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Nguyen JC, Caine D. Youth soccer players: patterns of injury involving the primary growth plates of epiphyses. Skeletal Radiol 2024:10.1007/s00256-023-04541-y. [PMID: 38175258 DOI: 10.1007/s00256-023-04541-y] [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: 07/12/2023] [Revised: 09/08/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
Youth soccer (football) is immensely popular internationally. Earlier participation, sport sub-specialization, and year-around practice have led to an increased incidence of injury from both acute trauma and repetitive overuse. The growth plates (physes) of the immature skeleton are particularly vulnerable to injury and delayed diagnosis can lead to future growth disturbance and long-term morbidity. Familiarity with the various components of the growth plate complex necessary for ensuring normal endochondral ossification is fundamental in understanding the various patterns of imaging findings following injury. This review discusses the zonal columnar arrangement of the growth plate proper and the contrasting function of the vasculature within the subjacent epiphysis and metaphysis. This is followed by an evidence-based discussion of the common patterns of injury involving the epiphyseal primary growth plate observed among youth soccer players: subcategorized into physeal fractures (direct injury) and physeal stress injuries (indirect insult to subjacent metaphysis). In this section, the role of imaging and characteristic imaging features will be discussed. While the normal physiologic and pathophysiologic mechanisms can be applied to other growth plates, such as primary growth plates underlying the apophyses and secondary growth plates surrounding the secondary ossificiation centers, which also undergo endochondral ossification, the current review is focused on injuries involving the primary growth plates underlying epiphyses.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Dennis Caine
- Kinesiology and Public Health Education, Division of Education, Health and Behavior Studies, University of North Dakota, Grand Forks, ND, 58202-8235, USA
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Robles-Palazón FJ, López-Valenciano A, De Ste Croix M, Oliver JL, García-Gómez A, Sainz de Baranda P, Ayala F. Epidemiology of injuries in male and female youth football players: A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:681-695. [PMID: 34700052 PMCID: PMC9729930 DOI: 10.1016/j.jshs.2021.10.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/10/2021] [Accepted: 07/21/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND To conduct a systematic review and meta-analysis of epidemiological data of injuries in male and female youth football players. METHODS Searches were performed in MEDLINE/PubMed, Web of Science, Cochrane Library, and SPORTDiscus databases. Studies were considered if they reported injury incidence rate in male and female youth (≤19 years old) football players. Two reviewers (FJRP and ALV) extracted data and assessed trial quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale. The Grading of Recommendations Assessment, Development, and Evaluation approach determined the quality of evidence. Studies were combined using a Poisson random effects regression model. RESULTS Forty-three studies were included. The overall incidence rate was 5.70 injuries/1000 h in males and 6.77 injuries/1000 h in females. Match injury incidence (14.43 injuries/1000 h in males and 14.97 injuries/1000 h in females) was significantly higher than training injury incidence (2.77 injuries/1000 h in males and 2.62 injuries/1000 h in females). The lower extremity had the highest incidence rate in both sexes. The most common type of injury was muscle/tendon for males and joint/ligament for females. Minimal injuries were the most common in both sexes. The incidence rate of injuries increased with advances in chronological age in males. Elite male players presented higher match injury incidence than sub-elite players. In females, there was a paucity of data for comparison across age groups and levels of play. CONCLUSION The high injury incidence rates and sex differences identified for the most common location and type of injury reinforce the need for implementing different targeted injury-risk mitigation strategies in male and female youth football players.
