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Inclan PM, Kuhn AW, Troyer SC, Solomon GS, Matava MJ. Use of Publicly Obtained Data in Sports Medicine Research: A Systematic Review and Bibliometric Analysis. Am J Sports Med 2024; 52:1367-1373. [PMID: 37306057 DOI: 10.1177/03635465231177054] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Publicly obtained data (POD) have recently been utilized frequently by sports medicine researchers to describe injury patterns, risk factors, and outcomes in elite athletes. The relative ease of this type of research that is based solely on internet and media sources has resulted in a near exponential increase in the number of these POD studies. PURPOSE To systematically review the sports medicine literature for studies based solely on POD. STUDY DESIGN Systematic review and bibliometric analysis; Level of evidence, 4. METHODS A systematic review of POD studies published since 2000 was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies of interest were those relying on publicly available injury reports or online media for data acquisition in collegiate, semiprofessional, and professional athletes. RESULTS There were 209 POD studies published between 2000 and 2022, with 173 (82.8%) of these studies published after 2016. Studies were published most frequently on athletes participating in North American professional leagues: National Football League (n = 69 [28.4%]), Major League Baseball (n = 56 [23.0%]), National Basketball Association (n = 37 [15.2%]), and National Hockey League (n = 33 [13.6%]). The most common injuries assessed were head injuries/concussions (n = 43 [21.1%]), anterior cruciate ligament injuries (n = 33 [16.2%]), and ulnar collateral ligament injuries (n = 23 [11.3%]). One-quarter of the studies (n = 53 [25.4%]) reported only 1 POD source, and 1 study (0.5%) reported no source. Additionally, 65 studies (31.1%) listed nonspecific POD resources or solely cited previous literature to describe the POD search methodology and data acquisition. CONCLUSION POD studies are exponentially increasing in number, particularly across major North American professional sports leagues, with significant variability in the injury of interest, search methodology, and number of data sources. The accuracy of the conclusions reached based on the POD methodology appears highly variable. Given the potential impact of these publications as both contributors to current knowledge and drivers of future research, the sports medicine community should be aware of the inherent biases and limitations of POD injury studies.
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Affiliation(s)
- Paul M Inclan
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Andrew W Kuhn
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Stockton C Troyer
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | | | - Matthew J Matava
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, Missouri, USA
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Card RK, Harrington JM, Reyes NP, Huish EG, Pettegrew J. Does playing surface affect the risk of anterior cruciate ligament injuries in the National Football League? A look at the 2017 - 2021 NFL seasons. PHYSICIAN SPORTSMED 2024; 52:98-101. [PMID: 36757375 DOI: 10.1080/00913847.2023.2178817] [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] [Received: 12/05/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are devastating injuries for athletes. Prior studies have shown increased ACL injury rates on non-natural surfaces versus natural grass in several sports. The purpose of this study is to calculate the prevalence of ACL injuries in the NFL on natural versus non-natural surfaces to determine if there is a significant increase on non-natural surfaces. METHODS Accessing publicly available data for NFL seasons beginning with the 2017-2018 season through 2021-2022 seasons, all ACL injuries with publicly available data concerning timing and playing surface were recorded and categorized according to playing surface. Practice injuries or those without an identifiable playing surface were excluded. Incidence rates, defined as ACL ruptures per game, were calculated. ACL injuries were recorded for each playing surface, as well as the combined category of non-natural grass surface. Odds ratio was calculated to compare the risk of ACL rupture on non-natural surfaces vs natural grass. RESULTS During the 2017-2021 NFL seasons, 173 ACL ruptures were identified with known surfaces. Injury rate for non-natural surfaces was 0.134 compared to 0.097 for grass. Injury rate ratio for non-natural vs natural grass surfaces was 1.211, a 21.1% increased risk of ACL injury in the NFL on non-natural surfaces vs natural grass. OR for non-natural surfaces 1.239 (95% CI 0.900-1.704). Based on these findings there is a trend toward increased risk of ACL injury on non natural grass surfaces, however this did not reach statistical significance. CONCLUSION Numerous published studies show trends toward increasing rates of ACL injuries on non-natural playing surfaces vs natural grass. Based on our findings the difference is not statistically significant, however it does trend toward increased risk of ACL injury with non-natural surfaces. Further studies should be performed with larger sample sizes in order to further determine the risk of non-natural surfaces.
