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Schneider KN, Zafeiris T, Gosheger G, Klingebiel S, Rickert C, Schachtrup T, Theil C. Shoulder dislocations in professional male football (soccer): A retrospective epidemiological analysis of the German Bundesliga from season 2012/2013 until 2022/2023. Knee Surg Sports Traumatol Arthrosc 2024; 32:1591-1598. [PMID: 38643395 DOI: 10.1002/ksa.12199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE Injuries exert a detrimental impact on the team performance in professional football. Shoulder dislocations are known for their severity and often cause substantial lay-off times. However, there is a notable gap in the general understanding regarding the frequency and convalescence of these events in professional football. Thus, the aims of this study were (1) to determine the incidence, (2) to evaluate return to competition (RTC) and redislocation events (RDEs) and (3) to identify relevant player-, match- and injury-related parameters. METHODS All shoulder dislocations within the highest three German football leagues (1.-3. Bundesliga) during the seasons 2012/2013 until 2022/2023 were identified. Player-, injury- and match-related data were obtained by performing a media analysis. Data were analysed using descriptive statistics. p Value was set at 0.05. RESULTS A total of 90 first-time shoulder dislocations in 89 players with a median age of 25 years (interquartile range [IQR]: 23-28) were available for analysis. The incidence was 9.1 per 1000 Bundesliga matches played and increased over time. Forty-four (49%) shoulder dislocations were treated conservatively and 46 (51%) operatively. Median RTC was 24 days (IQR: 12-43) following conservative and 103 days (IQR: 85-135) following surgical treatment (p < 0.001). Twenty-two (24%) players suffered a redislocation, of whom 13 (59%) underwent initial conservative and nine (41%) initial surgical treatment (not significant [n.s.]). RDE following conservative treatment was after a median of 4 months (IQR: 2-22) and 7 months (IQR: 3-23) following surgical treatment (n.s.). CONCLUSION The incidence of shoulder dislocation within professional football is increasing and currently amounts to 9.1 per 1000 matches played. A conservative treatment leads to a quicker RTC, while frequency and time to RDE were similar regardless of treatment. The increasing incidence of shoulder dislocations in professional football necessitates an analysis of relevant injury mechanisms and the implementation of specific preventive measures. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Theodoros Zafeiris
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Sebastian Klingebiel
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Carolin Rickert
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Tim Schachtrup
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
| | - Christoph Theil
- Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany
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Ryan L, Doody O. The treatment, outcomes and management of hand, wrist, finger, and thumb injuries in the professional/amateur contact sport athletes: A scoping review. Int J Orthop Trauma Nurs 2024; 54:101108. [PMID: 38885544 DOI: 10.1016/j.ijotn.2024.101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Amateur and professional participation in sport and physical activity worldwide is increasing in popularity, which in turn is increasing the volume and types of injuries sustained by athletes. Ensuring these injuries are treated appropriately and efficiently is paramount for athletes' recovery and return to sport in a timely and safe manner. METHODS A scoping review to map the evidence regarding the treatment, outcomes and management of hand, wrist, finger, and thumb injuries in the professional/amateur athlete from contact sports. A search of seven electronic databases; SPORTdiscus, CINAHL, Medline, Scopus, Web of Science, Embase and Cochrane Library and grey literature was conducted in January 2024. The reporting of the review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. Inductive content analysis was used to examine the data and the Critical Appraisal Skills Programme was used to appraise the quality of the included studies. RESULTS Eight papers met the inclusion criteria and three themes emerged addressing the return to play/sport, surgical and conservative treatment and the most common/reoccurring injuries sustained from contact sports. CONCLUSION Managing hand, wrist, finger, and thumb injuries in athletes requires a varied approach depending on the type of injury, treatment options, and external pressures. While conservative treatment is common and effective, surgical intervention may be necessary in certain cases to improve recovery and facilitate a faster return to sport. Preventive measures in high-risk sports settings could help reduce the incidence of these injuries.
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Affiliation(s)
- Linda Ryan
- Injury Unit, Nenagh Hospital, Nenagh, Co. Tipperary, Ireland.
| | - Owen Doody
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
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Moran FG, Hurley ET, Storme JG, Karavan MP, Downey SA, Klifto CS, Delaney RA, Mullett H. Studies on Bankart Repair for Anterior Shoulder Instability Show Poor Reporting of Data and Reflect Low Level of Evidence: A Systematic Review. Arthroscopy 2024; 40:963-969.e5. [PMID: 37474082 DOI: 10.1016/j.arthro.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE To assess the quality and level of evidence of studies reporting on Bankart repair for anterior shoulder instability. METHODS A search was performed using the PubMed/Medline database for all studies that reported clinical outcomes on Bankart repair for anterior shoulder instability. The search term "Bankart repair" with all results were analyzed via strict inclusion and exclusion criteria. Two independent investigators scored each included study based on the 10 criteria of the Modified Coleman Methodology Score (CMS) out of 100 and gave each study a score out of 25 based on the Anterior Shoulder Instability (ASI) Methodology criteria. RESULTS Two hundred sixty-six studies were included in the analysis and encompassed a total of 19,156 patients and 19,317 surgical procedures for Bankart repair for shoulder instability. Overall, 81.6% of studies were Level III or IV evidence. The mean CMS score for the studies was 55.3 out of 100, and the mean ASI Methodology score for the studies was 12.1 out of 25. Weaknesses in the studies were identified in sample size, description of preoperative investigations and diagnoses, reporting of mean glenoid bone loss, nonsubjective clinical outcome reporting, and description of associated pathologies. CONCLUSIONS A large proportion of studies reporting the clinical outcomes of Bankart repair for anterior shoulder instability are of low methodological quality and have a low level of evidence. CLINICAL RELEVANCE This study emphasizes need for greater reporting of many variables such as body mass index, mean glenoid bone loss, and patient-reported outcomes and provides a framework for future studies reporting.