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Affiliation(s)
- Francisco Javier Robles-Palazón
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Campus of Excellence Mare Nostrum, University of Murcia, Murcia 30720, Spain
| | | | - Mark De Ste Croix
- School of Sport and Exercise, University of Gloucestershire, Gloucester GL2 9HW, UK
| | - Jon L Oliver
- Youth Physical Development Centre, School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff CF23 6XD, UK; Sport Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland 0632, New Zealand
| | - Alberto García-Gómez
- Operative Research Centre, Miguel Hernández University of Elche, Elche 03202, Spain
| | - Pilar Sainz de Baranda
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Campus of Excellence Mare Nostrum, University of Murcia, Murcia 30720, Spain
| | - Francisco Ayala
- Department of Physical Activity and Sport, Faculty of Sport Sciences, Campus of Excellence Mare Nostrum, University of Murcia, Murcia 30720, Spain; School of Sport and Exercise, University of Gloucestershire, Gloucester GL2 9HW, UK
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Materne O, Chamari K, Farooq A, Tabben M, Weir A, Holmich P, Bahr R, Greig M, McNaughton LR. Shedding light on incidence and burden of physeal injuries in a youth elite football academy: A 4-season prospective study. Scand J Med Sci Sports 2021; 32:165-176. [PMID: 34551163 DOI: 10.1111/sms.14059] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Physeal injuries have been overlooked in epidemiological research in youth sports. Our prospective study investigated the incidence, severity, and burden of physeal injuries in a youth elite football academy. METHODS In total, 551 youth male football players from under-9 to under-19 were included and observed over four consecutive seasons. Injuries involving the physis were diagnosed and recorded according to type, location, and diagnosis. Injury incidence (II), severity (days lost), and injury burden (IB) were calculated per squad per season (25 players/squad). RESULTS There were 307 physeal injuries: 262 apophyseal (85%), 26 physeal (9%), 2 epiphyseal (1%), and 17 other physeal injuries (5%) with 80% (n=245) causing time-loss. The overall mean incidence of time-loss physeal injuries was 6 injuries/squad-season, leading to a total of 157 days lost/squad-season. The U-16s had the highest burden with 444 days lost per squad-season [median: 20 (95% CI: 12-30) days; II: 10 (95% CI: 7.3.1-13.4)]. Apophyseal injuries of the hip-pelvis resulted in the greatest burden [median: 13 (95% CI: 10-17); II: 2.5 (95% CI: 2.1-3.0)]. Peak apophyseal injury incidence per body parts occurred in U-11 for foot-ankle (II: 2.4; 95% CI: 1.0-4.9), U-14 for knee (II: 4.5; 95% CI: 2.7-7.1), and U-17 for hip-pelvis (II: 6.4; 95% CI: 4.2-9.3). CONCLUSION Physeal injuries accounted for a quarter of all-time loss with the largest injury burden in U-16. Most physeal injuries involved the lower limb and affected the apophysis. Physeal and apophyseal injuries incidence, burden, and pattern vary substantially depending on age. Hip-pelvic apophyseal injuries accounted for the largest injury burden.
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Affiliation(s)
- Olivier Materne
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Aspire Health Centre, Aspire Academy, Doha, Qatar.,Rangers Football Club, Glasgow, Scotland
| | - Karim Chamari
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | | | - Adam Weir
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.,Sport Medicine and Exercise Clinic Haarlem (SBK), Haarlem, The Netherlands
| | - Per Holmich
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Orthopaedic Research Center - Copenhagen (SORC-C), Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Roald Bahr
- ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Matt Greig
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Lars R McNaughton
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK.,Department of Sport and Movement Studies, Faculty of Health Science, University of Johannesburg, Auckland Park, South Africa
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Randell RK, Clifford T, Drust B, Moss SL, Unnithan VB, De Ste Croix MBA, Datson N, Martin D, Mayho H, Carter JM, Rollo I. Physiological Characteristics of Female Soccer Players and Health and Performance Considerations: A Narrative Review. Sports Med 2021; 51:1377-1399. [PMID: 33844195 PMCID: PMC8222040 DOI: 10.1007/s40279-021-01458-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/18/2022]
Abstract
Female soccer has seen a substantial rise in participation, as well as increased financial support from governing bodies over the last decade. Thus, there is an onus on researchers and medical departments to develop a better understanding of the physical characteristics and demands, and the health and performance needs of female soccer players. In this review, we discuss the current research, as well as the knowledge gaps, of six major topics: physical demands, talent identification, body composition, injury risk and prevention, health and nutrition. Data on female talent identification are scarce, and future studies need to elucidate the influence of relative age and maturation selection across age groups. Regarding the physical demands, more research is needed on the pattern of high-intensity sprinting during matches and the contribution of soccer-specific movements. Injuries are not uncommon in female soccer players, but targeting intrinsically modifiable factors with injury prevention programmes can reduce injury rates. The anthropometric and physical characteristics of female players are heterogeneous and setting specific targets should be discouraged in youth and sub-elite players. Menstrual cycle phase may influence performance and injury risk; however, there are few studies in soccer players. Nutrition plays a critical role in health and performance and ensuring adequate energy intake remains a priority. Despite recent progress, there is considerably less research in female than male soccer players. Many gaps in our understanding of how best to develop and manage the health and performance of female soccer players remain.
