High School Football Research Articles

Head Injury - High School Football

Head Injury - High School Football

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

Atypical Cause Of Lateral Knee Pain In A High School Football Athlete

Atypical Cause Of Lateral Knee Pain In A High School Football Athlete

The Effect Of Exterior Helmet Padding On Concussion Severity In High School Football Players

The Effect Of Exterior Helmet Padding On Concussion Severity In High School Football Players

Reduced Cortical Excitability is Associated with Cognitive Symptoms in Concussed Adolescent Football Players.

American tackle football is associated with high rates of concussion, leading to neurophysiological disturbances and debilitating clinical symptoms. Previous investigations of the neurophysiological effects of concussion have largely ignored aperiodic neurophysiological activity. We examined whether concussion during a season of high school football is related to changes in aperiodic and periodic neurophysiological activity and whether any such changes are associated with clinical outcomes. Pre- and post-season resting-state MEG data were collected from 91 high school football players, of whom 10 were diagnosed with concussion. Data were source-imaged, frequency-transformed and parameterized, and linear mixed models were used to examine effects of concussion on pre-to-post-season changes in neurophysiological activity. Scores on the Post-Concussive Symptom Inventory were correlated with pre-to-post-season neurophysiological changes to determine their clinical relevance. Concussion was associated with increased aperiodic exponents in superior frontal cortices, indicating a relative reduction in cortical excitability. This slowing of aperiodic neurophysiology mediated concussion effects on raw delta and gamma power and was associated with worse cognitive concerns across participants. Pre-to-post-season changes in aperiodic-corrected alpha and theta rhythmic activity were also decreased in posterior cortices in instances of concussion. These findings indicate that concussion alters both the excitability and rhythmic signaling of the cortex, with differing spatial topographies and implications for clinical symptoms.

Cognitive and Salience Network Connectivity Changes following a Single Season of Repetitive Head Impact Exposure in High School Football.

During a season of high school football, adolescents with actively developing brains experience a considerable number of head impacts. Our aim was to determine whether repetitive head impacts in the absence of a clinically diagnosed concussion during a season of high school football produce changes in cognitive performance or functional connectivity of the salience network and its central hub, the dorsal anterior cingulate cortex. Football players were instrumented with the Head Impact Telemetry System during all practices and games, and the helmet sensor data were used to compute a risk-weighted exposure metric (RWEcp), accounting for the cumulative risk during the season. Participants underwent MRI and a cognitive battery (ImPACT) before and shortly after the football season. A control group of noncontact/limited-contact-sport athletes was formed from 2 cohorts: one from the same school and protocol and another from a separate, nearly identical study. Sixty-three football players and 34 control athletes were included in the cognitive performance analysis. Preseason, the control group scored significantly higher on the ImPACT Visual Motor (P = .04) and Reaction Time composites (P = .006). These differences increased postseason (P = .003, P < .001, respectively). Additionally, the control group had significantly higher postseason scores on the Visual Memory composite (P = .001). Compared with controls, football players showed significantly less improvement in the Verbal (P = .04) and Visual Memory composites (P = .01). A significantly greater percentage of contact athletes had lower-than-expected scores on the Verbal Memory (27% versus 6%), Visual Motor (21% versus 3%), and Reaction Time composites (24% versus 6%). Among football players, a higher RWEcp was significantly associated with greater increments in ImPACT Reaction Time (P = .03) and Total Symptom Scores postseason (P = .006). Fifty-seven football players and 13 control athletes were included in the imaging analyses. Postseason, football players showed significant decreases in interhemispheric connectivity of the dorsal anterior cingulate cortex (P = .026) and within-network connectivity of the salience network (P = .018). These decreases in dorsal anterior cingulate cortex interhemispheric connectivity and within-network connectivity of the salience network were significantly correlated with deteriorating ImPACT Total Symptom (P = .03) and Verbal Memory scores (P = .04). Head impact exposure during a single season of high school football is negatively associated with cognitive performance and brain network connectivity. Future studies should further characterize these short-term effects and examine their relationship with long-term sequelae.

