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Svantesson J, Piussi R, Weissglas E, Svantesson E, Horvath A, Börjesson E, Williams A, Prill R, Samuelsson K, Hamrin Senorski E. Shedding light on the non-operative treatment of the forgotten side of the knee: rehabilitation of medial collateral ligament injuries-a systematic review. BMJ Open Sport Exerc Med 2024; 10:e001750. [PMID: 38933372 PMCID: PMC11202733 DOI: 10.1136/bmjsem-2023-001750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Objective The purpose of this study was to review the current literature regarding the non-operative treatment of isolated medial collateral ligament (MCL) injuries. Design Systematic review, registered in the Open Science Framework (https://doi.org/10.17605/OSF.IO/E9CP4). Data sources The Embase, MEDLINE and PEDro databases were searched; last search was performed on December 2023. Eligibility criteria Peer-reviewed original reports from studies that included information about individuals who sustained an isolated MCL injury with non-surgical treatment as an intervention, or reports comparing surgical with non-surgical treatment were eligible for inclusion. Included reports were synthesised qualitatively. Risk of bias was assessed with the Risk of Bias Assessment tool for Non-randomized Studies. Certainty of evidence was determined using the Grading of Recommendations Assessment Development and Evaluation. Results A total of 26 reports (1912 patients) were included, of which 18 were published before the year 2000 and 8 after. No differences in non-operative treatment were reported between grade I and II injuries, where immediate weight bearing and ambulation were tolerated, and rehabilitation comprised different types of strengthening exercises with poorly reported details. Some reports used immobilisation with a brace as a treatment method, while others did not use any equipment. The use of a brace and duration of use was inconsistently reported. Conclusion There is substantial heterogeneity and lack of detail regarding the non-operative treatment of isolated MCL injuries. This should prompt researchers and clinicians to produce high-quality evidence studies on the promising non-operative treatment of isolated MCL injuries to aid in decision-making and guide rehabilitation after MCL injury. Level of evidence Level I, systematic review.
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Affiliation(s)
| | - Ramana Piussi
- Department of Health and Rehabilitation, University of Gothenburg, Institute of Neuroscience and Physiology, Goteborg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
| | | | - Eleonor Svantesson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopedics, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Alexandra Horvath
- Department of Orthopedics, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Börjesson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopedics, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Andy Williams
- FIFA Medical Centre of Excellence, Fortius Clinic City, London, Greater London, UK
| | - Robert Prill
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, University of Gothenburg, Institute of Neuroscience and Physiology, Goteborg, Sweden
- Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
- Swedish Olympic Comitee, Stockholm, Sweden
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Della Villa F, Buckthorpe M, Pellegrini A, Ranzini A, Esposito F, Crescenzo C, Nanni G, Zago M. A comparative video analysis of hamstring injuries mechanism and situational pattern in men's and women's football (soccer). Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38881374 DOI: 10.1002/ksa.12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/03/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE To describe the injury mechanism and situational patterns of severe (absence >28 days) hamstring muscle injuries in professional male and female football (soccer) players. METHODS The data for males were sourced from Serie A clubs participating in both national and international competitions from 2018 to 2021. For the female cohort, hamstring injuries were identified during matches of the top national/international competitions from 2017 to 2023. Video footage was obtained, and three raters categorised injury mechanisms and situational patterns. Injuries were also examined according to the month, minute and location. RESULTS A total of 129 severe hamstring injuries were identified, with 64 occurring in females and 65 in males. Video analysis was possible for 29 (45%) female cases and 61 (94%) male cases. Female injuries had longer lay-off times (97.8 ± 77.1 days) than males (39.6 ± 20.9 days). Females had a higher proportion of indirect contact injuries (34%) than males (13%) and a lower proportion of non-contact injuries (66% vs. 87%). Four situational patterns were identified: running was the most common for both sexes, representing 59% of female injuries and 41% of male injuries. Over-stretching injuries were split across open and CKC scenarios but collectively explained nearly half (48%) of male injuries but only one in five (21%) female injuries. Kicking injuries had a higher proportion in females (17%) than males (10%). Injuries were more common in the second half for females and the first half for males. CONCLUSION Females had a higher proportion of indirect contact, running and kicking injuries and a lower proportion of non-contact and stretch-type injuries than males. Understanding injury patterns can inform tailored prevention programs, considering sex-specific differences. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Matthew Buckthorpe
- Education and Research Department, Isokinetic Medical Group, Bologna, Italy
- Faculty of Sport, Technology and Health Sciences, St Mary's University, Twickenham, London, UK
| | - Alessandro Pellegrini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Alice Ranzini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | - Gianni Nanni
- Medical Area, Bologna Football Club 1909, Bologna, Italy
| | - Matteo Zago
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
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Serner A, Chamari K, Hassanmirzaei B, Moreira F, Bahr R, Massey A, Grimm K, Clarsen B, Tabben M. Time-loss injuries and illnesses at the FIFA world cup Qatar 2022. SCI MED FOOTBALL 2024:1-8. [PMID: 38860817 DOI: 10.1080/24733938.2024.2357568] [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: 12/28/2023] [Accepted: 05/12/2024] [Indexed: 06/12/2024]
Abstract
The study aimed to analyse incidence and characteristics of time-loss injuries and illnesses during the FIFA World Cup Qatar 2022. Of 838 male football players, 705 consented to participate. Team medical staff reported 82 time-loss injuries, corresponding to an injury event incidence of 5.6 injuries/1000 h of total exposure (95%CI 4.5 to 7.0 injuries/1000 h), with a median of 2 time-loss injury events per team (IQR, 1 to 4.5, range 0-7). The total injury burden was 103 (95% CI 61 to 152) days per 1000 h. Muscle/tendon injuries had the highest incidence of tissue types (48 cases, 3.3/1000 h (95% CI 2.5 to 4.4), and hamstring muscle injuries were the most frequent diagnosis (16 cases, incidence 1.1/1000 h, 95% CI 0.6 to 1.8). Match injury event incidence was 20.6/1000 h (15.0 to 27.7) and training injury event incidence was 2.1/1000 h (1.4 to 3.1). The majority (52%) of sudden-onset injuries were non-contact injuries, 40% direct contact and 8% indirect contact. We recorded 15 time-loss illnesses, corresponding to an illness event incidence of 1.1 per 1000 competition days, (95% CI: 0.6 to 1.8), and illness burden of 2.1 (1.0 to 3.4) days lost per 1000 competition days. The most common illness was respiratory infection (12 cases, 80%). Match injury event incidence was the lowest in any FIFA World Cup since injuries have been monitored.
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Affiliation(s)
- Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Karim Chamari
- Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
- Higher institute of Sport and Physical Education, ISSEP Ksar Saïd, Manouba University, Manouba, Tunisia
| | - Bahar Hassanmirzaei
- Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Francisco Moreira
- Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Roald Bahr
- Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Andrew Massey
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Katharina Grimm
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Ben Clarsen
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
| | - Montassar Tabben
- Aspetar Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
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Borque KA, Han S, Dunbar NJ, Lanfermeijer ND, Sij EW, Gold JE, Ismaily SK, Amis AA, Laughlin MS, Kraeutler MJ, Williams A, Lowe WR, Noble P. Single-Strand "Short Isometric Construct" Medial Collateral Ligament Reconstruction Restores Valgus and Rotational Stability While Isolated Deep MCL and Superficial MCL Reconstruction Do Not. Am J Sports Med 2024; 52:968-976. [PMID: 38343203 DOI: 10.1177/03635465231224477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND Historical MCL (medial collateral ligament) reconstruction (MCLR) techniques have focused on the superficial MCL (sMCL) to restore valgus stability while frequently ignoring the importance of the deep MCL (dMCL) in controlling tibial external rotation. The recent recognition of the medial ligament complex importance has multiple studies revisiting medial anatomy and questioning contemporary MCLR techniques. PURPOSE To assess whether (1) an isolated sMCL reconstruction (sMCLR), (2) an isolated dMCL reconstruction (dMCLR), or (3) a novel single-strand short isometric construct (SIC) would restore translational and rotational stability to a knee with a dMCL and sMCL injury. STUDY DESIGN Controlled laboratory study. METHODS Biomechanical testing was performed on 14 fresh-frozen cadaveric knee specimens using a custom multiaxial knee activity simulator. The specimens were divided into 2 groups. The first group was tested in 4 states: intact, after sectioning the sMCL and dMCL, isolated sMCLR, and isolated dMCLR. The second group was tested in 3 states: intact, after sectioning the sMCL and dMCL, and after single-strand SIC reconstruction (SICR). In each state, 4 loading conditions were applied at 0°, 20°, 40°, 60°, and 90° of knee flexion: 8-N·m valgus torque, 5-N·m external rotation torque, 90-N anterior drawer, and combined 90-N anterior drawer plus 5-N·m tibial external rotation torque. Anterior translation, valgus rotation, and external rotation of the knee were measured for each state and loading condition using an optical motion capture system. RESULTS sMCL and dMCL transection resulted in increased laxity for all loading conditions at all flexion angles. Isolated dMCLR restored external rotation stability to intact levels throughout all degrees of flexion, yet valgus stability was restored only at 0° of flexion. Isolated sMCLR restored valgus and external rotation stability at 0°, 20°, and 40° of flexion but not at 60° or 90° of flexion. Single-strand SICR restored valgus and external rotation stability at all flexion angles. In the combined anterior drawer plus external rotation test, isolated dMCL and single-strand SICR restored stability to the intact level at all flexion angles, while the isolated sMCL restored stability at 20° and 40° of flexion but not at 60° or 90° of flexion. CONCLUSION In the cadaveric model, single-strand SICR restored valgus and rotational stability throughout the range of motion. dMCLR restored rotational stability to the knee throughout the range of motion but did not restore valgus stability. Isolated sMCLR restored external rotation and valgus stability in early flexion. CLINICAL RELEVANCE In patients with anteromedial rotatory instability in the knee, neither an sMCLR nor a dMCLR is sufficient to restore stability.
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Affiliation(s)
- Kyle A Borque
- Houston Methodist Hospital, Houston, Texas, USA
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
| | - Shuyang Han
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
| | - Nicholas J Dunbar
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
| | - Nicholas D Lanfermeijer
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
| | - Ethan W Sij
- UT McGovern Medical School, Houston, Texas, USA
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
| | - Jonathan E Gold
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
| | - Sabir K Ismaily
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
| | - Andrew A Amis
- Imperial College London, London, UK
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
| | - Mitzi S Laughlin
- Houston Methodist Academic Institute, Houston, Texas, USA
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
| | - Matthew J Kraeutler
- Houston Methodist Hospital, Houston, Texas, USA
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
| | - Andy Williams
- Fortius Clinic, London, UK; FIFA Medical Centre of Excellence, London, UK
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
| | - Walter R Lowe
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
| | - Philip Noble
- Department of Orthopedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Investigation performed at the Department of Orthopedic Surgery, UT McGovern Medical School, Houston, Texas, USA
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Svantesson E, Piussi R, Beischer S, Thomeé C, Samuelsson K, Karlsson J, Thomeé R, Hamrin Senorski E. Only 10% of Patients With a Concomitant MCL Injury Return to Their Preinjury Level of Sport 1 Year After ACL Reconstruction: A Matched Comparison With Isolated ACL Reconstruction. Sports Health 2024; 16:124-135. [PMID: 36896698 PMCID: PMC10732101 DOI: 10.1177/19417381231157746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND There is a need for an increased understanding of the way a concomitant medial collateral ligament (MCL) injury may influence outcome after anterior cruciate ligament (ACL) reconstruction. HYPOTHESIS Patients with a concomitant MCL injury would have inferior clinical outcomes compared with a matched cohort of patients undergoing ACL reconstruction without an MCL injury. STUDY DESIGN Matched registry-based cohort study; case-control. LEVEL OF EVIDENCE Level 3. METHODS Data from the Swedish National Knee Ligament Registry and a local rehabilitation outcome registry were utilized. Patients who had undergone a primary ACL reconstruction with a concomitant nonsurgically treated MCL injury (ACL + MCL group) were matched with patients who had undergone an ACL reconstruction without an MCL injury (ACL group), in a 1:3 ratio. The primary outcome was return to knee-strenuous sport, defined as a Tegner activity scale ≥6, at the 1-year follow-up. In addition, return to preinjury level of sport, muscle function tests, and patient-reported outcomes (PROs) were compared between the groups. RESULTS The ACL + MCL group comprised 30 patients, matched with 90 patients in the ACL group. At the 1-year follow-up, 14 patients (46.7%) in the ACL + MCL group had return to sport (RTS) compared with 44 patients (48.9%) in the ACL group (P = 0.37). A significantly lower proportion of patients in the ACL + MCL group had returned to their preinjury level of sport compared with the ACL group (10.0% compared with 25.6%, adjusted P = 0.01). No differences were found between the groups across a battery of strength and hop tests or in any of the assessed PROs. The ACL + MCL group reported a mean 1-year ACL-RSI after injury of 59.4 (SD 21.6), whereas the ACL group reported 57.9 (SD 19.4), P = 0.60. CONCLUSION Patients with a concomitant nonsurgically treated MCL injury did not return to their preinjury level of sport to the same extent as patients without an MCL injury 1 year after ACL reconstruction. However, there was no difference between the groups in terms of return to knee strenuous activity, muscle function, or PROs. CLINICAL RELEVANCE Patients with a concomitant nonsurgically treated MCL injury may reach outcomes similar to those of patients without an MCL injury 1 year after an ACL reconstruction. However, few patients return to their preinjury level of sport at 1 year.
