Collegiate Football Athletes Research Articles

Prevalence Of Game-Related Hip Pointers Between High School And Collegiate Football Athletes

Prevalence Of Game-Related Hip Pointers Between High School And Collegiate Football Athletes

Sub-Concussive Impact Analysis in Collegiate Football Athletes

Contact athletes are at a significantly elevated risk of experiencing sub-concussive impacts—those that do not reach the threshold to cause typical concussion symptoms but may still contribute to long-term neurological damage (Johnson et al., 2014). Current literature suggests that repeated exposure to these impacts may be linked to neurodegeneration, potentially resulting in long-term cognitive deficits and neurodegenerative disorders in this group (Stern et al., 2011). Previous research has relied on helmet accelerometers to detect and quantify the magnitude of these impacts by measuring peak linear acceleration and peak rotational velocity(Champagne et al., 2019). However, numerous studies have revealed that helmet-mounted accelerometers often overestimate both the acceleration and the severity of impacts, leading to inaccuracies in data collection (Camarillo et al., 2013, Greybe et al., 2020, O’Connor et al., 2017). To overcome this limitation, we hypothesize that acceleration measurements obtained from mouthguard accelerometers will show significantly lower peak linear and rotational accelerations compared to helmet-mounted accelerometers when measuring impacts over the same duration in Queen's University Football players. Each participating player will be fitted with a custom boil-and-bite mouthguard accelerometer engineered by Prevent Biometrics, ensuring a closer coupling to the skull for enhanced measurement accuracy. The players will wear these mouthguards throughout training camp and the season, with each impact exceeding a 15-g threshold validated through video analysis. We expect that the study’s findings will include lower recorded peak linear velocity, peak rotational velocity and more frequent sub-concussive exposure due to the increased sensitivity of the device. These findings will support the current literature that mouthguard accelerometers offer an accurate representation of the forces experienced by athletes. These findings will contribute to the growing body of knowledge on sub-concussive exposure in football players. The research has the potential to identify high-risk hitting patterns and influence new protocols for concussion management. Ultimately, this could increase player safety and promote healthier athletic development across all levels of competition.

Effects of mTBI with loss of consciousness on neurobehavioral symptoms, depression, and insomnia in former collegiate and NFL football athletes

ABSTRACT Objective Considering that diagnostic decisions about mTBI are often predicated on clinical symptom criteria, it is imperative to determine which initial presentation features of mTBI have prognostic significance for identifying those at high risk for long-term functional impairment. Setting Zoom interview Participants: Male, former NCAA Division I, and professional-level National Football League (NFL) athletes (n = 177) between the ages of 27 and 85 (M = 54.1, SD = 14.7). Design Cross-sectional case-control. Main Measures: History of mild TBI, history of loss of consciousness (LOC), depression symptoms, insomnia, neurobehavioral symptoms. Results Number of mTBI exposures did not predict neurobehavioral symptoms (B = 0.21, SE = 0.18, p = 0.23), but number of mTBI + LOC events did (B = 2.27, SE = 0.64, p = <.001). Further analysis revealed that the number of mTBI + LOC events predicted neurobehavioral symptoms indirectly through both depression (B = 0.85, 95% CI = [0.27, 1.52) and insomnia (B = 0.81, 95% CI = [0.3, 1.4]). Further, the direct effect of mTBI + LOC events on neurobehavioral symptoms became non-significant when depression and insomnia were added to the model (B = 0.78, SE = 0.45, p = 0.08). Conclusions Findings support LOC at time of injury as an important predictor of long-term outcomes. Additionally, results suggest depression and insomnia as potential mediators in the association between mTBI + LOC and neurobehavioral symptoms. These findings provide justification for early depression and insomnia symptom monitoring following mTBI + LOC.