On-Field Evaluation of Mouthpiece-and-Helmet-Mounted Sensor Data from Head Kinematics in Football

PurposeWearable sensors are used to measure head impact exposure in sports. The Head Impact Telemetry (HIT) System is a helmet-mounted system that has been commonly utilized to measure head impacts in American football. Advancements in sensor technology have fueled the development of alternative sensor methods such as instrumented mouthguards. The objective of this study was to compare peak magnitude measured from high school football athletes dually instrumented with the HIT System and a mouthpiece-based sensor system.MethodsData was collected at all contact practices and competitions over a single season of spring football. Recorded events were observed and identified on video and paired using event timestamps. Paired events were further stratified by removing mouthpiece events with peak resultant linear acceleration below 10 g and events with contact to the facemask or body of athletes.ResultsA total of 133 paired events were analyzed in the results. There was a median difference (mouthpiece subtracted from HIT System) in peak resultant linear and rotational acceleration for concurrently measured events of 7.3 g and 189 rad/s2. Greater magnitude events resulted in larger kinematic differences between sensors and a Bland Altman analysis found a mean bias of 8.8 g and 104 rad/s2, respectively.ConclusionIf the mouthpiece-based sensor is considered close to truth, the results of this study are consistent with previous HIT System validation studies indicating low error on average but high scatter across individual events. Future researchers should be mindful of sensor limitations when comparing results collected using varying sensor technologies.

Helmetless Tackling Training Intervention and Preseason Self-efficacy Effects on Head Impacts in Hawai'i High School Football.

To determine how football head impacts are influenced by self-efficacy (SE), helmetless tackling intervention participation (IP), and years of experience (YE) playing football. Cross-sectional. Three high schools. 120 (male; n = 118, female; n = 2, 15.57 ± 1.23 years) participants were recruited from 5 high school teams (3 varsity and 2 junior-varsity). SE, days of IP, and YE playing tackle football. SE was measured using a 53-question survey and categorized into 5 subscales. The accumulation of total head impacts (THI) was measured using Riddell InSite Speedflex helmets (Elyria, OH) throughout the season. Head impact exposure (HIE) was standardized as a ratio of impacts per session (games, scrimmages, and practices). Multiple regression analyses tested the relationship between THI or HIE with the predictor variables. For THI, 22.1% was explained by the predictors (r = 0.470, r2 = 0.221). Intervention participation had a negative correlation (B = -4.480, P = 0.019), whereas confidence in performing proper tackling and blocking (SE1) (B = 3.133, P = 0.010) and >8 YE (B = 135.9, P = 0.009) positively correlated with THI. For HIE, 25.4% was explained by the predictors (r = 0.504, r2 = 0.254). Intervention participation negatively correlated (B = -0.077, P = 0.007), whereas SE1 (B = 3.133, P = 0.010) and >8 YE (B = 2.735, P ≤ 0.001) correlated positively with HIE. Increased head impacts were associated with less helmetless tackling participation, more than 8 YE, and more self-confidence in tackling ability. Increasing the amount of time athletes spend practicing proper tackling and blocking techniques to reduce head first and risky play is warranted to reduce the amount of head impacts received over time.