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Affiliation(s)
- Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden
| | - Ramana Piussi
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden, Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Beischer
- Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden, Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jón Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden, Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine Center (SSMC), Gothenburg, Sweden, Sportrehab, Sport Medicine Clinic, Gothenburg, Sweden, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Della Villa F, Massa B, Bortolami A, Nanni G, Olmo J, Buckthorpe M. Injury mechanisms and situational patterns of severe lower limb muscle injuries in male professional football (soccer) players: a systematic video analysis study on 103 cases. Br J Sports Med 2023; 57:1550-1558. [PMID: 37898508 DOI: 10.1136/bjsports-2023-106850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE The objective of this study is to describe the mechanism of injury and situational patterns (based on ball possession and playing action leading to injury) of severe (lay-off time >28 days) lower limb muscle injuries in professional male football (soccer) players during match play. METHODS Players experiencing a severe muscle injury of the lower limb during Italian first (Serie A) division male football matches over three consecutive seasons (2018-2021) were identified. Video footage was obtained and three raters independently categorised injury mechanism and situational patterns using a standardised checklist. Injury epidemiology (month), timing of injuries within the match and location of injuries on the pitch were also examined. RESULTS We identified 121 lower limb severe muscle injuries. Videos of sufficient quality were available for 103 (85%) cases, including 61 (60%) hamstring, 17 (16%) calf, 16 (15%) adductor and 9 (9%) quadricep muscle injuries. Nearly two-thirds of injuries involved the dominant/kicking leg (n=65, 63%). Eighty-five (83%) injuries were non-contact and 18 (17%) indirect contact. Four main situational patterns were identified and accounted for 88% of injuries: (1) running/acceleration (n=35, 34%); (2) closed kinetic chain stretching (n=21, 20%); (3) open kinetic chain stretching (n=19, 18%) and (4) kicking (n=16, 16%), with differences between muscle groups. 71% of injuries occurred in the first half of the match (p<0.01), with a gradual increase through the first half. CONCLUSION Most severe muscle injuries during football matches were non-contact and occurred in the first half during running/acceleration, open and closed kinetic chain stretching, or kicking.
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Affiliation(s)
- Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Bruno Massa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Antonio Bortolami
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Gianni Nanni
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Jesus Olmo
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Matthew Buckthorpe
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
- Faculty of Sport, Technology and Health Sciences, St Mary's University, Twickenham, London, UK
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Bordalo M, Serner A, Yamashiro E, Al-Musa E, Djadoun MA, Al-Khelaifi K, Schumacher YO, Al-Kuwari AJ, Massey A, D'Hooghe P, Cardinale M. Imaging-detected sports injuries and imaging-guided interventions in athletes during the 2022 FIFA football (soccer) World Cup. Skeletal Radiol 2023:10.1007/s00256-023-04451-z. [PMID: 37715819 DOI: 10.1007/s00256-023-04451-z] [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: 08/02/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To describe imaging-detected musculoskeletal injuries and image-guided interventional procedures during the 2022 FIFA football (soccer) World Cup. MATERIALS AND METHODS Retrospective analysis of all radiologic examinations performed in a central medical facility for athletes was performed by two board certified musculoskeletal radiologists. Data on muscle, tendon, ligament, cartilage, and bone injuries were collected according to imaging modality and body part. RESULTS A total of 143 radiology examinations in 94 athletes were evaluated at the central medical facility. Magnetic resonance imaging (MRI) was the most utilized modality (67%), followed by radiography (12%), ultrasonography (9%), and computed tomography (4%). Image-guided interventions corresponded to 8% of all radiological examinations. There were 112 injuries described, affecting muscles and tendons (42%), ligaments (25%), cartilage (21%), and bone (12%). Most injured body parts were thigh (27%), foot and ankle (23%), knee (23%), and hip/groin (8%). Most injured players were within the age range of 24-35 years old (71%). CONCLUSION Imaging was utilized in 11% of players who participated in the 2022 FIFA World Cup in Qatar. MRI was the most utilized modality, and acute muscle tears were the most diagnosed type of injury. Diagnostic imaging played an important role in diagnosing sports-related injuries during the 2022 FIFA World Cup.
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Affiliation(s)
- Marcelo Bordalo
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar.
| | - Andreas Serner
- Fédération Internationale de Football Association (FIFA), Zurich, Switzerland
| | | | - Emad Al-Musa
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | | | | | | | | | - Andrew Massey
- Fédération Internationale de Football Association (FIFA), Zurich, Switzerland
| | - Pieter D'Hooghe
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Marco Cardinale
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
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Bleakley C, Netterström-Wedin F. Does mechanical loading restore ligament biomechanics after injury? A systematic review of studies using animal models. BMC Musculoskelet Disord 2023; 24:511. [PMID: 37349749 DOI: 10.1186/s12891-023-06653-x] [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: 01/04/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Mechanical loading is purported to restore ligament biomechanics post-injury. But this is difficult to corroborate in clinical research when key ligament tissue properties (e.g. strength, stiffness), cannot be accurately measured. We reviewed experimental animal models, to evaluate if post-injury loading restores tissue biomechanics more favourably than immobilisation or unloading. Our second objective was to explore if outcomes are moderated by loading parameters (e.g. nature, magnitude, duration, frequency of loading). METHODS Electronic and supplemental searches were performed in April 2021 and updated in May 2023. We included controlled trials using injured animal ligament models, where at least one group was subjected to a mechanical loading intervention postinjury. There were no restrictions on the dose, time of initiation, intensity, or nature of the load. Animals with concomitant fractures or tendon injuries were excluded. Prespecified primary and secondary outcomes were force/stress at ligament failure, stiffness, laxity/deformation. The Systematic Review Center for Laboratory animal Experimentation tool was used to assess the risk of bias. RESULTS There were seven eligible studies; all had a high risk of bias. All studies used surgically induced injury to the medial collateral ligament of the rat or rabbit knee. Three studies recorded large effects in favour of ad libitum loading postinjury (vs. unloading), for force at failure and stiffness at 12-week follow up. However, loaded ligaments had greater laxity at initial recruitment (vs. unloaded) at 6 and 12 weeks postinjury. There were trends from two studies that adding structured exercise intervention (short bouts of daily swimming) to ad libitum activity further enhances ligament behaviour under high loads (force at failure, stiffness). Only one study compared different loading parameters (e.g. type, frequency); reporting that an increase in loading duration (from 5 to 15 min/day) had minimal effect on biomechanical outcomes. CONCLUSION There is preliminary evidence that post-injury loading results in stronger, stiffer ligament tissue, but has a negative effect on low load extensibility. Findings are preliminary due to high risk of bias in animal models, and the optimal loading dose for healing ligaments remains unclear.
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Affiliation(s)
- Chris Bleakley
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Jordanstown campus, Newtownabbey, UK
| | - Fredh Netterström-Wedin
- Division of Public Health Science, School of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
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Pulici L, Certa D, Zago M, Volpi P, Esposito F. Injury Burden in Professional European Football (Soccer): Systematic Review, Meta-Analysis, and Economic Considerations. Clin J Sport Med 2022; 33:00042752-990000000-00071. [PMID: 36730365 DOI: 10.1097/jsm.0000000000001107] [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: 05/31/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to evaluate the injury burden and the related economic cost in European professional male football players. DATA SOURCES Multiple database research was performed up to August 5, 2022 (PubMed, EMbase, Scopus, Cochrane Library), including only studies that reported severity in the number of days of absence for each injury, incidence reported in the number of injuries/1000 hours, or reported number of injuries and exposure time and adult male football players, professionals from European clubs. Two reviewers extracted data and assessed paper quality with the Strengthening the Reporting of Observational Studies in Epidemiology statement and the Newcastle-Ottawa Scale. MAIN RESULTS Twenty-two studies have reported incidence, severity, and burden of injuries in professional football. The highest injury burden was found for ligament-joint injuries (37.9 days/1000 hours; 222 397 €/1000 hours) and for muscle injuries (34.7 days/1000 hours; 203 620 €/1000 hours). Injury locations with high burden were knee injuries (34.8 days/1000 hours; 20 4206 €/1000 hours)-mainly anterior cruciate ligament injuries (14.4 days/1000 hours; 84 499 €/1000 h)-followed by thigh injuries (25.0 days/1000 hours; 146 700 €/1000 hours), hamstrings injuries (15.4 days/1000 hours; 90 367 €/1000 hours), hip-and-groin injuries (16.1 days/1000 hours; 94 475 €/1000 hours), primarily adductor muscles injuries (9.4 days/1000 hours; 55 159€/1000 hours), and ankle injuries (13.1 days/1000 h; 76 871 €/1000 hours) with ankle sprains (7.4 days/1000 hours; 43 423 €/1000 hours). CONCLUSIONS Being exposed to injury risk has serious consequences for individual and club performance and economy. This review identified the most relevant targets in injury management, compared their injury data with reference values, and provided economic evidence when trying to gain buy-in from the key decision makers.
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Affiliation(s)
| | - Denis Certa
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; and
| | - Matteo Zago
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; and
| | - Piero Volpi
- Knee Surgery and Sport Traumatology Unit, Humanitas Clinical and Research Center, IRCCS Rozzano, Milan, Italy
| | - Fabio Esposito
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; and
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Thompson JW, Rajput V, Kayani B, Plastow R, Magan A, Haddad FS. Surgical Repair of Stener-like Injuries of the Medial Collateral Ligament of the Knee in Professional Athletes. Am J Sports Med 2022; 50:1815-1822. [PMID: 35593741 DOI: 10.1177/03635465221093807] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A "Stener-like" lesion of the knee is defined as a distal avulsion of the superficial medial collateral ligament (sMCL) with interposition of the pes anserinus between the ligament and its tibial insertion-a displacement impeding anatomic healing. Because of the scarcity of these injuries, the literature is limited to case reports and small case series. PURPOSE To assess the effect of surgical repair of acute Stener-like lesions of the sMCL on the following outcomes: return to preinjury level of sporting function; time to return to preinjury level of sporting function; functional performance; injury recurrence; and any other complications. STUDY DESIGN Case series: Level of evidence, 4. METHODS This prospective single-surgeon study included 23 elite athletes with a mean age of 27.2 years (range, 19-37 years). Of the participants, 20 were men (87%) and 3 were women (13%). The mean body mass index was 23.1 ± 2.3. A total of 16 athletes were soccer players (70%) and 7 were rugby players (30%), with isolated acute, traumatic Stener-like lesions of the sMCL of the knee confirmed on preoperative magnetic resonance imaging. Surgical repair was undertaken with primary suture anchor repair with ligament repair or reconstruction system (LARS) augmentation. Predefined outcomes were recorded at regular intervals after surgery. The minimum follow-up time was 24 months (range, 24-108 months) from the date of surgery. RESULTS The mean time from injury to surgical intervention was 9 days (range, 3-28 days). Overall, 15 (65%) athletes had isolated distal sMCL injuries requiring anatomic suture anchor repair at the distal tibial insertion site only, and 8 (35%) athletes had concomitant injuries of the proximal and distal sMCL and required anatomic suture anchor repair at the proximal and distal attachment sites. Ten athletes required LARS augmentation at the time of the index operation. All study patients returned to their preinjury level of sporting activity in professional soccer or rugby. The mean time from surgical intervention to return to full sporting activity was 16.8 ± 2.7 weeks. At 6 and 24 months' follow-up, all patients had Tegner scores of 10. At a 2-year follow-up, all study patients were still participating at their preinjury level of sporting activity. Three patients developed complications around the LARS that required further surgery to remove synthetic material; however, this did not affect function. CONCLUSION Surgical repair of acute Stener-like lesions of the sMCL is associated with a high return to preinjury level of sporting function, excellent functional performance, and a low risk of recurrence at short-term follow-up in elite athletes.