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Affiliation(s)
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A..
| | | | - Mark P Karavan
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | | | - Christopher S Klifto
- Sports Surgery Clinic, Dublin, Ireland; Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
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Hurley ET, Lunn K, Bethell M, Levin J, Pasqualini I, Frangiamore S, Anakwenze O, Klifto CS. Return to play following operative management of anterior shoulder instability in overhead athletes-A systematic review. Shoulder Elbow 2024; 16:15-23. [PMID: 38435042 PMCID: PMC10902415 DOI: 10.1177/17585732231205175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 03/05/2024]
Abstract
Background The purpose of this study was to systematically review the rate and timing of return to play in overhead athletes following operative management of anterior shoulder instability. Methods A systematic literature search based on PRISMA guidelines, utilizing the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to play among overhead athletes following arthroscopic Bankart repair, open Latarjet procedure or Remplissage procedure. Results There are 23 studies included with 961 patients. Among those undergoing arthroscopic Bankart repair, the rate of return to play was 86.2%, with 70.6% returning to the same level of play and the mean time to return to play was 7.1 months. Among those undergoing an open Latarjet procedure, the rate of return to play was 80.9%, with 77.7% returning to the same level of play and the mean time to return to play was 5.1 months. Among those undergoing a Remplissage procedure, the rate of return to play was 70.6%, with 70.0% returning to the same level of play or mean time to return to play. Discussion Overall, there were high rates of return to play following operative management of anterior shoulder instability in overhead athletes.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Kiera Lunn
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Jay Levin
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Lin E, Tummala SV, Morikawa L, Vij N, Petty SB, McQuivey KS, Chhabra A. Strains/Sprains and Fractures Are the Most Common Hand and Wrist Injuries in National Basketball Association Athletes Who Return to Preinjury Player Efficiency and Equal or Greater True Shooting Percentage Within Two Years of Injury. Arthrosc Sports Med Rehabil 2023; 5:100829. [PMID: 38107373 PMCID: PMC10724484 DOI: 10.1016/j.asmr.2023.100829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/24/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To characterize the prevalence and incidence of in-game hand and wrist injuries in the National Basketball Association (NBA), to determine the factors associated with an equal or greater player efficiency rating (PER), and to determine the factors associated with an equal or greater true shooting percentage (TS%) 2 years after a hand and wrist injury using a large-scale national database of NBA players. Methods Injury data from seasons 2015-2016 to 2020-2021, with exclusion of the 2019-2020 because of abbreviated play due to the coronavirus disease 2019, were extracted from a public online database, Pro Sports Transactions. Injury characteristics and NBA player demographic information were assessed using descriptive statistics. Poisson logistic regression analyses were performed to identify risk factors associated with equal or increased PER and TS% 2years after injury. Results There were 214 reported hand and wrist injuries, and of these injuries, 173 (81%) were classified as structural. The most common injury types were a strain or sprain (0.63 per 1,000 game exposures), followed by fractures (0.37 per 1,000 game exposures). Older age (relative risk [RR] 0.89; 95% confidence interval [CI] 0.84-0.95) and more years played in the NBA were modestly associated with relative risk of having a decreased PER at 2 years after injury. Increased weight (RR 1.02; 95% CI 1-1.05) and increased body mass index (RR 1.14; 95% CI 1.01-1.29) were also modestly associated with having a decreased PER and TS%, respectively at 2 years after injury. Conclusions Strains/sprains and fractures are the most common hand and wrist injuries sustained by NBA players. Regardless of dominant or nondominant hand and wrist injuries, NBA players are likely to return to baseline overall player efficiency based on PER and TS% within 2 years of injury. Clinical Relevance Our study characterizes hand and wrist injuries of NBA players and provides an understanding for these injuries on player performance at 2 years.
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Affiliation(s)
- Eugenia Lin
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | | | | | - Neeraj Vij
- Department of Orthopedic Surgery, University of Kansas – Wichita, Wichita, Kansas, U.S.A
| | | | - Kade S. McQuivey
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Anikar Chhabra
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
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Morikawa LH, Tummala SV, Brinkman JC, Crijns TJ, Lai CH, Chhabra A. Shoulder and Elbow Injuries in National Basketball Association Athletes and Their Effects on Player Performance. Orthop J Sports Med 2023; 11:23259671231202973. [PMID: 37810744 PMCID: PMC10559716 DOI: 10.1177/23259671231202973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background Shoulder and elbow function is essential to basic basketball actions. Outside of anterior shoulder instability, injuries in these joints are not well characterized in National Basketball Association (NBA) players. Purpose To describe the epidemiology and associated risk factors of shoulder and elbow injuries in NBA players and identify factors that influence player performance upon return to play. Study Design Descriptive epidemiology study. Methods Historical injury data from the 2015-2020 NBA seasons were retrieved from Pro Sports Transactions, a public online database. An injury was defined as a health-related concern resulting in an absence of ≥1 NBA games. Primary measures included pre- and postinjury player efficiency rating (PER) and true shooting percentage (TS%) with interquartile ranges (IQRs), stratified by extremity dominance. Multivariate logistic regression analyses with stepwise regression were performed to identify risk factors associated with return-to-play performance. Results A total of 192 shoulder and elbow injuries were sustained among 126 NBA athletes, with incidence rates of 1.11 per 1000 game exposures (GEs) and 0.30 per 1000 GEs, respectively. Sprain/strain and general soreness were the most common injury types in both the shoulder and the elbow. In the 2 years after injury, baseline PER was achieved in all groups, except for players with dominant shoulder injuries (baseline PER, 16 [IQR, 14-18] vs 2-year PER, 13 [IQR 11-16]; P = .012). Younger age was associated with quicker return to baseline PER (odds ratio, 0.77 [95% CI, 0.67-0.88]). Shoulder and elbow injuries did not negatively influence TS% upon return to play (baseline TS%, 0.55% [IQR, 0.51%-0.58%] vs 1-year TS%, 0.55% [IQR, 0.52%-0.58%]; P = .13). Conclusion Dominant shoulder injuries negatively influenced PER during the first 2 seasons upon return to play in NBA players. Therefore, expectations that players with this type of injury immediately achieve baseline statistical production should be tempered. Shooting accuracy appears to remain unaffected after shoulder or elbow injury.