A - 59 MEG Power Changes in Non-concussed High School Football Players: Implications of Cumulative Head Impact Risk

Abstract Purpose The purpose of this study was to determine how cumulative repetitive head impacts (RHI) over a single season affects functional brain activity in high school football players that are clinically asymptomatic for concussion. Method Pre-season and post-season magnetoencephalography (275 channel CTF MEG) and MRI were acquired for 88 football participant seasons (mean age = 16.09 yrs, mean BMI = 26.32). Helmet-based accelerometer data was collected for each practice and game. Cumulative risk-weighted exposure from linear acceleration (RWELinear) was calculated for each subject. Standard processing and source localization of 8-minutes eyes-open-resting state MEG data was performed using Brainstorm2. Voxel-wise relative power spectral density (PSD) was calculated for the theta frequency band (5-7 Hz). After transformation to MNI space2, pre-season to post-season percent change in PSD (%theta) was calculated and spatial clusters significantly correlated with RWELinear were identified using SPM8 (a = 0.05 and false discovery correction to account for multiple corrections). Mean cluster values were extracted, and linear regression analysis performed in R 3.21 with covariates of BMI, age, and time between scans. Results After covariate adjustment, there was a significant positive correlation between RWELinear and %Δtheta PSD in the right postcentral gyrus and inferior parietal lobe (p = 9.342e-05, adj. R2 = 0.2092), with no other significant associations noted. Conclusions Changes in functional brain activity may be associated with RHI specifically in the right postcentral gyrus and inferior parietal lobe over a typical football season. Future research will include examining how these affected areas are associated with cognitive performance.

Poster 378: Surface Impact Injuries During High School Football Games on Light- and Heavyweight Artificial Turf Fields. A 12-Season Prospective Study