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Affiliation(s)
- Joshua W Thompson
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK.,Department of Trauma & Orthopaedic Surgery, University College London Hospital Foundation NHS Trust, London, UK
| | - Vishal Rajput
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK.,Department of Trauma & Orthopaedic Surgery, University College London Hospital Foundation NHS Trust, London, UK
| | - Babar Kayani
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK.,Department of Trauma & Orthopaedic Surgery, University College London Hospital Foundation NHS Trust, London, UK
| | - Ricci Plastow
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK.,Department of Trauma & Orthopaedic Surgery, University College London Hospital Foundation NHS Trust, London, UK
| | - Ahmed Magan
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK.,Department of Trauma & Orthopaedic Surgery, University College London Hospital Foundation NHS Trust, London, UK
| | - Fares S Haddad
- Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK.,Department of Trauma & Orthopaedic Surgery, University College London Hospital Foundation NHS Trust, London, UK
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11
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Tensiomyography Allows to Discriminate between Injured and Non-Injured Biceps Femoris Muscle. BIOLOGY 2022; 11:biology11050746. [PMID: 35625474 PMCID: PMC9138955 DOI: 10.3390/biology11050746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/01/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022]
Abstract
The hamstring muscle group is the most frequently injured muscle group in non-contact muscle injuries in sports involving high-speed running. A total of 84% of hamstring injuries affect the biceps femoris (BF) muscle. Clinical assessments and magnetic resonance imaging (MRI) are routinely used for diagnosis and plan management. MRI-negative scans for clinically diagnosed hamstring injuries range from 14% to 45%. We tested the hypothesis that the functional differences between injured and non-injured BF assessed by tensiomyography can be used for diagnostic and classification purposes. We compared an injured group of 53 international-level soccer players and sprinters with 53 non-injured international-level soccer players and sprinters of both sexes. Comparing the injured vs. non-injured athletes and the left vs. right side in all of the athletes, we used the percentage of absolute differences in the BF contraction time (Tc) to classify non-injured and injured BF muscles. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) and the precision−recall curve (PRC) were used to measure the classification accuracy and to identify cut-off limits using the Tc differences. There was a very high ROC AUC value of 0.981 (SE = 0.009, p < 0.000), with 98.11% of the injured muscles being correctly classified (cut-off point 12.50% on Tc differences), and an AUPRC value of 0.981, with association classification criteria at >9.87. Tensiomyography has a high predictive ability to discriminate between injured and non-injured BF non-invasively and functionally.
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12
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Change of Direction Speed and Reactive Agility in Prediction of Injury in Football; Prospective Analysis over One Half-Season. Healthcare (Basel) 2022; 10:healthcare10030440. [PMID: 35326918 PMCID: PMC8949270 DOI: 10.3390/healthcare10030440] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Agility is an important factor in football (soccer), but studies have rarely examined the influences of different agility components on the likelihood of being injured in football. This study aimed to prospectively evaluate the possible influences of sporting factors, i.e., flexibility, reactive agility (RAG), and change of direction speed (CODS), on injury occurrence over one competitive half-season, in professional football players. Participants were 129 football professional players (all males, 24.4 ± 4.7 years), who underwent anthropometrics, flexibility, and RAG and CODS (both evaluated on non-dominant and dominant side) at the beginning of second half-season 2019/20 (predictors). Over the following half-season, occurrence of injury was registered (outcome). To identify the differences between groups based on injury occurrence, t-test was used. Univariate and multivariate logistic regressions were calculated to identify the associations between predictors and outcome. Results showed incidence of 1.3 injuries per 1000 h of training/game per player, with higher likelihood for injury occurrence during game than during training (Odds Ratio (OR) = 3.1, 95%CI: 1.63–5.88) Univariate logistic regression showed significant associations between players’ age (OR = 1.65, 95%CI: 1.25–2.22), playing time (OR = 2.01, 95%CI: 1.560–2.58), and RAG (OR = 1.21, 95%CI: 1.09–1.35, and OR = 1.18, 95%CI: 1.04–1.33 for RAG on dominant- and non-dominant side, respectively), and injury occurrence. The multivariate logistic regression model identified higher risk for injury in those players with longer playing times (OR = 1.81, 95%CI: 1.55–2.11), and poorer results for RAG for the non-dominant side (OR = 1.15, 95%CI: 1.02–1.28). To target those players who are more at risk of injury, special attention should be paid to players who are more involved in games, and those who with poorer RAG. Development of RAG on the non-dominant side should be beneficial for reducing the risk of injury in this sport.
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13
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Three Main Mechanisms Characterize Medial Collateral Ligament Injuries in Professional Male Soccer-Blow to the Knee, Contact to the Leg or Foot, and Sliding: Video Analysis of 37 Consecutive Injuries. J Orthop Sports Phys Ther 2021; 51:611-618. [PMID: 34784244 DOI: 10.2519/jospt.2021.10529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe the mechanisms, situational patterns, and biomechanics (kinematics) of medial collateral ligament (MCL) injuries in professional male soccer players. DESIGN Case series. METHODS Fifty-seven consecutive MCL injuries across 2 seasons of professional soccer matches were identified. We obtained and reviewed 37 of 57 (65%) injury videos to establish the injury mechanism, situational pattern, and knee flexion angle. We used detailed biomechanical analysis to assess the indirect and noncontact injuries. Injury layoff times, timing of injuries during the match, and location of the injuries on the pitch were also reported. RESULTS Twenty-three (62%) injuries were direct contact, 9 (24%) were indirect contact, and 5 (14%) were noncontact. Three main sprain mechanisms were noted: (1) direct contact/blow to the knee (n = 16), (2) contact to the leg or foot (lever like) (n = 7), and (3) sliding (n = 9). Seventy-three percent of MCL injuries occurred during 2 main situations: (1) pressing/tackling (n = 14, 38%) and (2) being tackled (n = 13, 35%). For indirect and noncontact injuries, knee valgus loading (100% of cases), hip abduction (73% of cases), and external foot rotation (92% of cases) were prominent injury kinematics, often with lateral trunk tilt (median, 10°; 64% of cases) and rotation (64% of cases). Knee flexion angles were higher for indirect and noncontact injuries (median, 100°) than for direct-contact injuries (median, 22°; P<.01). CONCLUSION Nearly two thirds of MCL injuries occurred after direct contact; 1 in every 4 MCL injuries occurred after indirect contact. Three sprain mechanisms characterized MCL injuries: (1) blow to the knee, (2) contact to the leg or foot (lever like), and (3) sliding. J Orthop Sports Phys Ther 2021;51(12):611-618. Epub 16 Nov 2021. doi:10.2519/jospt.2021.10529.
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14
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Bengtsson H, Ortega Gallo PA, Ekstrand J. Injury epidemiology in professional football in South America compared with Europe. BMJ Open Sport Exerc Med 2021; 7:e001172. [PMID: 34659791 PMCID: PMC8488699 DOI: 10.1136/bmjsem-2021-001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/04/2022] Open
Abstract
Objective To describe the injury epidemiology in professional football in South America and compare it with European professional football. Methods Data about football exposures and injury occurrences were registered in Six teams participating in Copa Libertadores in 2016. These teams’ exposure and injury data were compared with teams participating in the UEFA Elite Club Injury Study during the 2015/2016 and 2016/2017 seasons. Results A total of 271 injuries were reported in the South American cohort representing a training injury incidence of 3.2 (95% CI=2.7 to 3.7) injuries/1000 hours of training exposure and 20.9 (95% CI=17.3 to 25.1) injuries/1000 hours of match exposure. While no differences in muscle injury incidence were observed between South American and European teams, the ligament injury incidence in training among South American teams was significantly higher than European teams (0.6 vs 0.3, RR 1.87, 95% CI 1.21 to 2.87). In addition, a significantly higher proportion of all reported injuries among South American teams than European teams occurred in training. Conclusions A larger proportion of injuries occur in training in South American compared with European professional football. Specifically, ligament injuries in training were more frequent among South American teams.
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Affiliation(s)
- Håkan Bengtsson
- Unit of Community Medicine, Department of Health, Medicine and Caring Sciences, Linköpings Universitet, Linköping, Östergötland, Sweden.,Football Research Group, Linköpings Universitet, Linköping, Östergötland, Sweden
| | | | - Jan Ekstrand
- Unit of Community Medicine, Department of Health, Medicine and Caring Sciences, Linköpings Universitet, Linköping, Östergötland, Sweden.,Football Research Group, Linköpings Universitet, Linköping, Östergötland, Sweden
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15
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Lavoie-Gagne OZ, Retzky J, Diaz CC, Mehta N, Korrapati A, Forlenza EM, Knapik DM, Forsythe B. Return-to-Play Times and Player Performance After Medial Collateral Ligament Injury in Elite-Level European Soccer Players. Orthop J Sports Med 2021; 9:23259671211033904. [PMID: 34604429 PMCID: PMC8485161 DOI: 10.1177/23259671211033904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Participation in elite-level soccer predisposes athletes to injuries of the
medial collateral ligament (MCL), resulting in variable durations of time
lost from sport. Purpose: To (1) determine the rate of return to play (RTP) and timing after MCL
injuries, (2) investigate MCL reinjury incidence after RTP, and (3) evaluate
the long-term effects of MCL injury on future performance. Study Design: Descriptive epidemiology study. Methods: Using publicly available records, we identified athletes who had sustained
MCL injury between 2000 and 2016 across the 5 major European soccer leagues
(English Premier League, Bundesliga, La Liga, Ligue 1, and Serie A). Injured
athletes were matched to controls using demographic characteristics and
performance metrics from the season before injury. We recorded injury
severity, RTP rate, reinjury incidence, player characteristics associated
with RTP within 2 seasons of injury, player availability, field time, and
performance metrics during the 4 seasons after injury. Results: A total of 59 athletes sustained 61 MCL injuries, with 86% (51/59) of
injuries classified as moderate to severe and surgical intervention
performed in 14% (8/59) of athletes. After injury, athletes missed a median
of 33 days (range, 3-259 days) and 4 games (range, 1-30 games). Overall, 71%
(42/59) of athletes returned successfully at the same level, with
multivariable regression demonstrating no athlete characteristic predictive
of RTP. MCL reinjury was reported in 3% (2/59) of athletes. Midfielders
demonstrated decreased field time after RTP when compared with controls
(P < .05). No significant differences in player
performance for any position were identified out to 4 seasons after injury.
Injured athletes had a significantly higher rate of long-term retention
(P < .001). Conclusion: MCL injuries resulted in a median loss of 33 days in elite European soccer
athletes, with the majority of injuries treated nonoperatively. RTP remained
high, and few athletes experienced reinjury. While midfielders demonstrated
a significant decrease in field time after RTP, player performance and
long-term retention were not compromised. Future studies are warranted to
better understand athlete-specific and external variables predictive of MCL
injury and reinjury, while evaluating treatment and rehabilitation protocols
to minimize time lost and to optimize athlete safety and health.
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Affiliation(s)
- Ophelie Z Lavoie-Gagne
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Julia Retzky
- Hospital for Special Surgery, New York, New York, USA
| | - Connor C Diaz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nabil Mehta
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Avinaash Korrapati
- 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
| | - Derrick M Knapik
- 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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The dominant leg is more likely to get injured in soccer players: systematic review and meta-analysis. Biol Sport 2021; 38:397-435. [PMID: 34475623 PMCID: PMC8329968 DOI: 10.5114/biolsport.2021.100265] [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] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 12/26/2022] Open
Abstract
In soccer (football), dominant limb kicking produces higher ball velocity and is used with greater frequency than the non-dominant limb. It is unclear whether limb dominance has an effect on injury incidence. The purpose of this systematic review with meta-analysis is to examine the relationship between limb dominance and soccer injuries. Studies were identified from four online databases according to PRISMA guidelines to identify studies of soccer players that reported lower extremity injuries by limb dominance. Relevant studies were assessed for inclusion and retained. Data from retained studies underwent meta-analyses to determine relative risk of dominant versus non-dominant limb injuries using random-effects models. Seventy-four studies were included, with 36 of them eligible for meta-analysis. For prospective lower extremity injury studies, soccer players demonstrated a 1.6 times greater risk of injury to the dominant limb (95% CI [1.3-1.8]). Grouped by injury location, hamstring (RR 1.3 [95% CI 1.1-1.4]) and hip/groin (RR 1.9 [95% CI 1.3-2.7]) injuries were more likely to occur to the dominant limb. Greater risk of injury was present in the dominant limb across playing levels (amateurs RR 2.6 [95% CI 2.1-3.2]; youths RR 1.5 [95% CI 1.26-1.67]; professionals RR 1.3 [95% CI 1.14-1.46]). Both males (RR 1.5 [95% CI 1.33-1.68)] and females (RR 1.5 [95% CI 1.14-1.89]) were more likely to sustain injuries to the dominant limb. Future studies investigating soccer injury should adjust for this confounding factor by using consistent methods for assigning limb dominance and tracking use of the dominant versus non-dominant limb.
