The Epidemiology of Severe Injuries Sustained by National Collegiate Athletic Association Student-Athletes, 2009-2010 Through 2014-2015

Longitudinal assessments of balance and jump-landing performance before and after anterior cruciate ligament injuries in collegiate athletes

The purpose was to quantify the effect of an anterior cruciate ligament (ACL) injury on balance and jump-landing performance and bilateral asymmetries. Among 500 collegiate athletes who performed a reaching test and a double-leg counter-movement jump-landing test at baseline, 8 male and 6 female athletes suffered ACL injuries. In the follow-up, they performed the reaching test 3 and 6 months after ACL reconstruction (ACLR) and the jump-landing test 6 months after ACLR. Less reaching distances for the injured leg and increased reaching distance asymmetries were observed 3 and 6 months after ACLR compared to baseline. Less peak jumping and landing forces for the injured leg and increased jumping and landing force asymmetries were found 6 months after ACLR compared to baseline. The decreased performance of the injured leg and increased asymmetries may contribute to the high ACL re-injury rates. Baseline assessments would be useful for establishing an individual's pre-injury performance.

The Demographics of Fractures and Dislocations Across the Entire United States due to Common Sports and Recreational Activities

BACKGROUND

There exists little nationwide data regarding fracture and dislocation patterns across a wide variety of sporting activities for all ages and sexes.

HYPOTHESIS

Participant demographics (age and sex) will vary with regard to fracture and joint dislocation sustained during sport-related activities.

STUDY DESIGN

Descriptive epidemiology study.

LEVEL OF EVIDENCE

Level 3.

METHODS

The National Electronic Injury Surveillance System All Injury Program data 2005 through 2013 were accessed; 18 common sports and recreational activities in the United States were selected. Statistical software was used to calculate the numbers of fractures and dislocations, and incidence was calculated using US Census Bureau data. Multivariate logistic regression analysis determined the odds ratios (ORs) for the occurrence of a fracture or dislocation.

RESULTS

A fracture occurred in 20.6% and a joint dislocation in 3.6% of the emergency department visits for sports-related injuries; annual emergency department visit incidence was 1.51 for fractures and 0.27 for dislocations (per 1000 people). Most of the fractures occurred in football (22.5%). The OR for fracture was highest for inline skating (OR, 6.03), males (OR, 1.21), Asians, whites, and Amerindians compared with blacks (OR, 1.46, 1.25, and 1.18, respectively), and those older than 84 years (OR, 4.77). Most of the dislocations occurred in basketball (25.7%). The OR for dislocation was highest in gymnastics (OR, 4.08), males (OR, 1.50), Asians (OR, 1.75), and in those aged 20 to 24 years (OR, 9.04). The most common fracture involved the finger, and the most common dislocation involved the shoulder.

CONCLUSION

Inline skating had the greatest risk for fracture, and gymnastics had the greatest risk for joint dislocation.

CLINICAL RELEVANCE

This comprehensive study of the risks of sustaining a fracture or dislocation from common sports activities across all age groups can aid sports health providers in a better understanding of those sports at high risk and be proactive in prevention mechanisms (protective gear, body training).

Trends in Recurrent Anterior Cruciate Ligament Injuries Differ From New Anterior Cruciate Ligament Injuries in College and High School Sports: 2009-2010 Through 2016-2017

Background:

Knee injuries are common and result in extended time missed from sports participation. Little is known regarding the comparative characteristics of recurrent versus first-time anterior cruciate ligament (ACL) injuries sustained during athletic events and how they are influenced by sex, sports participation level, and game-time features.

Purpose:

To evaluate the characteristics (sex, sports level, and game timing [ie, early vs late in the game]) of recurrent ACL injury in National Collegiate Athletic Association (NCAA) and high school athletes compared with first-time ACL injury.

Study Design:

Descriptive epidemiology study.

Methods:

Athletic trainers reported ACL injury occurrences and characteristics for collegiate athletes during the 2009-2010 through 2016-2017 academic years and for high school athletes during the 2011-2012 through 2013-2014 academic years. Logistic regression was used to estimate odds ratios (ORs) and 95% CIs for recurrent versus first-time ACL injury. The number of ACL injuries, proportions, and ORs were calculated by sex, competition level, and time in game played. Results were also classified according to injury mechanism: noncontact, overuse, or surface contact.