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Affiliation(s)
- Ryan K Card
- Valley Consortium for Medical Education Orthopedic Surgery Residency, Modesto, CA, USA
- Department of Orthopedic Surgery, San Joaquin General Hospital, French Camp, CA, USA
| | - Justin M Harrington
- Valley Consortium for Medical Education Orthopedic Surgery Residency, Modesto, CA, USA
- Department of Orthopedic Surgery, San Joaquin General Hospital, French Camp, CA, USA
| | - Nathan P Reyes
- Valley Consortium for Medical Education Orthopedic Surgery Residency, Modesto, CA, USA
- Department of Orthopedic Surgery, San Joaquin General Hospital, French Camp, CA, USA
| | - Eric G Huish
- Valley Consortium for Medical Education Orthopedic Surgery Residency, Modesto, CA, USA
- Department of Orthopedic Surgery, San Joaquin General Hospital, French Camp, CA, USA
| | - Jonathan Pettegrew
- Valley Consortium for Medical Education Orthopedic Surgery Residency, Modesto, CA, USA
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3
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Bretzin AC, D'Alonzo BA, van der Mei ER, Gravel J, Wiebe DJ. Publicly available data sources in sport-related concussion research: a caution for missing data. Inj Epidemiol 2024; 11:3. [PMID: 38291513 PMCID: PMC10829213 DOI: 10.1186/s40621-024-00484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Researchers often use publicly available data sources to describe injuries occurring in professional athletes, developing and testing hypotheses regarding athletic-related injury. It is reasonable to question whether publicly available data sources accurately indicate athletic-related injuries resulting from professional sport participation. We compared sport-related concussion (SRC) clinical incidence using data from publicly available sources to a recent publication reporting SRC using electronic health records (EHR) from the National Football League (NFL). We hypothesize publicly available data sources will underrepresent SRC in the NFL. We obtained SRCs reported from two publicly available data sources (NFL.com, pro-football-reference.com) and data reported from the NFL's published EHR. We computed SRC per 100 unique player signings from 2015-2019 and compared the clinical incidence from publicly available data sources to EHR rates using clinical incidence ratios (CIR) and 95% confidence intervals (CI). FINDINGS From 2015-2019, SRC counts from published EHR record data ranged from 135-192 during the regular season, whereas SRC counts ranged from 102-194 and 69-202 depending on the publicly available data source. In NFL.com the SRC clinical incidence was significantly and progressively lower in 2017 (CIR: 0.73, 95% CI: 0.58-0.91), 2018 (CIR: 0.66, 95% CI: 0.50-0.87), and 2019 (CIR: 0.48, 95% CI: 0.35-0.64) relative to the gold-standard EHR. In the pro-football-reference.com data, the documented SRCs in publicly available data sources for other years were ~ 20-30% lower than the gold-standard EHR numbers (CIRs 0.70-0.81). CONCLUSIONS Publicly available data for SRCs per 100 unique player signings did not match published data from the NFL's EHR and in several years were significantly lower. Researchers should use caution before using publicly available data sources for injury research.
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Affiliation(s)
- Abigail C Bretzin
- Department of Emergency Medicine, Injury Prevention Center, School of Medicine, University of Michigan, Ann Arbor, USA.