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17
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Ciba M, Winkelmeyer EM, Schock J, Schad P, Kotowski N, Nolte T, Wollschläger LM, Knobe M, Prescher A, Kuhl C, Truhn D, Nebelung S. Comprehensive Assessment of Medial Knee Joint Instability by Valgus Stress MRI. Diagnostics (Basel) 2021; 11:diagnostics11081433. [PMID: 34441368 PMCID: PMC8392372 DOI: 10.3390/diagnostics11081433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 01/19/2023] Open
Abstract
Standard clinical MRI techniques provide morphologic insights into knee joint pathologies, yet do not allow evaluation of ligament functionality or joint instability. We aimed to study valgus stress MRI, combined with sophisticated image post-processing, in a graded model of medial knee joint injury. To this end, eleven human cadaveric knee joint specimens were subjected to sequential injuries to the superficial medial collateral ligament (sMCL) and the anterior cruciate ligament (ACL). Specimens were imaged in 30° of flexion in the unloaded and loaded configurations (15 kp) and in the intact, partially sMCL-deficient, completely sMCL-deficient, and sMCL- and ACL-deficient conditions using morphologic sequences and a dedicated pressure-controlled loading device. Based on manual segmentations, sophisticated 3D joint models were generated to compute subchondral cortical distances for each condition and configuration. Statistical analysis included appropriate parametric tests. The medial compartment opened gradually as a function of loading and injury, especially anteriorly. Corresponding manual reference measurements by two readers confirmed these findings. Once validated in clinical trials, valgus stress MRI may comprehensively quantify medial compartment opening as a functional imaging surrogate of medial knee joint instability and qualify as an adjunct diagnostic tool in the differential diagnosis, therapeutic decision-making, and monitoring of treatment outcomes.
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Affiliation(s)
- Malin Ciba
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (M.C.); (E.-M.W.); (P.S.); (N.K.); (T.N.); (C.K.); (D.T.)
| | - Eva-Maria Winkelmeyer
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (M.C.); (E.-M.W.); (P.S.); (N.K.); (T.N.); (C.K.); (D.T.)
| | - Justus Schock
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225 Düsseldorf, Germany; (J.S.); (L.M.W.)
| | - Philipp Schad
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (M.C.); (E.-M.W.); (P.S.); (N.K.); (T.N.); (C.K.); (D.T.)
| | - Niklas Kotowski
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (M.C.); (E.-M.W.); (P.S.); (N.K.); (T.N.); (C.K.); (D.T.)
| | - Teresa Nolte
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (M.C.); (E.-M.W.); (P.S.); (N.K.); (T.N.); (C.K.); (D.T.)
| | - Lena Marie Wollschläger
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225 Düsseldorf, Germany; (J.S.); (L.M.W.)
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland;
| | - Andreas Prescher
- Institute of Anatomy, RWTH Aachen University, 52074 Aachen, Germany;
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (M.C.); (E.-M.W.); (P.S.); (N.K.); (T.N.); (C.K.); (D.T.)
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (M.C.); (E.-M.W.); (P.S.); (N.K.); (T.N.); (C.K.); (D.T.)
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074 Aachen, Germany; (M.C.); (E.-M.W.); (P.S.); (N.K.); (T.N.); (C.K.); (D.T.)
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, 40225 Düsseldorf, Germany; (J.S.); (L.M.W.)
- Correspondence:
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Gentile JM, O'Brien MC, Conrad B, Horodyski M, Bruner ML, Farmer KW. A Biomechanical Comparison Shows No Difference Between Two Knee Braces used for Medial Collateral Ligament Injuries. Arthrosc Sports Med Rehabil 2021; 3:e901-e907. [PMID: 34195660 PMCID: PMC8220611 DOI: 10.1016/j.asmr.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 03/05/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose The purpose of this study was to assess the ability of 2 commonly used knee braces to control knee valgus motion and subsequent strain on the medial collateral ligament (MCL) in a laboratory-controlled environment. Methods Twenty healthy individuals (6 male, 14 female; mean age, 23 ± 3 years) with no history of knee injury or brace use performed a jump landing task while wearing either no brace or 1 of 2 braces: the Playmaker and Total Range of Motion . Three-dimensional joint kinematics and kinetics were measured in our biomechanics laboratory. Results Significantly less knee dynamic valgus angulation was noted when using either brace (−0.51° ± 3.9° and −1.3° ± 3.2°) compared no brace (4.8° ± 3.0°). Dynamic valgus angulation did not differ significantly between the 2 braces tested, which were both not statistically different from baseline alignment. There were significant differences seen in peak knee flexion angle between each brace (77.9° ± 8.8°and 83.1° ± 8.4°), as well as between both braces and no brace (90.6° ± 11.1°). There was no significant difference in knee frontal plane moment or peak vertical ground reaction force loading among all 3 testing conditions. Conclusions Compared to no brace, both braces allowed significantly less dynamic valgus angulation of the knee under physiological vertical loads but were not significantly different from one another. Clinical Relevance Knee braces are commonly used to protect the MCL when placed under physiological loads. It is important to know which braces effectively reduce valgus stress to provide the best outcomes.
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Affiliation(s)
- Joseph M Gentile
- University of Florida College of Medicine, Department of Orthopedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, Gainesville, Florida, U.S.A
| | - Michael C O'Brien
- University of Florida College of Medicine, Department of Orthopedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, Gainesville, Florida, U.S.A
| | - Bryan Conrad
- University of Florida College of Medicine, Department of Orthopedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, Gainesville, Florida, U.S.A
| | - MaryBeth Horodyski
- University of Florida College of Medicine, Department of Orthopedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, Gainesville, Florida, U.S.A
| | - Michelle L Bruner
- University of Florida College of Medicine, Department of Orthopedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, Gainesville, Florida, U.S.A
| | - Kevin W Farmer
- University of Florida College of Medicine, Department of Orthopedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, Gainesville, Florida, U.S.A
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Ekstrand J, Spreco A, Bengtsson H, Bahr R. Injury rates decreased in men's professional football: an 18-year prospective cohort study of almost 12 000 injuries sustained during 1.8 million hours of play. Br J Sports Med 2021; 55:1084-1091. [PMID: 33547038 PMCID: PMC8458074 DOI: 10.1136/bjsports-2020-103159] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The UEFA Elite Club Injury Study is the largest and longest running injury surveillance programme in football. OBJECTIVE To analyse the 18-season time trends in injury rates among male professional football players. METHODS 3302 players comprising 49 teams (19 countries) were followed from 2000-2001 through 2018-2019. Team medical staff recorded individual player exposure and time-loss injuries. RESULTS A total of 11 820 time-loss injuries were recorded during 1 784 281 hours of exposure. Injury incidence fell gradually during the 18-year study period, 3% per season for both training injuries (95% CI 1% to 4% decrease, p=0.002) and match injuries (95% CI 2% to 3% decrease, p<0.001). Ligament injury incidence decreased 5% per season during training (95% CI 3% to 7% decrease, p<0.001) and 4% per season during match play (95% CI 3% to 6% decrease, p<0.001), while the rate of muscle injuries remained constant. The incidence of reinjuries decreased by 5% per season during both training (95% CI 2% to 8% decrease, p=0.001) and matches (95% CI 3% to 7% decrease, p<0.001). Squad availability increased by 0.7% per season for training sessions (95% CI 0.5% to 0.8% increase, p<0.001) and 0.2% per season for matches (95% CI 0.1% to 0.3% increase, p=0.001). CONCLUSIONS Over 18 years: (1) injury incidence decreased in training and matches, (2) reinjury rates decreased, and (3) player availability for training and match play increased.
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Affiliation(s)
- Jan Ekstrand
- Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden .,Football Research Group, Linköping University, Linköping, Sweden
| | - Armin Spreco
- Center for Health Services Development, Linköping University, Linköping, Sweden
| | - Håkan Bengtsson
- Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Football Research Group, Linköping University, Linköping, Sweden
| | - Roald Bahr
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway.,Department of Research, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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20
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Bitchell CL, Varley-Campbell J, Robinson G, Stiles V, Mathema P, Moore IS. Recurrent and Subsequent Injuries in Professional and Elite Sport: a Systematic Review. SPORTS MEDICINE-OPEN 2020; 6:58. [PMID: 33270184 PMCID: PMC7714809 DOI: 10.1186/s40798-020-00286-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Injury surveillance in professional sport categorises injuries as either "new" or "recurrent". In an attempt to make categorisation more specific, subsequent injury categorisation models have been developed, but it is not known how often these models are used. The aim was to assess how recurrent and subsequent injuries are reported within professional and elite sport. METHODS Online databases were searched using a search strategy. Studies needed to prospectively report injury rates within professional or elite sports that have published consensus statements for injury surveillance. RESULTS A total of 1322 titles and abstract were identified and screened. One hundred and ninety-nine studies were screened at full text resulting in 81 eligible studies. Thirty studies did not report recurrent injuries and were excluded from data extraction. Within the studies that reported recurrent injuries, 21 reported the number and percentage; 13 reported only the proportion within all injuries; three reported only the number; five reported the number, percentage and incidence; and two only reported the incidence. Seven studies used subsequent injury terminology, with three reporting subsequent injury following concussion, one using an amended subsequent injury model and three using specific subsequent injury categorisation models. The majority of subsequent injuries (ranging from 51 to 80%) were categorised as different and unrelated to the index injury. The proportion of recurrent injuries (exact same body area and nature related to index injury) ranged from 5 to 21%. CONCLUSIONS Reporting recurrent or subsequent injuries remains inconsistent, and few studies have utilised subsequent injury models. There is limited understanding of subsequent injury risk, which may affect the development of injury prevention strategies. TRIAL REGISTRATION CRD42019119264.
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Affiliation(s)
| | | | - Gemma Robinson
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - Prabhat Mathema
- Welsh Rugby Union Group, WRU National Centre of Excellence, Vale of Glamorgan, UK
| | - Isabel Sarah Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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21
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Pedley JS, Lloyd RS, Read PJ, Moore IS, De Ste Croix M, Myer GD, Oliver JL. Utility of Kinetic and Kinematic Jumping and Landing Variables as Predictors of Injury Risk: A Systematic Review. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42978-020-00090-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose
Jump-landing assessments provide a means to quantify an individual’s ability to attenuate ground reaction forces, generate lower limb explosive power and maintain joint alignment. In order to identify risk factors that can be targeted through appropriate training interventions, it is necessary to establish which (scalar) objective kinetic, kinematic, and performance measures are most associated with lower-extremity injury.
Methods
Online searches of MEDLINE, SCOPUS, EBSCOHost, SPORTDiscus and PubMed databases were completed for all articles published before March 2020 in accordance with PRISMA guidelines.
Results
40 articles investigating nine jump-landing assessments were included in this review. The 79% of studies using drop jump (n = 14) observed an association with future injury, while only 8% of countermovement jump studies (n = 13) observed an association with injury risk. The 57% of studies using unilateral assessments found associations with risk of injury (n = 14). Studies using performance measures (jump height/distance) as outcome measure were only associated with injury risk in 30% of cases. However, those using kinetic and/or kinematic analyses (knee abduction moment, knee valgus angle, knee separation distance, peak ground reaction force) found associations with injury in 89% of studies.
Conclusion
The landing element of jump-landing assessments appears to be superior for identifying individuals at greater risk of injury; likely due to a closer representation of the injury mechanism. Consequently, jump-landing assessments that involve attenuation of impact forces such as the drop jump appear most suited for this purpose but should involve assessment of frontal plane knee motion and ground reaction forces.
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22
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Güler Ö, Aras D, Akça F, Bianco A, Lavanco G, Paoli A, Şahin FN. Effects of Aerobic and Anaerobic Fatigue Exercises on Postural Control and Recovery Time in Female Soccer Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176273. [PMID: 32872251 PMCID: PMC7503876 DOI: 10.3390/ijerph17176273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022]
Abstract
Sixteen female soccer players (age = 20.19 ± 1.52 years; body mass = 56.52 ± 4.95 kg; body height = 164.81 ± 4.21 cm) with no history of lower extremity injury participated in the study. The Biodex SD Balance system was used to determine the non-dominant single-leg stability. In anaerobic exercise, each subject performed four maximal cycling efforts against a resistance equivalent to 0.075 kg/body mass for 30 s with three-minute rest intervals. In aerobic exercise, subjects performed the Bruce protocol on a motorized treadmill. After each exercise, subjects subsequently performed a single-leg stability test and then repeated the same test for four times with five-minute passive rest periods. In accordance with the results, it was found that the impairment observed right after the aerobic loading was higher (p < 0.001) compared to the anaerobic one. However, the time-related deterioration in both aerobic and anaerobic loadings was similar. The B-pre value was lower than Bpost and B5 (p < 0.01) and B10 (p < 0.05) in both conditions. Subjects could reach the initial balance level at B15 after aerobic and anaerobic loadings. The lactate level did not reach resting value even after 20 min of both fatigue protocols. Although the fatigue after aerobic and aerobic exercise negatively affects a single-leg dynamic balance level, single leg balance ability returns to the baseline status after 10 min of passive recovery duration.