Results:

A total of 705 ACL injuries were reported, including 644 first-time injures and 61 recurrent injuries. When restricting to noncontact ACL injuries, 416 were reported (373 first-time injuries and 43 recurrent injuries). The odds of a recurrent versus new ACL injury in NCAA student-athletes were 4.6 times that of high school student-athletes (95% CI, 1.41-15.24; P = .01). When restricting to noncontact ACL injuries, the odds of a recurrent versus new ACL injury during postseason and preseason were 4.5 and 2.8 times that during the regular season, respectively. Athletes in limited-contact and noncontact sports had greater odds of a recurrent versus new ACL injury compared with athletes playing football and other contact and collision sports. There was no significant difference in the odds of a recurrent ACL injury by sex or time in game.

Conclusion:

Based on the current study, the odds of recurrent ACL injuries are associated with the level of competition but not associated with sex or timing of game play. Determinants of reinjury after primary ACL reconstruction will help advance care for young injured athletes who continue to participate in competitive sports.

Epidemiology of Cervical Injuries in NCAA Football Players

STUDY DESIGN

Descriptive epidemiology study.

OBJECTIVE

The purpose of this study was to describe the epidemiology of cervical spine injuries in collegiate football players.

SUMMARY OF BACKGROUND DATA

The incidence and etiology of cervical spine injuries in National Collegiate Athletic Association (NCAA) football players has not been well defined in recent years.

METHODS

The incidence and characteristics of cervical spine injuries were identified utilizing the NCAA-ISP database. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition.

RESULTS

An estimated 7496 cervical spine injuries were identified. Of these, 85.6% were categorized as new injuries. These occurred at a rate of 2.91 per 10000 AEs. Stingers were most common (1.87 per 10000 AEs) followed by cervical strains (0.80 per 10000 AEs). Injuries were nine times more likely to occur during competition when compared with practice settings. When compared with the regular season, the relative risks of sustaining a cervical spine injury during the preseason and postseason were 0.69 (95% CI 0.52-0.90) and 0.39 (95% CI 0.16-0.94), respectively. The rate of cervical spine injuries was highest in Division I athletes. Direct contact-related injuries were most common, representing 90.8% of all injuries sustained. Injuries were most common in linebackers (20.3%) followed secondarily by defensive linemen (18.2%). Most players returned to play within 24 hours of the initial injury (64.4%), while only 2.8% remained out of play for > 21 days.

CONCLUSION

Fortunately, the rate of significant and disabling cervical spine injuries appears to be low in the NCAA football athlete. The promotion of safer tackling techniques, appropriate modification of protective gear, and preventive rehabilitation in these aforementioned settings is of continued value.

LEVEL OF EVIDENCE

4.

The effects of mid-flight whole-body and trunk rotation on landing mechanics: implications for anterior cruciate ligament injuries

The purpose was to quantify the effects of mid-flight whole-body and trunk rotation on knee mechanics in a double-leg landing. Eighteen male and 20 female participants completed a jump-landing-jump task in five conditions: no rotation, testing leg ipsilateral or contralateral (WBRC) to the whole-body rotation direction, and testing leg ipsilateral (TRI) or contralateral to the trunk rotation direction. The WBRC and TRI conditions demonstrated decreased knee flexion and increased knee abduction angles at initial contact (2.6 > Cohen's dz > 0.3) and increased peak vertical ground reaction forces and knee adduction moments during the 100 ms after landing (1.7 > Cohen's dz > 0.3). The TRI condition also showed the greatest knee internal rotation angles at initial contact and peak knee abduction and internal rotation angles and peak knee extension moments during the 100 ms after landing (2.0 > Cohen's dz > 0.5). Whole-body rotation increased contralateral knee loading because of its primary role in decelerating medial-lateral velocities. Trunk rotation resulted in the greatest knee loading for the ipsilateral knee due to weight shifting and mechanical coupling between the trunk and lower extremities. These findings may help understand altered trunk motion in anterior cruciate ligament injuries.

Injury epidemiology and risk factors in competitive artistic gymnasts: a systematic review

Background

Artistic gymnastics is reported to have some of the highest injury rates in sports, which limits participation and often involves considerable medical expenses.

Purpose

To critically appraise the epidemiological literature on injury patterns and risk factors in competitive artistic gymnastics.

Study design

Systematic review.

Methods

Six databases were searched for articles that investigated injuries in competitive artistic gymnasts. Injury incidence, prevalence and risk factor data were extracted, alongside information on injury location, type, severity, nature and mechanism of injury. Quality and level of evidence were assessed using a modified Downs and Black quality index checklist and the Oxford Centre for Evidence-based Medicine guidelines.

