically, the epiphyseal extension) before and/or after physeal closure.

QUESTIONS/PURPOSES

We therefore raised three questions: (1) Do adolescent basketball players show abnormal epiphyseal extension? (2) Does the epiphyseal extension differ before and after physeal closure? (3) Is abnormal epiphyseal extension associated with high alpha angles?

METHODS

We performed a case-control comparative analysis of young (age range, 9-22 years) male elite basketball athletes with age-matched nonathletes, substratified by whether they had open or closed physes. We measured epiphyseal extension on radial-sequence MRI cuts throughout the cranial hemisphere from 9 o'clock (posterior) to 3 o'clock (anterior). Epiphyseal extension was correlated to alpha angle measurements at the same points.

RESULTS

Epiphyseal extension was increased in all positions in the athletes compared with the control group. On average, athletes showed epiphyseal extension of 0.67 to 0.83 versus 0.53 to 0.71 in control subjects. In the control group epiphyseal extension was increased at all measurement points in hips after physeal closure compared with before physeal closure. In contrast, the subgroup of athletes with a closed growth plate only had increased epiphyseal extension at the 3 o'clock position compared with the athletes with an open [corrected] growth plate (0.64-0.70). We observed a correlation between an alpha angle greater than 55° and greater epiphyseal extension in the anterosuperior femoral head quadrant: the corresponding Spearman r values were 0.387 (all hips) and 0.285 (alpha angle>55°) for the aggregate anterosuperior quadrant.

CONCLUSIONS

These findings suggest that a cam-type abnormality in athletes is a consequence of an alteration of the growth plate rather than reactive bone formation. High-level sports activity during growth may be a new and distinct risk factor for a cam-type deformity.

Mouthguard use and dental injury in sport: a questionnaire study of national school children in the west of Ireland

STATEMENT OF THE PROBLEM

The risk of children getting dental injuries during sport can be minimised by using a mouthguard. Within Ireland, information on mouthguard use and policy is limited. The extent of dental trauma experienced by children during sport is also unclear.

PURPOSE OF THE STUDY

To determine the extent of mouthguard use, dental trauma and barriers to use among children. The survey also investigated school and sports club policy on mouthguard use in sport.

MATERIALS AND METHODS

A questionnaire was sent to parents of 1,111 children aged nine to 13 years attending 25 randomly selected schools in the Health Service Executive West region of Ireland. It sought information about children's sporting activities, mouthguard policy and use, barriers to use, and dental accidents.

RESULTS

A total of 505 questionnaires were returned (46%). More than nine out of ten children were involved in sport. Mouthguards were worn by 22% of children during sport. Less than one-third of schools and sports clubs that children attended had a mouthguard policy. Significantly more children used mouthguards where there was a mouthguard policy. Reasons for not wearing mouthguards included cost, lack of knowledge and information, and lack of a mouthguard policy. One in ten children had suffered a sports accident in the previous year, of which 51% injured teeth. Of these, 72% visited a dentist within two hours.

CONCLUSIONS

The dental profession and individual practitioners should promote mouthguard use for children during sport and be advocates for the development of policies in schools and sporting organisations.

Acute compartment syndrome of the foot in a 17-year-old boy

Acute compartment syndrome is both a life and limb threatening surgical emergency, caused by an increase in compartment contents due to either trauma or surgery. We illustrate a foot compartment syndrome, clinically diagnosed, that took place after direct injury during a football match. Compartments release through fasciotomies promptly relieved symptoms. Educational images are furnished.

Concussions in wheelchair basketball

OBJECTIVE

To estimate the incidence rate of concussions in wheelchair basketball.

DESIGN

Survey.

SETTING

Wheelchair basketball tournaments during the 2009 to 2010 season.

PARTICIPANTS

Wheelchair basketball players (N=263) ranging in age from 18 to 60 years.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Participants completed a survey on their concussion history including how many concussions they have sustained, how many days they refrained from physical activity because of injury, to whom they reported their injury, and reasons for not reporting an injury if they did not. Participants also provided demographic information about their disability, age, sex, and length of wheelchair use and sports participation.