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Affiliation(s)
- Landon H. Morikawa
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | | | | | - Tom J. Crijns
- Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Cara H. Lai
- Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Collins AP, Ali S, Zaruta D, Perry N, Riemenschneider J, Service BC. Validity of Video-Based Analysis for Analyzing Shoulder Injuries in the National Basketball Association. Orthop J Sports Med 2023; 11:23259671231157768. [PMID: 36896095 PMCID: PMC9989390 DOI: 10.1177/23259671231157768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/09/2022] [Indexed: 03/11/2023] Open
Abstract
Background Shoulder injuries are very common in athletes playing in the National Basketball Association (NBA). With increasing injury video uploads available online, we may be able to identify and systematically describe the mechanism of these injuries in these athletes. Purpose To (1) determine the validity of video-based analysis to evaluate mechanisms of shoulder injuries in NBA players during the 2010-2020 seasons and (2) report on commonly sustained injuries, circumstances associated with injury, and number of games missed owing to injury. Study Design Cross-sectional study; Level of evidence, 3. Methods An injury report data set was queried for shoulder injuries among NBA players between the 2010-2011 season and the 2019-2020 season, and results were cross-referenced using YouTube.com to identify high-quality videos of the injuries. Out of 532 shoulder injuries in this time frame, video evidence from 39 (7.3%) were evaluated for mechanism of injury and other corresponding situational data. From the remaining shoulder injuries, a randomly selected control cohort of 50 injuries occurring in the same interval was assessed for descriptive injury data, incidence of recurrence, necessity for surgery, and number of games missed, to compare with corresponding data from injuries in the videographic evidence cohort. Results In the videographic evidence cohort, the most common mechanism of injury was lateral contact to the shoulder (41%; P < .001), which was associated with an injury to the acromioclavicular joint (30.8%; P < .001). Injuries occurred more often when the team was on offense (58.9%; P < .001) versus defense. Players who required surgery missed 33 more games on average than players who did not require surgery (P < .001). For the injured players, a 33% incidence of reinjury was identified in the 12 months after their initial injury. As compared with the control cohort, no significant differences were noted in injury laterality, recurrence rates, necessity for surgical management, time in the season, or number of games missed. Conclusion Despite its low yield of 7.3%, video-based analysis may be a useful tool to determine the mechanism of shoulder injuries in the NBA, given the similarities of injury characteristics as compared with the control group.
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Affiliation(s)
- Andrew P Collins
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Sabah Ali
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Douglas Zaruta
- Orlando Health Jewett Orthopedic Institute, Orlando, Florida, USA
| | - Nichole Perry
- Orlando Health Jewett Orthopedic Institute, Orlando, Florida, USA
| | | | - Benjamin C Service
- College of Medicine, University of Central Florida, Orlando, Florida, USA.,Orlando Health Jewett Orthopedic Institute, Orlando, Florida, USA.,College of Medicine, Florida State University, Tallahassee, Florida, USA
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Stokes DJ, McCarthy TP, Frank RM. Physical Therapy for the Treatment of Shoulder Instability. Phys Med Rehabil Clin N Am 2023; 34:393-408. [PMID: 37003660 DOI: 10.1016/j.pmr.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Shoulder instability is the separation of the humeral head from the glenoid. Injury to the static and dynamic stabilizers can result in instability. Anterior shoulder instability is the predominant form of instability. It is usually a result of trauma. Posterior shoulder instability often presents with an insidious onset of pain. Multidirectional instability of the shoulder is symptomatic laxity in more than one plane of motion. The primary goal of rehabilitation is to restore pain-free mobility, strength, and functioning. Rehabilitation implements range of motion and strengthening exercises to restore proprioceptive control and scapular kinematics.
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Wang D, Taek JY, Wang S. COMBINED TRAINING AND EXPLOSIVE STRENGTH IN BASKETBALL PLAYERS' LOWER LIMBS. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329012022_0572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
ABSTRACT Introduction: Basketball presents unique competitive characteristics, requiring athletes a high level of strength, especially explosive strength. Objective: Study the effect of combined training on the explosive power of lower limbs in basketball players. Methods: The author selected 18 basketball players, equally distributed with the random method into a unipodal combined training group (S group), a two-legged combined training group (D group), and a conventional strength training group (W group), for the three-test data. Statistical analysis was performed on the data collected from the experiment. Results: There was a significant difference in approach height and three-quarter sprint in group S (p<0.05). The difference was not evident in the height of touch in situ (p>0.05). In group D, there was a significant difference in situ touch height p<0.01. There was no significant difference in the results of the three test indicators in group W (p>0.05). Conclusion: Compared to conventional strength training, unipodal combined training is more effective for the development of explosive strength in the lower limbs of basketball students. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.
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Liu X. INFLUENCE OF LADDER TRAINING ON MOTOR COORDINATION IN BASKETBALL PLAYERS. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329012022_0660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
ABSTRACT Introduction: The ladder training method was implemented in the USA in the late 20th century to train the agility the motor coordination of athletes in the United States. It is believed that this exercise can be a beneficial addition to the training of basketball players. Objective: Study the ladder training method's influences on basketball players’ sensitivity. Methods: Following the parameters of the current scientific literature, an experimental ladder training protocol was designed. Basketball players aged 10-12 years in sports schools were selected as volunteers for the experiment. The influence of motor coordination qualities was measured pre and post-test. The collected data were statistically analyzed and discussed. Results: The experimental group had significant differences in the activities of running for 30 meters, and vertical jump. Very significant changes were also found in the cross jump repeated in 20 seconds, cross quadrant jump, and 5-meter triangular slide. Conclusion: Ladder training beneficially influenced the motor coordination of young basketball players, implementing general and sport-specific agility. Combining it with standardized training is recommended for further promotion of motor quality in young basketball players. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.
