Injury patterns in professional arena football

Epidemiology of Foot Injuries Using National Collegiate Athletic Association Data From the 2009-2010 Through 2014-2015 Seasons

CONTEXT

Researchers analyzing data from the National Collegiate Athletic Association Injury Surveillance Program have not considered the differences in foot injuries across specific sports and between males and females.

OBJECTIVE

To describe the epidemiologic differences in rates of overall foot injuries and common injuries among sports and between sexes.

DESIGN

Descriptive epidemiology study.

SETTING

Online injury-surveillance data from 15 unique sports involving males and females that demonstrated 1967 injuries over 4 821 985 athlete-exposures.

PATIENTS OR OTHER PARTICIPANTS

Male and female athletes competing in National Collegiate Athletic Association sports from the 2009-2010 through 2014-2015 seasons.

MAIN OUTCOME MEASURE(S)

Foot injury rates (per 10 000 athlete-exposures) and the proportion of foot injuries were calculated for each sport. The effect of sex was calculated using Poisson-derived confidence intervals for 8 paired sports. A risk analysis was performed using a 3 × 3 quantitative injury risk-assessment matrix based on both injury rate and mean days of time loss.

RESULTS

Foot injury rates differed between sports, with the highest rates in female gymnastics, male and female cross-country, and male and female soccer athletes. Cross-country and track and field had the highest proportions of foot injuries for both female and male sports. The 5 most common injuries were foot/toe contusions, midfoot injuries, plantar fascia injuries, turf toe, and metatarsal fractures. Only track and field athletes demonstrated a significant sex difference in injury rates, with female athletes having the higher rate. The quantitative injury risk-assessment matrix identified the 4 highest-risk injuries, considering both rate and severity, as metatarsal fractures, plantar fascia and midfoot injuries, and foot/toe contusions.

CONCLUSIONS

Important differences were present among sports in terms of injury rates, the most common foot injuries, and the risk (combination of frequency and severity) of injury. These differences warrant further study to determine the mechanisms of injury and target intervention efforts.

Health Care Provision During a Sporting Mass Gathering: A Structure and Process Description of On-Site Care Delivery

INTRODUCTION

Mass gatherings such as marathons are increasingly frequent. During mass gatherings, the provision of timely access to health care services is required for the mass-gathering population, as well as for the local community. However, the nature and impact of health care provision during sporting mass gatherings is not well-understood.

PURPOSE

The aim of this study was to describe the structures and processes developed for an emergency health team to operate an in-event, acute health care facility during one of the largest mass-sporting participation events in the southern hemisphere, the Gold Coast Marathon (Queensland, Australia).

METHODS

A pragmatic, qualitative methodology was used to describe the structures and processes required to operate an in-event, acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with emergency department (ED) clinical staff working during the two-day event was undertaken in 2016.

FINDINGS

Important structural elements of the in-event health care facility included: physical spaces, such as the clinical zones in the marathon health tent and surrounding area, and access and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms (ECGs) and intravenous fluids. Process elements of the in-event health care facility included clear communication pathways, as well as inter-professional care coordination and engagement involving shared knowledge of and access to resources, and distinct but overlapping clinical scope between nurses and doctors. This was seen to be critical for timely care provision and appropriate case management. Staff reported many perceived benefits and opportunities of in-event health care delivery, including ED avoidance and disaster training.

CONCLUSIONS

This in-event model of emergency care delivery, established in an out-of-hospital location, enabled the delivery of acute health care that could be clearly described and defined. Staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.JohnstonANB, WadhamJ, Polong-BrownJ, AitkenM, RanseJ, HuttonA, RichardsB, CrillyJ.Health care provision during a sporting mass gathering: a structure and process description of on-site care delivery. Prehosp Disaster Med. 2019;34(1):62-71.

Injuries in the Chinese Arena Football League: American Versus Chinese Players

Background

Arena football is an indoor version of American football played in indoor arenas on a smaller field with 8 players per team. Only 1 study has evaluated injury rates in arena football, and no study had compared 2 distinct cohorts of players.