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Affiliation(s)
- Özkan Güler
- Faculty of Sports Sciences, Ankara University, Gölbaşı, Ankara 06830, Turkey; (Ö.G.); (D.A.); (F.A.); (F.N.Ş.)
| | - Dicle Aras
- Faculty of Sports Sciences, Ankara University, Gölbaşı, Ankara 06830, Turkey; (Ö.G.); (D.A.); (F.A.); (F.N.Ş.)
| | - Fırat Akça
- Faculty of Sports Sciences, Ankara University, Gölbaşı, Ankara 06830, Turkey; (Ö.G.); (D.A.); (F.A.); (F.N.Ş.)
| | - Antonino Bianco
- Department of Psychological, Pedagogical, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy;
- Correspondence: ; Tel.: +39-091-23896910
| | - Gioacchino Lavanco
- Department of Psychological, Pedagogical, Educational Science and Human Movement, University of Palermo, 90144 Palermo, Italy;
| | - Antonio Paoli
- Department of Biomedical Science, University of Padova, 35122 Padova, Italy;
| | - Fatma Neşe Şahin
- Faculty of Sports Sciences, Ankara University, Gölbaşı, Ankara 06830, Turkey; (Ö.G.); (D.A.); (F.A.); (F.N.Ş.)
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23
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Lundblad M, Hägglund M, Thomeé C, Hamrin Senorski E, Ekstrand J, Karlsson J, Waldén M. Epidemiological Data on LCL and PCL Injuries Over 17 Seasons in Men's Professional Soccer: The UEFA Elite Club Injury Study. Open Access J Sports Med 2020; 11:105-112. [PMID: 32494208 PMCID: PMC7231769 DOI: 10.2147/oajsm.s237997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background There is limited epidemiological information on injury rates and injury mechanisms for lateral collateral ligament (LCL) and posterior cruciate ligament (PCL) injuries in male professional soccer. In addition, time trends and lay-off times for these injuries have not yet been determined. Aim To determine injury rates and circumstances of LCL and PCL injuries over 17 seasons in men’s professional soccer. Methods A prospective cohort study, in which 68 professional European soccer teams were followed over 17 consecutive seasons (2001/2002 to 2017/2018). The teams’ medical staff recorded player exposure and time-loss injuries. Lay-off time was reported as the median and the first and third quartile. Injury rate was defined as the number of injuries per 1000 player-hours. Results One hundred and twenty-eight LCL and 28 PCL injuries occurred during 2,554,686 h of exposure (rate 0.05 and 0.01/1000 h, respectively). The median lay-off time for LCL injuries was 15 (Q1=7, Q3=32) days, while it was 31 days for PCL injuries (Q1=15, Q3=74). The match injury rate for LCL injuries was 11 times higher than the training injury rate (0.21 vs 0.02/1000 h, rate ratio [RR] 10.5, 95% CI 7.3 to 15.1 p<0.001) and the match injury rate for PCL injuries was 20 times higher than the training injury rate (0.056 vs 0.003/1000 h, RR 20.1, 95% CI 8.2 to 49.6, p<0.001). LCL injuries saw a significant annual decrease of approximately 3.5% (p=0.006). In total, 58% (63/108) of all LCL injuries and 54% (14/26) of all PCL injuries were related to contact mechanism. Conclusion This study with prospectively registered data on LCL and PCL injuries in men’s professional soccer shows that the median lay-off from soccer for LCL and PCL injuries is approximately 2 and 4 weeks respectively. These rare knee ligament injuries typically occur during matches and are associated with a contact injury mechanism.
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Affiliation(s)
- Matilda Lundblad
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Football Research Group, Linköping University, Linköping, Sweden
| | - Martin Hägglund
- Football Research Group, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Ekstrand
- Football Research Group, Linköping University, Linköping, Sweden.,Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jón Karlsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Football Research Group, Linköping University, Linköping, Sweden
| | - Markus Waldén
- Football Research Group, Linköping University, Linköping, Sweden.,Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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24
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Medial collateral ligament (MCL) reconstruction results in improved medial stability: results from the Danish knee ligament reconstruction registry (DKRR). Knee Surg Sports Traumatol Arthrosc 2020; 28:881-887. [PMID: 31123793 DOI: 10.1007/s00167-019-05535-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to compare outcome data after isolated and combined (MCL) plus anterior cruciate ligament (ACL) reconstruction based on objective and subjective measures using data from the (DKRR). There are only a few small-sized case studies on outcomes after MCL reconstruction. MCL reconstruction was hypothesised to improve both objective and subjective outcomes. METHODS All patients who were registered in the DKRR between 2005 and 2016 (N = 25,281) and who underwent isolated ACL (n = 24,683), isolated MCL (n = 103) or combined MCL plus ACL (n = 495) reconstructions were retrospectively identified. Objective (valgus knee stability and sagittal knee laxity) and subjective (Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity scale score) outcomes in these three cohorts were evaluated at the 1-year follow-up by comparing pre- and post-operative values. RESULTS Medial stability improved significantly pre- to post-operatively after both isolated MCL and combined MCL plus ACL reconstruction, with 26 (53%) and 195 (69%) of the patients, respectively, having normal valgus stability (0-2 mm laxity). Sagittal stability was similar after MCL plus ACL reconstruction and isolated ACL reconstruction (1.7 and 1.5 mm, respectively). At the 1-year follow-up, although the KOOS of the patients in the isolated MCL and combined MCL plus ACL reconstruction cohorts improved significantly, they were lower than those of the patients in the isolated ACL reconstruction cohort. CONCLUSION Both isolated MCL reconstruction and combined MCL plus ACL reconstruction resulted in significant and clinically relevant improvements in the subjective outcomes from pre-operative conditions to the 1-year follow-up. Valgus stability also improved significantly, with two-thirds of patients obtaining normal valgus stability after MCL reconstruction. Subjective outcomes were similar between isolated MCL reconstruction and combined MCL plus ACL reconstructions, but were poorer than isolated ACL reconstructions. LEVEL OF EVIDENCE Level III.
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25
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Kramer DE, Miller PE, Berrahou IK, Yen YM, Heyworth BE. Collateral Ligament Knee Injuries in Pediatric and Adolescent Athletes. J Pediatr Orthop 2020; 40:71-77. [PMID: 31923166 DOI: 10.1097/bpo.0000000000001112] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The majority of research on medial (MCL) and lateral (LCL) collateral ligament injuries has focused on adults and combined collateral/cruciate injuries. The purpose of this study was to determine characteristics associated with isolated collateral ligament injuries in adolescents, and assess timing for return to sports. METHODS Electronic medical records were queried to identify patients aged below 17 years who sustained a magnetic resonance imaging-confirmed isolated MCL or LCL injury over an 8-year period. Retrospective review then documented patient and injury characteristics and clinical course. General linear modeling was used to analyze risk factors for prolonged return to sports, continued pain or reinjury. RESULTS Fifty-one knees (33 in males, 65%), mean age 13.8 years (range, 5 to 17), were identified, of which 40 (78%) had MCL injuries. Over half (29, 57%) of knees had an open distal femoral physis including all 5 bony avulsion injuries. Eleven (22%) had LCL injuries of which 3 (6%) had concurrent posterolateral corner injuries. Forty-two (82%) knees had injuries that occurred during sports. Eleven knees (28%) with MCL tears had a simultaneous patellar instability episode. Knee injuries that occurred during sports had 37% shorter recovery time (P=0.02). Eight knees (16%) experienced a reinjury and 12 (24%) were followed over an extended period of time for various knee issues. Football injuries were more likely to be grade 3 (P=0.03), and football and soccer accounted for all grade III injuries. The mean return to sports was 2.2 months, with grade III cases returning at 2.4 months, and 95% of cases within 4 months. CONCLUSIONS Isolated collateral ligament injuries are rare in adolescent athletes. MCL injuries, one-quarter of which occurred in conjunction with patellar instability events, were 4 times more common than LCL injuries, one quarter of which have other posterolateral corner structures involved. Grade III injuries represent 20% to 25% of collateral ligament injuries and occurred most commonly in football and soccer. LEVEL OF EVIDENCE Level IV-retrospective case series.
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Affiliation(s)
- Dennis E Kramer
- Boston Childrens Hospital, Harvard Medical School, Boston, MA
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26
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Cezarino LG, Grüninger BLDS, Scattone Silva R. Injury Profile in a Brazilian First-Division Youth Soccer Team: A Prospective Study. J Athl Train 2020; 55:295-302. [PMID: 31967863 DOI: 10.4085/1062-6050-449-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
CONTEXT Despite the popularity of soccer at the male first-division youth level, data on the incidence of injuries in Brazil are limited. OBJECTIVE To prospectively study the injury profile of male first-division youth soccer players during 1 season (January to December 2017). DESIGN Descriptive epidemiology study. SETTING Data compiled at a youth soccer academy. PATIENTS OR OTHER PARTICIPANTS The study involved 228 players between 10 and 20 years old from a first-division Brazilian soccer academy. MAIN OUTCOME MEASURE(S) Injury incidence rate was reported as the number of injuries divided by overall exposure (training and match hours) multiplied by 1000. The rate ratio (injury incidence rate during matches in relation to training) was also calculated. Time-loss injuries (ie, physical complaints sustained during soccer matches or training that resulted in a player being unable to take part in soccer training or match play) during the season were recorded. RESULTS A total of 187 injuries were documented in 122 players (65.2%). During the season, 100 389 hours of exposure (5995 hours of match play and 94 394 of training) were registered. The overall injury incidence rate was 1.86 per 1000 hours. In total, 4792 days were lost from soccer activities. The majority of injuries were noncontact thigh muscle disorders and ankle sprains. Injury incidence was greater in matches than in training, and the oldest age group (under 20 years old) had the highest injury incidence rate in matches, while the under 17-year-old group had the highest injury incidence rate in training sessions (22.48 and 3.05 per 1000 hours, respectively). CONCLUSIONS Muscle injury incidence rates observed among Brazilian soccer athletes under 20 years old were similar to those reported in professional players. Preventive measures are recommended to reduce injury rates. Additionally, the number of injuries incurred during training was high compared with match play, and training programs need to be assessed so that injury prevention can be improved.
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Affiliation(s)
- Leandro Gonçalves Cezarino
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | | - Rodrigo Scattone Silva
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
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27
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Korolev AV, Afanasyev AP, Il'in DO, Gerasimov DO, Ryazantsev MS, Kadantsev PM, Zaripov AR. [Damage of the knee posterior cruciate ligament: biomechanics, basic diagnostics, treatment and secondary osteoarthritis prevention directions]. Khirurgiia (Mosk) 2020:130-136. [PMID: 33030014 DOI: 10.17116/hirurgia2020091130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The analysis of literature data was performed on the pathogenesis, diagnosis and treatment of injuries of the posterior cruciate ligament (PCL) of the knee joint. PCL is the largest intra-articular ligament of the knee joint, can withstand the maximum loads compared with other ligaments. It was noted that, in general, in cases of damage to the PCL, it is necessary to use a set of diagnostic methods, and the basic principles for the choice of optimal treatment plan for this patient. It considered the results of the conservative treatment of PCL partial ruptures, and it is indicated that this approach increases the risk of degenerative anatomical structures and functional disorders of the joint. It was noted that it is advisable to conduct surgical treatment to restore the stability of the knee joint and normalize function, while a number of methods for the reconstruction of PCL have been proposed to date. The usage of chondroprotectors for prevention of the secondary osteoarthrosis of the knee joint affected by posterior cruciate ligament rupture was analyzed in the literature data.
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Affiliation(s)
- A V Korolev
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
- Peoples Friendship University of Russia, Moscow, Russia
| | - A P Afanasyev
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - D O Il'in
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - D O Gerasimov
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - M S Ryazantsev
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
| | - P M Kadantsev
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
- Peoples Friendship University of Russia, Moscow, Russia
| | - A R Zaripov
- European Clinic of Sports Traumatology and Orthopaedics (ECSTO), Moscow, Russia
- Peoples Friendship University of Russia, Moscow, Russia
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28
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Abstract
The high injury rate among men's professional football players is well-known. Therefore, the Union of European Football Associations (UEFA) launched an injury study already in 2001. This study, the UEFA Elite Club Injury Study (ECIS), currently includes data from a total of 51 clubs from 18 European countries with more than 14,000 registered injuries. With the 21st World Cup (WC) in Russia just around the corner, we have from our study identified a higher match injury rate and a higher proportion of severe injuries in the European Championships compared to the preceding club competitive seasons. Moreover, we have also recently showed that the muscle injury rate is higher when players are given a recovery window of five days or less between two matches. Considering the congested match schedule of the upcoming WC, it is therefore likely that injuries and fatigue once again will be a topic of discussion this summer.