Management of Hand and Wrist Injuries in NCAA Division I Football Players From a Single Institution: Factors Associated With Epidemiology, Surgical Intervention, and Return to Play

Background: Upper extremity injuries account for approximately 16.9% of football injuries in the National Collegiate Athletic Association (NCAA). Purpose: To determine the epidemiology, management, and outcomes of hand/wrist injuries in collegiate football athletes so as to identify factors associated with surgical intervention and delayed return to play (RTP). Study Design: Descriptive epidemiology study. Methods: We retrospectively reviewed hand/wrist injuries that occurred within a single NCAA Division I football team from January 1, 2003, to December 31, 2020. Data analyzed included player position, college seniority, injury characteristics, injury management, surgical procedures performed, and timing of RTP. A univariate analysis was performed to identify factors associated with increased risk for surgical intervention and delayed (&gt;21 days) RTP after hand and wrist injury in this cohort. Results: Overall, 124 patients with 168 hand/wrist injuries were identified (9.9 wrist/hand injuries per year). Sprain of the thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL) was the most common diagnosis (19.6%). Surgery was required in 22% of injuries, with injury of the UCL of the thumb MCP joint (8/37) being the most common indication. Injuries occurring during competitive games (odds ratio = 4.29; 95% CI, 1.2-15.9) were associated with an increased risk for surgery. Most (70%) injuries did not lead to time missed from football, whereas the remaining 30% resulted in an average of 33 ± 36 days missed. Conclusion: Over 17 athletic seasons, the annual incidence of hand and wrist injury in these NCAA Division I football players was 9.9 injuries per year, with 22% requiring surgical treatment. Injury to the UCL of the thumb MCP joint was the most common injury and indication for surgery, and 30% of injuries resulted in approximately 1 month lost. Injuries sustained in games were associated with operative management and delayed RTP.

Recovery of the autonomic nervous system following football training among division I collegiate football athletes: The influence of intensity and time

The autonomic nervous system (ANS) is profoundly affected by high intensity exercise. However, evidence is less clear on ANS recovery and function following prolonged bouts of high intensity exercise, especially in non-endurance athletes. Therefore, this study aimed to investigate the relationships between duration and intensity of acute exercise training sessions and ANS recovery and function in Division I football athletes. Fifty, male football athletes were included in this study. Subjects participated in 135 days of exercise training sessions throughout the 25-week season and wore armband monitors (Warfighter Monitor, Tiger Tech Solutions) equipped with electrocardiography capabilities. Intensity was measured via heart rate (HR) during an ‘active state’, defined as HR ≥ 85 bpm. Further, data-driven intensity thresholds were used and included HR < 140 bpm, HR < 150 bpm, HR < 160 bpm, HR ≥ 140 bpm, HR ≥ 150 bpm and HR ≥ 160 bpm. Baseline HR and HR recovery were measured and represented ANS recovery and function 24h post-exercise. Linear regression models assessed the relationships between time spent at the identified intensity thresholds and ANS recovery and function 24h post-exercise. Statistical significance set at α < 0.05. Athletes participated in 128 training sessions, totaling 2735 data points analyzed. Subjects were predominantly non-Hispanic black (66.0%), aged 21.2 (±1.5) years and average body mass index of 29.2 (4.7) kg⋅(m2)−1. For baseline HR, statistically significant associations between duration and next-day ANS recovery were observed at HR < 140 bpm (β = −0.08 ± 0.02, R2 = 0.31, p < 0.001), HR above 150 and 160 bpm intensity thresholds (β = 0.25 ± 0.02, R2 = 0.69, p < 0.0000 and β = 0.59 ± 0.06, R2 = 0.71, p < 0.0000). Similar associations were observed for HR recovery: HR < 140 bpm (β = 0.15 ± 0.03, R2 = 0.43, p < 0.0000) and HR above 150 and 160 bpm (β = −0.33 ± 0.03, R2 = 0.73, p < 0.0000 and β = −0.80 ± 0.06, R2 = 0.71, p < 0.0000). The strengths of these associations increased with increasing intensity, HR ≥ 150 and 160 bpm (baseline HR: β range = 0.25 vs 0.59, R2: 0.69 vs 0.71 and HR recovery: β range = −0.33 vs −0.80, R2 = 0.73 vs 0.77). Time spent in lower intensity thresholds, elicited weaker associations with ANS recovery and function 24h post-exercise, with statistical significance observed only at HR < 140 bpm (β = −0.08 ± 0.02, R2 = 0.31, p < 0.001). The findings of this study showed that ANS recovery and function following prolonged high intensity exercise remains impaired for more than 24h. Strength and conditioning coaches should consider shorter bouts of strenuous exercise and extending recovery periods within and between exercise training sessions.