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Betsch M, Darwich A, Chang J, Whelan D, Ogilvie-Harris D, Chahal J, Theodoropoulos J. Wide Variability in Return-to-Sport Criteria used by Team Physicians After Anterior Cruciate Ligament Reconstruction in Elite Athletes—A Qualitative Study. Arthrosc Sports Med Rehabil 2022; 4:e1759-e1766. [DOI: 10.1016/j.asmr.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
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Testa EJ, Brodeur PG, Li LT, Berglund-Brown IS, Modest JM, Gil JA, Cruz AI, Owens BD. Social and Demographic Factors Impact Shoulder Stabilization Surgery in Anterior Glenohumeral Instability. Arthrosc Sports Med Rehabil 2022; 4:e1497-e1504. [PMID: 36033183 PMCID: PMC9402473 DOI: 10.1016/j.asmr.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/04/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess independent predictors of surgery after an emergency department visit for shoulder instability, including patient-related and socioeconomic factors. Methods Patients presenting to the emergency department were identified in the New York Statewide Planning and Research Cooperative System database from 2015 to 2018 by International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes for anterior shoulder dislocation or subluxation. All shoulder stabilization procedures in the outpatient setting were identified using Current Procedural Terminology codes (23455, 23460, 23462, 23466, and 29806). A multivariable logistic regression was performed to assess the impact of patient factors on the likelihood of receiving surgery. The variables included in the analysis were age, sex, race, social deprivation, Charlson Comorbidity Index, recurrent dislocation, and primary insurance type. Results In total, 16,721 patients with a shoulder instability diagnosis were included in the analysis and 1,028 (6.1%) went on to have surgery. Patients <18 years old (odds ratio [OR] 8.607, P < .0001), those with recurrent dislocations (OR 2.606, P < .0001), or worker’s compensation relative to private insurance (OR 1.318, P = .0492) had increased odds of receiving surgery. Hispanic (OR 0.711, P = .003) and African American (OR 0.63, P < .0001) patients had decreased odds of surgery compared with White patients. Patients with Medicaid (OR 0.582, P < .0001) or self-pay (OR 0.352, P < .0001) insurance had decreased odds of undergoing surgery relative to privately insured patients. Patients with greater levels of social deprivation (OR 0.993, P < .0001) also were associated with decreased odds of surgery. Conclusions Anterior glenohumeral instability and subsequent stabilization surgery is associated with disparities among patient race, primary insurance, and social deprivation. Clinical Relevance Considering the relationship between differential care and health disparities, it is critical to define and increase physician awareness of these disparities to help ensure equitable care.
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Affiliation(s)
- Edward J. Testa
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
- Address correspondence to Edward J. Testa, Department of Orthopaedic Surgery, Brown University, 2 Dudley St., Providence, RI 02903.
| | - Peter G. Brodeur
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Lambert T. Li
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Isabella S. Berglund-Brown
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Jacob M. Modest
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Joseph A. Gil
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Aristides I. Cruz
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
| | - Brett D. Owens
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, U.S.A
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Rossi LA, Pasqualini I, Tanoira I, Ranalletta M. Factors That Influence the Return to Sport After Arthroscopic Bankart Repair for Glenohumeral Instability. Open Access J Sports Med 2022; 13:35-40. [PMID: 35401017 PMCID: PMC8985826 DOI: 10.2147/oajsm.s340699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Numerous studies have reported high rates of return to sports following arthroscopic Bankart repair (ABR) However, there is enormous controversy regarding the optimal management of these patients in the postoperative period. Controversy issues include rehabilitation, criteria for returning to sports, and the specific management of each athlete according to the sport they practice. Even though there are several rehabilitation protocols published in the literature, wide variability exists concerning the key elements of rehabilitation after an ABR. Regarding criteria for return to sports, there is a wide variation across the different published studies. The type of sports has been shown to affect an athlete’s decision to return to sports. Nevertheless, most research is evaluated by classifications that cluster different sports into categories that may have other influences in return to sports when analyzed separately. Finally, in addition to physical readiness, the athlete’s psychological state is crucial for returning to sports. However, the contribution of psychological readiness to an athlete’s return to sports after shoulder instability surgery remains uncertain and unexplored.
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Affiliation(s)
- Luciano Andrés Rossi
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
- Correspondence: Luciano Andrés Rossi, Peron 4190 (C1199ABB), Buenos Aires, Argentina, Email
| | - Ignacio Pasqualini
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Ignacio Tanoira
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
| | - Maximiliano Ranalletta
- Hospital Italiano de Buenos Aires, Investigation Performed at the Shoulder Unit Department of Orthopedic Surgery, Buenos Aires, Argentina
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Lian J, Sewani F, Dayan I, Voleti PB, Gonzalez D, Levy IM, Musahl V, Allen A. Systematic Review of Injuries in the Men's and Women's National Basketball Association. Am J Sports Med 2022; 50:1416-1429. [PMID: 34213367 DOI: 10.1177/03635465211014506] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous studies have reported the incidence and outcomes of injuries in the men's and women's National Basketball Association (NBA and WNBA, respectively). PURPOSE To synthesize published data regarding the incidence and outcomes of all injuries in the NBA and WNBA in a comprehensive review. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched 3 electronic databases (PubMed, MEDLINE, Embase) for studies of all levels of evidence since 1990 pertaining to injuries sustained by active players in the NBA and WNBA. Studies were excluded if the cohort of interest included ≤3 active players. RESULTS The initial search of the 3 databases yielded 1253 unique studies, of which 49 met final inclusion criteria for this review. Only 4 studies included athletes in the WNBA. Based on the mean annual incidence, the 5 most common orthopaedic sports injuries sustained in the NBA were concussions (9.5-14.9 per year), fractures of the hand (3.5-5.5 per year), lower extremity stress fractures (4.8 per year), meniscal tears (2.3-3.3 per year), and anterior cruciate ligament tears (1.5-2.6 per year). Cartilage defects treated using microfracture, Achilles tendon ruptures, and anterior cruciate ligament injuries were 3 injuries that led to significant reductions in performance measurements after injury. CONCLUSION With advances in sports technology and statistical analysis, there is rapidly growing interest in injuries among professional basketball athletes. High-quality prospective studies are needed to understand the prevalence and effect of injuries on player performance and career length. This information can inform preventative and treatment measures taken by health care providers to protect players and guide safe return to play at a high level.