RESULTS

Within the sample of 263 wheelchair basketball players, 6.1% reported experiencing a concussion in the current season. Of those experiencing concussions during the current season, 44% did not report their concussion. Of those not reporting the incident, 67% did not because they did not want to be removed from physical activity. Analysis by sex indicated that 5.82% of the male athletes sustained a concussion during the current season, and 14.36% had sustained an injury during their athletic career. Female athletes, however, sustained concussions at a higher rate, with 6.67% having concussions during the current season and 30.6% during their athletic careers. Women were also 2.5 times more likely to sustain a concussion than men. Athletes were most likely to report their concussion to their coach (60% of concussed athletes).

CONCLUSIONS

The current investigation was consistent with previous research in that women were more likely to sustain a concussion than men, and injury rates were similar to those in able-bodied basketball. Further work is needed in concussion assessment in persons with disability, as well as greater education concerning concussion in disability sports.

Sports injuries among professional male athletes in Kuwait: prevalence and associated factors

OBJECTIVES

To assess a 12-month period and the lifetime prevalence of sports injuries among male athletes according to type of sport, type of injury and its seriousness, and to examine the association of injuries with sociodemographic, lifestyle and preventive factors.

SUBJECTS AND METHODS

In this cross-sectional study, we approached 475 professional athletes participating in ball sports, aged 15 years and older, from 5 sports clubs in Kuwait. Of them, 452 responded. Four ball games--football (soccer), basketball, handball and volleyball--were included. Data were collected through a self-administered questionnaire. Bivariate and multivariate relationships between associated factors and experience of injury were tested by using χ(2) and logistic regression.

RESULTS

The overall 12-month and lifetime prevalence of sports injuries were 73.8 and 89.8%, respectively. Prevalence was highest among volleyball athletes (79%) and lowest among football (soccer) athletes (69%). Lower limbs (73.1%) were the most common site of injuries and joint injuries (43.6%) were the most common type. For the most recent injury, 138 (42%) of athletes took more than 10 days off practice. Compared to volleyball, football (soccer) and handball athletes were 2.9 times (95% CI: 1.3-6.3) and 3.4 times (95% CI: 1.5-7.8) more likely to take more than 10 days off practice. Athletes who sometimes wore protective gears were 3.1 times (95% CI: 1.7-5.8) more likely to report an injury compared with those who never wore protective gears (p < 0.001).

CONCLUSIONS

Sports injuries are highly prevalent among professional athletes in Kuwait. Future studies are needed to provide guidelines for interventions that may reduce such injuries.

Injury reporting rates and injury concealment patterns differ between high-school cirque performers and basketball players

OBJECTIVE

The performing arts style of cirque has grown in popularity, with high-school participants increasingly practicing this style. Still, little research has examined the injury reporting rates and patterns in this population. Our study aimed to compare injury reporting rates and injury concealment patterns between high-school cirque performers and a peer-group of basketball players.

METHODS

Fifty participants (30 cirque, 20 basketball) completed a 12-item injury history and concealment instrument with chi-squared analyses and Fisher's exact tests comparing groups (p = 0.05).

RESULTS

While no group differences (p = 0.36) existed in injuries reported, basketball players were more likely (p = 0.01) to miss participation due to injury than cirque performers. No significant difference existed between participants regarding which healthcare provider they reported to first (p = 0.27), but basketball players reported their injuries to the athletic trainer at higher rates (50%) than cirque performers (20%). A nonsignificant trend (p = 0.08) was noted in promptness to report injury, with more cirque performers (13%) concealing their injuries than basketball players (5%). Several reasons were noted for concealment of injury, with the most common being the belief that the injury would "go away" on its own. Knee injuries were most common in basketball players (23.7%) and back and knee injuries (10.5% each) in cirque performers.

CONCLUSIONS

Despite similar injury rates, cirque participants concealed injuries more than peer-basketball players. Reasons may include losing performance roles, unfamiliarity and low trust with healthcare providers, ignorance about initially minor-looking injuries, and higher pain tolerance thresholds. Education and communication are essential to allow performing artists to seek healthcare support. Research is needed to appropriately understand and meet the needs of this underserved performing artist population.