A-21 Do Guardian Caps Reduce Concussion Frequency, Symptom Severity, and Time-Loss After Concussion In Football Athletes?

Abstract Purpose The Guardian Cap (GC) was designed to mitigate biomechanical forces to football helmets. This pilot study was designed to examine if the use of GCs reduced concussion frequency, total symptom severity (TST), and days-until-symptom-resolution (DUSR) following a SC in collegiate football athletes. We hypothesized the GCs would not decrease SC frequency, TST, or DUSR. Methods Participants (N=14) in our cross-sectional study were Division I collegiate football athletes who were diagnosed with a SC (20.0±1.32 years old) who did (GC; n=3) or did not (NoGC; n=11) wear the GC. Only SCs that occurred to athletes required to wear the GC during practice were included in our analyses. As spring practice was cancelled during 2020 due to COVID-19, only fall practices were included in our analyses. The head coach remained consistent during the NoGC and GC study periods. Descriptive statistics were used to examine concussion frequency. Mann-Whitney U tests were used to compare TST and DUSR between groups. Also, [interquartile range] could not be calculated for the GC group due to the low number of SCs. Results On median, the number of SCs decreased from 4 to 1.5 per season from the NoGC to the GC period. On median DUSR decreased from 13.5[11] to 5[n/a] for the NoGC and GC groups, respectively (U=9.50,z=-.93,p=.35). TST also decreased from 16[27] to 6[n/a] in the NoGC and GC groups, respectively (U=5.0,z=-1.79,p=.07). Conclusions GCs may potentially reduce concussion frequency, TST, and DUSR, however, future research with a larger sample size is needed to confirm and extend our findings.

Revisiting the Assessment of Strength, Power, and Change of Direction in Collegiate American Football Athletes.

Burke, AA, Guthrie, BM, Magee, M, Miller, AD, and Jones, MT. Revisiting the assessment of strength, power, and change of direction in collegiate american football athletes. J Strength Cond Res 37(8): 1623-1627, 2023-The primary purpose was to assess the effect of strength on vertical jump (VJ) and change of direction (COD) with a secondary purpose to examine if these relationships were moderated by the sport position group through path analysis using structural equation modeling. Subjects were collegiate American football athletes grouped by skill (SK; n = 98) and nonskill (NS; n = 83) sport position groups. Maximal strength was assessed by 1 repetition maximum back squat and hang clean (HC). Vertical jump was used to evaluate power. Change of direction was assessed through the 20-yard shuttle (i.e., 5-10-5) test. Multigroup path analysis examined causal pathways among variables and moderating effects of sport position. The final model revealed that VJ fully mediated the relationship between HC and COD (HC-VJ: β = 0.408, p < 0.001; VJ-COD: β = -0.376, p < 0.001; and HC-COD: β = -0.137, p = 0.17) in SK. The NS showed only direct effects of HC on COD ( β = -0.335, p < 0.001). These findings suggest that strength does not solely explain COD ability but also can serve to enhance underpinning qualities, such as relative force production in the VJ. Relationships between strength, power, and COD are different depending on the positional group. The results provide further insight into performance outcomes in field tests. It is recommended that sport position differences be considered when assessing and analyzing physical qualities in a team setting within the sport of American football.