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29
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Epidemiology of injury in English Professional Football players: A cohort study. Phys Ther Sport 2019; 35:18-22. [DOI: 10.1016/j.ptsp.2018.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
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30
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Lundblad M, Hägglund M, Thomeé C, Hamrin Senorski E, Ekstrand J, Karlsson J, Waldén M. Medial collateral ligament injuries of the knee in male professional football players: a prospective three-season study of 130 cases from the UEFA Elite Club Injury Study. Knee Surg Sports Traumatol Arthrosc 2019; 27:3692-3698. [PMID: 30949749 PMCID: PMC6800843 DOI: 10.1007/s00167-019-05491-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/18/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Medial collateral ligament (MCL) injury is the single most common traumatic knee injury in football. The purpose of this study was to study the epidemiology and mechanisms of MCL injury in men's professional football and to evaluate the diagnostic and treatment methods used. METHODS Fifty-one teams were followed prospectively between one and three full seasons (2013/2014-2015/2016). Individual player exposure and time-loss injuries were recorded by the teams' medical staffs. Moreover, details on clinical grading, imaging findings and specific treatments were recorded for all injuries with MCL injury of the knee as the main diagnosis. Agreement between magnetic resonance imaging (MRI) and clinical grading (grades I-III) was described by weighted kappa. RESULTS One hundred and thirty of 4364 registered injuries (3%) were MCL injuries. Most MCL injuries (98 injuries, 75%) occurred with a contact mechanism, where the two most common playing situations were being tackled (38 injuries, 29%) and tackling (15 injuries, 12%). MRI was used in 88 (68%) of the injuries, while 33 (25%) were diagnosed by clinical examination alone. In the 88 cases in which both MRI and clinical examination were used to evaluate the grading of MCL injury, 80 (92% agreement) were equally evaluated with a weighted kappa of 0.87 (95% CI 0.77-0.96). Using a stabilising knee brace in players who sustained a grade II MCL injury was associated with a longer lay-off period compared with players who did not use a brace (41.5 (SD 13.2) vs. 31.5 (SD 20.3) days, p = 0.010). CONCLUSION Three-quarter of the MCL injuries occurred with a contact mechanism. The clinical grading of MCL injuries showed almost perfect agreement with MRI grading, in cases where the MCL injury is the primary diagnosis. Not all grade II MCL injuries were treated with a brace and may thus indicate that routine bracing should not be necessary in milder cases. LEVEL OF EVIDENCE Prospective cohort study, II.
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Affiliation(s)
- Matilda Lundblad
- Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
- Football Research Group, Linköping University, Linköping, Sweden.
| | - Martin Hägglund
- Football Research Group, Linköping University, Linköping, Sweden
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Ekstrand
- Football Research Group, Linköping University, Linköping, Sweden
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jón Karlsson
- Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Football Research Group, Linköping University, Linköping, Sweden
| | - Markus Waldén
- Football Research Group, Linköping University, Linköping, Sweden
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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31
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Åman M, Larsén K, Forssblad M, Näsmark A, Waldén M, Hägglund M. A Nationwide Follow-up Survey on the Effectiveness of an Implemented Neuromuscular Training Program to Reduce Acute Knee Injuries in Soccer Players. Orthop J Sports Med 2018; 6:2325967118813841. [PMID: 30622995 PMCID: PMC6304704 DOI: 10.1177/2325967118813841] [Citation(s) in RCA: 9] [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: 11/29/2022] Open
Abstract
Background: A cruciate ligament (CL) injury is a severe injury in soccer. Neuromuscular
training programs have a well-documented preventive effect, but there are
few studies on the effectiveness of such a program at a national level. The
Swedish Knee Control Program (KCP) was found to be effective in preventing
CL injuries in youth female soccer players. The KCP was implemented
nationwide in Sweden in 2010. Purpose: To evaluate the effectiveness of the Swedish KCP in reducing acute knee
injuries in soccer players at a nationwide level. Study Design: Descriptive epidemiology study. Methods: All licensed soccer players in Sweden are covered by the same insurance
company. Using this insurance database, around 17,500 acute knee injuries
that were reported to the insurance company between 2006 and 2015 were
included in the study. By matching the number of licensed soccer players
with the number of reported injuries each year, the annual incidence of knee
and CL injuries was able to be calculated. To evaluate the spread of the KCP
nationally, a questionnaire was sent to all 24 Swedish district football
associations (FAs) with questions regarding KCP education. The number of
downloads of the KCP mobile application (app) was obtained. Results: The incidence of CL injuries decreased during the study period for both male
(from 2.9 to 2.4 per 1000 player-years) and female players (from 4.9 to 3.9
per 1000 player-years). The overall incidence of knee injuries decreased in
both male (from 5.6 to 4.6 per 1000 player-years) and female players (from
8.7 to 6.4 per 1000 player-years). Comparing before and after the nationwide
implementation of the KCP, there was a decrease in the incidence of CL
injuries by 6% (rate ratio [RR], 0.94 [95% CI, 0.89-0.98]) in male players
and 13% (RR, 0.87 [95% CI, 0.81-0.92]) in female players and a decrease in
the incidence of knee injuries by 8% (RR, 0.92 [95% CI, 0.89-0.96]) and 21%
(RR, 0.79 [95% CI, 0.75-0.83]), respectively (P < .01
for all). This trend corresponded to a reduction of approximately 100 CL
injuries each year in Sweden. A total of 21 of 24 district FAs held
organized KCP educational courses during the study period. The percentage of
district FAs holding KCP courses was between 46% and 79% each year. There
were 101,236 downloads of the KCP app. Conclusion: The KCP can be considered partially implemented nationwide, and the incidence
of knee and CL injuries has decreased in both sexes at a nationwide
level.
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Affiliation(s)
- Malin Åman
- Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Karin Larsén
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Magnus Forssblad
- Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | | | - Markus Waldén
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Martin Hägglund
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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The lack of standardized outcome measures following lower extremity injury in elite soccer: a systematic review. Knee Surg Sports Traumatol Arthrosc 2018; 26:3109-3117. [PMID: 29955929 DOI: 10.1007/s00167-018-5032-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/22/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE Sport-specific, performance-based outcomes are increasingly used to improve evaluation of treatment efficacy in elite athletes; however, its usage in elite soccer may be limited. The purpose of this investigation is to (1) assess current outcome reporting in elite soccer; (2) identify any variability in reporting of outcomes; and (3) determine how sport-specific performance-based outcomes are utilized to assess treatment efficacy in elite soccer. METHODS A systematic review of the Pubmed, MEDLINE, and Embase, Scopus, SportDiscus, CINAHL and HealthSource: Nursing databases was performed without limitation on publication year. Inclusion criteria were (1) reporting of outcomes after a (2) lower extremity injury in (3) elite soccer players. The study's population, type of injury, return to play, as well as functional, objective, and sport-specific performance-based outcomes were extracted from each article. The methodological index for nonrandomized studies was used for quality assessment. RESULTS Twenty-one studies were selected after application of the inclusion and exclusion criteria. Objective outcomes were reported by 6 (29%) studies, and 6 (29%) employed patient-reported outcomes. The visual analog scale, Lysholm, and Tegner scores were the most common patient-reported outcomes (PROs). Return to play was reported by 18 (86%) studies, and only 2 (10%) utilized sport-specific performance-based outcomes. Despite the majority of studies reporting return to play, variation was seen in the definitions, and 15 (71%) studies reported the activity level of the players at final follow-up. CONCLUSION Assessment of treatment efficacy is limited in elite athletes, and PROs lack the sensitivity to identify residual performance deficits after an injury. Although performance-based measures are available at the elite level, these outcomes were seldom used for evaluation of treatment efficacy. CLINICAL RELEVANCE When treating elite soccer players, patient-reported outcome measures lack the sensitivity to detect changes in patient function, thus performance-based metrics may be more efficacious in assessing return from injury in these patients. LEVEL OF EVIDENCE IV.
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Incidence, Positional Distribution, Severity, and Time Missed in Medial Collateral Ligament Injuries of the Knee in NCAA Division I Football Athletes. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 1:e019. [PMID: 30211356 PMCID: PMC6132294 DOI: 10.5435/jaaosglobal-d-17-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction: We studied injury to the medial collateral ligament (MCL) in National Collegiate Athletic Association (NCAA) Division I football players, their incidence, magnitude of injury, distribution by position, and missed time, which has not previously been described in a consecutive series. Methods: The knee injuries sustained in 163 consecutive NCAA Division I collegiate football players at our institution were evaluated over a span of 6 years. Results: The incidence of MCL injuries with any knee injury was 29% (47 of 163). Of 47 MCL injuries, 34% occurred in defensive linemen and 29% in offensive linemen. The average days missed by linemen were 14.65 compared with 4.5 by nonlinemen (P = 0.07). The MCL injuries in linemen were more severe than nonlinemen (0.018). Discussion: MCL injuries occur most commonly in linemen in whom the magnitude of injury is also more significant than nonlinemen. Linemen miss more days than do nonlinemen to MCL injury. Study Design: Descriptive Epidemiology Study.
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Logan CA, Murphy CP, Sanchez A, Dornan GJ, Whalen JM, Price MD, Bradley JP, LaPrade RF, Provencher MT. Medial Collateral Ligament Injuries Identified at the National Football League Scouting Combine: Assessment of Epidemiological Characteristics, Imaging Findings, and Initial Career Performance. Orthop J Sports Med 2018; 6:2325967118787182. [PMID: 30083562 PMCID: PMC6066829 DOI: 10.1177/2325967118787182] [Citation(s) in RCA: 9] [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: 11/15/2022] Open
Abstract
Background: The medial collateral ligament (MCL) is one of the most commonly injured
structures in the knee, especially in young athletes. The impact of MCL
injury on National Football League (NFL) performance in elite collegiate
athletes has not yet been described in the literature. Purpose: We aim to (1) describe the prevalence and severity of MCL injuries in NFL
Combine participants, (2) detail injury management, and (3) analyze the
impact of MCL injury on NFL performance in terms of draft position, games
played, games started, and snap percentage. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of all NFL Combine participants from 2009 to 2015 was
performed by reviewing medical records and imaging reports from the combine
to identify all players with MCL injuries. A control group was developed
from the players evaluated at the combine without MCL injury. For each
affected knee, the MCL injury was classified by location and severity based
on results of magnetic resonance imaging (MRI). Each player’s respective NFL
draft position, number of NFL games played, number of NFL games started, and
NFL snap percentage for the first 2 seasons in the league were collected
through the use of NFL.com and Pro-Football-Focus, which are web-based,
publicly accessible, comprehensive sports statistics databases. Results: A total of 2285 players participated in the NFL Combine between 2009 and
2015. Three hundred one athletes (13.2%) were identified as having MCL
injuries; 36 (12%) of the athletes with MCL injury presented with bilateral
injuries, for a total of 337 MCL injuries. Additional soft tissue injury was
identified on 187 of 337 (55%) MRIs. Players with a history of MCL injury
were more likely to play at least 2 years in the NFL compared with those in
the control group (P = .003). Players who had isolated MCL
injury performed significantly better compared with athletes who had
combined injuries with regard to draft position (P = .034),
proportion playing at least 2 seasons in the NFL (P =
.022), games played (P = .014), and games started
(P = .020) in the first 2 years. No significant
difference was found between players who underwent operative versus
nonoperative management of their MCL injury. Conclusion: A relatively high percentage of players at the NFL Combine had evidence of
MCL injury (13%). A prior history of MCL tear had no negative impact on an
athlete’s NFL performance. Players who had isolated MCL injury performed
significantly better compared with athletes who had combined injuries with
regard to draft position, proportion playing 2 seasons or more in the NFL,
and games played and started in the first 2 years.
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Affiliation(s)
- Catherine A Logan
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Colin P Murphy
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Mark D Price
- New England Patriots, Foxborough, Massachusetts, USA.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James P Bradley
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Robert F LaPrade
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Matthew T Provencher
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
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Sevick JL, Heard BJ, Lo IKY, Randle JA, Frank CB, Shrive NG, Thornton GM. Are re-injured ligaments equivalent mechanically to injured ligaments: The role of re-injury severity? Proc Inst Mech Eng H 2018; 232:665-672. [DOI: 10.1177/0954411918784088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The consequences of ligament re-injury have received limited attention. Although the mechanical properties of injured ligaments improve over time, these properties are never fully recaptured, rendering these injured ligaments susceptible to re-injury. Previous injury is a significant risk factor for recurrent injury, and this re-injury can result in longer absence from activity than the initial injury. A rabbit medial collateral ligament model was used to compare mechanically re-injured right medial collateral ligaments to injured left medial collateral ligaments. Two groups of different re-injury severity were investigated: ‘minor’ re-injury comparing transection re-injured right medial collateral ligaments to transection injured left medial collateral ligaments; ‘major’ re-injury comparing gap re-injured right medial collateral ligaments to transection injured left medial collateral ligaments. Initial injuries for both groups were right medial collateral ligament transections 1 week before re-injury. After 5–6 weeks of healing, mechanical testing was performed to determine (dimensionally) cross-sectional area; (structurally) medial collateral ligament laxity, failure load, and stiffness; and (materially) cyclic creep strain and failure stress. Because we wanted to evaluate whether the mechanical properties of re-injured ligaments were equivalent or, at least, no worse than injured ligaments, we used equivalence/noninferiority testing. This approach evaluates a research hypothesis of equivalence, rather than difference, and determines whether comparisons are ‘statistically equivalent’, ‘noninferior’, or ‘potentially inferior’. Transection re-injured and gap re-injured ligaments were ‘statistically equivalent’ structurally to transection injured ligaments. Transection re-injured ligaments were ‘noninferior’ both materially and dimensionally to transection injured ligaments. Gap re-injured ligaments were ‘potentially inferior’ both materially and dimensionally to transection injured ligaments. Two differences between the re-injuries, which affect healing, may explain the mechanical outcomes: the presence or lack of healing products and the proximity of ligament ends at the time of re-injury. Our findings suggest that (in the short term) there is a severity of re-injury below which there is no additional disadvantage to the healing process, mechanical behaviour, and resulting potential for re-injury.