Objectives: Artificial turf fields are increasingly being installed to duplicate the playing characteristics of natural grass. With the numerous proprietary sand/rubber infill systems available, the effect of infill weight on injuries when landing on an artificial surface has not been extensively addressed. Therefore, this study was conducted to quantify surface impact injuries during high school football games on light- and heavyweight artificial turf playing surfaces. Methods: Artificial turf infill systems were divided into two sand/rubber infill weight groups based on lbs per square foot: heavyweight (≥9.0 lb/ft2) and lightweight (3.0-6.0 lb/ft2). A total of 89 high schools participated across 6 states over the course of 12 competitive seasons. Outcomes of interest included injury severity; head, knee, and shoulder trauma; primary type of injury; anatomic location of injury; type of tissue injured; injury situation; player and skill position; environmental factors; elective imaging and surgical procedures; and turf age. Data underwent multivariate analyses of variance (MANOVA) and Wilks’ λ criteria using general linear model procedures and were expressed as injury incidence rates (IIR) per 10-game season. Results: Of 3,788 high school games documented, 1055 games (27.9%) were played on heavyweight (≥9.0 lb/ft2) infill and 2,733 games (72.1%) played on the lightweight (3.0-6.0 lb/ft2) infill surface. In sum, of 8,995 total injuries, 1,462 cases [heavyweight infill (n=269), lightweight infill (n=1,193)] were attributed to player-to-surface impacts. MANOVA indicated a significant main effect between infill weight by injury severity ( F3,1458 = 6.210; P &lt; .001), primary type of injury ( F8,1453 = 2.865; P &lt; .001), anatomic location of injury ( F12,1449 = 1.354; P = .021), type of tissue injured ( F4,1457 = 5.619; P &lt; .001), injury situation ( F10,1451 = 2.211; P &lt; .001), player position ( F2,1459 = 3.856; P &lt; .001), skill position ( F7,1454 = 6.526; P &lt; .001), environmental factors ( F6,1455 = 5.478; P &lt; .001), elective imaging and surgical procedures ( F4,1457 = 4.212; P = .015), and turf age ( F3,1458 = 2.514; P = .010). No significant main effect between infill weight was observed by head injury ( F3,1458 = 0.880; P = .451), knee injury ( F7,1454 = 1.196; P = .246), or shoulder injury ( F7,1454 = 1.447; P = .110). Post hoc analyses of surface impact trauma indicated significantly lower ( P &lt; .05) incidence of injury on the heavyweight (≥9.0 lb/ft2) infill when compared to the lightweight (3.0-6.0 lb/ft2) infill surface, in regard to total injuries [2.6 (95% CI, 2.3-2.8) vs 4.4 (4.2-4.6)], substantial injuries [7-21 days of injury time loss; 0.5 (95% CI, 0.4-0.6) vs 1.1 (1.0-1.2)], ligament sprain/tears [0.7 (95% CI, 0.6-0.9) vs 1.1 (1.0-1.2)], muscle-tendon strain/tears [0.1 (95% CI, 0.1-0.2) vs 0.5 (0.4-0.5)], joint [1.0 (95% CI, 0.9-1.2) vs 1.6 (1.4-1.7)] and muscle [0.6 (95% CI, 0.5-0.8) vs 1.8 (1.7-1.9)] trauma; injuries during rushing [1.0 (95% CI, 0.8-1.2) vs 1.8 (1.7-2.0)], passing [0.1 (95% CI, 0.1-0.2) vs 0.3 (0.2-0.4)], pass rush/defense [0.5 (95% CI, 0.4-0.6) vs 0.8 (0.8-1.0)], and kickoff/kickoff returns [0.1 (95% CI, 0.0-0.2) vs 0.3 (0.2-0.3)]; surface impact injuries to the shoulder girdle [0.7 (95% CI, 0.6-0.9) vs 1.1 (1.0-1.2)], arm [0.6 (95% CI, 0.5-0.8) vs 1.1 (1.0-1.2)], hand/wrist [0.3 (95% CI, 0.2-0.4) vs 0.5 (0.5-0.6)], foot/toe [0.1 (95% CI, 0.0-0.1) vs 0.2 (0.2-0.3)], and lower extremity injuries combined [0.5 (95% CI, 0.4-0.7) vs 1.0 (0.9-1.1)]; and during offensive [1.4 (95% CI, 1.2-1.6) vs 2.3 (2.2-2.5)], defensive [1.0 (95% CI, 0.9-1.2) vs 1.6 (1.5-1.8)], and special teams play [0.2 (95% CI, 0.1-0.2) vs 0.4 (0.3-0.5)], respectively. Post-injury medical procedures indicated significantly ( P &lt; .05) less radiographs [0.6 (95% CI, 0.5-0.7) vs 0.8 (0.7-0.9)], and total elective imaging and surgeries combined [1.0 (95% CI, 0.8-1.2) vs 1.5 (1.4-1.7)] following surface impacts while competing on a heavyweight (≥9.0 lb/ft2) versus a lightweight (3.0-6.0 lb/ft2) infill surface, respectively. A significantly lower incidence ( P &lt; . 05) of surface impact trauma was also observed among backfield, receiver, and secondary athletes, all ages of artificial turf, all temperature conditions, and during play on non-precipitation/dry fields while playing on heavyweight infill when compared to lightweight infill surfaces. Conclusions: The incidence of player-to-surface impact injury was significantly lower on the heavyweight playing surface during game-related high school football across numerous playing conditions. Based on the findings, a heavyweight artificial infill system is recommended for high school football fields to optimize player safety.

Anatomic popliteal entrapment syndrome with atypical presentation onset in a 17-year-old high school football player: a case report

Anatomic popliteal entrapment syndrome with atypical presentation onset in a 17-year-old high school football player: a case report

Preventing Exertional Heat Stroke in Football: Time for a Paradigm Shift.