| | - Bernadette A D'Alonzo
- Department of Biostatistics Epidemiology and Informatics, University of Pennsylvania, Philadelphia, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, USA
| | - Elsa R van der Mei
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Jason Gravel
- Department of Criminal Justice, Temple University, Philadelphia, USA
| | - Douglas J Wiebe
- Department of Emergency Medicine, Injury Prevention Center, School of Medicine, University of Michigan, Ann Arbor, USA
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
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4
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Jo J, Davidar AD, Hersh AM, Theodore N, Zuckerman SL. Cervical and Lumbar Disk Replacement in Athletes: Is It Safe to Return to Play? A Systematic Review of the Scientific Literature and Lay Press. Neurosurgery 2024; 94:4-13. [PMID: 37607091 DOI: 10.1227/neu.0000000000002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/14/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cervical/lumbar total disk replacements (TDRs) are often performed for degenerative conditions but rarely in athletes. Therefore, we sought to conduct a systematic review of athletes undergoing TDRs of both the scientific literature and lay press, with an emphasis on contact sport athletes. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed/Embase/Cochrane/Scopus/Web of Science databases were queried for all primary literature reporting TDRs in athletes, including both cervical/lumbar disk replacements (CDRs/LDRs). Sports were dichotomized into contact vs limited/noncontact. Because of the public nature of injuries in elite athletes, the lay press was also queried. RESULTS A total of 488 scientific studies were screened, of which 10 met inclusion criteria. Cervical: seven studies reported CDRs in 53 athletes, of which 7 were professional, 22 semiprofessional, and 24 recreational. Of the seven professional athletes, there was one contact sport athlete (kickboxer). All 7/7 professional and 21/22 semiprofessional athletes successfully returned-to-play at 8-52 weeks without complication. Lumbar: Three studies discussed LDRs in 51 athletes, of which 17 were professional, 6 semiprofessional, and 28 recreational. Of the 17 professional athletes, eight played contact sports (2 boxing, 2 alpine skiing, 2 soccer, judo, rugby). All 17 professional and 6 semiprofessional athletes successfully returned to play at 9-21 weeks. Lay Press: five professional contact sport athletes underwent CDRs, and all returned to play: 3 hockey, 1 mixed-martial arts, and 1 Australian-rules football. CONCLUSION The scientific literature and lay press revealed 14 professional contact sport athletes who underwent TDR-6 CDRs and 8 LDRs-all with successful return to play. From the little data that exist, it seems that TDR may be safe in elite athletes; however, the small number of patients highlights the major paucity of data on the safety of TDR in elite contact sport athletes.
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Affiliation(s)
- Jacob Jo
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Vanderbilt University School of Medicine, Nashville , Tennessee , USA
| | - A Daniel Davidar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Scott L Zuckerman
- Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
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5
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Pinheiro VH, Borque KA, Laughlin MS, Jones M, Balendra G, Kent MR, Ajgaonkar R, Williams A. Determinants of Performance in Professional Soccer Players at 2 and 5 Years After ACL Reconstruction. Am J Sports Med 2023; 51:3649-3657. [PMID: 37960868 DOI: 10.1177/03635465231207832] [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: 11/15/2023]
Abstract
BACKGROUND A number of studies have investigated return to play after anterior cruciate ligament reconstruction (ACLR) in professional soccer players, but it is unclear which factors are associated with a return to the preinjury performance and ability to play over time. PURPOSE To identify factors that contribute to a professional soccer player's return to preinjury performance after ACLR, as well as to report their playing performance at 2 and 5 years after ACLR compared with their preinjury performance. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A consecutive cohort of professional soccer players undergoing primary ACLR were analyzed between 2005 and 2019. A minimum 2-year follow-up was required. The effect of patient, surgical, and postoperative factors on performance rates, defined as a combination of league level and playing time, was evaluated with univariate and multivariate logistic regression models. RESULTS A total of 200 male professional soccer players were included. When combining league level and playing time, 30% of athletes returned to their preinjury performance at 2 years and 22% at 5 years. However, 53% of athletes returned to their preinjury performance for at least 1 season by year 5. At 2 years, a chondral lesion of grade 3 or 4 decreased the odds of return to preinjury performance (odds ratio [OR], 0.37; P = .010). Athletes receiving an ACLR with the addition of a lateral extra-articular tenodesis procedure were 2.42 times more likely to return to preinjury performance at 2 years than athletes with ACLR alone (P = .004). By 5 years after ACLR, athletes aged ≥25 years at the time of reconstruction were 3 times less likely to be performing at their preinjury performance (OR, 0.32; P < .001), and those with a grade ≥3 chondral lesion were >2 times less likely to be performing at their preinjury performance (OR, 0.43; P = .033). CONCLUSION The presence of >50% thickness chondral pathology, ACLR without lateral extra-articular tenodesis, and age >25 years at the time of surgery were all significant risk factors of worse performance rates after ACLR. Significant decreases in performance rates were noted at 2 and 5 years postoperatively.