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Affiliation(s)
- Jayson Lian
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Faraz Sewani
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Isaac Dayan
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Pramod B Voleti
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - David Gonzalez
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - I Martin Levy
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Answorth Allen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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15
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Castle JP, Cotter DL, Jildeh TR, Abbas MJ, Gaudiani MA, Ghali A, Bridges C, Moutzouros V. Reduced Career Longevity but Return to Baseline Performance After Arthroscopic Shoulder Labral Repair in National Hockey League Players. Arthrosc Sports Med Rehabil 2022; 4:e599-e605. [PMID: 35494311 PMCID: PMC9042737 DOI: 10.1016/j.asmr.2021.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/16/2021] [Indexed: 10/25/2022] Open
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16
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Lavoie-Gagne O, Mehta N, Patel S, Cohn MR, Forlenza E, Nwachukwu BU, Forsythe B. Adductor Muscle Injuries in UEFA Soccer Athletes: A Matched-Cohort Analysis of Injury Rate, Return to Play, and Player Performance From 2000 to 2015. Orthop J Sports Med 2022; 9:23259671211023098. [PMID: 35146028 PMCID: PMC8822003 DOI: 10.1177/23259671211023098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The effects of adductor muscle injury on performance in soccer athletes are unknown. Purpose: To (1) determine the rate and time to return to play (RTP) after adductor muscle injury, (2) investigate the rate of reinjury after RTP, and (3) investigate any long-term effects of injury on elite soccer player performance. Study Design: Cohort study; Level of evidence, 3. Methods: Using publicly available records, athletes sustaining adductor muscle injury were identified across the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A) between 2000 and 2015. Injured athletes were matched to controls by demographic characteristics and performance metrics from 1 season before the index timepoint. Investigations included the rate of RTP, reinjuries, player characteristics associated with RTP within 2 seasons, player availability, field time, and performance metrics during the 4 seasons after injury. Results: A total of 671 players with adductor muscle injury were included. Based on time to RTP, 86% of injuries were mild to moderate (4-28 days missed), and 4% required surgical intervention. Players with adductor muscle injury were absent for a median of 22 days (range, 1-700 days) and 4 games (range, 1-76 games). A total of 521 (78%) players returned at the same level, with no demographic or clinical characteristics associated with RTP on the multivariable regression. Of those returning to play, 143 (21%) experienced adductor reinjury. After RTP, defenders demonstrated decreased field time compared with controls (P < .05). As compared with controls, defenders and midfielders scored more points and goals per game during the season of the injury (P < .01), while attackers recorded more goals and assists per game the season after injury (P < .05). Conclusion: Only 3 in 4 players (78%) returned to participate in an official match, and the reinjury rate was high (21%). After RTP, defenders demonstrated decreased field time versus controls. On the other hand, defenders and midfielders recorded more points and goals per game, while attackers recorded more goals and assists per game versus controls. Although the multivariable analysis results did not identify player characteristics associated with RTP, there was a position-dependent association on player performance after RTP.
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Affiliation(s)
| | - Nabil Mehta
- Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois, USA
| | - Sumit Patel
- Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois, USA
| | - Matthew R Cohn
- Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois, USA
| | - Enrico Forlenza
- Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois, USA
| | - Benedict U Nwachukwu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois, USA
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17
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Lavoie-Gagne OZ, Korrapati A, Retzky J, Bernstein DN, Diaz CC, Berlinberg EJ, Forlenza EM, Fury MS, Mehta N, O'Donnell EA, Forsythe B. Return to Play and Player Performance After Meniscal Tear Among Elite-Level European Soccer Players: A Matched Cohort Analysis of Injuries From 2006 to 2016. Orthop J Sports Med 2022; 10:23259671211059541. [PMID: 35047646 PMCID: PMC8761888 DOI: 10.1177/23259671211059541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Meniscal injuries are extremely common in soccer athletes, and little is known about postrecovery performance. Purpose: To (1) identify characteristics associated with return to play (RTP) to the same league level and (2) evaluate long-term effects that injury and management approach may have on player performance. Study Design: Cohort study; Level of evidence, 3. Methods: Using publicly available records, we identified athletes who sustained meniscal tears across the 5 major European soccer leagues (English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A) between 2006 and 2016. Injured athletes were matched to controls 1:2 by demographics and performance. Investigations included rate of RTP to the same league level, reinjury, player characteristics associated with RTP within 2 seasons, long-term availability, field time, and performance metrics standardized to 90 minutes of play during the next 4 seasons. Results: A total of 250 players sustaining meniscal tears were included, of which 106 (42%) received surgical management. Median absence was 57.5 days (interquartile range [IQR], 35-92) or 7 games (IQR, 4-12). Rate of RTP was 70%, and the reinjury rate 5% if a player could RTP. Age greater than 30 years was a negative predictor for RTP (odds ratio [OR], 0.62; P = .002), whereas higher preinjury goals per game (OR, 2.80; P = .04) and surgical management (OR, 1.38; P = .002) were positive predictors for RTP. Surgical management was associated with higher long-term availability (P < .01). As compared with the control, there were no significant differences in field time or performance metrics after RTP, either overall or by player position. As compared with nonoperative management, defenders undergoing surgery demonstrated decreased field time. Attackers and midfielders demonstrated similar field time and performance regardless of management. Conclusion: RTP of elite soccer athletes sustaining meniscal tear is contingent on age, preinjury performance, and management approach. Those who RTP to the same league level can be expected to demonstrate equivalent field time, performance, and long-term availability as noninjured athletes.
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Affiliation(s)
- Ophelie Z Lavoie-Gagne
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Avinaash Korrapati
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Julia Retzky
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, New York, USA
| | - David N Bernstein
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Connor C Diaz
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Elyse J Berlinberg
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Enrico M Forlenza
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Matthew S Fury
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nabil Mehta
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Evan A O'Donnell
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian Forsythe
- Department of Sports Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
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18
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Wolf BR, Tranovich MA, Marcussen B, Powell KJ, Fleming JA, Shaffer MA. Team Approach: Treatment of Shoulder Instability in Athletes. JBJS Rev 2021; 9:01874474-202111000-00002. [PMID: 34757979 DOI: 10.2106/jbjs.rvw.21.00087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Shoulder instability is a complex problem with a high rate of recurrence in athletes. Treatment of a first-time subluxation or dislocation event is controversial and depends on patient-specific factors as well as the identified pathology. » Athletic trainers and physical therapists are an integral part of the treatment team of an in-season athlete who has experienced a shoulder instability event. Through comprehensive physiological assessments, these providers can effectively suggest modifications to the patient's training regimen as well as an appropriate rehabilitation program. » Surgical intervention for shoulder stabilization should use an individualized approach for technique and timing. » A team-based approach is necessary to optimize the care of this high-demand, high-risk population.