Results

The search identified 894 articles, with 22 eligible for inclusion. Descriptive analysis showed that injury incidence and prevalence varied from 0.3 to 3.6 injuries per gymnast (female=0.3–3.6, male=0.7) and 2.0–2.3 (female=2.0–2.3, male=2.0), respectively. Male gymnasts sustained mostly upper limb injuries, while female gymnast reported lower limb injuries. Floor was associated with the greatest number of injuries for both male and female gymnasts. Higher competitive level and exposure to competition were risk factors for gymnastics injury: age, body mass, body size, training duration and life stress were significant associated factors.

Conclusion

Injury incidence and prevalence results are substantial among artistic gymnasts of all competitive levels. Gymnasts who train at highly competitive levels and are exposed to competition environments are a greater risk of injury. Future researchers should implement consistent reporting methods.

Incidence of Sport-Related Internal Organ Injuries Due to Direct-Contact Mechanisms Among High School and Collegiate Athletes Across 3 National Surveillance Systems

CONTEXT

Although sport-related internal organ injuries among athletes are relatively infrequent, combining data sources enables a more comprehensive examination of their incidence.

OBJECTIVE

To describe the incidence and characteristics of sport-related internal organ injuries due to direct-contact mechanisms among high school (HS) and collegiate athletes from 2005-2006 through 2014-2015.

DESIGN

Descriptive epidemiology study.

SETTING

United States HS and collegiate sports data from 3 national sports injury-surveillance systems: High School Reporting Information Online (HS RIO), the National Collegiate Athletic Association Injury Surveillance Program (ISP), and the National Center for Catastrophic Sport Injury Research.

PATIENTS OR OTHER PARTICIPANTS

High school and collegiate athletes in organized sports.

MAIN OUTCOME MEASURE(S)

Characteristics of the athlete, event, and injury were examined and stratified by data source and sport. Descriptive statistics of internal organ injuries via direct-contact mechanisms consisted of frequencies and incidence rates (IRs) per 1 000 000 athlete-exposures and 95% confidence intervals (CIs).

RESULTS

During the 10-year period, 174 internal organ injuries were captured: 124 in HS RIO and 41 in the ISP; 9 were catastrophic. Most noncatastrophic injuries occurred among males (RIO = 85%, ISP = 89%), in football (RIO = 65%, ISP = 58%), and during competitions (RIO = 67%, ISP = 49%) and were due to player-player contact (RIO = 78%, ISP = 68%). The highest injury rates were in male contact sports: RIO football (IR = 11.7; 95% CI = 9.1, 14.2) and lacrosse (IR = 10.0; 95% CI = 3.1, 16.9); ISP: football (IR = 8.3; 95% CI = 5.0, 11.6) and ice hockey (IR = 7.9; 95% CI = 1.0, 14.7). A quarter of noncatastrophic injuries were season ending (RIO = 25%, ISP = 23%). Of the 9 catastrophic injuries, most occurred in HS (7/9) and football (7/9) and were due to player-player contact (6/9). Four resulted in death.

CONCLUSIONS

Direct-contact internal organ injuries occur infrequently; yet when they do occur, they may result in severe outcomes. These findings suggest that early recognition and a better understanding of the activities associated with the event and use or nonuse of protective equipment are needed.

Epidemiology of Injuries Requiring Emergency Transport Among Collegiate and High School Student-Athletes

CONTEXT: 

Data regarding the epidemiology of emergency-transport incidents (ETIs) of patients with sport-related injuries are lacking. Understanding the use of emergency services by athletic trainers can help improve emergency preparedness and prehospital care for injured student-athletes.

OBJECTIVE: 

To determine the frequencies and types of ETIs resulting from athletic participation.

DESIGN: 

Descriptive epidemiology study.

SETTING: 

Participating colleges and high schools during 2009-2010 to 2014-2015 and 2011-2012 to 2013-2014, respectively.

PATIENTS OR OTHER PARTICIPANTS: 

Student-athletes in 23 high school and 25 intercollegiate sports.

MAIN OUTCOME MEASURE(S): 

Data on injuries requiring emergency transport were collected by each team's athletic trainer via their respective online injury-tracking software. Athletic trainers also collected data on athlete-exposures (AEs). Emergency-transport incident frequencies and injury rates per 10 000 AEs with 95% confidence intervals (CIs) were reported. For each ETI, the sport, body part, injury mechanism, and final diagnosis were recorded.

RESULTS: 

A total of 339 and 146 ETIs were reported in collegiate and high school players, respectively. Collegiate women's ice hockey had the highest ETI rate (1.28/10 000 AEs; 95% CI = 0.71, 1.86). In high school, football had the highest rate at 0.80 per 10 000 AEs (95% CI = 0.64, 0.97). Athletes with head or face injuries required the most transports in college (n = 71, 20.9%) and high school (n = 33, 22.6%) across all sports. Strains (n = 50, 14.7%) and fractures (n = 35, 24.0%) were the leading diagnoses for patients undergoing transport in college and high school, respectively.