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Affiliation(s)
| | - Kyle A Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Mitzi S Laughlin
- Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Mary Jones
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
| | - Ganesh Balendra
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
| | | | - Ryan Ajgaonkar
- University of Texas Rio Grande Valley Medical School, Edinburg, Texas, USA
| | - Andy Williams
- Fortius Clinic, London UK, FIFA Medical Centre of Excellence, London, United Kingdom
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Gill VS, Tummala SV, Boddu SP, Brinkman JC, McQuivey KS, Chhabra A. Biomechanics and situational patterns associated with anterior cruciate ligament injuries in the National Basketball Association (NBA). Br J Sports Med 2023; 57:1395-1399. [PMID: 37648410 DOI: 10.1136/bjsports-2023-107075] [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: 08/21/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES Perform a comprehensive video analysis of all anterior cruciate ligament (ACL) injuries in National Basketball Association (NBA) athletes from 2006 to 2022 to determine the associated biomechanics, injury mechanism and game situation. METHODS NBA players diagnosed with an ACL tear from 2006 to 2022 were identified and videos of each injury evaluated by two reviewers. Visual evaluation included assessment of joint kinematics at three time points: initial contact of the injured leg with the ground (IC), 33 milliseconds later (IC+33) and 66 milliseconds later (IC+66). Game situation was assessed qualitatively. RESULTS Videos of 38 out of 47 (80.9%) ACL tears were obtained. 9 injuries were non-contact, while 29 involved indirect contact. Between IC and IC+33, average knee valgus increased from 5.1° to 12.0° and knee flexion increased from 12.6° to 32.6°. At all time points, the majority of injuries involved trunk tilt and rotation towards the injured leg, hip abduction and neutral foot rotation. The most common game situations for injury included the first step when attacking the basket following picking up the ball (n=13), landing following contact in the air (n=11) and jump stop (n=5). CONCLUSION Three major mechanisms predominate ACL tears in NBA players: the first step following picking up the ball when attacking, landing and jump stops. None of the injuries reviewed demonstrated direct contact to the knee, emphasising the importance of body kinematics in this injury pattern. The increase in knee valgus and knee flexion between IC and IC+33 should be noted as a possible precipitant to injury.
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Affiliation(s)
- Vikram S Gill
- School of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Sailesh V Tummala
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Sayi P Boddu
- School of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Joseph C Brinkman
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Kade S McQuivey
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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7
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Carey JL. The Critical Reader: Data Sources. Am J Sports Med 2023; 51:3103-3105. [PMID: 37777867 DOI: 10.1177/03635465231200790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
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Inclan PM, Kuhn AW, Chang PS, Mack C, Solomon GS, Sills AK, Matava MJ. Validity of Research Based on Publicly Obtained Data in Sports Medicine: A Quantitative Assessment of Concussions in the National Football League. Sports Health 2023; 15:527-536. [PMID: 37029663 PMCID: PMC10293571 DOI: 10.1177/19417381231167333] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
CONTEXT Numerous researchers have leveraged publicly available internet sources to publish clinical research concerning incidence and recovery from injuries in National Football League (NFL) players. OBJECTIVE This study aims to (1) provide a comprehensive systematic review of all publicly obtained data studies (PODS) regarding concussions in NFL athletes and (2) quantify the percentage of injuries identified by these studies in comparison with published concussion data from the NFL injury database. STUDY SELECTION A systematic review was conducted in accordance with PRISMA guidelines to identify all published studies utilizing publicly obtained data regarding concussions in NFL athletes. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Manuscript details, factors related to the athletes of interest (eg, study period, positions included), and results (eg, concussion rate, number of total concussions, return-to-play data) were extracted independently by 2 authors. Results were compared with incident concussions reported from 2015 to 2019 by each medical staff member to the NFL database linked to the League's electronic health record (EHR). RESULTS A total of 20 concussion-focused manuscripts based on PODS were identified from 2014 to 2020. PODS captured between 20% and 90% of concussions (mean, 70%) reported by medical staff to the injury database. PODS reported that 55% of concussions occurred on offensive plays, 45% on defensive plays and <1% occurred during special teams plays, compared with 44%, 37%, and 18%, respectively, as indicated by published data from the NFL injury database. When analyzed by position groups, running backs and quarterbacks comprised the most over-represented positions concussed in PODS, while offensive linemen, defensive backs, and linebackers comprised the most under-represented positions. CONCLUSION PODS captured approximately 70% of concussions reported by NFL medical staff to the NFL injury database. There is heterogeneity in the degree to which PODS were able to identify concussions, with a bias toward concussions among players at higher profile positions.