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Affiliation(s)
- Brian R Wolf
- University of Iowa Sports Medicine, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
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de Sire A, Marotta N, Lippi L, Scaturro D, Farì G, Liccardi A, Moggio L, Letizia Mauro G, Ammendolia A, Invernizzi M. Pharmacological Treatment for Acute Traumatic Musculoskeletal Pain in Athletes. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111208. [PMID: 34833426 PMCID: PMC8618079 DOI: 10.3390/medicina57111208] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022]
Abstract
Pain management is a crucial issue for athletes who train and compete at the highest performance levels. There are still evidence gaps for the use of analgesics for sports injuries despite the growing interest in training and competition settings. However, high-quality research is needed to determine the most appropriate and optimal timing and formulations in non-steroidal anti-inflammatory drug and opioid management, particularly given the strictness of anti-doping regulations. Indeed, the role of pharmacological therapy in reducing acute traumatic pain in athletes should still be addressed to minimize the timing of return to sport. Therefore, the aim of this comprehensive review was to summarize the current evidence about pain management in the setting of acute injury in elite athletes, providing the most informed strategy for pain relief and performance recovery.
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Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (L.M.); (A.A.)
- Correspondence: ; Tel.: +39-0961712819
| | - Nicola Marotta
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (L.M.); (A.A.)
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (L.L.); (M.I.)
| | - Dalila Scaturro
- Physical and Rehabilitative Medicine, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90100 Palermo, Italy; (D.S.); (G.L.M.)
| | - Giacomo Farì
- Motor and Sports Sciences, Department of Sciences and Biological and Environmental Technologies, Salento University, 73100 Lecce, Italy;
| | - Alfonso Liccardi
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy;
| | - Lucrezia Moggio
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (L.M.); (A.A.)
| | - Giulia Letizia Mauro
- Physical and Rehabilitative Medicine, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90100 Palermo, Italy; (D.S.); (G.L.M.)
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (L.M.); (A.A.)
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (L.L.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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20
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Diaz CC, Forlenza EM, Lavoie-Gagne OZ, Knapik DM, Korrapati A, Chahla J, Forsythe B. Acromioclavicular Joint Separation in UEFA Soccer Players: A Matched-Cohort Analysis of Return to Play and Player Performance From 1999 to 2018. Orthop J Sports Med 2021; 9:23259671211026262. [PMID: 34708134 PMCID: PMC8543588 DOI: 10.1177/23259671211026262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background Acromioclavicular joint (ACJ) separation injuries are uncommon in professional soccer players, threatening future performance and team contributions. Data regarding return to play (RTP) in professional soccer players after ACJ separation are limited. Purpose To determine the rate, time to RTP, and player performance after ACJ separation in soccer players from the top 5 professional European leagues when compared with a retrospective, matched cohort of uninjured players. Study Design Cohort study; Level of evidence, 3. Methods Professional soccer players suffering ACJ separation injuries between 1999 and 2018 were identified and were matched to uninjured players (2 controls to 1 injured player) by position, height, age, season year, and length of time played. Information on date of injury, timing to RTP, and player performance metrics (minutes played, games played, goals scored, assists made, and points per game) were collected from transfermarkt.co.uk, uefa.com, fifa.com, official team websites, public injury reports, and press releases. Change in performance metrics for the 4 seasons after the season of injury were based on metrics 1 season before injury. Univariate comparisons were performed using independent 2-group t tests and Wilcoxon rank-sum tests when normality of distributions was violated. Results A total 59 soccer players with ACJ separation injuries were identified. Mean age at injury was 24.6 ± 5.3 years. Of these, 81% of the players returned to play, with 69% returning within postinjury season 1. Mean time to RTP was 49.8 ± 24.3 days (5.9 ± 4.1 games). Two players suffered recurrent ACJ separation injuries in their professional soccer careers. There were no significant differences between athletes who sustained ACJ injuries versus control athletes in the number of games played, minutes per game per season, goals scored, assists, or points in the 4 seasons after injury. Defenders played fewer minutes and recorded fewer assists during postinjury season 1 when compared with control athletes. Conclusion Of the 59 elite soccer players who sustained ACJ separation injuries during the study period, 81% returned to elite competition. Performance metrics were similar to preinjury levels and matched, uninjured control players.
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Affiliation(s)
- Connor C Diaz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Enrico M Forlenza
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ophelie Z Lavoie-Gagne
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Avinaash Korrapati
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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21
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Forlenza EM, Lavoie-Gagne OZ, Lu Y, Diaz CC, Chahla J, Forsythe B. Return to Play and Player Performance After Achilles Tendon Rupture in UEFA Professional Soccer Players: A Matched-Cohort Analysis of Players From 1999 to 2018. Orthop J Sports Med 2021; 9:23259671211024199. [PMID: 35146029 PMCID: PMC8822021 DOI: 10.1177/23259671211024199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 02/03/2023] Open
Abstract
Background: Achilles tendon rupture (ATR) is a potentially career-ending injury in professional athletes. Limited information exists regarding return to play (RTP) in professional soccer players after this injury. Purpose: To determine the RTP rate and time in professional soccer players after ATR and to evaluate player performance relative to matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 132 professional soccer players who suffered an ATR between 1999 and 2018. These athletes were matched 2:1 to uninjured controls by position, age, season of injury, seasons played, and height. We collected information on the date of injury, the date of RTP, and player performance metrics (minutes played, games played, goals scored, assists made, and points per game) from official team websites, public injury reports, and press releases. Changes in performance metrics for the 4 years after the season of injury were compared with metrics 1 season before injury. Univariate comparisons were performed using independent-sample, 2-group t tests and Wilcoxon rank-sum tests when normality of distributions was violated. Results: The mean age at ATR was 27.49 ± 4.06 years, and the mean time to RTP was 5.07 ± 2.61 months (18.19 ± 10.96 games). The RTP rate was 71% for the season after injury and 78% for return at any timepoint. Overall, 9% of the injured players experienced a rerupture during the study period. Compared with controls, the injured players played significantly less (-6.77 vs -1.81 games [P < .001] and -560.17 vs -171.17 minutes [P < .05]) and recorded fewer goals (-1.06 vs -0.29 [P < .05]) and assists (-0.76 vs -0.02 [P < .05]) during the season of their Achilles rupture. With the exception of midfielders, there were no significant differences in play time or performance metrics between injured and uninjured players at any postinjury timepoint. Conclusion: Soccer players who suffered an ATR had a 78% RTP rate, with a mean RTP time of 5 months. Injured players played less and demonstrated inferior performance during the season of injury. With the exception of midfielders, players displayed no significant differences in play time or performance during any of the 4 postinjury seasons.
