COVID-19 Return to Sport: NFL Injury Prevalence Analysis

Mechanism of Injury for Traumatic Mid-Foot Lisfranc Injuries: Impact of the COVID-19 Pandemic

Background During the COVID-19 pandemic, Americans transitioned away from their normal routines, drove in motor vehicles less, and reduced their physical activity, ultimately influencing the incidence and nature of orthopedic injuries that were operatively managed. The purpose of this study was to evaluate the effect of the COVID-19 pandemic lockdown and subsequent deconditioning on the mechanism of injury and severity of Lisfranc injury. Methods This retrospective study included patients with a traumatic Lisfranc injury who were surgically treated by a foot and ankle fellowship-trained orthopedic surgeon between 2015 and 2021. Electronic health records were queried for patient demographics, mechanism of injury, physical exam findings, and pain scores. Preoperative radiographs were reviewed to grade Lisfranc injuries using the previously described Nunley-Vertullo classification system. Descriptive and univariate statistics were performed to compare 15 patients in the pre-COVID-19 cohort and 15 patients in the post-COVID-19 cohort. Results In the pre-COVID-19 cohort, 80% (n=12/15) of the patients were female, the mean age was 46±15 years, the mean BMI was 29.7±7 kg/m2, and the mean follow-up period was 18.1±12 months. In the post-COVID-19 cohort, 53% (n=8/15) of the patients were female, the mean age was 48.5±17 years, the mean BMI was 31.4±7 kg/m2, and the mean follow-up period was 9.5±4 months. Significantly higher proportions of plantar ecchymosis (n=8/15, 53%), neuropathic pain (n=7/15, 47%), and swelling (n=12/15, 80%) were present in the post-COVID-19 cohort. A low-energy mechanism of injury was sustained by 73% (n=11/15) of the pre-COVID-19 cohort and 80% (n=12/15) of the post-COVID-19 cohort. Lisfranc injuries for the pre-COVID-19 cohort and the post-COVID-19 cohort demonstrated the following classifications: Grade 1 (33%, n=5/15 vs. 40%, n=6/15), Grade 2 (60%, n=9/15 vs. 53%, n=8/15), and Grade 3 (7%, n=1/15 vs. 7%, n=1/15). Conclusion Although a higher proportion of plantar ecchymosis, neuropathic pain, and swelling was observed, there was no association between a low mechanism of injury and a higher grade of Lisfranc injury following the COVID-19 pandemic.

COVID-19 National Football League (NFL) Injury Analysis: Follow-Up Study

Background

In 2020, COVID-19 spread across the world and brought normal daily life to a halt, causing the shutdown of nearly everything in order to prevent its spread. The National Football League (NFL) similarly experienced shutdowns and the resulting effects, leaving athletes unable to train in some of the most advanced facilities with many of the best trainers in the world. A previous study, titled COVID-19 Return to Sport: NFL Injury Prevalence Analysis, determined that there was increased injury prevalence during the 2020 season, likely due to decreased physiological adaptations within athletes' bodies as a result of facility shutdowns. Understanding injury epidemiology is vital to the prevention of injuries and the development of return-to-play protocols.

Objective

The objective of this study is to perform a follow-up study to COVID-19 Return to Sport: NFL Injury Prevalence Analysis in order to examine the longitudinal effects of the COVID-19 pandemic on injury epidemiology. This study examines if there was a recovery to baseline levels of injuries or if there are still lingering effects from the COVID-19 pandemic-induced spike in injuries.

Methods

To determine if there was change in the number of injuries for each season, injury tallies collected from the 17-week-long 2018, 2019, and 2020 NFL regular seasons were compared with those from the 18-week-long 2021 and 2022 NFL regular seasons. A Kruskall-Wallis test with post hoc Dunn analysis was conducted to compare the rate of injuries per team per week between each of the 2018, 2019, 2020, 2021, and 2022 regular seasons.

Results

The Kruskall-Wallis test revealed an H statistic of 32.61 (P<.001) for the comparison of the injury rates across the 5 seasons. The post hoc Dunn analysis showed that 2020 had a statistically significant difference when compared with each of the 2018 (P<.001), 2019 (P=.04), 2021 (P=.02), and 2022 (P=.048) seasons. The 2019 season showed no statistical significance when compared with the 2021 (P=.23) and 2022 (P=.13) seasons.