Relationship between Pre-Practice Urine Specific Gravity Hydration Levels and the Type of Sustained Practice Outcomes in Collegiate Football Athletes

Relationship between Pre-Practice Urine Specific Gravity Hydration Levels and the Type of Sustained Practice Outcomes in Collegiate Football Athletes

Prevalence of Dehydration Among American Collegiate Football Athletes with Sickle Cell Trait

Prevalence of Dehydration Among American Collegiate Football Athletes with Sickle Cell Trait

The development of a HAMstring InjuRy (HAMIR) index to mitigate injury risk through innovative imaging, biomechanics, and data analytics: protocol for an observational cohort study

BackgroundThe etiology of hamstring strain injury (HSI) in American football is multi-factorial and understanding these risk factors is paramount to developing predictive models and guiding prevention and rehabilitation strategies. Many player-games are lost due to the lack of a clear understanding of risk factors and the absence of effective methods to minimize re-injury. This paper describes the protocol that will be followed to develop the HAMstring InjuRy (HAMIR) index risk prediction models for HSI and re-injury based on morphological, architectural, biomechanical and clinical factors in National Collegiate Athletic Association Division I collegiate football players.MethodsA 3-year, prospective study will be conducted involving collegiate football student-athletes at four institutions. Enrolled participants will complete preseason assessments of eccentric hamstring strength, on-field sprinting biomechanics and muscle–tendon volumes using magnetic-resonance imaging (MRI). Athletic trainers will monitor injuries and exposure for the duration of the study. Participants who sustain an HSI will undergo a clinical assessment at the time of injury along with MRI examinations. Following completion of structured rehabilitation and return to unrestricted sport participation, clinical assessments, MRI examinations and sprinting biomechanics will be repeated. Injury recurrence will be monitored through a 6-month follow-up period. HAMIR index prediction models for index HSI injury and re-injury will be constructed.DiscussionThe most appropriate strategies for reducing risk of HSI are likely multi-factorial and depend on risk factors unique to each athlete. This study will be the largest-of-its-kind (1200 player-years) to gather detailed information on index and recurrent HSI, and will be the first study to simultaneously investigate the effect of morphological, biomechanical and clinical variables on risk of HSI in collegiate football athletes. The quantitative HAMIR index will be formulated to identify an athlete’s propensity for HSI, and more importantly, identify targets for injury mitigation, thereby reducing the global burden of HSI in high-level American football players.Trial Registration The trial is prospectively registered on ClinicalTrials.gov (NCT05343052; April 22, 2022).

Metabolomic response to collegiate football participation: Pre- and Post-season analysis

Contact sports participation has been shown to have both beneficial and detrimental effects on health, however little is known about the metabolic sequelae of these effects. We aimed to identify metabolite alterations across a collegiate American football season. Serum was collected from 23 male collegiate football athletes before the athletic season (Pre) and after the last game (Post). Samples underwent nontargeted metabolomic profiling and 1131 metabolites were included for univariate, pathway enrichment, and multivariate analyses. Significant metabolites were assessed against head acceleration events (HAEs). 200 metabolites changed from Pre to Post (P < 0.05 and Q < 0.05); 160 had known identity and mapped to one of 57 pre-defined biological pathways. There was significant enrichment of metabolites belonging to five pathways (P < 0.05): xanthine, fatty acid (acyl choline), medium chain fatty acid, primary bile acid, and glycolysis, gluconeogenesis, and pyruvate metabolism. A set of 12 metabolites was sufficient to discriminate Pre from Post status, and changes in 64 of the 200 metabolites were also associated with HAEs (P < 0.05). In summary, the identified metabolites, and candidate pathways, argue there are metabolic consequences of both physical training and head impacts with football participation. These findings additionally identify a potential set of objective biomarkers of repetitive head injury.

The Effects of Body Tempering on Force Production, Flexibility and Muscle Soreness in Collegiate Football Athletes.

There has been limited research to explore the use of body tempering and when the use of this modality would be most appropriate. This study aimed to determine if a body tempering intervention would be appropriate pre-exercise by examining its effects on perceived soreness, range of motion (ROM), and force production compared to an intervention of traditional stretching. The subjects for this study were ten Division 1 (D1) football linemen from Sacred Heart University (Age: 19.9 ± 1.5 years, body mass: 130.9 ± 12.0 kg, height: 188.4 ± 5.1 cm, training age: 8.0 ± 3.5 years). Subjects participated in three sessions with the first session being baseline testing. The second and third sessions involved the participants being randomized to receive either the body tempering or stretching intervention for the second session and then receiving the other intervention the final week. Soreness using a visual analog scale (VAS), ROM, counter movement jump (CMJ) peak force and jump height, static jump (SJ) peak force and jump height, and isometric mid-thigh pull max force production were assessed. The results of the study concluded that body tempering does not have a negative effect on muscle performance but did practically reduce perceived muscle soreness. Since body tempering is effective at reducing soreness in athletes, it can be recommended for athletes as part of their pre-exercise warmup without negatively effecting isometric or dynamic force production.

