Determinants Of Lower-extremity Injury Severity And Recovery Among High School Soccer Players In The U.S.

Abstract

PURPOSE: Lower-extremity injuries are common among soccer players, yet few studies have attempted to identify determinants of lower-extremity injury severity in this group. We examined the impact of injury site, injury mechanism, sex, injury history, setting and playing surface on lower-extremity injury severity. METHODS: The NATION-SP captured soccer-related injury data collected by athletic trainers (ATs) during the 2011/12-2013/14 academic years. Lower-extremity injury sites of interest were hip/groin, thigh, knee, lower-leg/Achilles, and the ankle/foot. The nature/type of injuries, surgery for treatment (yes/no), season-ending outcomes (yes/no), and the recovery process (using observed time loss) were the outcomes of interest. Exposures of interest were injury site, injury mechanism (contact vs. non-contact), sex, injury history (new vs. recurrent), event-type (game vs. practice), and playing surface (natural vs. turf). Summary statistics (frequencies, %s) were used to examine the nature/type of injuries. Multivariable logistic regressions were used to examine odds of season-ending outcomes, and surgery, as a function of the exposures; random effects Poisson regressions were used to examine exposure effects on the recovery process. Odds Ratios (ORs) and Time Loss Ratios (TLRs) with 95% confidence intervals (CI) excluding 1.00 were deemed significant. RESULTS: The majority of all lower-extremity injuries (n=2871) in this sample were sprains, strains/tears, or contusions (72%). Odds of a season-ending injury were higher in games than practices (ORadj=2.64, 95%CI=1.39,5.01). Also, odds of a lower-extremity injury resulting in time loss were significantly higher in female players compared to male players (ORadj=1.34, 95%CI=1.05,1.71), and in games compared to practices (ORadj=2.19, 95%CI=1.72,2.80). Sex, event-type, and playing surface emerged as significant determinants of any time loss following lower-extremity injuries, as well as predictors of recovery duration. CONCLUSIONS: Sex, injury setting, playing surface differentially determine injury severity and recovery. Future studies using multi-method, multivariable approaches may be used to identify determinants of lower-extremity injury severity in this context.