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Affiliation(s)
- Johnathan L Sevick
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Bryan J Heard
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Ian KY Lo
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - John A Randle
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Cyril B Frank
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Nigel G Shrive
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Gail M Thornton
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
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Mahapatra P, Horriat S, Anand BS. Anterior cruciate ligament repair - past, present and future. J Exp Orthop 2018; 5:20. [PMID: 29904897 PMCID: PMC6002325 DOI: 10.1186/s40634-018-0136-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/31/2018] [Indexed: 12/14/2022] Open
Abstract
Background This article provides a detailed narrative review on the history and current concepts surrounding ligamentous repair techniques in athletic patients. In particular, we will focus on the anterior cruciate ligament (ACL) as a case study in ligament injury and ligamentous repair techniques. PubMed (MEDLINE), EMBASE and Cochrane Library databases for papers relating to primary anterior cruciate ligament reconstruction were searched by all participating authors. All relevant historical papers were included for analysis. Additional searches of the same databases were made for papers relating to biological enhancement of ligament healing. Current standard The poor capacity of the ACL to heal is one of the main reasons why the current gold standard surgical treatment for an ACL injury in an athletic patient is ACL reconstruction with autograft from either the hamstrings or patella tendon. It is hypothesised that by preserving and repairing native tissues and negating the need for autograft that primary ACL repair may represent a key step change in the treatment of ACL injuries. History of primary ACL repair The history of primary ACL repair will be discussed and the circumstances that led to the near-abandonment of primary ACL repair techniques will be reviewed. New primary repair techniques There has been a recent resurgence in interest with regards to primary ACL repair. Improvements in imaging now allow for identification of tear location, with femoral-sided injuries, being more suitable for repair. We will discuss in details strategies for improving the mechanical and biological environment in order to allow primary healing to occur. In particular, we will explain mechanical supplementation such as Internal Brace Ligament Augmentation and Dynamic Intraligamentary Stabilisation techniques. These are novel techniques that aim to protect the primary repair by providing a stabilising construct that connects the femur and the tibia, thus bridging the repair. Bio enhanced repair In addition, biological supplementation is being investigated as an adjunct and we will review the current literature with regards to bio-enhancement in the form platelet rich plasma, bio-scaffolds and stem cells. On the basis of current evidence, there appears to be a role for bio-enhancement, however, this is not yet translated into clinical practice. Conclusions Several promising avenues of further research now exist in the form of mechanical and biological augmentation techniques. Further work is clearly needed but there is renewed interest and focus for primary ACL repair that may yet prove the new frontier in ligament repair.
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Affiliation(s)
- Piyush Mahapatra
- Trauma and Orthopaedic Department, Croydon University Hospital, 530 London Road, London, CR7 7YE, UK.
| | - Saman Horriat
- Trauma and Orthopaedic Department, Croydon University Hospital, 530 London Road, London, CR7 7YE, UK
| | - Bobby S Anand
- Trauma and Orthopaedic Department, Croydon University Hospital, 530 London Road, London, CR7 7YE, UK
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Whalan M, Lovell R, McCunn R, Sampson JA. The incidence and burden of time loss injury in Australian men's sub-elite football (soccer): A single season prospective cohort study. J Sci Med Sport 2018; 22:42-47. [PMID: 29884595 DOI: 10.1016/j.jsams.2018.05.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 05/18/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES This study aimed to conduct the first injury surveillance study in sub-elite football in Australia, using methods from the international football consensus statement. DESIGN Descriptive epidemiological study. METHODS 1049 sub-elite football players were recruited during the 2016 season. Injury and exposure data was collected by trained Primary Data Collectors (PDCs) who attended every training session and match. RESULTS There were 1041 time loss injuries recorded during 52,127h of exposure resulting in an injury incidence rate of 20 injuries/1000h (95% Confidence Interval [CI]: 15.9-23.3). The injury burden (days lost to injury relative to exposure) was 228days lost/1000h. Muscle and ligament injuries were the most prevalent (41% and 26%) and incurred the highest injury burden (83 and 80days lost/1000h, respectively). The most common injuries were observed at the thigh (22%) and ankle (17%), with hamstring (13%) the highest reported muscle injury. The profile of injury severity was: mild - 35%; minor - 29%; moderate - 28% and severe - 8%. Recurrent injuries accounted for 20% of all injuries. CONCLUSIONS By addressing issues identified with injury recording in sub-elite football, this study found that the injury incidence was twice that observed in previous research in elite and sub-elite football cohorts. Injury burden was also twice that of the elite setting, with similar injuries associated with the highest burden. The results highlight the need for investment into medical provision, facilities, coach education and injury mitigation programmes to reduce healthcare costs to sub-elite players in Australia.
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Affiliation(s)
- Matthew Whalan
- Centre for Human and Applied Physiology, School of Medicine, University of Wollongong, Australia; NSW Football Medicine Association, Australia; Figtree Physiotherapy, Australia.
| | - Ric Lovell
- School of Science and Health, Western Sydney University, Australia; NSW Football Medicine Association, Australia
| | - Robert McCunn
- Institute of Sport and Preventive Medicine, Saarland University, Germany; NSW Football Medicine Association, Australia; Oriam: Scotland's Sports Performance Centre, Heriot-Watt University, United Kingdom
| | - John A Sampson
- Centre for Human and Applied Physiology, School of Medicine, University of Wollongong, Australia; NSW Football Medicine Association, Australia
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Hamrin Senorski E, Svantesson E, Beischer S, Grassi A, Krupic F, Thomeé R, Samuelsson K. Factors Affecting the Achievement of a Patient-Acceptable Symptom State 1 Year After Anterior Cruciate Ligament Reconstruction: A Cohort Study of 343 Patients From 2 Registries. Orthop J Sports Med 2018; 6:2325967118764317. [PMID: 29780834 PMCID: PMC5954350 DOI: 10.1177/2325967118764317] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background There is insufficient knowledge regarding the influence of concomitant injuries on the recovery of short-term subjective knee function after anterior cruciate ligament (ACL) reconstruction. Purpose To determine whether patient characteristics, concomitant injuries, and graft choice during ACL reconstruction can predict which patients achieve acceptable knee function 1 year after reconstruction. Study Design Case-control study; Level of evidence, 3. Methods Data from 1 physical therapist-specific and 1 surgeon-specific register were used. Patients who had completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at 1-year follow-up were included. Additional intraoperative information was extracted from a database. The primary outcome was achieving a patient-acceptable symptom state (PASS) for each subscale of the KOOS. Univariable and multivariable logistic regression models were used, with patient sex, age, and preinjury level of physical activity as covariates. Results A total of 343 patients (51% females) were included. The proportion of patients achieving PASS 1 year after ACL reconstruction varied between 40% and 85% among the KOOS subscales. Younger age at reconstruction and male sex provided favorable odds of achieving acceptable knee function across the KOOS subscales. Patients without cartilage injury had increased odds of achieving PASS in the KOOS sport and recreation subscale; the increase was 1.63-fold (95% CI, 1.01-2.64; P = .045). Patients receiving patellar tendon autograft had a 0.41-fold (95% CI, 0.19-0.85; P = .017) decrease in odds of achieving PASS on the KOOS quality of life (QoL) subscale. In the multivariable analysis, increased odds of achieving PASS on the KOOS QoL subscale were associated with the absence of meniscal injury (odds ratio, 1.62; 95% CI, 1.04-2.54; P = .035), and increased odds were found for hamstring tendon autograft (OR, 2.63; 95% CI, 1.25-5.56; P = .011). Conclusion More than half of the patients reported an acceptable symptom state on 4 of the 5 KOOS subscales 1 year after ACL reconstruction. A lack of consistency was noted related to the effect of concomitant knee injuries and graft choice on acceptable knee function. However, younger age and male sex were favorable, nonmodifiable characteristics that increased the odds of early acceptable function.
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Affiliation(s)
- Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sportrehab, Sports Medicine Clinic, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Beischer
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sportrehab, Sports Medicine Clinic, Gothenburg, Sweden
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II-Lab. di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ferid Krupic
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Roland Thomeé
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Sportrehab, Sports Medicine Clinic, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
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39
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Baker HP, Varelas A, Shi K, Terry MA, Tjong VK. The NFL's Chop-Block Rule Change: Does It Prevent Knee Injuries in Defensive Players? Orthop J Sports Med 2018; 6:2325967118768446. [PMID: 29780842 PMCID: PMC5954335 DOI: 10.1177/2325967118768446] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The chop block, a football maneuver in which an offensive player blocks an opponent around the thigh while another offensive player engages the same opponent above the waist, was declared illegal by the National Football League (NFL) before the 2016-2017 season. Chop blocks have been hypothesized to be associated with medial collateral ligament and anterior cruciate ligament injury, especially in offensive/defensive linemen. Purpose: To quantify the impact that the chop-block rule change had on the incidence of knee injuries to defensive players in the NFL over 4 seasons (2014-2018). Study Design: Cohort study; Level of evidence, 3. Methods: NFL injury data for all defensive players from regular-season games played from 2014 through 2018 were collected. For this study, all knee injuries were attributed to competitive game play. Injury rates were reported as the number of injuries per 1000 athletic exposures (with 95% CIs). Results: A total of 256 games were played during the 2014-2015, 2015-2016, 2016-2017, and 2017-2018 NFL regular seasons, and all were included in this study. Among defensive players, the relative risk for a knee injury per 1000 athletic exposures was 0.84 (95% CI, 0.75-0.96) for the 2 seasons after the chop-block rule change (2016-2017 and 2017-2018) versus the 2 seasons before (2014-2015 and 2015-2016) (P = .009). Thus, the relative risk reduction was 16%. The relative risk for a defensive player to be placed on injured reserve per season was 0.90 (95% CI, 0.72-1.13) for the 2 seasons after the rule change versus the 2 seasons before (P = .39). Conclusion: The NFL’s recent ruling against in-game chop blocks may have reduced the incidence of knee injuries among defensive players.
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Affiliation(s)
- Hayden P. Baker
- The University of Illinois College of Medicine, Chicago, Illinois, USA
- Hayden Baker, BA, 1537 West Barry Avenue, Chicago, IL 60657, USA ()
| | - Antonios Varelas
- The University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Kevin Shi
- Rush University Medical Center, Chicago, Illinois, USA
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40
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Investigating the effects of maximal anaerobic fatigue on dynamic postural control using the Y-Balance Test. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2017.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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41
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Krutsch W, Zeman F, Zellner J, Pfeifer C, Nerlich M, Angele P. Increase in ACL and PCL injuries after implementation of a new professional football league. Knee Surg Sports Traumatol Arthrosc 2016; 24:2271-9. [PMID: 25293676 DOI: 10.1007/s00167-014-3357-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 09/23/2014] [Indexed: 01/12/2023]
Abstract
PURPOSE In the season 2008-2009, a third professional football league was established in Germany. This study analysed the influence of increased training and playing intensity on severe knee injuries in football players. METHODS In a prospective controlled one-season trial, injury incidence and injury patterns of players of the newly established professional football league were analysed, particularly with regard to ruptures of the anterior (ACL) and posterior (PCL) cruciate ligaments. Players of the highest amateur level served as a control group. RESULTS Four hundred and eight players of 24 teams were allocated to two groups. The overall training exposure was significantly (p < 0.001) higher in the new professional league (335.3 h per player) than at the amateur level (286.6 h per player). Players at both levels showed similar overall injury rates and injury patterns. However, players in the professional league had a significantly higher (p = 0.04) incidence of ACL and PCL injuries, than players at the amateur level. More than 90 % of all ACL and PCL ruptures in both groups were sustained by players, who had played at least one level lower in the previous season. In addition, injuries of players who had sustained repeat injuries over the season were more severe. CONCLUSION The introduction of a new professional football league increased the training and playing intensity of players as well as the number of ACL and PCL ruptures. A specific injury prevention concept, particularly for players facing rapidly increasing training and playing intensity, seems to be mandatory. LEVEL OF EVIDENCE Prospective controlled cohort study, Level II.
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Affiliation(s)
- Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, FIFA Medical Centre of Excellence, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Florian Zeman
- Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany
| | - Johannes Zellner
- Department of Trauma Surgery, University Medical Centre Regensburg, FIFA Medical Centre of Excellence, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Christian Pfeifer
- Department of Trauma Surgery, University Medical Centre Regensburg, FIFA Medical Centre of Excellence, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, University Medical Centre Regensburg, FIFA Medical Centre of Excellence, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Peter Angele
- Department of Trauma Surgery, University Medical Centre Regensburg, FIFA Medical Centre of Excellence, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- sporthopaedicum Straubing/Regensburg, Regensburg, Germany
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Abstract
Medial collateral ligament injuries are common in the athletic population. Partial injuries are treated nonoperatively with excellent outcomes. Complete ruptures may be treated nonoperatively, although some will require surgery. A comprehensive rehabilitation program is critical to outcome, but a standardized program for all injuries does not exist. Most of the literature regarding nonoperative and postoperative rehabilitation include observational reports and case studies. Level I studies comparing rehabilitation protocols have not been published. The goal of the injured athlete is to not only return to play with no functional limitations, but to also address risk factors and prevent future injuries.