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Affiliation(s)
- Paul M Inclan
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Andrew W Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Peter S Chang
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- Department of Orthopaedic Surgery, The Steadman Clinic, Vail, Colorado
| | | | - Gary S Solomon
- National Football League, New York, New York
- Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Allen K Sills
- National Football League, New York, New York
- Department of Neurological Surgery, Vanderbilt University, Nashville, Tennessee
| | - Matthew J Matava
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
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9
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Brophy RH, Baker JC, Crain JM, Herzog MM, Stollberg B, Wojtys EM, Mack CD. MRI Findings Associated With Anterior Cruciate Ligament Tears in National Football League Athletes. Orthop J Sports Med 2023; 11:23259671231169190. [PMID: 37332531 PMCID: PMC10273788 DOI: 10.1177/23259671231169190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/09/2023] [Indexed: 06/20/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) tears are a high-frequency injury requiring a lengthy recovery in professional American football players. Concomitant pathology associated with ACL tears as identified on magnetic resonance imaging (MRI) is not well understood in these athletes. Purpose To describe the MRI findings of concomitant injuries associated with ACL tears among athletes in the National Football League (NFL). Study Design Cross-sectional study; Level of evidence, 3. Methods Of 314 ACL injuries in NFL athletes from 2015 through 2019, 191 complete MRI scans from the time of primary ACL injury were identified and reviewed by 2 fellowship-trained musculoskeletal radiologists. Data were collected on ACL tear type and location, as well as presence and location of bone bruises, meniscal tears, articular cartilage pathology, and concomitant ligament pathology. Mechanism data from video review were linked with imaging data to assess association between injury mechanism (contact vs noncontact) and presence of concomitant pathology. Results Bone bruises were evident in 94.8% of ACL tears in this cohort, most often in the lateral tibial plateau (81%). Meniscal, additional ligamentous, and/or cartilage injury was present in 89% of these knees. Meniscal tears were present in 70% of knees, lateral (59%) more than medial (41%). Additional ligamentous injury was present in 71% of all MRI scans, more often a grade 1/2 sprain (67%) rather than a grade 3 tear (33%), and most often involving the medial collateral ligament (MCL) (57%) and least often the posterior cruciate ligament (10%). Chondral damage was evident in 49% of all MRI scans, with ≥1 full-thickness defect in 25% of all MRI scans, most often lateral. Most (79%) ACL tears did not involve direct contact to the injured lower extremity. Direct contact injuries (21%) were more likely to have a concomitant MCL tear and/or medial patellofemoral ligament injury and less likely to have a medial meniscal tear. Conclusion ACL tears were rarely isolated injuries in this cohort of professional American football athletes. Bone bruises were almost always present, and additional meniscal, ligamentous, and chondral injuries were also common. MRI findings varied by injury mechanism.