Purpose/Hypothesis

The purpose of this study was to evaluate and compare injury rates in American versus Chinese athletes in the Chinese Arena Football League. Our hypothesis was that the rate of significant injuries (≥7 days of time lost from play) would be statistically significantly higher in Chinese athletes.

Study Design

Cohort study; Level of evidence, 2.

Methods

Each of the 6 teams included in this study comprised 11 American and 11 Chinese athletes, for a total of 132 included athletes (66 Chinese, 66 American). All players stayed in the same hotel, trained and played in the same facilities, and were covered by the same medical staff. A total of 18 games were played consecutively in 6 cities from October 1 to November 6, 2016. At least 4 Chinese players had to be on the field for each team at all times during game play.

Results

American athletes were significantly older, taller, and heavier than Chinese athletes. The total exposure was 759 athlete-hours, and there were 80 reported injuries, with 74 (92.5%) occurring during games (overall injury rate, 105.4 injuries per 1000 athlete-hours). For American athletes, the exposure was 387 athlete-hours with 38 injuries observed, and the injury rate was 98.2 injuries per 1000 athlete-hours. For Chinese athletes, the exposure was 372 athlete-hours with 42 injuries observed, and the injury rate was 112.9 injuries per 1000 athlete-hours. There was no statistically significant difference in exposure or overall injury rate between American and Chinese athletes. The rate of significant injuries was 30.3 per 1000 athlete-hours; there were 17 such injuries in Chinese athletes compared with 6 such injuries for American athletes. The rate of significant injuries was 45.7 (Chinese) and 15.5 (American) injuries per 1000 athlete-hours, and the relative risk for Chinese versus American athletes for significant injuries was 3.0 (95% CI, 1.2-7.8; P = .019) . Binary logistic regression models were utilized to analyze whether the baseline variables (height, weight, body mass index, age, years of experience, and nationality) were potential predictors for an injury, and only years of experience (odds ratio, 1.147 [95% CI, 1.034-1.271]; P = .009) was found to be associated with severe injuries (>21 days of time loss).

Conclusion

The overall risk of injuries was similar between Chinese and American athletes, but Chinese athletes showed statistically higher rates of significant injuries than their American counterparts. Years of experience was the only factor that was associated with severe injuries. As professional sports become more global, medical personnel must take into account the distinct differences and levels of experience between the national and international professional athletes. The results of this study will be used to make recommendations to develop preventive training measures, including techniques to improve tackling.

Incidence and Severity of Foot and Ankle Injuries in Men's Collegiate American Football

Background:

American football is an extremely physical game with a much higher risk of injury than other sports. While many studies have reported the rate of injury for particular body regions or for individual injuries, very little information exists that compares the incidence or severity of particular injuries within a body region. Such information is critical for prioritizing preventative interventions.

Purpose:

To retrospectively analyze epidemiological data to identify the most common and most severe foot and ankle injuries in collegiate men’s football.

Study Design:

Descriptive epidemiology study.

Methods:

Injury data were obtained from the National Collegiate Athletic Association (NCAA) Injury Surveillance System (ISS) for all foot and ankle injuries during the 2004-2005 to 2008-2009 seasons. Injuries were analyzed in terms of incidence and using multiple measures of severity (time loss, surgeries, medical disqualifications). This frequency and severity information is summarized in tabular form as well as in a 4 × 4 quantitative injury risk assessment matrix (QIRAM).

Results:

The rate of foot and ankle injuries was 15 per 10,000 athletic exposures (AEs). Five injuries were found to be responsible for more than 80% of all foot and ankle injuries: lateral ankle ligament sprains, syndesmotic (high ankle) sprains, medial ankle ligament sprains, midfoot injuries, and first metatarsophalangeal joint injuries. Ankle dislocations were found to be the most severe in terms of median time loss (100 days), percentage of surgeries (83%), and percentage of medical disqualifications (94%), followed by metatarsal fractures (38 days, 36%, and 49%, respectively) and malleolus fractures (33 days, 41%, and 59%, respectively). Statistical analysis suggests that the 3 measures of severity are highly correlated (r > 0.94), thereby justifying the use of time loss as a suitable proxy for injury severity in the construction of the QIRAM.