CONCLUSIONS: 

Athletic trainers should maintain a high level of emergency preparedness when working with sports that have high rates and numbers of ETIs. Athletes with injuries to the head/face required the most frequent transport across competition levels. Athletic trainers should have the appropriate equipment and protocols in place to handle these patients. Future researchers should examine the differences between field and hospital diagnoses to help improve prehospital care and decrease the likelihood of unnecessary emergency transports.

Epidemiology of shoulder and elbow injuries in National Collegiate Athletic Association wrestlers, 2009-2010 through 2013-2014

OBJECTIVES

Examination of the incidence of shoulder and elbow injuries in the collegiate wrestling population is limited. Therefore, we sought to determine the incidence of shoulder and elbow injuries in wrestlers competing in the National Collegiate Athletic Association (NCAA), and investigate the risk factors involved.

METHODS

All shoulder and elbow injuries in wrestlers from the 2009-2010 through 2013-2014 academic years in the NCAA Injury Surveillance Program database were extracted. The incidence of different injuries, sports, activity, time-in-game, competition status, and injury characteristics was recorded. Risk-ratios were calculated to determine risk factors for injury.

RESULTS

Collegiate wrestlers had an incidence of 21.59 shoulder and elbow injuries per 10,000 athletic exposures (AEs). The most frequent injury types included elbow ulnar collateral ligament tears, shoulder impingement, and acromioclavicular joint sprains, although there was significant variability. Freshman collegiate wrestlers suffered a significantly higher percentage of shoulder and elbow injuries than more senior athletes, signifying an association between experience and injury risk. There was a 4-fold higher incidence of injury during competition. Injuries were significantly more likely to occur later in the match, with a 2.5-fold increased risk compared with early. While 26.8% of wrestlers were out of play for at least 14 days, only 5.9% of all injuries required surgery. Lastly, Division I collegiate wrestlers had the highest overall injury rate.

CONCLUSIONS

Collegiate wrestlers have a high incidence of shoulder and elbow injury, with specific risk factors identified here. This at-risk patient population should be monitored closely for signs of fatigue, which may leave them susceptible to injury. Further prospective investigation of wrestling injuries with a special attention to injury prevention in higher risk athletes are needed to further validate these findings.

Effect of Concussions on Lower Extremity Injury Rates at a Division I Collegiate Football Program

Background:

Football has one of the highest injury rates (IRs) in sports, ranging from 4.1 to 8.6 per 1000 athlete-exposures (AEs). Previous research has reported that athletes may be at an increased risk of suffering lower extremity (LE) injuries after a concussion.

Purpose/Hypothesis:

The purpose of this study was to evaluate the rate of LE injuries in collegiate football athletes after a concussion. We predicted that the overall LE IR would increase after a concussion and that each position group would also demonstrate a similar increase in LE injuries after a concussion.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Daily attendance and injury records were prospectively collected by licensed team medical providers for the 2012 through 2016 college football regular seasons. Each injury report included the date of injury, position group, body part injured, and type of injury. IRs per 1000 AEs with 95% CIs were calculated to evaluate LE injuries at different time points after a concussion (remainder of season, next season, any additional seasons) and by months (<6 months, 6-12 months, >12 months). Mid-P exact tests were utilized to establish injury rate ratios (IRRs) to compare the IR between variables.

Results:

There was no significant difference in LE IRRs between the athletes post- versus preconcussion (P = .20) or between the postconcussion and no concussion (control) athletes (P = .08). There was an increased LE IR beyond 12 months in the postconcussion group (IR, 9.08 [95% CI, 3.68-18.89]) compared with the no concussion group (IR, 2.88 [95% CI, 2.04-3.96]) (IRR, 3.16 [95% CI, 1.21-7.15]; P = .02). Line position players had an increase in LE injuries after a concussion (IRR, 6.22 [95% CI, 1.31-23.68]; P = .03) compared with linemen with no concussion.

Conclusion:

There was no initial increase in LE IRs immediately after a concussion; however, there was an increased LE IR more than 12 months after a concussion. There was no increase in LE IRs demonstrated by skill and other position groups. Line position players experienced an increased LE IR the next season after a concussion or greater than 12 months after the injury.