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Affiliation(s)
- Robert H. Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jon C. Baker
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jana M. Crain
- National Orthopedic Imaging Associates California Advanced Medical Imaging Associates, San Francisco, California, USA
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10
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Borque KA, Jones M, Laughlin MS, Balendra G, Willinger L, Pinheiro VH, Williams A. Effect of Lateral Extra-articular Tenodesis on the Rate of Revision Anterior Cruciate Ligament Reconstruction in Elite Athletes. Am J Sports Med 2022; 50:3487-3492. [PMID: 36255290 DOI: 10.1177/03635465221128828] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is growing evidence that anterolateral procedures can reduce the risk of rerupture in high-risk recreational athletes undergoing primary anterior cruciate ligament (ACL) reconstruction (ACLR). However, this effectiveness has never been evaluated in elite athletes. PURPOSE The purpose of this study was to evaluate the effectiveness of lateral extra-articular tenodesis (LET) in reducing revision rates in primary ACLR in elite athletes. Additionally, this study evaluated whether LET had a greater effect when combined with ACLR utilizing a hamstring or patellar tendon graft. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A consecutive cohort of elite athletes with an isolated ACL tear undergoing autograft patellar or hamstring tendon reconstruction with or without Lemaire LET were analyzed between 2005 and 2018. A minimum 2-year follow-up was required. The association between the use of LET and ACL graft failure as defined by revision ACLR was evaluated with univariate and multivariate logistic regression models. RESULTS A total of 455 elite athletes (83% men and overall age 22.5 ± 4.7 years) underwent primary ACLR with (n = 117) or without (n = 338) a LET procedure. Overall, 36 athletes (7.9%) experienced ACL graft failure, including 32 (9.5%) reconstructions without a LET and 4 (3.4%) with a LET. Utilization of LET during primary ACLR reduced the risk of graft failure by 2.8 times, with 16.5 athletes needing LET to prevent a single ACL graft failure. Multivariate models showed that LET significantly reduced the risk of graft rupture (relative risk = 0.325; P = .029) as compared with ACLR alone after controlling for sex and age at ACLR. Including graft type in the model did not significantly change the risk profile, and although a patellar tendon graft had a slightly lower risk of failure, this was not statistically significant (P = .466). CONCLUSION The addition of LET reduced the risk of undergoing revision by 2.8 times in elite athletes undergoing primary ACLR. This risk reduction did not differ significantly between the patellar tendon and hamstring tendon autografts. With these results, status as an elite athlete should be included in the indications for a LET, as they are at increased risk for ACL graft failure.
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Affiliation(s)
| | - Mary Jones
- Fortius Clinic, London, UK.,FIFA Medical Centre of Excellence, London, UK
| | | | - Ganesh Balendra
- Fortius Clinic, London, UK.,FIFA Medical Centre of Excellence, London, UK
| | - Lukas Willinger
- Department of Trauma Surgery, Technical University of Munich, Munich, Germany
| | | | - Andy Williams
- Fortius Clinic, London, UK.,FIFA Medical Centre of Excellence, London, UK
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11
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Zeblisky P, Collins AP, Cassinat J, Riemenschneider J, Ebaugh P, Shaath MK, Service BC. Is Video-Based Analysis a Valid Method for Determining Mechanisms of Ankle Injuries During Gameplay in the National Basketball Association? Orthop J Sports Med 2022; 10:23259671221123027. [PMID: 36329950 PMCID: PMC9623379 DOI: 10.1177/23259671221123027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background In the National Basketball Association (NBA), lower extremity injuries account for over 70% of games missed, with ankle injuries being the most common. High-quality video analysis has been successful for studying injury mechanism. Purpose To (1) determine the validity of video-based analysis as a method to evaluate ankle injury mechanisms in NBA players and (2) analyze the circumstances associated with injury, games missed due to injury, and associated costs in player salary due to time missed. Study Design Case series; Level of evidence, 4. Methods Ankle injuries were identified using an injury report database, and corresponding videos were searched using YouTube.com to access high-quality video evidence of these injuries during the 2015-2020 NBA regular season. We reviewed 822 injuries, of which 93 had corresponding videos (video subset), in our final analysis. Variables including number of games missed, necessity for surgical treatment, and injury recurrence were reported for the entire cohort. In the video subset, the mechanism of injury and other corresponding situational data were evaluated. Results The most common mechanism of injury occurred via ankle inversion (83.9%; n = 78; P < .001). These injuries were significantly associated with indirect contact with the player's ankle (79.6%; n = 74; P < .001). There were significant differences based on player position, within both the video subset (P = .008) and the entire cohort (P < .001), with guards being injured the most frequently. The average number of games missed due to injury was 7 games in the video subset and 5 games in the entire cohort (P = .14). There were significant differences between the groups in average player salary per game ($133,878 [video subset] versus $87,577 [entire cohort]; P < .001). Conclusion Despite its low yield of 11.3%, video analysis proved to be a useful tool to determine ankle injury mechanisms as well as the distribution of injuries based on player position. However, this methodology was subject to selection bias, as evidenced by a $50,000 increase in player salary among the video cohort. These findings should be considered when using video analysis in future studies.