Among American sports, football has the highest incidence of exertional heat stroke (EHS), despite decades of prevention strategies. Based on recent reports, 100% of high school and college EHS football fatalities occur during conditioning sessions. Linemen are the at-risk population, constituting 97% of football EHS deaths. Linemen heat up faster and cool down slower than other players. Case series were identified from organized, supervised football at the youth, high school, and collegiate levels and compiled in the National Registry of Catastrophic Sports Injuries. Sources for event occurrence were media reports and newspaper clippings, autopsy reports, certificates of death, school-sponsored investigations, and published medical literature. Articles were identified through PubMed with search terms "football," "exertional heat stroke," and "prevention." Clinical review. Level 5. Football EHS is tied to (1) high-intensity drills and conditioning that is not specific to individual player positions, (2) physical exertion as punishment; (3) failure to modify physical activity for high heat and humidity, (4) failure to recognize early signs and symptoms of EHS, and (5) death when cooling is delayed. To prevent football EHS, (1) all training and conditioning should be position specific; (2) physical activity should be modified per the heat load; (3) understand that some players have a "do-or-die" mentality that supersedes their personal safety; (4) never use physical exertion as punishment; (5) eliminate conditioning tests, serial sprints, and any reckless drills that are inappropriate for linemen; and (6) consider air-conditioned venues for linemen during hot practices. To prevent EHS, train linemen based on game demands. n/a.

Head Impact Exposure in Hawaiian High School Football: Influence of Adherence Rates on a Helmetless Tackling and Blocking Training Intervention.

High school football remains a popular, physically demanding sport despite the known risks for acute brain and neck injury. Impacts to the head also raise concerns about their cumulative effects and long-term health consequences. To examine the effectiveness of a helmetless tackling training program to reduce head impact exposure in football participants. A three-year, quasi-experimental, prospective cohort (clinicaltrials.gov #NCTXXX) study. Honolulu (XXX, XXX) area public and private secondary schools with varsity and junior varsity football. Football participants (n=496) ages 14 to 18 years old. Intervention(s) Participants wore new football helmets furnished with head impact sensor technology. Teams employed a season-long helmetless tackling and blocking intervention in Years 2 and 3 consisting of a 3-phase, systematic progression of 10 instructional drills. Head impact frequency per athlete exposure (ImpAE), location, and impact magnitude per participant intervention adherence levels (60% and 80%). An overall regression analysis revealed a significant negative association between ImpAE and adherence (p=0.003, beta=-1.21, SE=0.41). In year 3, a longitudinal data analysis of weekly ImpAE data resulted in an overall difference between the adherent and non-adherent groups (p=0.040 at 80%; p=0.004 at 60%), mainly due to decreases in top and side impacts. Mean cumulative impact burden for the adherent group (n=131: 2,105.84g ± 219.76,) was significantly (p=0.020) less than the non-adherent group (n=90: 3,158.25g ± 434.80) at the 60% adherence level. Participants adhering to the intervention on at least a 60% level experienced a 34% to 37% significant reduction in the number of head impacts (per exposure) through the season. These results provide additional evidence that a helmetless tackling and blocking training intervention (utilizing the HuTT® program) reduces head impact exposure in high school football players. Adherence to an intervention is crucial for achieving intended outcomes.

A Comparative Study on the Efficacy of Basic Resistance Training Versus Plyometric Training in High School Football Players

A Comparative Study on the Efficacy of Basic Resistance Training Versus Plyometric Training in High School Football Players

Arthroscopic Shoulder Stabilization in High School Football Players.

Destabilizing shoulder injuries are common in high school American football players; however, the rate of recurrent glenohumeral instability and return to play after arthroscopic labral stabilization surgery remains unknown. The purpose of this study was to determine the rate of recurrent instability on return to competitive high school football after arthroscopic shoulder labral stabilization and capsulorrhaphy procedures. It was hypothesized that the instability rate would be greater in players with more years of eligibility remaining (YER) to play at the high school level. Case series; Level of evidence, 4. Consecutive male high school football players with at least 1 YER who sustained at least 1 anterior traumatic inseason shoulder instability episode and underwent arthroscopic stabilization between 2012 and 2017 were identified. Patients and/or families were contacted by phone to discuss (1) recurrent instability episodes and (2) return to competitive sport and/or recreational athletic activity. Statistical analysis was conducted using chi-square tests to compare recurrent shoulder instability with return to play and YER. A total of 45 football players aged 14 to 17 years were included, with a mean follow-up of 4.1 years. Most patients (60%) chose not to return to competitive football, due mainly to fear of recurrent injury. Overall, the recurrent instability rate was 15.6% (7/45). The instability rate in players who returned to football was 16.7%, with 66.7% requiring revision surgery. The instability rate in patients who did not return to football was 14.8%, with no revision procedures required. In players who returned to football, the instability rate in YER group 4 was significantly higher than that in YER groups 1 to 3 (42% vs 10.5%, respectively, P = .03), with each year of play conferring an additional 10% risk of reinjury. There was a significant difference in the type of recurrent instability in players who returned to any sport versus those who did not (P = .029). High school football players who returned to competitive play after arthroscopic shoulder stabilization surgery experienced a higher rate of recurrent instability that was dependent on their YER. Over half of the players chose not to return to football, with fear of reinjury being the most common reason.