In-Season Variations in Head Impact Exposure among Youth Football Players

Head impact exposure (HIE) is often summarized by the total exposure measured during the season and does not indicate how the exposure was accumulated, or how it varied during the season. Therefore, the objective of this study was to compare HIE during pre-season, the first and second halves of the regular season, and playoffs in a sample of youth football players (n = 119, aged 9-13 years). Athletes were divided into one of four exposure groups based on quartiles computed from the distribution of risk-weighted cumulative exposure (RWE_CP). Mean impacts per session and mean 95th percentile linear and rotational acceleration in practices and games were compared across the four exposure groups and time frames using mixed effects models. Within games, the mean 95th percentile accelerations for the entire sample ranged from 47.2g and 2331.3 rad/sec² during pre-season to 52.1g and 2533.4 rad/sec² during the second half of regular season. Mean impacts per practice increased from pre-season to the second half of regular season and declined into playoffs among all exposure groups; however, the variation between time frames was not greater than two impacts per practice. Time of season had a significant relationship with mean 95th percentile linear and rotational acceleration in games (both, p = 0.01) but not with practice accelerations or impacts per session. The in-practice mean levels of 95th percentile linear and rotational acceleration remained fairly constant across the four time frames, but in games these changed over time depending on exposure group (interactions, p ≤ 0.05). The results of this study improve our understanding of in-season variations in HIE in youth football and may inform important opportunities for future interventions.

Head coaches' attitudes towards injury prevention and use of related methods in professional basketball: A survey

OBJECTIVES

To investigate the practices and attitudes of professional basketball head coaches towards injury prevention.

DESIGN

Survey.

SETTING

Elite-level basketball.

PARTICIPANTS

Head coaches of all 366 German professional teams.

MAIN OUTCOME MEASURES

Use of injury risk screening methods, rated importance of different musculoskeletal injuries and rated effectiveness of preventive interventions.

RESULTS

Eighty-three of 366 invited coaches (23%) responded to the survey. No non-response bias was detected. Only one of three teams conducts systematic injury screenings. The most commonly used test was the functional movement screen (73.1% of users), while balance and strength testing (both 38.5%) were least prevalent. Top-rated preventive interventions included balance and strength training, training of functional movement patterns, and stretching. In contrast, passive interventions, e.g. the use of orthoses, were not considered effective. The involvement of a health professional (e.g. physiotherapist) was associated with the performance of injury screening, but not with the choice of specific tests or preventive strategies.

CONCLUSIONS

The methods applied to conduct injury screening and prevent musculoskeletal disorders in German professional basketball teams seem only partially backed by scientific evidence. Although not correlated with the tests and interventions used, the involvement of health-related stakeholders might help to identify players at increased injury risk.

The Evolving Treatment Patterns of NCAA Division I Football Players by Orthopaedic Team Physicians Over the Past Decade, 2008-2016

Background:

Previous studies have analyzed the treatment patterns used to manage injuries in National Collegiate Athletic Association (NCAA) Division I football players.

Hypothesis:

Treatment patterns used to manage injuries in NCAA Division I football players will have changed over the study period.

Study Design:

Descriptive epidemiology study.

Level of Evidence:

Level 5.

Methods:

The head orthopaedic team physicians for all 128 NCAA Division I football teams were asked to complete a survey containing questions regarding experience as team physician, medical coverage of the team, reimbursement issues, and treatment preferences for some of the most common injuries occurring in football players. Responses from the current survey were compared with responses from the same survey sent to NCAA Division I team physicians in 2008.

Results:

Responses were received from 111 (111/119, 93%) NCAA Division I orthopaedic team physicians in 2008 and 115 (115/128, 90%) orthopaedic team physicians between April 2016 and April 2017. The proportion of team physicians who prefer a patellar tendon autograft for primary anterior cruciate ligament reconstruction (ACLR) increased from 67% in 2008 to 83% in 2016 (P < 0.001). The proportion of team physicians who perform anterior shoulder stabilization arthroscopically increased from 69% in 2008 to 93% in 2016 (P < 0.0001). Of team physicians who perform surgery for grade III posterior cruciate ligament (PCL) injuries, the proportion who use the arthroscopic single-bundle technique increased from 49% in 2008 to 83% in 2016 (P < 0.0001). The proportion of team physicians who use Toradol injections prior to a game to help with nagging injuries decreased from 62% in 2008 to 26% in 2016 (P < 0.0001).

Conclusion:

Orthopaedic physicians changed their injury treatment preferences for NCAA Division I football players over the study period. In particular, physicians have changed their preferred techniques for ACLR, anterior shoulder stabilization, and PCL reconstruction. Physicians have also become more conservative with pregame Toradol injections.

Clinical Relevance:

These opinions may help guide treatment decisions and lead to better care of all athletes.