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Affiliation(s)
- Peter Zeblisky
- University of Central Florida College of Medicine, Orlando, Florida,
USA.,Peter Zeblisky, BS, University of Central Florida College of
Medicine, 6850 Lake Nona Boulevard, Orlando, FL 32827, USA (
)
| | - Andrew P. Collins
- University of Central Florida College of Medicine, Orlando, Florida,
USA
| | - Joshua Cassinat
- University of Central Florida College of Medicine, Orlando, Florida,
USA
| | | | - Pierce Ebaugh
- Orlando Health Jewett Orthopedic Institute, Orlando, Florida,
USA
| | - Mohamed K. Shaath
- University of Central Florida College of Medicine, Orlando, Florida,
USA
| | - Benjamin C. Service
- University of Central Florida College of Medicine, Orlando, Florida,
USA.,Florida State University College of Medicine, Tallahassee, Florida,
USA
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12
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Walker J, Marigi EM, Dancy M, Okoroha KR, Kharrazi FD, Mehran N. Concussions in the Women's National Basketball Association: Analysis of Incidence, Return-to-Play Timing, and Player Performance From 1997 to 2020. Orthop J Sports Med 2022; 10:23259671221105257. [PMID: 35898206 PMCID: PMC9310240 DOI: 10.1177/23259671221105257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The extent to which concussions affect Women’s National Basketball Association (WNBA) athletes has not been thoroughly examined. Purpose: To evaluate the incidence and impact of concussion injuries occurring in the WNBA. Study Design: Descriptive epidemiology study. Methods: Publicly available records were searched to identify all documented basketball-related concussions from WNBA seasons 1997 to 2020. Player demographics, injury details, and basketball career information were collected. Concussion incidence and return-to-play (RTP) timing were evaluated before and after the institution of the WNBA concussion protocol in 2012. Minutes per game and game score per minute were compared 5 games before and 5 games after the concussion was sustained. Player game availability and RTP performance were also compared with an age-, body mass index–, position-, and experience-matched control group of players who did not sustain any injuries during the index season. Results: A total of 70 concussions among 55 players were reported in the WNBA from 1997 to 2020, with a mean incidence of 2.9 ± 2.3 concussions per season. After the implementation of the WNBA concussion protocol, the incidence significantly increased from 1.7 to 5.0 concussions per season (P < .001). All players returned after a first-time concussion, missing a mean of 3.8 ± 4.7 games and 17.9 ± 20.7 days. After the adoption of the concussion protocol, the time to RTP significantly increased with games missed (P = .006) and days missed (P = .006). Minutes per game and game score per minute were not significantly affected by sustaining a concussion (P = .451 and P = .826, respectively). Conclusion: Since the adoption of the WNBA concussion protocol in the 2012 season, the incidence of concussions increased significantly. Athletes retained a high rate of RTP after missing a median of 4 games, and the time to RTP increased after the institution of the concussion protocol. Player game availability and performance within the same season were not significantly affected by concussion injuries after a successful RTP.