Eccentric Hamstring Strength Imbalance among Football and Soccer Athletes.

Hamstring strain injuries (HSI) are common among football and soccer athletes. Eccentric strength imbalance is considered a contributing factor for HSI. There is, however, a paucity of data on hamstring imbalances of soccer and American football athletes as they age and advance in skill level. High school athletes will display greater interlimb discrepancies compared with collegiate and professional athletes. In addition, soccer athletes will exhibit greater hamstring asymmetry than American football athletes. Hamstring testing was performed on soccer and American football athletes using the NordBord Hamstring Testing System (Vald Performance, Albion, Australia). Age, sex, weight, sport specialization, and sport level were recorded. Maximum hamstring forces (N), torque (N · m), and work (N · s) were measured. Hamstring imbalance (%) was calculated by dividing the absolute value of the difference in leg forces divided by their sum. One-way analysis of variance and independent sample t tests compared measurements between athlete groups. A total of 631 athletes completed measurements, including 88 high school male soccer, 25 college male soccer, 23 professional male soccer, 83 high school female soccer, 28 college female soccer, 288 high school football, and 96 college football athletes. High school soccer players displayed significantly greater imbalances for torque (P = 0.03) and work (P < 0.01) than football athletes. Imbalances for maximum force (P = 0.035), torque (P = 0.018), and work (P = 0.033) were significantly higher for male soccer athletes in high school compared with college- and professional-level athletes. Female high school soccer players had significantly higher imbalance in torque (P = 0.045) and work (P = 0.001) compared with female collegiate soccer players. Football athletes did not experience significant changes in force imbalances between skill levels. High school soccer athletes exhibit greater hamstring imbalances than football athletes. Higher levels of play in soccer, for both male and female athletes, correlate with less hamstring asymmetry.

Behavioral skills training produces acquisition and generalization of run-blocking skills of high school football players.

Behavioral skills training (BST) has been used to improve football players' performance in one prior study, but limited data were collected on how the skill generalized from the training environment to the natural environment. The purpose of this study was to further evaluate the effects of BST in enhancing football players' performance while also evaluating the generalization of a skill taught in a training environment (i.e., practice) to the natural environment (i.e., game-simulated scrimmage). This study included five high school offensive line football players and recorded their run-blocking skills in the training context and a game context in baseline and following BST. The results showed that BST improved performance in the training environment, with run-blocking skills slightly generalizing from the training environment to game-simulated scrimmages. When BST was conducted in the natural environment, it further improved the participants' run-blocking skills.

Impact Deceleration Differences on Natural Grass Versus Synthetic Turf High School Football Fields

American football has the highest rate of concussions in United States high school sports. Within American football, impact against the playing surface is the second-most common mechanism of injury. The objective of this study was to determine if there is a difference in impact deceleration between natural grass and synthetic turf high school football fields. A Century Body Opponent Bag (BOB) manikin was equipped with a Riddell football helmet and 3 accelerometers were placed on the forehead, apex of the head, and right ear. The manikin was dropped from a stationary position onto its front, back, and left side onto natural grass (n = 10) and synthetic turf (n = 9) outdoor football fields owned and maintained by public and private institutions on O‘ahu, Hawai‘i. Data was collected on 1,710 total drops. All accelerometers in forward and backward falls, and 1 accelerometer in side falls showed significantly greater impact deceleration on synthetic turf compared to the natural grass surfaces (P &lt; .05). The results of this study provide evidence-based rationale to inform youth sports policies, particularly those aimed at injury prevention through safer playing environments and equipment.