A preliminary model of football-related neural stress that integrates metabolomics with transcriptomics and virtual reality

SummaryResearch suggests contact sports affect neurological health. This study used permutation-based mediation statistics to integrate measures of metabolomics, neuroinflammatory miRNAs, and virtual reality (VR)-based motor control to investigate multi-scale relationships across a season of collegiate American football. Fourteen significant mediations (six pre-season, eight across-season) were observed where metabolites always mediated the statistical relationship between miRNAs and VR-based motor control ( 0.05; total effect 50%), suggesting a hypothesis that metabolites sit in the statistical pathway between transcriptome and behavior. Three results further supported a model of chronic neuroinflammation, consistent with mitochondrial dysfunction: (1) Mediating metabolites were consistently medium-to-long chain fatty acids, (2) tricarboxylic acid cycle metabolites decreased across-season, and (3) accumulated head acceleration events statistically moderated pre-season metabolite levels to directionally model post-season metabolite levels. These preliminary findings implicate potential mitochondrial dysfunction and highlight probable peripheral blood biomarkers underlying repetitive head impacts in otherwise healthy collegiate football athletes.

Decreases in Dorsal Cervical Spinal Cord White Matter Tract Integrity Are Associated with Elevated Levels of Serum MicroRNA Biomarkers in NCAA Division I Collegiate Football Players.

This prospective, controlled, observational cohort study assessed the performance of a novel panel of serum microRNA (miRNA) biomarkers relative to findings on cervical spinal cord magnetic resonance imaging (MRI) in collegiate football players. There were 44 participants included in the study: 30 non-athlete control subjects and 14 male collegiate football athletes participating in a Division I Football Bowl Subdivision of the National Collegiate Athletic Association. Diffuse tensor MRI and blood samples were acquired within the week before the athletic season began and within the week after the last game of the season. All miRNAs were significantly higher in athletes regardless of their fractional anisotropy (FA) values (p < 0.001), even those considered to be in the “normal” range of FA for white and gray matter integrity in the cervical spinal cord. miRNA biomarkers were most significantly correlated with FA of the white matter (WM) tracts of the dorsal (posterior) spinal cord; particularly, the fasciculus gracilis, fasciculus cuneatus, lateral corticospinal tract, rubrospinal tract, lateral reticulospinal tract, spinal lemniscus, and spinothalamic and -reticular tracts. Areas under the curve for miRNA biomarkers predicting lower FA of WM dorsal (posterior) cervical spinal tracts, therefore lower white matter integrity (connectivity), were miR-505* = 0.75 (0.54–0.96), miR-30d = 0.74 (0.52–0.95), and miR-92a = 0.75 (0.53–0.98). Should these findings be replicated in a larger cohort of athletes, these markers could potentially serve as measures of neuroimaging abnormalities in athletes at risk for concussion and subconcussive injuries to the cervical spinal cord.

Identifying Factors Associated with Head Impact Kinematics and Brain Strain in High School American Football via Instrumented Mouthguards.