Conclusions

The results of this follow-up study, combined with the previous study, show that extended training interruptions stemming from COVID-19 in 2020 induced detraining and led to increased injuries. Additionally, the results of this study show that retraining can occur, resulting in the development of injury protective factors, as injury rates returned to baseline levels after 2020. This is the first large-scale and long-term opportunity to demonstrate the effects of these principles and how they are important to understanding injury epidemiology.

Epidemiology of Rugby-Related Injuries Presenting to the Emergency Department: A 10-Year Review

Background Rugby is a popular contact sport played with little to no protective clothing. There exist few comprehensive studies investigating emergency department (ED) visit patterns for rugby-related injuries.We hypothesize that male athletes remain the most common patient demographic to present to the ED with rugby-related injuries and that the number of patients diagnosed with soft tissue injuries such as sprains and strains decreased during the COVID-19 pandemic. Methodology The National Electronic Injury Surveillance System database was examined for rugby injuries from January 2012 through December 2021. Cases were stratified by sex, age, and injury type to monitor epidemiological patterns. This is a descriptive epidemiology study. Level of evidence III. Results A total of 2,896 individuals with rugby-related ED visits were identified. ED patients were most common among males (73.9%), Caucasians (45.3%), and in the 15-19-year-old age range (44.9%). Injuries most commonly affected the upper body, specifically the head (23.1%), face (13.8%), and shoulder (12.4%) with fractures and sprains comprising 22.3% and 18.5% of ED diagnoses, respectively. Concussions were the most frequent injury to any one body part (11.2%). During the COVID-19 pandemic, ED patients with rugby-related injuries were significantly more likely to be males presenting with lacerations or hemorrhages. ED visits for sprains and strains significantly decreased in the peri-COVID-19 period. Conclusions Annual ED visits due to rugby injuries are declining. The head and neck are the most common sites of injuries. Decreased presentation to the ED during the COVID-19 pandemic may raise concern for the potential for untreated injuries. Physicians should anticipate the presence of chronic sports-related injuries when evaluating future patients.

A Study on the Injury Rate of Spanish Competitive Athletes as a Consequence of the COVID-19 Pandemic Lockdown

The COVID-19 lockdown may have had collateral effects on the conditions of athletes, with possible increases in injury risks upon the return to sports. Due to the existence of multiple factors of injury risks based on the lockdown and the return to sports, the aim of this study was to analyze the injury rates after the lockdown in competitive athletes. A non-experimental quantitative design based on a survey was carried out, and 94 athletes (42 males and 52 females; 23.57 ± 6.20 years) participated. Statistical analyses were carried out using non-parametric tests. Injury rates did not increase significantly after the lockdown, and there were no statistical differences between performance levels, types of sports, the design of a specific training program by sports professionals during the lockdown, the moment of injury, and the mechanism of injury. It is important to develop injury prevention protocols to prepare athletes after such a long period of detraining.

Injury Characteristics among Young Adults during and Immediately after the COVID-19 Lockdown

The lockdown due to the COVID-19 pandemic inherently changed people’s lifestyles. Forty-eight days of isolation led to worsening physical fitness in addition to the development of other unhealthy habits. The aim of this study was to describe sport-related injuries in the active general population. Physical therapy centres and sports medicine clinics were contacted via e-mail, seeking patients who had sustained an injury during or immediately (up to two weeks) after the lockdown. Patients who agreed to participate completed an online survey that followed the International Olympic Committee Statement. The questionnaire focused on physical exercise habits, type of injury, location and tissue affected. A total of 51 females and 67 males (30.5, SD = 8.8 years) participated in the study. Eighty percent of the participants performed aerobic training sessions, while the rest dedicated their workouts to strength training. Two in every three injuries were located in the lower limbs, and 80% affected the musculoskeletal tissue. Of all the injuries recorded, 67% occurred during the first week after lockdown. The number of aerobic exercise sessions was positively correlated with lower limb injuries (χ2 = 17.12, p < 0.05). Exercise habits should be considered when planning to return to a sport after a period of confinement to avoid injury.