Association of Auditory Interference and Ocular-Motor Response with Subconcussive Head Impacts in Adolescent Football Players.

The aim of this study was to examine whether neuro-ophthalmological function, as assessed by the King-Devick test (KDT), alters during a high school football season and to explore the role of auditory interference on the sensitivity of KDT. During the 2021 and 2022 high school football seasons, football players' neuro-ophthalmological function was assessed at five time points (preseason, three in-season, postseason), whereas control athletes were assessed at preseason and postseason. Two-hundred ten football players and 80 control athletes participated in the study. The year 1 cohort (n = 94 football, n = 10 control) was tested with a conventional KDT, whereas the year 2 cohort (n = 116 football, n = 70 control) was tested with KDT while listening to loud traffic sounds to induce auditory interference. There were improvements in KDT during a season among football players, regardless of conventional KDT (preseason 53.4 ± 9.3 vs. postseason 46.4 ± 8.5 sec; β = -1.7, SE = 0.12, p < 0.01) or KDT with auditory interference (preseason 52.3 ± 11.5 vs. postseason 45.1 ± 9.5 sec; β = -1.7, SE = 0.11, p < 0.001). The degree of improvement was similar between the tests, with no significant group-by-time interaction (β = -0.08, SE = 0.17, p = 0.65). The control athletes also improved KDT performance at a similar degree as the football cohorts in both KDT conditions. Our data suggest that KDT performance improves during a season, regardless of auditory interference or head impact exposure. KDT performance was not impacted by a noisy environment, supporting its sideline utility for screening more severe forms of injury.

Tibiofemoral Dislocation Management in a Rural High School Football Scenario: Development of a Popliteal Artery Injury Suspicion Index.

This study evaluated the knowledge and preparedness of athletic trainers (ATs) for diagnosing and managing an anterior tibiofemoral knee dislocation in a rural or limited-resource high school football setting scenario. The study hypothesis was that more experienced ATs would display greater preparedness than less experienced ATs. A secondary objective was to develop evidence-based guidelines to help the AT provide better emergency triage care. This prospective cross-sectional study distributed a rural high school football game scenario survey electronically to a random sample of 2000 certified ATs to determine their perceptions of readiness to diagnose and manage an anterior tibiofemoral knee dislocation with signs or symptoms of possible popliteal artery injury. A total of 249 surveys (12.5%) were completed. Years of athletic training experience were ≤5 years (n = 82, group 1) and ≥6 years (n = 167, group 2). Both groups perceived that they could not "rule out" an arterial injury and had similar "red flag" sign and symptom rankings. Group 2 perceived a more serious situation than group 1 (77.5 ± 15 vs 70.8 ± 14, P < 0.0001) and were more likely to activate the emergency action plan (74.5 ± 25 vs 64.4 ± 26, P = 0.005). Both groups were "neutral" about their ability to diagnose the condition or manage the case, had poor ankle-brachial index test familiarity, and agreed that evidence-based guidance was needed. More experienced ATs perceived a more serious situation than less experienced ATs and were more likely to activate the emergency action plan. Both groups were neutral about their ability to diagnose the condition or manage the case, had poor ankle-brachial index test familiarity, and agreed that they would benefit from evidence-based guidance. Proposed guidelines provide the AT with a more measured, evidence-based index of suspicion for potential popliteal artery injury in anterior tibiofemoral dislocation cases. This will complement existing hospital emergency department-based management algorithms, decreasing the likelihood of this condition progressing to limb loss or death.