Acute exertional medial compartment syndrome of the foot after playing basketball

Compartment syndrome of the foot is an uncommon event. The most common cause of compartment syndrome of the foot is a crush injury. Exceedingly rare is acute compartment syndrome of the foot occurring in the absence of trauma. We describe the clinical scenario involving a 23-year-old healthy male who developed acute exertional compartment syndrome isolated to the medial compartment of the foot after playing basketball. The patient had no evidence of injury nor trauma, and the diagnosis was made based on physical exam, magnetic resonance imaging (MRI), and compartment pressure measurements. The patient did undergo successful fasciotomy on the day of presentation to the emergency department and has since completely recovered. We found four cases reported in the literature of acute exertional medial compartment syndrome of the foot in the absence of trauma or injury. This is the second case reported after playing basketball, while the others occurred after aerobics, a long distance run, and football. The most recent case was reported by Miozzari et al. [Am J Sports Med. 36(5):983-6, 2008] and involved a marathon runner who developed an isolated medial compartment syndrome of the foot. We would like to increase awareness of this uncommon clinical presentation in the absence of trauma and present the dramatic radiographic findings.

Orofacial injuries reported by junior and senior basketball players

The increased popularity of sports, apart from being beneficial to health, also results in a larger number of injuries, a part of which are also injuries to the stomatognatic system. According to the data from literature orofacial injuries in basketball are frequent, but relatively minor. The World Dental Federation places basketball into the category of medium-risk sports for the occurrence of injuries to the stomatognatic system. The purpose of this investigation was to determine incidence, type and severity of orofacial injuries during basketball and the frequent of the mouthguard use in a selected sample of basketball players from the City of Zagreb and the Zagreb County. The sample consists of 195 athletes who actively participate in basketball, 61 junior and 134 senior players. A total of 2 615 injuries to the stomatognatic system were documented in this research, 529 (20.2%) of those refer to juniors and 2 086 (79.8%) to seniors. The most common injuries are lacerations and contusions of soft tissue 84.4% (21.5% juniors and 78.5% seniors), followed by temporomandibular joint injuries and oral muscles stiffness 13.4% (14.9% juniors and 85.1% seniors) and 2.2% dental injuries (3.5% juniors and 96.5% seniors). Only 6.7% of players (13 players--2 juniors and 11 seniors) have tried to wear a mouthguard, while only one 1% of them (2 players--one junior and one senior) frequently used it. Total number of injuries shows that sports injuries are common during basketball. Average number of almost 4 injuries per player is relatively high. Dental injuries and temporomandibular joint injuries and oral muscles stiffness are relatively rare, only 16%. Lacerations and contusions of soft tissues represent 84% of all injuries and that minor injuries do not require professional care.

Biomechanics laboratory-based prediction algorithm to identify female athletes with high knee loads that increase risk of ACL injury

OBJECTIVE

Knee abduction moment (KAM) during landing predicts non-contact anterior cruciate ligament (ACL) injury risk with high sensitivity and specificity in female athletes. The purpose of this study was to employ sensitive laboratory (lab-based) tools to determine predictive mechanisms that underlie increased KAM during landing.

METHODS

Female basketball and soccer players (N=744) from a single county public school district were recruited to participate in testing of anthropometrics, maturation, laxity/flexibility, strength and landing biomechanics. Linear regression was used to model KAM, and logistic regression was used to examine high (>25.25 Nm of KAM) versus low KAM as surrogate for ACL injury risk.

RESULTS

The most parsimonious model included independent predictors (β±1 SE) (1) peak knee abduction angle (1.78±0.05; p<0.001), (2) peak knee extensor moment (0.17±0.01; p<0.001), (3) knee flexion range of motion (0.15±0.03; p<0.01), (4) body mass index (BMI) Z-score (-1.67±0.36; p<0.001) and (5) tibia length (-0.50±0.14; p<0.001) and accounted for 78% of the variance in KAM during landing. The logistic regression model that employed these same variables predicted high KAM status with 85% sensitivity and 93% specificity and a C-statistic of 0.96.

CONCLUSIONS

Increased knee abduction angle, quadriceps recruitment, tibia length and BMI with decreased knee flexion account for 80% of the measured variance in KAM during a drop vertical jump.

CLINICAL RELEVANCE

Females who demonstrate increased KAM are more responsive and more likely to benefit from neuromuscular training. These findings should significantly enhance the identification of those at increased risk and facilitate neuromuscular training targeted to this important risk factor (high KAM) for ACL injury.