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Affiliation(s)
- Enrico M Forlenza
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ophelie Z Lavoie-Gagne
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Yining Lu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Connor C Diaz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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22
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Forsythe B, Lavoie-Gagne OZ, Forlenza EM, Diaz CC, Mascarenhas R. Return-to-Play Times and Player Performance After ACL Reconstruction in Elite UEFA Professional Soccer Players: A Matched-Cohort Analysis From 1999 to 2019. Orthop J Sports Med 2021; 9:23259671211008892. [PMID: 34104662 PMCID: PMC8165856 DOI: 10.1177/23259671211008892] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) rupture is one of the most common injuries afflicting soccer players and requires a lengthy recovery processes after reconstructive surgery. The impact of ACL reconstruction (ACLR) on return to play (RTP) time and player performance in professional soccer players remains poorly studied. Purpose/Hypothesis: To determine player performance and RTP rate and time after ACLR in elite professional soccer players with a retrospective matched-cohort analysis. We expected that the RTP time and rate will be similar to those of other professional-level athletes. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 51 players from 1 of the 5 elite Union of European Football Associations (UEFA) soccer leagues who suffered a complete ACL rupture between 1999 and 2019. These athletes were matched by position, age, season of injury, seasons played, and height and compared to uninjured control players. Change in performance metrics for the 4 years after the season of injury were compared with metrics 1 season before injury. Univariate 2-group comparisons were performed using independent 2-group t tests; Wilcoxon rank-sum tests were used when normality of distributions was violated. Results: Overall, 41 players (80%) returned to play after ACL rupture, with 6 (12%) experiencing a subsequent ipsilateral or contralateral ACL tear. The mean (±SD) RTP time for soccer players after ACLR was 216 ± 109 days (26 ± 18 games). Injured athletes played significantly fewer games and minutes per season and recorded inferior performances for 2 seasons after their injury (P < .001). However, the game performance of injured players equaled or exceeded that of their matched controls by season 3 after injury, with the exception of attackers, who demonstrated a continued decline in performance (P < .001). Conclusion: Results indicated that the mean RTP time for soccer players after ACLR is short in comparison with other major sports leagues (216 days). However, RTP rates were high, and rerupture rates were comparable with those of other sports. With the exception of attackers, player performance largely equaled or exceeded that of matched controls by the third postinjury season.
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Affiliation(s)
- Brian Forsythe
- Midwest Orthopaedics at Rush, Division of Sports Medicine, Chicago, Illinois, USA
| | - Ophelie Z Lavoie-Gagne
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Enrico M Forlenza
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Connor C Diaz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Randy Mascarenhas
- Department of Orthopaedic Surgery, The Winnipeg Clinic, Winnipeg, Manitoba, Canada
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23
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McAdams TR. Editorial Commentary: Operative Versus Nonoperative Management of Shoulder Instability in the National Football League Athlete: Do What Needs to Be Done-Treatment Choice Does Not Affect Future Performance or Games Played. Arthroscopy 2021; 37:1446-1448. [PMID: 33896499 DOI: 10.1016/j.arthro.2021.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 02/02/2023]
Abstract
Shoulder instability is common in the National Football League athlete. Nonoperative versus operative treatment of shoulder labrum injury without bone loss depends on many factors, including type and direction of instability, presence or absence of pain and recurrent instability that limits function, and player and season situational issues. Prophylactic surgical treatment in an effort to enhance future player performance and increase the number of future games played should be discouraged. Management of shoulder instability should be based on clinical indication and surgical stabilization should not be done prophylactically in the hope of increasing the number of future games played or enhancing performance.
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24
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Career Longevity and Performance After Shoulder Instability in National Football League Athletes. Arthroscopy 2021; 37:1437-1445. [PMID: 33422614 DOI: 10.1016/j.arthro.2020.12.225] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the career longevity, game utilization, and performance of National Football League (NFL) athletes after glenohumeral instability events treated operatively versus nonoperatively. METHODS Using public resources, we identified NFL players who sustained a shoulder instability event from September 2000 to February 2019. Players with prior shoulder instability, without NFL experience before injury, or who did not return to play (RTP) after injury were excluded. Demographic information, utilization (games and seasons), and season approximate value (SAV) statistics were recorded 1 year prior to injury and 3 years after RTP. Statistical analysis compared utilization and the SAV after RTP for athletes managed operatively versus nonoperatively. RESULTS We identified 97 NFL players who sustained their first instability event while playing in the NFL, 91 of whom returned to play (93.8%). Quarterbacks were significantly more likely to undergo immediate surgical management compared with players in other positions (P = .023). The final analysis included 58 players managed operatively and 33 managed nonoperatively by the end of the index season. Players treated operatively played in significantly more seasons after RTP during their remaining careers (4.1 ± 2.7 seasons vs 2.8 ± 2.5 seasons, P = .015). There were no differences in games played or started, offensive or defensive snap count percentage, or performance (SAV) before and after injury when compared between cohorts (P > .05). After surgical stabilization, time to RTP (36.62 ± 10.32 weeks vs 5.43 ± 12.33 weeks, P < .05) and time interval before recurrent instability (105.7 ± 100.1 weeks vs 24.7 ± 40.6 weeks, P < .001) were significantly longer than with nonoperative treatment. Additionally, the operative cohort experienced less recurrent instability (27% vs 50%, P = .035). CONCLUSIONS Athletes who RTP in the NFL after a shoulder instability injury do so with a similar workload and performance irrespective of surgical or nonsurgical management. Whereas nonoperative treatment is associated with faster RTP, operative management is associated with fewer recurrent instability events, greater time between recurrent instability events, and greater career longevity. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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25