Repeated head impact exposure and concussions are common in American football. Identifying the factors associated with high magnitude impacts aids in informing sport policy changes, improvements to protective equipment, and better understanding of the brain's response to mechanical loading. Recently, the Stanford Instrumented Mouthguard (MiG2.0) has seen several improvements in its accuracy in measuring head kinematics and its ability to correctly differentiate between true head impact events and false positives. Using this device, the present study sought to identify factors (e.g., player position, helmet model, direction of head acceleration, etc.) that are associated with head impact kinematics and brain strain in high school American football athletes. 116 athletes were monitored over a total of 888 athlete exposures. 602 total impacts were captured and verified by the MiG2.0's validated impact detection algorithm. Peak values of linear acceleration, angular velocity, and angular acceleration were obtained from the mouthguard kinematics. The kinematics were also entered into a previously developed finite element model of the human brain to compute the 95th percentile maximum principal strain. Overall, impacts were (mean ± SD) 34.0 ± 24.3 g for peak linear acceleration, 22.2 ± 15.4 rad/s for peak angular velocity, 2979.4 ± 3030.4 rad/s2 for peak angular acceleration, and 0.262 ± 0.241 for 95th percentile maximum principal strain. Statistical analyses revealed that impacts resulting in Forward head accelerations had higher magnitudes of peak kinematics and brain strain than Lateral or Rearward impacts and that athletes in skill positions sustained impacts of greater magnitude than athletes in line positions. 95th percentile maximum principal strain was significantly lower in the observed cohort of high school football athletes than previous reports of collegiate football athletes. No differences in impact magnitude were observed in athletes with or without previous concussion history, in athletes wearing different helmet models, or in junior varsity or varsity athletes. This study presents novel information on head acceleration events and their resulting brain strain in high school American football from our advanced, validated method of measuring head kinematics via instrumented mouthguard technology.

Cannabinoid Hyperemesis Syndrome in an Athlete.

Cannabis (marijuana) is an increasingly prevalent substance used in college-aged adults. Cannabinoid Hyperemesis Syndrome (CHS) is 1 outcome of chronic cannabis use, which presents as cyclic intractable vomiting that can be temporarily relieved with hot baths or showers. This case discusses a collegiate football athlete who presents with intractable vomiting, and it underscores the importance of a detailed history to discern CHS from other more common diagnoses. The report will highlight key diagnostic characteristics, pathophysiology, and treatment options for patients with presumed CHS.

Acute Ischemic Stroke in a Male Collegiate Football Athlete

Acute Ischemic Stroke in a Male Collegiate Football Athlete

Relationships Between Sprinting, Broad Jump, and Vertical Jump Kinetics Are Limited in Elite, Collegiate Football Athletes.

Boone, JB, VanDusseldorp, TA, Feito, Y, and Mangine, GT. Relationships between sprinting, broad jump, and vertical jump kinetics are limited in elite, collegiate football athletes. J Strength Cond Res 35(5): 1306-1316, 2021-To evaluate the relationships and agreement in kinetics measured during a 10-yd sprint, a standing broad jump (SBJ), and a vertical jump (VJ), 73 collegiate football players (22.3 ± 0.8 years, 188 ± 7 cm, 113 ± 23 kg) volunteered for this cross-sectional study over a 3-year period. At the beginning of each athlete's off-season training phase and after a standard warm-up, each athlete completed 2-3 maximal trials of each test while tethered to a robotic, cable-resistance device (10-yd sprint and SBJ) or a linear position transducer (VJ alone). Force (N), velocity (m·s-1), and power (W) were measured during the first 2 steps, acceleration phase (units·step-1), and entire 10-yd sprint, and the entire SBJ and VJ. Spearman and partial correlations (controlling for stature) revealed small-to-moderate relationships (r = -0.30 to -0.34) between the second sprinting step and VJ force. Small negative relationships were also noted between sprinting and VJ force and power, but not when controlling for height. Agreement was determined by examining relationships between the differences in and averaged kinetics measured on each test. Trivial-to-small relationships (r < 0.29) were observed between sprinting (first step and 10-yd) and VJ velocity, and between VJ and SBJ velocity, although coefficient of variation (CV) ranged between 64 and 104%. All other relationships ranged from moderate-to-practically perfect with CVs exceeding 500%. Although some relationships exist between sprinting and jumping kinetics, their agreement is variable. These data suggest that coaches and athletes should not use one of these assessments in place of, or to predict performance in, the other assessments.