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43
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Pangrazio O, Forriol F. Epidemiology of soccer players traumatic injuries during the 2015 America Cup. Muscles Ligaments Tendons J 2016; 6:124-30. [PMID: 27331040 DOI: 10.11138/mltj/2016.6.1.124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM to provide an overview of the traumatic injuries sustained by players in the 2015 America Cup. MATERIAL AND METHODS we collected the medical reports on all the matches held during the 2015 America Cup, in Chile, in 2015. Twelve American teams took part in the championship, consisted of 26 matches with a total of 276 players. The physician for each team sent a request form of the traumatic injuries sustained, including the time at which the injury was produced, the location and diagnosis, its severity and the circumstances (contact injury, sanction, treatment required). RESULTS the mean number of minutes played was 233 (SD: 147) (5-570) minutes. An injury occurred every 58 minutes, which means that there were 17.25 injuries per 1,000 minutes of match time. We found 44 injuries in 30 players. There were 14 non-contact injuries, and 30 contact injuries, of which 13 were declared fouls and resulted in cards being given. Five teams had one injured player, two had 2, two had 4, and one had 25 injuries. The most frequent injuries were those to the lower limbs. The muscles strains happened in the second part of the second half of the match, the ACL rupture at the end of the first half, and the other sprains and strains in the second half. The contusions occurred at all times throughout the match, although they seemed to be concentrated towards the end of the first half, while the cases of tendinitis were caused in the first part of the second half. CONCLUSION football injuries are very common, and even though serious injuries are rare, it is increasingly necessary to set protocols for action which ensure good medical attention at all levels to address the problems that arise, both during training and in competitions, and to be prepared to treat serious injuries if these occur.
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Affiliation(s)
- Osvaldo Pangrazio
- Comisión Médica Conmebol (Confederación Su-damericana de Fútbol), Asunción, Paraguay
| | - Francisco Forriol
- Department of Clínica Sciences, University San Pablo - CEU, Boadilla del Monte, Spain
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Epidemiology of injuries sustained by players during the 16th Under-17 South American Soccer Championship. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ekstrand J. Preventing injuries in professional football: thinking bigger and working together. Br J Sports Med 2016; 50:709-10. [DOI: 10.1136/bjsports-2016-096333] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/03/2022]
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Waldén M, Hägglund M, Magnusson H, Ekstrand J. ACL injuries in men's professional football: a 15-year prospective study on time trends and return-to-play rates reveals only 65% of players still play at the top level 3 years after ACL rupture. Br J Sports Med 2016; 50:744-50. [PMID: 27034129 DOI: 10.1136/bjsports-2015-095952] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Studies investigating the development of ACL injuries over time in football are scarce and more data on what happens before and after return to play (RTP) are needed. AIM To investigate (1) time trends in ACL injury rates, (2) complication rates before return to match play following ACL reconstruction, and (3) the influence of ACL injury on the subsequent playing career in male professional football players. METHODS 78 clubs were followed between 2001 and 2015. Time trend in ACL injury rate was analysed using linear regression. ACL-injured players were monitored until RTP and tracked for 3 years after RTP. RESULTS We recorded 157 ACL injuries, 140 total and 17 partial ruptures, with a non-significant average annual increase in the ACL injury rate by 6% (R(2)=0.13, b=0.059, 95% CI -0.04 to 0.15, p=0.20). The match ACL injury rate was 20-fold higher than the training injury rate (0.340 vs 0.017 per 1000 h). 138 players (98.6%) with a total rupture underwent ACL reconstruction; all 134 players with RTP data (4 players still under rehabilitation) were able to return to training, but 9 of them (6.7%) suffered complications before their first match appearance (5 reruptures and 4 other knee surgeries). The median layoff after ACL reconstruction was 6.6 months to training and 7.4 months to match play. We report 3-year follow-up data for 106 players in total; 91 players (85.8%) were still playing football and 60 of 93 players (65%) with ACL reconstruction for a total rupture played at the same level. CONCLUSIONS The ACL injury rate has not declined during the 2000s and the rerupture rate before return to match play was 4%. The RTP rate within a year after ACL reconstruction was very high, but only two-thirds competed at the highest level 3 years later.
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Affiliation(s)
- Markus Waldén
- Football Research Group, Linköping University, Linköping, Sweden Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Department of Orthopaedics, Hässleholm-Kristianstad-Ystad Hospitals, Hässleholm, Sweden
| | - Martin Hägglund
- Football Research Group, Linköping University, Linköping, Sweden Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Henrik Magnusson
- Football Research Group, Linköping University, Linköping, Sweden Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Ekstrand
- Football Research Group, Linköping University, Linköping, Sweden Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Pangrazio O, Forriol F. Epidemiology of injuries sustained by players during the 16th Under-17 South American Soccer Championship. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:192-9. [PMID: 26838188 DOI: 10.1016/j.recot.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/19/2015] [Accepted: 12/02/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We performed an epidemiological study of the traumatic injuries during the XVI South American U-17 Football Championship, 2015. MATERIAL AND METHODS Observational surveys submitted by the 10 teams medical services of 220 players. Thirty-five games were held and 116 goals (3.31 per game) were recorded. RESULTS 103 lesions, ie, 2.94 per game or 32.7 injuries per 1,000 min were recorded. Fifty-six were from direct contact and 66 requiring treatment. 36% of the injuries were punished by fault and 26% of the injuries also saw card. Injuries were most common in the ankle (15 cases), Achilles tendon (14 cases) and thigh (14 cases), followed by trauma to the knee and foot (7 cases each), face and the lumbar region (6 cases each), being rare in the upper extremity. CONCLUSION Injuries during Soccer World Cup are difficult to predict and prevent, but serious injuries are rare. Is necessary to establish protocols that get adequate health care at all levels to solve problems produce, both in training and during the competition, and be prepared to solve the serious problems that may arise.
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Affiliation(s)
- O Pangrazio
- Comisión Médica Conmebol (Confederación Sudamericana de Fútbol), Universidad San Pablo-CEU, Madrid, España
| | - F Forriol
- Facultad de Medicina, Universidad San Pablo-CEU, Madrid, España.
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Whyte E, Burke A, White E, Moran K. A high-intensity, intermittent exercise protocol and dynamic postural control in men and women. J Athl Train 2015; 50:392-9. [PMID: 25689420 DOI: 10.4085/1062-6050-49.6.08] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
CONTEXT Deficits in dynamic postural control predict lower limb injury. Differing fatiguing protocols negatively affect dynamic postural control. The effect of high-intensity, intermittent exercise on dynamic postural control has not been investigated. OBJECTIVE To investigate the effect of a high-intensity, intermittent exercise protocol (HIIP) on the dynamic postural control of men and women as measured by the Star Excursion Balance Test (SEBT). DESIGN Descriptive laboratory study. SETTING University gymnasium. PATIENTS OR OTHER PARTICIPANTS Twenty male (age = 20.83 ± 1.50 years, height = 179.24 ± 7.94 cm, mass = 77.67 ± 10.82 kg) and 20 female (age = 20.45 ± 1.34 years, height = 166.08 ± 5.83 cm, mass = 63.02 ± 6.67 kg) athletes. INTERVENTION(S) We recorded SEBT measurements at baseline, pre-HIIP, and post-HIIP. The HIIP consisted of 4 repetitions of 10-m forward sprinting with a 90° change of direction and then backward sprinting for 5 m, 2 repetitions of 2-legged jumping over 5 hurdles, 2 repetitions of high-knee side stepping over 5 hurdles, and 4 repetitions of lateral 5-m shuffles. Participants rested for 30 seconds before repeating the circuit until they reported a score of 18 on the Borg rating of perceived exertion scale. MAIN OUTCOME MEASURE(S) A mixed between- and within-subjects analysis of variance was conducted to assess time (pre-HIIP, post-HIIP) × sex interaction effects. Subsequent investigations assessed the main effect of time and sex on normalized maximal SEBT scores. We used intraclass correlation coefficients to determine the test-retest reliability of the SEBT and paired-samples t tests to assess the HIIP effect on circuit times. RESULTS We found a time × sex effect (F(8,69) = 3.5; P range, <.001-.04; η(2) range, 0.057-0.219), with women less negatively affected. We also noted a main effect for time, with worse normalized maximal SEBT scores postfatigue (F(8,69) = 22.39; P < .001; η(2) range, 0.324-0.695), and for sex, as women scored better in 7 SEBT directions (F(8,69) = 0.84; P range, <.001-008; η(2) range, 0.088-0.381). The intraclass correlation coefficients demonstrated high (0.77-0.99) test-retest repeatability. Paired-samples t tests demonstrated increases in circuit time post-HIIP (P < .001). CONCLUSIONS The HIIP-induced fatigue negatively affected normalized maximal SEBT scores. Women had better scores than men and were affected less negatively by HIIP-induced fatigue.
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Affiliation(s)
- Enda Whyte
- School of Health and Human Performance, Dublin City University, Ireland
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Roach CJ, Haley CA, Cameron KL, Pallis M, Svoboda SJ, Owens BD. The epidemiology of medial collateral ligament sprains in young athletes. Am J Sports Med 2014; 42:1103-9. [PMID: 24603529 DOI: 10.1177/0363546514524524] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A medial collateral ligament (MCL) knee sprain is a prevalent injury in athletic populations that may result in significant time lost to injury. Remarkably little is known of the epidemiology of this injury. PURPOSE To define the incidence of MCL tears and to determine the demographic and athletic risk factors. STUDY DESIGN Descriptive epidemiological study. METHODS A longitudinal cohort study was performed to examine the epidemiology of isolated MCL sprains at the United States Military Academy (USMA) between 2005 and 2009. Charts and radiographic studies were reviewed by an independent orthopaedic surgeon to identify all new isolated MCL sprains resulting in time lost to sport and activity that occurred within the study period. Incidence rates (IRs) with 95% confidence intervals (CIs) were calculated per 1000 person-years at risk and by sex, sport, and level of competition. The IR per 1000 athlete-exposures (AEs) was also determined. Incidence rate ratios (IRRs) and respective 95% CIs were calculated between male and female students, intercollegiate and intramural athletes, and male and female intercollegiate athletes involved in selected sports. Chi-square and Poisson regression analyses were used to examine the relationship between the variables of interest and the incidence of MCL sprains, with statistical significance set at P < .05. RESULTS A total of 128 cadets sustained isolated MCL injuries during 17,606 student person-years from 2005 to 2009. This resulted in an IR of approximately 7.3 per 1000 person-years. Of the 128 injuries, 114 were in male athletes (89%) and 14 were in female athletes (11%). Male cadets had a 44% higher IR than did female cadets (7.60 vs 5.36, respectively), although this was not significant (P = .212). Of 5820 at-risk intercollegiate athletes, 59 (53 male, 6 female) sustained an isolated MCL sprain during 528,523 (407,475 male, 121,048 female) AEs for an overall IR of 10.14 per 1000 person-years and 0.11 per 1000 AEs. The IRR of MCL sprains of men compared with women involved in intercollegiate athletics was 2.87 (95% CI, 1.24-8.18) per 1000 person-years and 2.62 (95% CI, 1.13-7.47) per 1000 AEs. Of 21,805 at-risk intramural athletes, with quarterly participation, 16 (all male) sustained isolated MCL injuries during 225,683 AEs for an overall IR of 0.07 per 1000 AEs. The IRs of MCL injuries of intercollegiate and intramural athletes did not differ significantly. In intercollegiate sports, wrestling (0.57), judo (0.36), hockey (0.34), and rugby (men's, 0.22; women's, 0.23) had the highest IRs per 1000 AEs. When examining men's intercollegiate athletics, the IRRs of wrestling (13.41; 95% CI, 1.80-595.27) and hockey (8.12; 95% CI, 0.91-384.16) were significantly higher compared with that of lacrosse. Among women's intercollegiate sports as well as intramural sports, there were no significant differences in IRs. A median of 16 days was lost to injury, with 2407 total days lost for all injuries. Grade 1 MCL injuries lost a median of 13.5 days, while higher grade injuries lost a median of 29 days. CONCLUSION Medial collateral ligament injuries are relatively common in athletic cohorts. The most injurious sports are contact sports such as wrestling, hockey, judo, and rugby. Male athletes are at a greater risk than female athletes. Intercollegiate athletes are at a greater risk than intramural athletes. The average amount of time lost per injury was 23.2 days, with greater time lost with higher grade sprains than grade 1 sprains.
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Affiliation(s)
- Christopher J Roach
- Christopher J. Roach, Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, 3851 Roger Brooke Drive, San Antonio, TX 78234, USA.
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