The American journal of sports medicine
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Sports-related concussions (SRCs) have gained increased societal interest in the past decade. The National Collegiate Athletic Association (NCAA) has implemented legislation and rule changes to decrease the incidence and risk of head injury impacts. The "targeting" rule forbids initiating contact with the crown of a helmet and targeting defenseless players in the head and neck area; however, there are concerns that this rule change has unintentionally led to an increased incidence of lower extremity injuries. ⋯ The lower extremity injury rate has increased in NCAA football athletes. Similarly, SRC rates have increased, although this may be caused by concurrent policies related to better education, identification, and management. Targeting rule changes may be contributing to increased rates of player contact-related ankle injuries. Alongside continued surveillance research to examine longitudinal time trends, more in-depth individual-level examinations of how targeting rule changes influence coaching and player behaviors are warranted.
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The arthroscopic Bankart repair and open Bristow-Latarjet procedure are the 2 most commonly used techniques to treat recurrent shoulder instability. ⋯ Arthroscopic stabilization using anchors provided better return to sport and subjective perception of the shoulder compared with the open Bristow-Latarjet procedure in the population studied. Recurrence may be higher in the arthroscopic Bankart group; further study is needed on this point.
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Long-term prospective studies of isolated endoscopic anterior cruciate ligament (ACL) reconstruction are limited and may include confounding factors. ⋯ Compared with patients who received the HT graft, patients who received the PT graft had significantly worse outcomes with regard to radiologically detectable osteoarthritis, kneeling pain, and contralateral ACL injury. At 20-year follow-up, both HT and PT autografts continued to provide good subjective outcomes and objective stability. However, further ACL injury is common, particularly in male individuals, younger patients, and those with tunnel malposition.
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Effect of High-Grade Preoperative Knee Laxity on Anterior Cruciate Ligament Reconstruction Outcomes.
Knee laxity in the setting of suspected anterior cruciate ligament (ACL) injury is frequently assessed through physical examination using the Lachman, pivot-shift, and anterior drawer tests. The degree of laxity noted on these examinations may influence treatment decisions and prognosis. ⋯ The presence of high-grade pre-reconstruction knee laxity as assessed by manual physical examination under anesthesia is associated with significantly increased odds of revision ACL surgery but has no association with patient-reported outcome scores at 2 years after ACL reconstruction.
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There is increasing concern about the possible long-term effects of multiple concussions, particularly on the developing adolescent brain. Whether the effect of multiple concussions is detectable in high school football players has not been well studied, although the public health implications are great in this population. ⋯ In the largest study to date, high school football players with multiple past concussions performed the same on cognitive testing as those with no prior concussions. Concussion history was one of several factors that were independently related to symptom reporting.