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Affiliation(s)
- Rebecca K Randell
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK.
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - Thomas Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Barry Drust
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Samantha L Moss
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK
- Department of Sport and Exercise Sciences, University of Chester, Chester, UK
| | - Viswanath B Unnithan
- Institute of Clinical Exercise and Health Science, Division of Sport and Exercise, School of Health and Life Sciences, University of the West of Scotland, Hamilton, Scotland, UK
| | | | - Naomi Datson
- Institute of Sport, University of Chichester, Chichester, UK
| | - Daniel Martin
- School of Sport and Exercise Science, University of Lincoln, Lincoln, UK
| | - Hannah Mayho
- Sports Science Department, Manchester City Football Club, Manchester, UK
| | - James M Carter
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK
| | - Ian Rollo
- Gatorade Sports Science Institute, Life Sciences R&D, PepsiCo, Leicester, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Malina RM, Martinho DV, Valente-dos-Santos J, Coelho-e-Silva MJ, Kozieł SM. Growth and Maturity Status of Female Soccer Players: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1448. [PMID: 33557121 PMCID: PMC7913875 DOI: 10.3390/ijerph18041448] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/20/2022]
Abstract
Reported mean ages, heights and weights of female soccer players aged <19 years in 161 studies spanning the years 1992-2020 were extracted from the literature or calculated from data available to the authors; 35 studies spanning the years 1981-2020 also included an indicator of biological maturation. Heights and weights were plotted relative to U.S. reference data. Preece-Baines Model 1 was fitted to moving averages to estimate ages at peak velocity. Maturity indicators included skeletal age, pubertal status, age at menarche, percentage of predicted adult height and predicted maturity offset. Heights and weights showed negligible secular variation across the time interval. Heights were slightly above or approximated the reference medians through 14 years old and then varied between the medians and 75th percentiles through 18 years old. Weights were above the reference medians from 9 to 18 years old. Mean ages at menarche ranged from 12.7 to 13.0 years. The trend in heights and weights suggested the persistence and/or selection of taller and heavier players during adolescence, while estimated age at peak height velocity (PHV) and ages at menarche were within the range of mean ages in European and North American samples. Data for skeletal and sexual maturity status were limited; predicted maturity offset increased linearly with mean ages and heights at prediction.
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Affiliation(s)
- Robert M. Malina
- Department of Kinesiology and Health Education, University of Texas, Austin, TX 78712, USA
- School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40292, USA
| | - Diogo V. Martinho
- University of Coimbra, FCDEF, CIDAF (uid/dtp/042143/2020), 3040-248 Coimbra, Portugal; (D.V.M.); (M.J.C.-e.-S.)
| | - João Valente-dos-Santos
- Faculty of Physical Education and Sport, Lusófona University, 1749-024 Lisbon, Portugal;
- Faculty of Sports Science and Physical Education, University of Coimbra, CIDAF (uid/dtp/042143/2020), 3040-248 Coimbra, Portugal
| | - Manuel J. Coelho-e-Silva
- University of Coimbra, FCDEF, CIDAF (uid/dtp/042143/2020), 3040-248 Coimbra, Portugal; (D.V.M.); (M.J.C.-e.-S.)