Risk Factors for Glenohumeral Arthropathy in Collegiate Football Athletes with Shoulder Instability

Dislocation arthropathy is a well-documented complication of shoulder instability. The risk factors for the development of this problem are not clear. We performed a radiographic review of the affected shoulder in athletes participating at the NFL combine with a history of anterior glenohumeral instability in an effort to determine whether delayed stabilization lead to higher grades of shoulder arthropathy. We secondarily were interested in assessing the risk factors that correlated with the development of glenohumeral arthrosis. Using available records from athletic trainers and personal interview, athletes participating in the NFL combine were assessed for a history of anterior glenohumeral instability. The number of instability events was recorded as a combination of dislocations and subluxations. Current age, age at time of injury, age at time of surgery, and player position were recorded. All athletes with a history of shoulder instability underwent radiographic testing including multiplane radiographs, MRI and CT scan. De-personalized radiographs of the affected extremity were reviewed by 2 independent physicians and graded using the Samilson and Prieto classification for dislocation arthropathy. Multi-variate analysis was performed to assess variables that predicted severity of glenohumeral arthritis including: age at initial injury, time from injury to surgical intervention, surgical vs nonsurgical treatment, and player position (offense vs defense). 334 athletes underwent a comprehensive orthopedic evaluation during a recent NFL Scouting Combine. 11.4% of players (38 athletes) reported a history of anterior glenohumeral instability with three of the 38 athletes reporting bilateral involvement over their playing career for a total of 41 shoulders. Players surveyed were on average 22.3 years old and 39.3 months from injury. Average age at the time of the initial instability event was 19.2 years. Within this cohort, the average number of instability episodes was 2.1 at the time of evaluation. Of the 41 shoulders, 78 percent of radiographs demonstrated at least Grade 1 glenohumeral arthrosis. Among the athletes that underwent surgical stabilization, those with longer delays between the onset of instability and the date of surgery had worse radiographic arthropathy (p=0.04). When comparing those athletes who underwent surgery to those who were treated non-surgically, those who had undergone surgical stabilization were more likely to have worse arthropathy than the non-surgically treated shoulders (p=0.02). Radiographs revealed a significantly higher grade of arthrosis amongst defensive players as compared to offensive players (1.37 vs 0.79, p=0.004). High-level collegiate football athletes with a history of anterior glenohumeral instability frequently develop radiographic evidence of glenohumeral arthrosis within a few years of injury. Longer time between initial injury and surgical stabilization was associated with more severe arthropathy on radiographic evaluation. Defensive players demonstrate a higher grade of arthrosis as compared to offensive players.

USE OF AN UPPER EXTREMITY FUNCTIONAL TESTING ALGORITHM TO DETERMINE RETURN TO PLAY READINESS IN COLLEGIATE FOOTBALL PLAYERS: A CASE SERIES.

Return to play decision making for upper extremity injuries is challenging due to a lack of evidence-based protocols and testing. Current guidelines utilize tests and measures with minimal evidence on re-injury risks and prediction. The purpose of this case series is to highlight a functional testing algorithm for upper extremities injuries and the outcomes for the patients that followed it. Case series. Six subjects (18 - 21 years old) who underwent shoulder capsulolabral repair secondary to recurrent instability and/or unyielding pain are included. All subjects underwent a criterion-based rehabilitation program before being assessed with the authors' upper extremity functional testing algorithm. The upper extremity functional testing algorithm consists of measures of active range of motion (AROM), passive range of motion (PROM), peak isometric force, a fatigue testing battery, and the closed kinetic chain upper extremity stability test (CKCUEST) to assess readiness for return to sport. All athletes achieved > 90% symmetry on at least two out of three tests during a fatigue testing protocol and at least 25 touches on the CKCUEST. All of the athletes returned to unrestricted football the season following surgical intervention. None of the athletes sustained an additional glenohumeral subluxation, dislocation, or upper extremity injury requiring surgical intervention for the remainder of their athletic careers (six years). The presented cases help to illustrate the effectiveness of the upper extremity functional testing algorithm to assess return to sport readiness for male collegiate football athletes. The algorithm included testing of AROM/PROM and strength that is typically used, but also included the CKCUEST and fatigue testing to further challenge and assess the upper extremity prior to returning to sports. 4.