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Allahabadi S, Su F, Lansdown DA. Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players. Orthop J Sports Med 2021; 9:2325967120982076. [PMID: 33623799 PMCID: PMC7878958 DOI: 10.1177/2325967120982076] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/31/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Athletes in the Women’s National Basketball Association (WNBA) and National Basketball Association (NBA) are subject to high injury rates given the physical demands of the sport. Comprehensive data regarding injury patterns and rates in these athletes are limited. Purpose: To summarize available data on orthopaedic and sports medicine–related injuries through 2020 in professional female and male basketball players. Study Design: Systematic review; Level of evidence, 4. Methods: A search was conducted using PubMed and Embase through April 5, 2020, to identify injury studies regarding WNBA and NBA players. Studies were included if the injury or surgery was considered a direct consequence of game play including musculoskeletal/orthopaedic, concussion, ophthalmologic, and craniomaxillofacial injuries. Systematic reviews, screening studies, or studies without sufficient WNBA or NBA player subgroup analysis were excluded. Results: A total of 49 studies met inclusion criteria, 43 (87.8%) of which detailed musculoskeletal injuries. The lower extremity represented 63.3% of studies. A majority (59.2%) of studies were level 4 evidence. The source of data was primarily comprehensive online search (n = 33; 67.3%), followed by official databases (n = 11; 22.4%). Only 3 studies concerned WNBA athletes compared with 47 that concerned NBA athletes. The lowest return-to-play rates were cited for Achilles tendon repairs (61.0%-79.5%). Variability in return-to-play rates existed among studies even with similar seasons studied. Conclusion: The majority of literature available on orthopaedic and sports medicine–related injuries of NBA and WNBA athletes is on the lower extremity. The injuries that had the greatest effect on return to play and performance were Achilles tendon ruptures and knee cartilage injuries treated using microfracture. The reported outcomes are limited by heterogeneity and overlapping injury studies. There are limited available data on WNBA injuries specifically.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Favian Su
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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26
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Higgins MJ, DeFroda S, Yang DS, Brown SM, Mulcahey MK. Professional Athlete Return to Play and Performance After Shoulder Arthroscopy Varies by Sport. Arthrosc Sports Med Rehabil 2021; 3:e391-e397. [PMID: 34027447 PMCID: PMC8128995 DOI: 10.1016/j.asmr.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To determine whether differences in return-to-play (RTP) rate and performance-based outcomes exist following shoulder arthroscopy in athletes from the National Football League (NFL), National Basketball League (NBA), Major League Baseball (MLB), and National Hockey League (NHL). Methods Professional athletes from the NFL, NBA, MLB, and NHL who underwent shoulder arthroscopy between January 1998 and December 2016 were identified through an established review of injury reports and public archives. Sport-specific statistics were collected before and after shoulder arthroscopy for each athlete, providing a performance score. RTP was defined as the first game played postsurgery. Results Of the 208 professional athletes who met the inclusion criteria, 167 (80.3%) returned to play following shoulder arthroscopy, with MLB players returning at a significantly lower rate than those of other sports (P < .0001). NBA players had significantly shorter recovery times (201 days; P < .01) and MLB players had significantly longer recovery times (413 days; P < .001) when compared with athletes in other sports. The mean number of seasons played after shoulder arthroscopy was 3.7, 4.7, 4.8, and 5.8 for MLB, NFL, NHL, and NBA, respectively. NBA players performed worse in their first season postoperative compared with their preoperative performance (P = .0017), but their postoperative season 2 performance returned to their preoperative performance level (P = .1893). Similarly, NHL players performed worse in their postoperative season 1 compared with preoperative performance (P = .0274), but their postoperative season 2 performance improved upon their preinjury performance level (P = .0861). Conclusions There is a modest RTP rate among professional athletes following shoulder arthroscopy. MLB players have the longest average time to RTP and the shortest postinjury careers following shoulder arthroscopy. However, they demonstrate no significant decline in performance following their injury. Conversely, NBA players had the shortest average time to RTP and the longest post-injury career. Both NBA and NHL athletes experienced a decrease in performance in post-operative season one. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
| | - Steven DeFroda
- Department of Orthopaedic Surgery, Brown University School of Medicine, Providence, Rhode Island, U.S.A
| | - Daniel S Yang
- Department of Orthopaedic Surgery, Brown University School of Medicine, Providence, Rhode Island, U.S.A
| | - Symone M Brown
- Department of Orthopaedic Surgery, New Orleans, Louisiana, U.S.A.,Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, New Orleans, Louisiana, U.S.A.,Tulane University School of Medicine, New Orleans, Louisiana, U.S.A
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27
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Khalil LS, Jildeh TR, Tramer JS, Abbas MJ, Hessburg L, Mehran N, Okoroha KR. Effect of Achilles Tendon Rupture on Player Performance and Longevity in National Basketball Association Players. Orthop J Sports Med 2020; 8:2325967120966041. [PMID: 33294475 PMCID: PMC7708715 DOI: 10.1177/2325967120966041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: National Basketball Association (NBA) players who return to sport (RTS) after Achilles tendon rupture have been reported to have poor outcomes. Purpose: To evaluate the effect of Achilles tendon ruptures on player performance and career longevity in NBA athletes. Study Design: Cohort study; Level of evidence, 3. Methods: NBA players who sustained Achilles tendon ruptures between 1970 and 2019 were identified using publicly available resources and were matched 1:1 to a healthy control group by age, position, height, and body mass index. Demographic characteristics, player utilization (games and minutes), and performance efficiency rating (PER) were documented for all athletes. The season of Achilles tendon rupture was set as the index year, and statistical analysis compared postindex versus preindex data both acutely and in the long term. Percentages relative to preoperative values were calculated to compare the injured and control groups in a standardized fashion. Results: Of 47 players, 34 (72.3%) with Achilles tendon ruptures returned to play at the NBA level after surgical intervention. A total of 7 players were excluded from the study. No differences were found in demographic characteristics or PER (2 years before injury) between the remaining 27 players and matched controls. The injured players had significantly shorter careers compared with control players (3.1 ± 2.3 vs 5.8 ± 3.5 seasons, respectively; P < .05). Injured players demonstrated significant declines in games per season (GPS), minutes per game (MPG), and PER at 1 year and 3 years after RTS compared with preindex baseline (P < .05). Injured players, compared with control players, had reduced relative percentages of games started (GS) (50% vs 125%, respectively), MPG (83% vs 103%), and PER (80% vs 96%) at 1 year after return (P < .05), but reductions at extended 3-year follow-up were seen only in GPS (71% vs 91%) and GS (39% vs 99%) (P < .05). Conclusion: Our study found that 72.3% of NBA players returned to play after Achilles tendon repair, but they had shorter careers compared with uninjured controls. Players returning from Achilles tendon repairs had decreased game utilization and performance at all time points relative to their individual preindex baseline. However, for the injured players when compared with controls, game utilization but not performance was found to be decreased at 3-year follow-up.
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Affiliation(s)
- Lafi S Khalil
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Joseph S Tramer
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muhammad J Abbas
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Luke Hessburg
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nima Mehran
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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