| | - Sławomir M. Kozieł
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wrocław, Poland;
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Materne O, Chamari K, Farooq A, Weir A, Hölmich P, Bahr R, Greig M, McNaughton LR. Injury incidence and burden in a youth elite football academy: a four-season prospective study of 551 players aged from under 9 to under 19 years. Br J Sports Med 2020; 55:493-500. [PMID: 33199359 DOI: 10.1136/bjsports-2020-102859] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Investigate the incidence and burden of injuries by age group in youth football (soccer) academy players during four consecutive seasons. METHODS All injuries that caused time-loss or required medical attention (as per consensus definitions) were prospectively recorded in 551 youth football players from under 9 years to under 19 years. Injury incidence (II) and burden (IB) were calculated as number of injuries per squad season (s-s), as well as for type, location and age groups. RESULTS A total of 2204 injuries were recorded. 40% (n=882) required medical attention and 60% (n=1322) caused time-loss. The total time-loss was 25 034 days. A squad of 25 players sustained an average of 30 time-loss injuries (TLI) per s-s with an IB of 574 days lost per s-s. Compared with the other age groups, U-16 players had the highest TLI incidence per s-s (95% CI lower-upper): II= 59 (52 to 67); IB=992 days; (963 to 1022) and U-18 players had the greatest burden per s-s: II= 42.1 (36.1 to 49.1); IB= 1408 days (1373 to 1444). Across the cohort of players, contusions (II=7.7/s-s), sprains (II=4.9/s-s) and growth-related injuries (II=4.3/s-s) were the most common TLI. Meniscus/cartilage injuries had the greatest injury severity (95% CI lower-upper): II= 0.4 (0.3 to 0.7), IB= 73 days (22 to 181). The burden (95% CI lower-upper) of physeal fractures (II= 0.8; 0.6 to 1.2; IB= 58 days; 33 to 78) was double than non-physeal fractures. SUMMARY At this youth football academy, each squad of 25 players averaged 30 injuries per season which resulted in 574 days lost. The highest incidence of TLI occurred in under-16 players, while the highest IB occurred in under-18 players.
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Affiliation(s)
- Olivier Materne
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar .,Aspire Health Centre, Aspire Academy, Doha, Qatar
| | - Karim Chamari
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Abdulaziz Farooq
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Adam Weir
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sport medicine and exercise, clinic Haarlem (SBK), Haarlem, The Netherlands.,Erasmus MC, Department of Orthopaedics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Per Hölmich
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Orthopaedic Research Center, Copenhagen (SORC-C) - Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Roald Bahr
- ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Matt Greig
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Lars R McNaughton
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK.,Department of Sport and Movement Studies, Faculty of Health Science, University of Johannesburg, Auckland Park, South Africa
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Angoorani H, Haratian Z, Mazaherinezhad A, Younespour S. Injuries in iran futsal national teams: a comparative study of incidence and characteristics. Asian J Sports Med 2014; 5:e23070. [PMID: 25520767 PMCID: PMC4267490 DOI: 10.5812/asjsm.23070] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 03/25/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Futsal is a growing sport with lots of fans in many countries including Iran, but there are few papers in the literature which report injuries in top level futsal. Objectives: The aim of this study is to record and analyze the incidence and characteristics of injuries in Iran futsal national teams from March 2011 to September 2012. Patients and Methods: 55 Iranian national futsal players participated in this prospective cohort study. Before entering the study, all players took part in Pre-Competition Medical Assessment (PCMA) in accordance with FIFA protocol. Team physicians recorded the injuries throughout the match and trainings in a special form which was designed for this purpose. Finally, data analysis was done with the SPSS software. Results: The total exposure time for all players was 24326 hours (21138 hours during training and 3188 hours during matches). During the study period, 32 of the 55 national players (58.2%) incurred 54 injuries (incidence rate = 2.22 injuries per 1000 players-hours). The incidence rate of injury in female players was significantly higher than male players (P = 0.001). The majority of injuries (85.2%) were located on the lower extremities. The ankle was the most frequent injury location (40.7%) and sprain was the most frequent type of injury. Conclusions: Injuries are common among futsal players and female players are more prone to injuries than male players. The ankle is the most frequent site and sprain is the most frequent type of injury among futsal players.
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Affiliation(s)
- Hooman Angoorani
- Department of Sports and Exercise Medicine, Hazrat Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, IR Iran
| | - Zohreh Haratian
- Department of Sports and Exercise Medicine, Hazrat Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Zohreh Haratian, Department of Sports and Exercise Medicine, Hazrat Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2164352446, Fax: +98-2166509108, E-mail:
| | - Ali Mazaherinezhad
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Shima Younespour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
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Jacobson I, Tegner Y. Injuries among female football players – With special emphasis on regional differences. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/14038190600621706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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