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Affiliation(s)
- Jasmine Walker
- Howard University College of Medicine, Washington, District of Columbia, USA
| | - Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Malik Dancy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Nima Mehran
- Department of Orthopedic Surgery, Kaiser Permanente, Los Angeles, California, USA
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13
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LaPrade CM, Cinque ME, Safran MR, Freehill MT, Wulf CA, LaPrade RF. Using Advanced Data to Analyze the Impact of Injury on Performance of Major League Baseball Pitchers: A Narrative Review. Orthop J Sports Med 2022; 10:23259671221111169. [PMID: 35898207 PMCID: PMC9310227 DOI: 10.1177/23259671221111169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/12/2022] [Indexed: 12/05/2022] Open
Abstract
Major league baseball (MLB) pitchers are at risk of numerous injuries during
play, and there is an increasing focus on evaluating their performance in the
context of injury. Historically, performance after return to play (RTP) from
injury has focused on general descriptive statistics, such as innings or games
played, or rate statistics with inherent variability (eg, earned run average,
walks and hits per inning pitched, strikeouts per 9 innings, or walks per 9
innings). However, in recent years, MLB has incorporated advanced technology and
tracking systems in every stadium, allowing for more in-depth analysis of
pitcher-specific data that are captured with every pitch of every game. This
technology allows for the ability to delve into the pitching performance on a
basis that is more specific to each pitcher and allows for more in-depth
analysis of different aspects of pitching performance. The purpose of this
narrative review was to illustrate the current state of injury recording for
professional baseball pitchers, highlight recent technological advances in MLB,
and describe the advanced data available for analysis. We used advanced data in
the literature to review the current state of performance analysis after RTP in
MLB pitchers after injury. Finally, we strived to provide a framework for future
studies to more meticulously assess RTP performance given the current available
resources for analysis.
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Affiliation(s)
- Christopher M LaPrade
- Department of Orthopaedic Surgery and Department of Sports Medicine, Stanford University, Redwood City, California, USA
| | - Mark E Cinque
- Department of Orthopaedic Surgery and Department of Sports Medicine, Stanford University, Redwood City, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery and Department of Sports Medicine, Stanford University, Redwood City, California, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery and Department of Sports Medicine, Stanford University, Redwood City, California, USA
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14
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Buckley TA, Browne S, Hunzinger KJ, Kaminski TW, Swanik CB. Concussion is not associated with elevated rates of lower-extremity musculoskeletal injuries in National Football League Players. PHYSICIAN SPORTSMED 2022:1-6. [PMID: 35591786 DOI: 10.1080/00913847.2022.2080515] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Emerging evidence has identified an ~2x elevated risk of musculoskeletal (MSK) injury in the year following a concussion. Most of these studies have examined a single college/university athletic department and may lack generalizability to professional sports. Therefore, the purpose of this study was to assess the odds of post-concussion MSK injury utilizing publicly available National Football League (NFL) injury reports. METHODS Concussions were identified through a review of published NFL injury reports during the 2015, 2016, and 2017 regular seasons. Concussed players were matched by team and position, and injuries were tracked for both groups for the remainder of the season. A chi-square analysis compared the frequency of MSK injury in both groups and a Cox Proportional Hazard model calculated the risk of sustaining a subsequent MSK injury. RESULTS There were 322 concussed NFL players who met inclusion criteria and were successfully matched. From the time of concussion through the remainder of the season, 21.4% of the concussed players were injured and 26.4% of control participants were injured. There was no difference in MSK injury rates (p = 0.166), and the relative risk ratio was 0.90 for subsequent injury in the concussion group. There was no difference in the time to event for subsequent MSK between the two groups (p = 0.123). CONCLUSION The primary finding of this study was no elevated risk of post-concussion MSK in NFL football players.
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Affiliation(s)
- Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.,Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
| | - Steven Browne
- Department of Intercollegiate Athletics, University of Delaware, Newark, DE, USA
| | - Katherine J Hunzinger
- Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.,Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
| | - Charles Buz Swanik
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.,Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA
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