Conclusion:

Based on the QIRAM analysis, the 5 highest risk injuries were identified based on both incidence and severity (ankle dislocations, syndesmotic sprains, lateral ankle ligament sprains, metatarsal fractures, and malleolus fractures). A better understanding of the relative incidence and severity of these injuries will allow coaches, trainers, and researchers to more effectively focus their preventative interventions.

Level of agreement between field-based data collectors in a large scale injury prevention randomised controlled trial

In sports injury prevention field trials, data collectors are often club volunteers with considerable knowledge of the game but with limited detailed medical backgrounds or knowledge of formal scientific processes. The aim of this paper is to determine the agreement among trained primary data collectors (PDCs) with a sport science background and no prior involvement in data collection in a large randomised controlled trial. During the 'Preventing Australian Football Injury through eXercise' (PAFIX) project, player participation and injury data were collected by trained PDCs at training and games over the 2007 and 2008 playing seasons in 40 community level Australian football teams. PDC-collected data relating to player exposure and whether or not a player sustained an injury and subsequently left the field of play was compared to the same information from independent observers (IOs) who attended one randomly selected game for each of the 40 teams. There was 98% agreement between the PDC and the IO on game details (i.e., date, time, grade and score), 79% (ICC 0.9, 95% CI 0.85-0.95) agreement on the number of players per game and 76% (ICC 0.8, 95% CI 0.69-0.91) agreement on the number of injuries sustained in the games. There was 100% agreement on whether the player left the field for all injuries. This study found that exercise and sport science students are reliable data collectors in sports injury fieldwork studies.

Magnetic resonance imaging-documented chondral injuries about the knee in college football players: 3-year National Football League Combine data

PURPOSE

To evaluate the incidence and risk factors for knee cartilage injury in elite college football players invited to attend the US National Football League (NFL) Scouting Combine over a 3-year period.

METHODS

All players entering the NFL Scouting Combine (National Invitational Camp) from 2005 through 2007 were evaluated. "At-risk" knees underwent magnetic resonance imaging (MRI), and the results were evaluated for chondral injuries.

RESULTS

During the 3-year period reviewed, a total of 980 players were available for analysis, and a total of 516 players' knee MRI scans were obtained (53% of all players at the Combine). The total number of full-thickness chondral injuries evident on MRI was 197 (20.1%) among all players, or 38.2% of the players who had an MRI scan. Of the players, 30 (3.06% of all players at the Combine, or 5.8% of the players who had an MRI scan) had isolated medial compartment full-thickness chondral injuries, 41 (4.2%, or 7.9%) had isolated lateral compartment full-thickness chondral injuries, 48 (4.9%, or 9.3%) had patellofemoral compartment full-thickness chondral damage, and 78 (7.96%, or 15.1%) had full-thickness chondral injuries in more than 1 compartment.

CONCLUSIONS

The epidemiologic and risk assessment data presented in this study offer a cross-section of a young and elite athletic population who were "prescreened" at the NFL Combine over a 3-year period and judged to have at-risk knees. The total number of full-thickness chondral injuries evident on MRI was 197 (20.1%) among all players, or 38.2% of the players who had an MRI scan: 30 players (3.06%, or 5.8%) had an isolated medial compartment full-thickness chondral injury, 41 players (4.2%, or 7.9%) had an isolated lateral compartment full-thickness chondral injury, 48 players (4.9%, or 9.3%) had isolated patellofemoral compartment full-thickness chondral damage, and 78 players (7.96%, or 15.1%) had full-thickness chondral injuries in more than 1 compartment.

LEVEL OF EVIDENCE

Level IV, diagnostic study.